A case of atypical myeloid leukæmia with nodular infiltration of the skin / by H.D. Rolleston, M.D., F.R.C.P., ... and Wilfrid Fox, M.D., M.R.C.P.

  • Rolleston, Humphry Davy, Sir, 1862-1944
Date:
[1909]
Catalogue details

Licence: In copyright

Credit: A case of atypical myeloid leukæmia with nodular infiltration of the skin / by H.D. Rolleston, M.D., F.R.C.P., ... and Wilfrid Fox, M.D., M.R.C.P. Source: Wellcome Collection.

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    On examination the patient was seen to be a very pale, rather shrunken woman, the skin having a transparent look, but not lemon- coloured. The nodules were of a grey-slate colour for the most part, but some of the larger ones were plum-coloured, not unlike in shape, colour, and size a half damson. The skin over them was shiny, smooth, free from scales, and not umbilicated. They were oval in shape, the long axis of the ovoid tending to run obliquely across the body, especially in the lower part of the abdomen. The distribution was roughly symmetrical. They were firm to touch, very superficial, in the true skin rather than in the subcutaneous tissue; some of them were a little tender. The nodules, as will be noted in the photograph (Plate), were distributed thickly over the front of the trunk; above the pubes, and to a less extent at the top of the sternum (not shown in the photo¬ graph) ; they were so near together as to be confluent in places. Thei’e were very few on the back, one or two groups on the internal surface of both thighs, and some isolated nodules on the calves and upper arms. There were none on the head and neck, or on the mucous membranes as far as could be seen. Enlarged glands could be felt in the axillae and groins; they were soft and freely movable. The spleen was shown to be enlarged on percussion, dulness extend¬ ing upwards to the eighth rib in the anterior axillary line, but on admission to the hospital it could not be felt below the costal margin. A few days afterwards, however, it could be detected on deep inspiration, and steadily increased in size. There was nothing else abnormal detected in either the abdominal or thoracic organs. The teeth showed several carious stumps, but there was no marked degree of pyorrhoea and no stomatitis. The general aspect of the case suggested the provisional diagnosis of multiple pigmented sarcoma, but the possibility of leukaemia was raised before the result of a biopsy established the presence of leukaemia. The biopsy was kindly carried out by Mr. Fraukau, who removed a nodule from the abdominal wall under a local anaesthetic. He found considerable difficulty in stopping the bleeding from the small wound, which continued to ooze for several hours. It is remarkable that neither before nor during the subsequent course of the disease was there any sign of spontaneous haemorrhage. The photo¬ micrographs shown were taken from slides prepared from the biopsy.