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

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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$lymphocytes; though a relative increase of the latter was by Pincus supposed to constitute a characteristic of “pseudoleukaemia.” The degree of eosinophilia, and doubtless the distribution of the eosinophil cells, varies considerably in different cases of Hodgkin’s disease, and in the same case at different periods. The increase of eosinophil cells in the blood of the present case was very moderate when compared to the extraordinary number of eosinophil cells present in the mediastinal growth, the affected glands, and the bone-marrow. Up to a certain extent the findings in the present case would confirm the results arrived at by W. T. Longcope [10] in his investigations into the distribution of the eosinophils in Hodgkin’s disease, though in the present case the eosinophils were not specially situated at the periphery of the lymph- adenomatous glands, as he found them to be. According to his observations it seemed probable that the eosinophil cells were not produced in the lymphadenomatous glands themselves; the distribution of these cells in the affected glands suggested rather that they were carried thither by the blood-stream—in fact, that they were derived from the eosinophil myelocytes, which were present in excessive numbers in the bone-marrow, and that they were carried from the bone-marrow to the affected glands in the circulating blood. It is therefore quite intelligible that at times the blood may show only slight eosinophilia, though the lymphadeno- matous glands may be crammed with eosinophil cells. (6) The “Milky” Pleural Effusion.—The milkiness of the effusion was evidently due to fat, though in exceedingly fine division, since it was removed by shaking with caustic soda and ether, as already stated. In this respect the case may be compared to one at St. Bartholomew’s Hospital described by Dr. J. A. Ormerod [12]. His patient was a boy, aged 13, with enlarged lymphatic glands (doubtless lymphadenomatous) on the right side of the neck, and a right-sided pleural effusion of fluid resembling thin milk in appearance. The fluid was of specific gravity 1,017, and alkaline in reaction; when shaken with ether the milkiness disappeared, leaving a clear opalescent fluid, of the usual type in pleural effusions. The fluid differed somewhat, however, from that in my case, since on microscopic examination it was found to contain actual fat globules besides multitudinous small refractile bodies. Moreover, in my case the milky character of the effusion disappeared spontaneously after the patient had been tapped five times, and from the sixth tapping to the patient’s death it had the ordinary appearance; that is to say, resembled the fluid in ordinary cases of pleural effusion.$