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Statistical assessment of laboratory data relating to about 700 cases of lymphopathy of various kinds was used in the elaboration of material to be used in diagnosis in the very early stages of the disease. Diagnostic tables giving a high degree of probability were prepared.
Measurements of the DNA content of mononuclear cells in the blood of patients with malignant lymphatic disease were made. In one case of acute lymphoblastic leukaemia, a large fraction of large type of blasts were in S phase. In the blood of a patient with leukaemic transformation of lymphosarcoma, a population of aneuploid tumour cells with a high percentage of cells in S phase was recognized. The increase of DNA synthesizing cells in the blood of patients with malignant lymphoma was associated with activity of the disease. The fraction of DNA synthesizing cells was raised sharply during chemotherapy.
A patient with chylothorax, mediastinal lymphangiomatous malformation of the thoracic duct, and multiple lymphangiomas of bone is reported. If a patient has radiographic findings of increased pleural fluid with multiple lucent lesions of the skeleton, the possibility of a generalized abnormality in the lymphatic system should be considered. Early diagnosis and treatment can prevent a protracted course and wasting of the body due to the loss of essential body nutrients in the chylous fluid.
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The usefulness and reliability of lymphography for staging purposes in Hodgkin's disease are discussed with reference to a personal series.
Untreated malignant lymphatic system diseases are characterized by a preponderance of cell new formation (proliferation) against the destruction of lymphatic cells. If the lymph nodes are enlarged during these diseases, then cell new formation occurs largely or mostly in these lymph nodes. The proliferating cells of the lymph node are bigger than small lyphocytes and have, in general, a mean diameter of the nucleus of 10 mu and more. In normal lymph nodes they belong morphologically to the big lymphocytes, immunoblasts and plasmoblasts. In pathological lymph nodes they have to be looked for among the bigger cells of the disease-specific cell population. Whereas in healthy lymph nodes and in chronic lymphatic leukemia only about 1% of lymph node cells was found to proliferate, they amount on the average to 5% in lymphomas of lymphogranulomatosis and mostly to 30--50% in the lympho-reticulosarcoma (lymphoblast and immunoblast sarcoma, corresponding to large-cell, poorly differentiated lymphomas). The proliferating cells often appear as foci in the lymphomas. The generation times of the proliferating cells both in normal and pathological lymph nodes are about 24 hrs. or slightly longer. In lymphatic proliferation, apart from plasma cells big and smallymphocytes are produced in the normal lymph node; in CLL, big and small lymphocytes, in lymphogranulomatosis, big and small lymphocytes and Hodgkin-cells, and in poorly differentiated lymphomas, the corresponding lymphoma cells are produced. The clinicist is at the beginning of drawing conclusions from prevalent kinetic disturbances.
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Keloidal blastomycosis (Lobo's disease) is reported in a 34-year-old man from the Brazilian Amazon area. His left ear and posterior auricular region were involved. He is the eighth of 99 patients known to have lymph node involvement.
After lymphography from the foot, with uncertain findings, fine-needle biopsy during fluoroscopy was performed in 107 patients. In 69 patients with possible metastases, involvement was demonstrated in 46, confirmed in 43 at operation. Lymph node involvement by general lymphatic disease was suggested in 38 patients, with biopsy confirmation in 12. In metastatic disease non-representative material was obtained in only 2 patients, in general lymphatic disease in 10. No significant complications occurred, and the side effects were small.
The results of T- and B-cell determinations are described in 105 cases of lymphoreticular and lymphoepithelial neoplasia, and are compared to similar investigations of 582 cases as published in the literature. In addition, T- and B-cell values are determined in blood of 35 healthy individuals, in 12 normal lymph nodes, as well as in hyperplastic conditions of lymph nodes from 30 patients and of tonsils from 85 patients. Cell characterizations are done by immunofluorescence and use of monospecific anti-immunoglobulin antisera (H chain specific), anti-thymus antiserum, as well as by the E-rosette test. While normal blood and normal and hyperplastic tissues show a polyclonal distribution or proliferation of lymphoreticular cells, neoplastic conditions are often characterized by an exuberant, possibly monoclonal proliferation of one cell type. According to this, lymphoreticular neoplasias are immunologically grouped into four main classes: B-cell neoplasias comprising most of the chronic lymphocytic leukemias, well differentiated lymphocytic lymphomas, BURKITT's tumor, follicular lymphoma BRILL-SYMMERS, and hairy cell leukemia. T-cell lymphomas represent a large part of poorly or undifferentiated leukemias of children, poorly differentiated lymphocytic lymphomas, prolymphocytic leukemia, and Sézary's syndrome. Monocytic neoplasias are malignant histiocytoses and leukemic reticuloendothelioses. A fourth group, which probably is not homogeneous and might be further classified in the future by use of more sophisticated methods, consists of tumors with T- and B-cell lack. Such tumors are histologically classified as Hodgkin's lymphomas, a certain number of histiocytic lymphomas, and mycosis fungoides. The prognostic and pathogenetic implications of a combined morphological and immunological classification of lymphoreticular neoplasias are briefly outlined.
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Fibrosis of the intestinal lymphatic vessels, produced in one case by tuberculosis and, in the other, by appendicitis and peritonitis, caused blockage of the main lymphatic vessels causing, clinically, a protein-losing enteropathy similar to that noted in congenital lymphatic diseases of childhood. In the laboratory, there was noted a fall in serum protein, lipid and cholesterol. A fat absorption test was very abnormal showing a flat curve. During laparotomy, there was discovered on the small intestine, the same layout of lymph vessels, resembling a lace network, as that observed in congenital malformations. Intestinal lymphography showed considerable stasis of the opaque substance and absence of injection of the lymph vessels in the mesentery.
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Neoplastic invasion as seen in the rat Rd/3 neoplasm has been studied electron microscopically in three sites: abdominal wall, footpad and liver. This neoplasm invades by peripheral cell division and active cell migration. Neoplastic cells protrude many fine processes and compress host cells. Neoplastic cells invade lymphatic vessels in a way similar to that in which white blood cells penetrate them - by the protrusion of fine cytoplasmic processes and passage, sometimes in clumps through open cell junctions. There is no ultrastructural evidence of secretory phenomena.
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