General lymphadenomatosis of bones, one form of "multiple myeloma"
The Journal of Pathology and Bacteriology
PLATE IX.) I WILL first give brief clinical notes of this unusual case, and then describe what was found a t the necropsy. The patient, E. P., et. 61, was an Austrian, who had been long resident in Mexico. He was admitted to the German Hospital on 17th October 1896, complaining of various pains, resembling those often described in chronic rheumatism. There was considerable kyphosis, and this was apparently progressive. He walked very stiffly and carefully with the aid of a stick. I n general
... ick. I n general appearance he was rather emaciated, and looked more like a man of 80 than of 61. His urine contained no albumin. The symptoms he complained of were apparently of comparatively recent date. Various medicines were tried, including glycerophosphates, iodide of iron, and arsenic, but they seemed to have no effect whatever. Patient had a fair appetite, and was free from fever; yet he seemed to get weaker and to complain more of the pains. In particular there were bilateral pains in the sides of the abdomen; these were usually worse when he stood up. The pains, and the increasing lumbo-dorsal kyphosis, made one think of the possibility of malignant tumour of the spinal column, or of a diffuse caries in the front part of several vertebral centra, or of spondylitis deforinans. The whole spinal column was kept rigidly fixed in one position. Slight cedema over the lower part of the spine and over one leg was noticed on different occasions. The weakness increased, and the patient developed an asthenic type of pneumonia. He became half unconscious some time before his death, which took place on 18th January 1897. NECROPSY.-T~~ skeleton.-All the ribs, the whole vertebral column, the clavicles, the sternum, and the skull were examined, and were all found to be the site of a very vascular pulpy neoplasm, growing from the interior of the bone outwards. The ribs were all converted into delicate tubes formed of periosteum, with only a thin imperfect shell of bone ; they were stuffed full of the new growth. The slightest pressure sufficed to break them in any part ; many spontaneous fractures had occurred during life, and had already thoroughly united by callus. I n some places the new growth had distended the periosteum and bony shell, so as to form a nodular enlargement on the rib. Here and there the osseous tissue had been completely absorbed, so that the new growth lay directly under the periosteum. A chance blow on the sternum during life would certainly have forced in the whole front wall of the chest. The ragged appearance of the properly prepared dried ribs is very striking. I n one of the Read before the Pathological Society, 4th May 1897. No organic disease could be found in the viscera. In December there was a little ninco-purulent expectoration. 60 I;: PARKES WEBER. lower dorsal vertebrz a bluish substance could be seen under the periosteum, and on cutting into it a thick dark fluid flowed out, leaving a cavity crossed only by a few fleshy shreds. The sternum and the vertebral coluinii are about equally affected. The clavicles have suffered somewhat less. A certain amount of new growth is present in the diplog of the skull, and the black spots seen below both tables of the calvarium are doubtless due to bone absorption from nodules of growth in the diploe. Microscopic examination showed the new growth to consist of small mononuclear round cells (Plate IX. Fig. l) , with none or scarcely any substance between them. Interspersed amongst the cells are small blood vessels (a), with swollen looking, almost hyaline, walls. Spicules of bone taken from the new growth do not show any clear margin, such as is well seen in a spicule from a case of osteomalacia shown me by Mr. Shattock, the bone in the latter specimen being decalcified at the margins a5 a preliminary step towards absorption. I n the present case, the bone seems to be absorbed by the new growth without undergoing any previous process of decalcification. Specimens of the new growth from the vertebrz, the ribs, and the diploe of the skull, all presented the same characters. Behind the right clavicle were some enlarged lynzph glands, which the microscope (see Plate IX. Fig. 2) showed to be the site of a similar but less vascular growth. KO growth was discovered in other lymph glands or elsewhere ill the body. Nothing abnormal mas cliscovered in the brain.