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The pathology and clinical significance of the reticulo-endothelial system


, : The pathology and clinical significance of the reticulo-endothelial system. Haematologica 9(4): 349-368

This is a sequel to the author's first paper on the peripheral blood in a case of acute erythremia and acute septicemia. Smears and sectioned material of bone marrow, spleen, and liver showed that in acute erythremia there was prevalent a generalized hypertrophy and hyperplasia of the reticulo-endothelial system with marked macrophagocytosis. Extremely polymorphous and very large, the cell protoplasm was predominately oxyphilic, at times basic or polychromatic. Vacuolization and phagocytosis of cell elements was frequent. The normal architecture of the bone marrow parenchyma was completely distorted; it contained few granulocytes, few acidophilic erythroblasts, but exhibited an intense hyperplasia of reticulo-endothelium and many basophilic erythroblasts. The liver showed circumscribed foci composed of reticulo-endothelial elements, with intergrade stages to mono-cytes and various representatives of the erythroblast series. In acute septicemia the reaction of the reticulo-endothelial system, while similar, was notably less in degree and functionally exhibited microphagocytosis. Sections of the lung showed vessels having lumina filled with totally detached vascular endothelial cells, morphologically identical with those encountered in the peripheral stream. A clasmatosis of free vascular endothelial cells was frequent, the fragmented protoplasmic masses carrying a varying quantity of streptococci. The latter were abundantly met with in fixed vascular endothelium. Renal vessels exhibited an identical hypertrophy, rounding up and detachment of vascular endothelial cells, which as free structures in the lumen acquired a phagocytic function (streptococci). On the basis of the above the author concludes that, in respect to cytopoiesis and functional activity, the generalized vascular endothelium should be included in the concept of the reticulo-endothelial system. The extremely high ratio of endothelial cells in the peripheral circulation, the hypertrophy and hyperplasia of the reticulo-endothelial constituents noted in both cases are not merely reactionary phenomena, but indications of a systemic disturbance, which for diagnostic purposes may well be termed reticulo-endotheliosis, or hemohistioblasto-sis.

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