Mediastinal form of lymphadenoma (Hodgkin's disease) with extreme so-called pulmonary hypertrophic osteo-arthropathy / by F. Parkes Weber ; with a report on the histology of the case by J.C.G. Ledingham.

  • Frederick Parkes Weber
Date:
1909
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Licence: In copyright

Credit: Mediastinal form of lymphadenoma (Hodgkin's disease) with extreme so-called pulmonary hypertrophic osteo-arthropathy / by F. Parkes Weber ; with a report on the histology of the case by J.C.G. Ledingham. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the presence of clubbing of the fingers and characteristic secondary osteo-arthropathy in the extremities. What was the nature of the mediastinal mass ? Localized tertiary syphilitic disease and thoracic aneurysm were both exceedingly im- probable. The patient gave a characteristic positive response to Calmette’s ophthalmo-reaction for tuberculosis, but I had already seen and read of cases which threw great doubt on the absolute reliability of that clinical test for tuberculosis [21]. The appearance of moderately enlarged glands in the neck and the “ biopsy ” examination of one of them made the diagnosis of mediastinal tumour absolutely certain. Although the microscopic structure of the gland removed was charac- teristic of lymphadenoma, according to the descriptions of Andrewes, Keed, Longcope and others, I hesitated to decide against the possibility of lymphosarcoma. The post-mortem examination made it certain, however, that the growth in the chest was really what is now generally regarded as lymphadenoma (Hodgkin’s disease). (2) Histological Features of the Tumour.—The microscopic appear- ance of the mediastinal tumour and of the enlarged lymphatic glands in the neck was characteristic of lymphadenoma (Hodgkin’s disease), accord- ing to the description of F. W. Andrewes [1], Dorothy M. Keed [14], C. C. Simmons [15], W. T. Longcope [8], F. Warnecke [20], Kobert Muir [11], F. S. Kidd and H. M. Turnbull [7], &c.—that is to say, in regard to the features on which these authors are agreed. In the present case the main histological features of the growth were (A) the presence of abundant epithelioid and giant-cells (megakaryocytes and polykaryocytes) scattered throughout the growth; (B) its extraordinary • richness in eosinophil cells, which in properly stained sections at first sight constitute the most striking feature of all; (C) the secondary fibrosis. The fibrosis is characteristically more advanced in the older growth in the mediastinum than in the newer growth in the lymphatic glands at the root of the neck. In the present case the spleen, liver, and most of the lymphatic glands were as yet uninvolved. (3) Localization of the Frimarij Tumour and Bemarhs on Lymph- adenoma.—H. A. Hare, in his well-known monograph [6] on affections of the mediastinum (1889), gives a table of twenty-one cases of lymphoma and lymphadenoma of the mediastinum, some of which were probably examples of true lymphadenoma, though forming a definite mediastinal tumour, as in the present case. But subsequent authors have questioned the possibility of lymphadenoma (Hodgkin’s disease) ever constituting a primary mediastinal “tumour.” J. L. Stevens [16] (1892), for instance,
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