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
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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![tapped at fairly frequent intervals until the patient’s death in October. At first the effusion was always milky, but at the end of July (after the first five tappings) it became clear. The (jodema of the extremities gradually gave place to a chronic puff’y-looking enlargement of the hands {see fig. 1) and feet {see fig. 2), apparently due to a condition of Marie’s so-called “ pulmonary hypertrophic osteoarthropathy.” The existence of this was afterwards demonstrated by Bontgen-ray examination, and, in fact, at the end, when the patient was emaciated, the periosteal bony deposit could be seen and felt projecting in the forearm. Under treatment by hypodermic injections of atoxyl (commenced May 28), and a certain amount of exposure of the thorax to X-rays, there seemed at first to be some improvement in the general condition, but afterwards the patient began decidedly to lose ground. One or two lymphatic glands in the neck were felt moderately enlarged in August, and in the latter part of September one or two small glands could be felt in the left axilla on careful examination. Several glands could be felt in both inguinal regions, but they were not larger than they are in many healthy persons. About the middle of August one of the enlarged cervical glands (the first one noticed) was removed for “biopsy” purposes, and was found to show the changes characteristic of lymphadenoma; it contained numerous epithelioid cells and small giant-cells (megakaryocytes and small-sized polykaryocytes), and was permeated by an extraordinarily large proportion of eosinophil cells (Dr. Ledingham). The physical signs in the thorax after paracentesis and Bontgen-ray examination made it clear that there was a large and increasing tumour in the mediastinum. There was generally moderate pyrexia, but none after October 5. Emaciation and weakness progressed. The final cause of death, which occurred with asphyxia-like symptoms on October 28, was doubtless a serous effusion into the pericardium (see later). There was considerable general oedema at the end. The Hypertrophic Osteo-arthropathy.—The swollen appearance of the hands, wrists, feet and ankles {see figs. 1 and 2) with the clubbing of the fingers was very striking. There was no, or very little, accom- panying pain, even when the periosteal bony deposit could be seen and felt projecting in the forearm. Dr. N. S. Finzi kindly made skiagrams to show the bony changes {see figs. 8 to 5), and all the bones of the extremities were found to be affected in the way so well described and illustrated by Dr. H. E. Symes-Thompson in his paper before the Boyal Medical and Chirurgical Society in 1904 [18]. In the hands and feet the terminal phalanges and the carpal and tarsal bones appeared least](https://iiif.wellcomecollection.org/image/b2241941x_0007.jp2/full/800%2C/0/default.jpg)
