(LYMPHADENOMA; PSEUDO-LEUCEMIA)
In a general way, the several conditions which are clinically
leucemia, yet do not possess leukemic blood, can be classified as
pseudo-leukemias. We do not definitely know the cause of leucemia as
yet and can but little more than speculate on the various etiologic
factors of the pseudo-leucemias.
Syphilis, malaria, tuberculosis, and malignancy are all considered as
factors, and probably certain cases can be definitely associated with
these conditions.
All of this group of pseudo-leucemias are characterized by early
swelling of cervical lymph glands, followed by general gland
enlargement, and by great destruction of the erythrocytes. There may
be metastatic-like growths of lymphoid tissue in other organs. The
enlargement of cervical glands usually begins on one side near the
angle of the jaw, and most commonly in young male adults. These glands
progressively increase in size, first are soft, then later become hard
through fibrous proliferation. Each gland tends to increase in size by
itself, not to coalesce with its neighbors, so that each separate gland
can be palpated. This is more readily done as there is little tendency
to fibrous adhesion formation to the overlying skin. These glands are
painless throughout the course of the disease, and tend neither to
caseate nor to suppurate.
The excised glands show a combined hyperplasia and connective tissue
proliferation. In the soft stage of the tumefaction, the lymphoid
hyperplasia is in preponderance, while, at the stage of hardening,
the fibrous tissue derived from the trabeculae and capsule of the
gland is in prominence. There is increase in the size of the spleen,
and occasionally of the liver, but these are never as marked as those
resulting from leucemia.
The =symptoms= are, first, those due to the glandular enlargement in
the order of: dyspnea, hydrothorax, dysphagia, ascites, swelling of the
extremities, and jaundice.
The destruction of red cells gives a resulting anemia which goes with
and exaggerates the pressure symptoms.
A process of this kind to induce such grave changes over as well
protected organs as make up the lymph system, must be virulent enough
to set up other symptoms, to be associated with those due to pressure
or to anemia. These are usually emaciation (giving greater prominence
to glandular tumefaction), cachexia, and the implantation of masses of
lymphatic tissue in organs where normally only traces of this tissue
exist.
Fever is dependent upon the disturbed thermic metabolism and may be
practically absent or subject to wide variations.
The erythrocyte count shows a progressive decrease with a greater
proportion of broken down cells and abnormal types as the condition
advances. The actual count is usually between 2,000,000 and 3,500,000
per cubic millimeter. The hemoglobin usually reduces in proportion to
the erythrocytes, so that there is little change in color index.
The leucocytes are not markedly changed in number (seldom over 10,000),
and this is often the =diagnostic= finding between leukemia and the
pseudo-leukemias. Hodgkin’s disease usually has a high percentage of
lymphocytes, so that there is an actual as well as relative decrease of
the granular leucocytes.
The =treatment= is unsatisfactory, and is in the main symptomatic.
Roentgen therapy has given temporary improvement, in some cases
lasting several years. In general the =prognosis= is hopeless, the end
occurring within four years of the time the condition is recognized.