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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    increase of lymphocytes, and with the presence of a periosteal swelling, which are commonly seen in chloroma. This disease is very closely related to lymphatic leukaemia, though a few examples of myeloid chloroma have been reported, and is very rare; in 1904 Dock (6) accepted thirty-six cases, and since then Treadgold (17) has collected six more cases, making forty-two in all. Histology. The only material available was that taken at the biopsy. This was put through paraffin in the usual manner, cut and stained by the following methods: Borax methylene blue, Jenner’s, LeishmaiTs, Giemsa’s, and PappenheinTs. The epidermis was seen to be thin, but not unusually so for the part of the body from which the tissue came. There was some intra¬ cellular oedema in the prickle-cell layer due to pressure, otherwise there was nothing abnormal. There was no leucocytic infiltration between the epidermal cells. The corium and upper part of the subcutaneous tissue showed between the collagen bundles a dense infiltration of cells, which appeared to be lymphocytes and polymorphonuclear leucocytes. The cells were so close together in places as to mask the fibrous tissue supporting them. Where they were not so numerous, near the edges of the infiltration, the cells were chiefly collected around the blood-vessels and lymphatics, and appeared to have exuded from the blood-vessels rather than to have been produced on the spot. Pincus (16), writing on the changes in the skin in leukaemia and pseudo-leukaemia, favours the view that the nodules are derived from the normal lymphatic tissues in the skin, and are not the result of exudation from the blood. He also is of the opinion that the tumour formations in leukaemia and in pseudo-leukaemia are indis¬ tinguishable ; in our case the entire absence of the appearances, which have since been shown by Andrewes (1) to be characteristic of lymphadenoma, together with the clinical signs, eliminate that diagnosis. The section stained by Pappenheinds method showed a complete absence of plasma-cells; this is opposed to Unna, who speaks of these nodules as a “ special form of granuloma.” The section stained by borax methylene-blue showed a few mast-