Psoriasis--verruca--epithelioma : a sequence / by James C. White.

  • White, James C. (James Clarke), 1833-1916.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Psoriasis--verruca--epithelioma : a sequence / by James C. White. Source: Wellcome Collection.

    10/12 (page 172)
    and size, separated by narrow bands of fibrous tissue, and extending deeply downwards into the subcutaneous fat tissue. The appearance and group¬ ing of the epithelioid cells suggested that all the epithelial constituents of the skin were involved, rete and epidermis, hair and sebaceous follicles, likewise the sweat glands. An atypical new formation, simulating the last-mentioned structures, with a central cavity, was abundantly present in the main tumor. The smaller nodule ' (from anal region) of more superficial growth simulated in its new formation rather the other cutane¬ ous structures. “A comparison of the specimens from the two cases showed a marked difference of composition. That from Case I. presented an abundant, dense, fibrous stroma, with narrow and sparse anastomosing bands of small, round epithelioid cells. The shape, size, and j unction of these bands directly suggested the distribution of the lymph-vessels of the skin. Indeed, the question directly arose, whether the new growth may not have affected primarily the lymphatics, representing what has been called catarrhal lymphangitis. The specimen from Case II. showed an abundant, luxu¬ riant growth of large epithelioid cells with but a scanty fibrous stroma between the masses. Epidermoid pearls were numerous in the small nodule, and cavities of considerable size with irregularly projecting and abundantly cellular walls suggested the dilatation, as well as new forma¬ tion, of an adenoid structure resembling the sweat-gland.” [During the preparation of this paper for the Society, I discovered in Ziemssen’s Handbuch, Band xiv. (Hautkrankheiten), a reference to a case, the following brief account of which is published in the Gaz. des Hopit., 1878, p. 750. Dr. Cartaz presented to the Anatomical Society the report of a healthy man, 40 years old, who had never had any other disease excepting a psoriasis, which began twenty-three years previously, and had invaded among other regions the palms and soles. In conse¬ quence of scratching, the scales upon one of these processes, situated upon the palmar surface of the second phalanx of the ring finger of the right hand, was removed, and there remained a little ulceration, which gradually extended to the size of four centimetres. The callous borders and the deep-seated granulations, bleeding at the slightest touch, estab¬ lished the diagnosis of cancroide. Amputation at the metacarpo-phalan- geal joint was performed, and there was no return of the disease. Although no mention is made in this very brief report of the interme¬ diate formation of warty growths, there can be no doubt at least of the close resemblance of the case to those above reported in the connection of its initial and final processes, probably none of its complete identity.] We have thus the record of three cases of psoriasis terminating in carcinoma of the cutaneous tissues. There are no peculiarities in the history or character of the primary dermatosis in the first two, at least, to suggest even an explanation of so rare and grave a transformation of process. Innumerable cases of as long duration and intractable type occur with no such termination, and it is unlikely that psoriasis is capable