摘要：

The correlation of the histologie features of Hodgkin's disease with its clinical progress and its response to therapy presents a challenge to pathologists as well as to therapists. Dr. Lukes' very interesting data tend to indicate that within each clinical stage certain histologie types are indicative of a better prognosis than others. Based on this premise a subclassification has been proposed that adds to the complexity of the problem but at the same time emphasizes certain observations, some of them pre viously reported (1, 5, 7), that are of great interest: (a) that abundance of mature, well-differentiated lymphocytes in tissue sections is of favorable prognostic significance; (6) that, in general, lymphocytic depletion, whether associated with diffuse fibrosis or marked proliferation of Sternberg-Reed cells and other malignant histiocytes, indicates a bad prognosis; (c) that 1 form of fibrosis that has been designated as nodular sclerosis is often associated with long patient survival (2, 6, 8) even though there is lymphocytic depletion. In the discussion of the pathology of Hodgkin's, 3 major problems arise: (a) Why do we regard Hodgkin's disease as a neoplasm? (6) What is the possible biologic significance of the great variations in the histologie appearance of Hodgkin's disease? (c) What are the histologie criteria that enable us to diagnose Hodgkin's disease as a progressive neoplastia disorder? Even though Dr. Lukes is not fully convinced that every variant or type of Hodgkin's disease is necessarily a neoplasm, a common denominator does exist in all types of Hodgkin's disease in the form of atypical reticulum cells that appear to be neoplastic cells by generally accepted cytologie criteria. Some or many of them are the diagnostic Sternberg-Reed cells with multiple or inultilobed nuclei; others are mononuclear cells with similar nuclear chromatin structures. Almost invariably this neoplastic cellular proliferation is associated with a presumably reactive process that is composed of differentiated lymphocytes, plasma cells, eosinophilic and neutrophilic segmented granulocytes, histiocytes, and fibroblasta. The relative numerical proportions of these cell types vary and so do the ratios of neoplastic and inflammatory elements. When the reactive cellular proliferation is purely or almost purely lymphocytic, the term "paragranuloma" has been employed. When inflammatory elements are scant or lacking, the term "Hodgkin's sarcoma" is applicable. All other variants of Hodgkin's disease have been grouped together under the term "Hodgkin's granuloma," representing roughly 90% of all instances of Hodgkin's disease. Dr. Lukes has shown that between the 2 extremes€"namely, Hodgkin's paragranuloma, on one end of the spectrum, and Hodgkin's sarcoma on the other€"a considerable morphologic heterogenicity exists, with a particularly wide range in the ratio of lymphocytes to neoplastic histiocytes. Of great interest is the

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