Remarks on cystic lymphangioma in childhood : its differential diagnosis and treatment / by D'Arcy Power.

  • Power, D'Arcy, 1855-1941.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on cystic lymphangioma in childhood : its differential diagnosis and treatment / by D'Arcy Power. 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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    o societies. The patient, a girl, aged i8 montlis, presented a tense and elastic swelling, covered by healthy skin, on the hand. It invaded the thumb, the forefinger, and the radial side of the right hand, rendering the thumb and finger so use- less that they had to be amputated. The swelling was smooth and uniform, and its growth was so slow and steady that its nature was correctly diagnosed before the operation was undertaken. Subsequent microscopical examination showed that the whole of the subcutaneous connective tissue, and even the intermuscular planes were infiltrated with adipose tissue, which did not differ in any respect from healthy fat. The bones are thin and elongated, but the change is, I think, secondary to the increased deposit of fat, and did not imply that they were involved in the hypertrophy. The enlargement, therefore, was due to an overgrowth of fat which for some oljscure reason had increased out of all due proportion over this very liniited area of the body. Other difi'use lipomata also occur in children. They are deeply placed amongst the muscles of the limb, and they grow from the outer layers of the periosteum. These forms of diflfuse lipomata are much more likely to be mistaken for cystic lymphangiomata than are the lobulated and well circumscribed swellings, which there is no difiiculty in recognising, for they present the characters of an ordinary fatty tumour. Cystic lymphangioma may be distinguished from difi'use lipomata by the greater tenseness of the lymph- atic swelling and by the peculiar elastic sensation which is given when a number of cysts are felt beneath the skin, whilst the lipomata are softer and more doughy. The skin too is more intimately blended with the lymphatic tumour than with the lipoma unless the cyst lies beneath the deep fascia, when the skin is freely movable and is absolutely un- afiected. Lymphangiomata usually present prolongations of their tissue, which may run considerable distances either deeply or superficially, and they are thus less well defined than even difiused fatty tumours. These prolongations are sometimes represented by isolated tumours, which are separated from the main growth by an area of healthy tissue, as was the case in the girl you have seen to-day. The recurrent attacks of lymphangitis, if they are present, will go far to prove the lymphatic origin of such a tumour, but the surgeon must be on his guard lest he mistake these attacks for true erysipelas. Cystic lymphangiomata have also to be distinguished from cavernous nsevi and those rarer forms of blood tumours which arise either subcutaneously or much more deeply beneath the muscles as pockets or pouches in the veins, like the botryoidal appendages seen in some of the vermes. Cavernous nsevi very closely resemble the cystic lymphangio- mata, from which indeed they only difier in being developed from the vascular instead of from the lymphatic system. Nsevi, however, are more common than lymphangiomata, they can always be emptied, or at any rate they can be reduced in size by well regulated pressure applied for some length of time, whilst muscular exertion and all efiorts lead- ing to venous engorgement of necessity increase their size. Some nsevi have a distinct varicocele-like feel, and in some the skin is the seat of a capillary nsevus or it presents other evidence of disturbance of the vascular system. Nsevi in which there is much connective tissue and those rarer forms