Lymphadenoses

LYMPHADENOSES, a term proposed by Aschoff and Schridde to denote systemic hyperplastic processes in lymphatic glands and generally in adenoid tissue observed in lymphatic leukemia and aleukemia; hence the designations leukemic and aleukemic lymphadenosis (see Leukemia), opposed to analogous varieties of myelosis and reticuloendotheliosis. Instead of L. one also speaks of leukoses (Ellermann). The terms "adenia" and "adenopathy" are very little popular in our literature, and in essence their use instead of L. is not rational. LYMPHOANGIOMA (fymphangioma), a neoplasm consisting of lymph vessels; in some cases it is a true tumor, a blastoma, in others it represents a developmental defect. True L. are very rare tumors. Forming during the embryonic period, L. can be noted in the very early childhood and, although slowly, increase progressively, but in most cases their growth stops for some unknown reason, and often a reverse development begins through the obliteration of lymph vessels. Small L. turn into soft scar tissue. The overwhelming majority of L. represent simply dilations of lymph vessels, wrongly laid down in one place or another in excess (Albrecht's hamartomas). In both cases L. are completely benign. By their structure L. are divided into simple lymphangiectasias (lymphangioma simplex, s. capillare-varicosum), cavernous L. and cystic L. Lymphangiectasias represent dilations of tissue clefts filled with lymph and lined with endothelium; these clefts are usually laid down in b. or m. dense fibrous connective tissue, often rich in adipose tissue and containing bundles of smooth muscles and, as a rule, groups of lymphoid elements. The latter are a constant, inseparable part of L. in general. Sometimes dilations of lymph vessels (clefts) are located among muscles, e.g., in the tongue, lips, giving these organs large sizes (macroglossia, macrocheilia). Cavernous L. (lymphangioma cavernosum) are distinguished by the fact that the lymphatic cavities possess their own b. or m. thick walls made of fibrous tissue with bundles of smooth muscle fibers. Finally, the third form of L. are cystic cavities (lympllangioma cysticum), single-chambered or multi-chambered. Their most frequent localization is the neck, mesentery, and retroperitoneal space. Mesenteric lymphangioma often contains milky-like fluid and is then called chylangioma. The most frequent localization of L. is the skin. Here they form small whitish or translucent yellowish, sometimes oozing areas, slightly raised above the level of the skin, occurring in early childhood (lymphangioma circumscriptum). In the skin formations known under the name of colorless birthmarks are also encountered, which apparently have a close relation to lymphangiomas (see Naevus). Besides the skin, L. are very rarely encountered in serous membranes, rarely in internal organs (liver, spleen, kidneys). Regarding the pathogenesis of L. little is known. They develop exclusively in a growing organism and either from areas occupied by lymphoid accumulations (Oppel), or by the disintegration of central cells in nest-like accumulations of endothelium (Ziegler, Opokin), whereby peripheral cells gradually flatten and turn into the endothelial lining of the cavities. According to the opinion of V. A. Oppel, L. can also develop by the disappearance of adipose cells of the subcutaneous tissue, in which sometimes a slow growth of these formations is observed. It should be noted that the pathogenesis of L. is very similar to the pathogenesis of hemangiomas; combinations of the two are sometimes encountered. Ziegler also described so-called lymphangioma hypertrophicum, in which the walls of the cavities appear thickened due to the multiplication of endothelium laid down in several layers. Such L. are a transition to true tumors-endotheliomas (lymphangioendotheliomas). F. Chistovich. The symptoms of L. depend on the affected organ, tissue, or area, as well as on the nature of the patho-anatomical process. L. simplex are characterized by small painless, easily disappearing under pressure of a finger, soft swellings, noticed already from the moment of birth of the patient (if located on external coverings). The transition from L. simplex to L. cavernosum forms diffuse tumors (most often on the lips, cheeks, often in combination with macroglossia) of soft, sometimes elastic consistency, increasing during crying or tension of the patient, decreasing upon compression. The skin, in contrast to angiomas, is pale, often fused with the tumor. They can be easily confused with soft fibroma, lipoma. L. cysticum differs sharply from the described ones, representing conglomerates of well palpable cavities, ranging from a pinhead to huge tumors the size of a child's head (see figure). Most often they are located in the subcutaneous tissue of the lateral parts of the neck, in the groin, axillary, popliteal regions, retroperitoneal tissue, at the root of the mesentery (single observations) in children. They can be easily confused with lateral neck cysts, with sarcoma. L. grow slowly. (Some authors have observed spontaneous disappearance of L.) Growth intensifies during the period of sexual maturity (Söppchen). L. easily undergo inflammation with the development of severe phlegmons, the consequence of which are long-healing fistulas discharging lymph. L. of the oral cavity in case of inflammation can lead to death from spread of the process to the pharynx and larynx. Treatment is surgical—extirpation of the tumor, to which a limited L. cysticum submits most easily. More diffuse L. of another type often have to be removed only partially, in stages, adding to the knife resection injections (Lexer) into the tumor and along its periphery of alcohol, iodine, 1% solution of zinc chloride.