Tumours of lymphoid tissue in military personnel

Abstract

1. The structure, histology and .function of normal lymphoid tissue are described. (Chapter I).

2. The genetic relationship of the cells of lymphoid tissue is discussed. (Chapter I).

3. The history of the recognition of the various types of lymphoid tumours is traced (Chapter II) and further reviews of the published literature are given in the chapters devoted to the individual tumours. (Chapters VI - IX).

4. The neoplastic origin of the diseases included in this survey is accepted but alternative views an the aetiology of Hodgkin's disease are considered.(Chapters II and VI).

5. The evolution of the modern view that lymphoid tumours may be classified on a basis of Maximow's concept of the development of cells of reticular tissue is outlined. (Chapter II).

6. The classifications in common use are tabulated for easy reference (Table I) and the classification used detailed. (Chapter IV).

7. A plea is made for some form of agreement on nomenclature and classification. (Chapter II).

8. The history of lymphoid tumours in British military medicine is briefly reviewed. (Chapter V).

9. Lymphoid tumours are the most common malignant neoplasms in soldiers. (Chapter III).

10. There were 112 histologically proven cases of lymphoid tumour in the period 1948 - 1955 and these were distributed as follows :- Male service personnel - 106 cases Female service personnel - 1 case Families - 3 cases Chelsea pensioners - 2 cases (Chapter V).

11. The histological classification of these tumours was :- Reticular lymphoma 11 Hodgkin's disease 63 Hodgkin's sarcoma 8 Follicular lymphoma 6 Lymphosarcoma 11 Reticulum cell sarcoma 8 Mixed cell sarcoma 2 Miscellaneous 3 (Chapter V).

12. The incidence of lymphoid tumours in male and female service personnel has been calculated and the conclusion drawn that these tumours have no higher an incidence in the army than elsewhere and that their relative frequency is due to the age structure of the army. (Chapter V).

13. Neither rank, corps, service nor station had any significant effect on incidence. (Chapter V).

14.. Each group of cases is analysed in some detail to give information on symptons on admission, duration of symptoms, physical signs on admission, the course of the disease, pathology of biopsy and autopsy material and prognosis. (Much of this information cannot be summarized). (Chapters VI - IX).

15. In general the clinical findings in the cases of reticular lymphoma, Hodgkin's disease and Hodgkin's sarcoma were similar to those reported by other authors. (Chapter VI).

16. Three of the six cases of follicular lymphoma were unusual in that they occurred in patients under the age of 25. (Chapter VII).

17. The high incidence of gastro -intestinal involvement in lymphosarcoma and reticulum cell sarcoma is remarked on. (Chapter VIII) .

18. Three cases of histiocytic medullary reticulosis are included. One of these is of particular interest in that a gland biopsy taken two years before death showed Hodgkin's disease. (Chapter M.

19. Two instances in which sequential biopsies showed transition from reticular lymphoma to Hodgkin's disease are described. A third example in a Royal Air Force patient is mentioned. (Chapter VI).

20. Eosinophils were frequently found in lymph node biopsies in Hodgkin's disease but there was no correlation between blood, marrow and tissue eosinophilia. (Chapter VI).

21. The co-existence of tuberculosis and Hodgkin's disease in the same gland was noted in the biopsy specimens from one patient only. (Chapter VI).

22. The histological distinction between Hodgkin's disease and Hodgkin's sarcoma is ill defined, the two conditions merging into each other. Autopsy material when compared with the corresponding biopsy material frequently shows in areas a more pleomorphic and sarcomatous picture. (Chapter VI).

23. The transformation of a follicular lymphoma to lymphosarcoma in one patient is recorded. (Chapters VII and VIII).

24. That in three of the cases lymphosarcoma may have arisen in a gland previously the site of a follicular lymphoma is suggested by the finding of a definite or indefinite follicular pattern in the biopsy sections. (Chapter VIII).

25. Lymphosarcoma and reticulum cell sarcoma may closely resemble each other and mixed forms are seen. (Chapter VIII).

26. The distribution of blood groups in fifty cases of lymphoid tumours is almost identical with that of the general population. (Chapter X).

27. Haematological findings on admission and afterwards are recorded. No characteristic or diagnostic changes were found in the blood or bone marrow. (Chapter X).

28. The Presence of primitive white cells in the peripheral blood in a number of cases is noted. (Chapter X).

29. Megakaryocytes can be distinguished from the giant cells of Hodgkin's disease by their reaction when stained by P.A.S., megakaryocytes being strongly P.A.S. positive. (Chapter X).

30. Changes in serum proteins as determined by paper electrophoresis were noted in over half of the cases. The alterations included a decrease of total protein, a decrease in albumin, an increase in a( globulins and increase or decrease in y globulins. (Table =II and. Appendix 2) .

31. No evidence of any significant reduction of hypersensitivity to tuberculin could be detected in patients with lymphoid tumours by the Mantoux test. (Chapter X) .

32. The difficulty of diagnosing cases presenting without superficial lymphadenopathy is discussed. (Chapter XI).

33. The first essential in the histological examination of a lymphoid tumour is the preparation of a good section. (Chapter XI).

34. The histological diagnosis of lymphoid tumours is discussed. (Chapter XI).

35. Treatment is briefly described. (Chapter XII).

36. The use of cyto -toxic drugs necessitates frequent blood counts. (Chapter XLI).

37. Repeated blood transfusions may become necessary and every effort should be made to prevent the development of immune antibodies. (Chapter XII).

38. The relationship between histology and prognosis is investigated. Cases of reticular lymphoma or follicular lymphoma have a relatively good prognosis, those of Hodgkin's sarcoma, lymphosarcoma and reticulam cell sarcoma a very bad prognosis, while those of Hodgkin's disease have an expectation of life of about two years. Exceptions to these rules are not uncommon. (Chapter XIII).

39. The effect of a diagnosis of lymphoid tumour on a soldier's military career is discussed. The majority are discharged from the army as unfit for service. (Chapter XIV).

40. Invalidings from the army on account of lymphoid tumours fault only a very small proportion of the total medical discharges. (Chapter XIV).