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.

  • Weber, Frederick Parkes, 1863-1962.
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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    wrote: “ There has of recent years been too great a tendency to search for some relationship between mediastinal tumours and Hodgkin’s disease, when in reality there was no need to do so, and when the effort to demonstrate a connection simply led to the formation of erroneous views.” Further on Stevens refers to Gowers’s article on “ Hodgkin’s Disease [5] (1879), and says [17] : “All this goes, I think, to prove that anything in the nature of a mediastinal tumour which can be regarded as essentially a local manifestation, whether liable to metastasis or not, can have no relationship to Hodgkin’s disease.” Even as recently as the present year (1908) H. A. Christian [3], although he is apparently acquainted with the modern description of the histology of lymphadenoma, or Hodgkin’s disease, writes: “ Cases, however, in which there is a tumour of the mediastinum having the histological characteristics as described by Eeed, Longcope, and others, for Hodgkin’s disease, but no general lymph-node involvement, may be included in the lymphosarcoma group for the present” {see supplementary note, p. 86). The question is : What are we to regard as the criterion of a case being one of lymphadenoma or not ? In regard to other growths, benign and malignant, the recognized classification of the various kinds of tumour is based on their microscopic features, and I am therefore certainly in favour of accepting the histological characteristics which have been demonstrated (not merely described) by Andrewes, Eeed, Longcope, &c., as the criterion of lymphadenoma. If this criterion be generally admitted, I believe it will be found that the old idea of lymphadenoma (Hodgkin’s disease) being from the com- mencement, or almost from the commencement, a generalized disease of the lymphatic glands and lymphatic tissue of the body is erroneous— that is, the old view of lymphadenoma as a “ pseudoleukaemia.” In a recent article on Hodgkin’s disease [22] I wrote : “ For the diagnosis of Hodgkin’s disease there ought to be gi'eat enlargement of some one or more regional groups of lymphatic glands. It is doubtful whether any of the so-called “ pseudoleukaemia ” cases showing a universal but only slight enlargement of lymphatic glands can be included as examples of Hodgkin’s disease.” I believe that in lymphadenoma (Hodgkin’s disease), whether running an acute or chronic course, some one or more regional groups of lymphatic glands are generally specially affected, so as to constitute a regular tumour formation, before the lymphatic glands throughout the body become definitely involved. The first part of the body affected, constituting, in fact, a primary tumour, may be the glands on one side of the neck, or the glands in one axilla, or, as E. Muir [11]