General lymphadenomatosis of bones, one form of 'multiple myeloma' / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: General lymphadenomatosis of bones, one form of 'multiple myeloma' / by F. Parkes Weber. 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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    lower dorsal vertebrae a bluish substance could be seen under the periosteum, and on cutting into it a thick dark fluid flowed out, leaving a cavity crossed only by a few fleshy shreds. The sternum and the vertebral column are about equally affected. The clavicles have suffered somewhat less. A certain amount of new growth is present in the diploe of the skull, and the black spots seen below both tables of the calvarium are doubtless due to bone absorption from nodules of growth in the diploe. Microscopic examination showed the new growth to consist of small mononuclear round cells (Plate IX. Fig. 1), with none or scarcely any substance between them. Interspersed amongst the cells are small blood vessels (a), with swollen looking, almost hyaline, walls. Spicules of bone taken from the new growth do not show any clear margin, such as is well seen in a spicule from a case of osteomalacia shown me by Mr. Shattock, the bone in the latter specimen being decalcified at the margins as a preliminary step towards absorption. In the present case, the bone seems to be absorbed by the new growth without undergoing any previous process of decalcification. Specimens of the new growth from the vertebrae, the ribs, and the diploe of the skull, all presented the same characters. Behind the right clavicle were some enlarged lymph glands, which the microscope (see Plate IX. Fig. 2) showed to be the site of a similar but less vascular growth. Xo growth was discovered in other lymph glands or elsewhere in the body. Xothing abnormal was discovered in the brain. In the lungs there was greyish consolidation at both bases. In some parts of the consolidated lung no boundaries of the alveoli could be microscopically distinguished (Plate IX. Fig. 3); the tissue in these parts seems as if it had been boiled ; it appears to consist of a number of small cells embedded in a homo- geneous, almost hyaline, ground substance, with here and there collections of red blood corpuscles, either in the vessels or extravasated. The outer portions of the vessel walls have likewise become unnaturally hyaline, as if they, like the walls of the alveoli, were gradually becoming dissolved in the homogeneous material of the exudation. The heart presented nothing unnatural. There were several atheromatous ulcers in the middle portion of the aorta. The liver appeared, macroscopically and microscopically, to be normal. The spleen was slightly enlarged and soft, and showed considerable chronic thickening of the capsule (perisplenitis). The stomach was abnormally dilated. The kidneys.—One was (apparently congenitally) larger than the other. They showed a moderate amount of chronic interstitial change. In one of the kidneys two white spots were noticed in the cortex, just below the capsule. Microscopic sections (Plate IX. Fig. 4) were made through these spots, and the razor grated slightly in passing through them, as if they con- tained some gritty material. Under the microscope this was seen to be due to the presence of spherules1 (microscopic calculi) embedded in the white spots. The spherules stain deeply with hsematoxylin; concentric markings can be distinctly made out in some of them. In what structures of the kidney the spherules are lying is not easy to make out; one or two of them seem to be in the convoluted tubules, but most of them are in portions of the kidney where the epithelial cells have degenerated, and where some fibroid change has taken place (Plate IX. Fig. 4), so that it cannot now be determined whether they were first deposited in normal renal tubules, which degenerated afterwards, or in already degenerated librotic tissue. Mr. Shattock has kindly made a chemical examination of the spherules 1 I have on several occasions seen similar spherules, when examining the inspissated contents of small cysts, often found at necropsies in the renal cortex. These, however, showed a certain amount of ray-like, as well as concentric markings. They were usually easily broken up by pressure on the coverslip.