A case of late Hodgkin's disease (lymphoma granulomatosum) : with remarks on various cases presenting the clinical picture of splenic anemia (Banti's disease) / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1911
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Licence: In copyright

Credit: A case of late Hodgkin's disease (lymphoma granulomatosum) : with remarks on various cases presenting the clinical picture of splenic anemia (Banti's disease) / 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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    Q A blood examination by Dr. G. Dorner, on September 30, 1910, gave: Hemoglobin, 56 per cent.; red cells, 3,333,330 in the cubic millimeter; color index, 0.86; white cells only, 2480 in the cubic millimeter; no eosinophilia. A differential count of 500 white cells (October 25, 1910) gave: Polymorphonuclear leukocytes, 84 per cent.; small lymphocytes, 3 per cent.; large lymphocytes, 1.7 per cent.; large mononuclears, 7 per cent.; transitionals, 4.3 per cent. Only one nucleated red cell was seen during the count of 500 white cells. The red cells showed anisocytosis and moderate poikilocyto- sis, as in secondary anemias. On November 12 the hemoglobin was only 35 per cent.; red cells, 1,910,000 in the cubic millimeter; color index, 0.9; white cells, 4124 in the cubic millimeter. Necropsy and Microscopic Examination. Body much emaciated and jaundiced. The brain and cerebrospinal fluid are not bile stained. The brain weighs 42 ounces and shows slight apparent atrophy of the convolutions. The pericardium contains about 70 c.c. of clear bile-stained serous fluid. On the heart (weight, 9 ounces) are a few pericarditic patches; there is some old thickening of the mitral valve. No atherosclerosis of the aorta or coronary arteries noted. There is chronic indurative pneumonia (as proved by sub- sequent microscopic examination) of part of the middle and upper lobes of the right lung. Both lungs show hypostatic edema. Pleu- ritic adhesions are present on both sides. No pulmonary tubercu- losis. The peritoneum contains 2400 c.c. of somewhat turbid, bile-stained, ascitic fluid, which is found by microscopic exami- nation to owe its turbidity to the presence of fairly numerous white corpuscles. No evidence of tuberculous peritonitis. Spleen. Weight, 32 ounces. Uniformly enlarged; rather hard; surface smooth, but showing patches of perisplenitic thickening of the capsule; also one or two scars, which on section are found to be connected with small anemic infarcts. The splenic substance is of a red color and contains numerous small miliary to pea-sized, pale nodules, and a few small hemorrhages. Liver. Weight, 66 ounces. The surface is smooth and even, with the exception of a little old patchy perihepatitis; it is of greenish color with scattered spots of red. On section, the hepatic substance is found to contain a few pea-sized pale nodules. The red spots beneath the capsule are evidently due to the presence of similar minute nodules, into which hemorrhage has taken place. The com- mon bile duct during life was probably obstructed by a large, chestnut-sized lymphatic gland in the hilum of the liver, but at the necropsy, by firm pressure on the gall-bladder, some bile can be squeezed out through the ducts into the duodenum. In the kidneys, which weighed together 12 ounces, a little patchy greenish coloration observed in the cortex has been found by subsequent microscopic examination to be probably due to the presence of bile-stained casts in the renal tubules. Nothing special