Some aspects of lymphadenoma (Hodgkin's Disease) / by H.D. Rolleston.

  • Rolleston, Humphry Davy, Sir, 1862-1944.
Date:
[1911?]
Catalogue details

Licence: In copyright

Credit: Some aspects of lymphadenoma (Hodgkin's Disease) / by H.D. Rolleston. Source: Wellcome Collection.

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    In cases of thoracic lymphadenoma in which the other evidences of the disease are slight, difficulties in diagnosis may occur. It may be thought to be an aneurysm; or, if glands above the clavicle are detected, to be a primary mediastinal tumour with secondary growth' in the palpable lymphatic glands. The presence of high fever in a patient with intrathoracic lymphadenoma has suggested the diagnosis of pneumonia. The Abdominal Form of Lymphadenoma.—Usually this follows primary disease of the cervical glands and consists in enlarge¬ ment of the retroperitoneal and mesenteric glands and of the spleen and liver. But in some instances the retroperitoneal glands are primarily and even solely attacked. In such cases the diagnosis may be very difficult. Dreschfeld states that acute tuberculous peritonitis may be simulated. In one case which I saw the onset wras marked by sudden acute dilatation of the colon. McDonald refers to a case in which the pain and indefinite resistance in the upper part of the abdomen and the irregular fever led to an operation for a leaking gastric ulcer; a large mass of glands was found. Abdominal pain may be due to pressure of retroperitoneal glands on the branches of the lumbar and sacral nerves, and give rise to a clinical picture difficult to explain. Enlarged mesenteric glands may imitate appendicitis. Pressure exerted by enlarged glands in the portal fissure may produce a serous ascites. In rare instances pressure on the lymphatic vessels may give rise to a chylous ascites ; out of 102 collected cases of chylous ascites Scholberg and Wallis41 found that two were due to lymph¬ adenoma. The ascitic effusion in abdominal lymphadenoma may be milky, but not due to the presence of chyle ; this pseudo-chylous ascites is also rare in abdominal lymphadenoma, for in 71 collected cases of pseudo-chylous ascites twTo only were associated with this disease (Scholberg and Wallis). The pressure of retroperitoneal glands on the inferior vena cava may cause oedema of the legs and albuminuria; and pressure on the ureters may interfere wTith the excretion of urine. Pressure on the bile ducts by enlarged lymphadenomatous glands may produce jaundice. Usually this is a comparatively late event in the course of the disease in cases in which the superficial glands were first affected. But it may occur when 41 Scholberg and Wallis : Quart. Journ. Med., Oxford, 1911, IV., 170.