Symmetrical lymphomata of the lacrimal and salivary glands (Mikulicz's disease) / by S. Lewis Ziegler.

  • Ziegler, S. Lewis (Samuel Lewis), 1861-1926.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Symmetrical lymphomata of the lacrimal and salivary glands (Mikulicz's disease) / by S. Lewis Ziegler. 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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    promptly established as soon as the respiratory ob- structions were removed. These are significant facts worthy of our most careful thought. The con- viction is forced upon us that a careful examina- tion of every case of Mikulicz’s disease would prob- ably reveal some lesion of the respiratory tract which had not been reported, either through inad- vertence or through lack of special knowledge on the part of the observer. Finally, we should bear in mind the setiological element of hereditary or racial predisposition to lymphatic dyscrasise, which factor has been most pronounced in the cases so far reported in America, all of whom were members of the negro race. Pvthology.—The pathology of this disease is obscure. The histological picture has not been painted in the clearest colors, nor are the micro- scopic details as distinct as they should be. The macroscopical examination of the section of an ex- tirpated gland made by Mikulicz showed enlarged normal gland structure imbedded in a loose mass of pale, yellowish red tissue of fatty consistency, but very poor in bloodvessels. The microscope revealed this mass to be an enormous infiltration of small, round cells into the interstitial tissue. In this mass were grouped the apparently unchanged acini, which seemed to be pushed or torn apart by the new tissue. In certain areas a portion of the normal gland had been choked out by the engorgement. I will quote Mikulicz’s own pithy description: “The microscop- ical examination shows that the gland parenchyma proper plays a completely passive role. The en- largement is produced solely by the enormous small cell infiltration of the interstitial connective tissue.” He asserts that the preservation of the capsule of the gland, and of the interlobular septa, forbid a diagnosis of typical sarcoma, the small cell infiltra- tion histologically resembling most nearly the lvmphadenoid tissue of true lymphoma. Fuchs examined the nodular growths in his case and found the glandular elements absent, but the avascular texture of lymphoma present. Reymond’s case showed lymphoid tissue with areas of amyloid degeneration. Adler found what he diagnosticated as small cell sarcoma, but complete resolution oc- curred under arsenic. The patient reported a “per- fect cure” at the end of four and a half years, al- though he continued to take the arsenic for some