Clinical and pathological report of a case of cavernous lymphangioma of the subcutaneous tissue of the forearm : (under the care of Professor Chiene) / by Harold J. Stiles.

  • Harold Stiles
Date:
1893
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Licence: Public Domain Mark

Credit: Clinical and pathological report of a case of cavernous lymphangioma of the subcutaneous tissue of the forearm : (under the care of Professor Chiene) / by Harold J. Stiles. 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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    More recently Beyer has attributed the origin of the cavernous forms of lymphangiomata to a cell infiltration, spreading from the perivascular spaces and adventitia of the vessels into the surrounding fat and cellular tissue, the pre- existing cells of which (especially the fat cells) become destroyed, so that spaces and cavities arise, which by their enlargement open eventually into the pre-existing lymphatics, and occasionally into the blood-vessels, accounting, in the latter case, for the mixed lymph and blood-vascular tumours occasionally met with. The homoplastic new formation of lymphatics is even more difficult to demonstrate, and appears to have been less frequently observed than the heteroplastic; judging, however, from the analagous process, as it occurs in blood-vessels, one would be inclined to regard the former as the more frequent and important. In 3 of the 18 cases examined by Nasse, he found the endothelial cells of the smallest lymphatics to be more closely placed than those of the larger vessels into which they opened, and infers from this that an endothelial proliferation has occurred. It is true that in the tumour I have described there is a well-marked follicular, perivascular, and diffuse leucocyte in- filtration into various parts of the stroma. In many of these lymphoid collections, appearances may he seen similar to those described by Nasse and Schmidt; nevertheless, they do not afford sufficient evidence to warrant the conclusion that these lymphoid nodules represent new foci in which either a hetero- or homo-plastic formation of lymphatics takes place. Many of the strings of flattened cells are sections of the walls of the capillary blood-vessels. The fact that the cells lining the smaller lymphatics are placed closer together than those lining the larger spaces into which they open, is no proof of endothelial proliferation, as the appearance might equally well he accounted for by supposing the latter to have been the result of dilatation. We have already seen that the cavernous spaces contain many uninucleated or migratory leucocytes, and that in the infiltrated tissue outside them are dilated, but otherwise normal looking, lymphatics, completely filled with the same variety of leucocytes. It is probable, therefore, that these lymphoid areas, in which a new formation
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