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Giant hemolymph node of the mediastinum
Giant
Hemolymph
Node
of the Mediastinum
LOUIS F. KNOEPP, M.D. AND EDWARD C. UHRICH,
From tbe Veterans Administration Louisiana.
Hospital, Alexandria,
Alexandria,
Louisiana
progress in a benign manner but have been known to metastasize to para-aortic regions.
are CASE REPORT rare. Up to 1956, Grimes was abIe to V. R., a sixty-five year old coIored man, entered coIIect onIy five cases and added one of his the Veterans Administration HospitaI in Alexown [I]. As far as one can teI1, no other cases andria on ApriI 2, 1956, complaining of nocturia, have appeared in the Iiterature up to the case nervousness and dyspnea and dysphagia of two presented herein. Of previousIy reported cases, years duration. At the beginning, ordy semisolid two reported by Symmers [q in 1921 and one food could be swahowed, but the dysphagia progressed during the Iast month to the point where by Lederer [2] in 1923 expired, but the two the patient couId toIerate only liquids. Food apreported by Pemberton, Broders and Maino [4] peared to stick in the upper part of the esophagus. and the one by Grimes a11 survived surgery. PhysicaI examination reveaIed a we11 deveIoped The anatomy of the hemoIymph gIands was and we11 nourished man, who did not appear first described by Robertson [y] in 1890. They acuteIy III. His bIood pressure was r5o/go mm. Hg are found in sheep, buIIocks and human beings. and he was afebrile. There was no clinica cardiac In the Iatter, they normaIIy reach a size of enIargement and no suggestion of thrih or murmur. 2 to 6 mm. and lie in the prevertebra1 areas He had small hemorrhoida tags. Other positive of the neck, thorax and abdomen. They usuaIIy findings were limited to the fundi which showed are Iocated near Iarge bIood vessels from which narrowing of the arterioles, but otherwise norma appearing discs. they derive their blood suppIy. The microscopic Laboratory findings showed a hemogIobin of study of these gIands was first reported by I I .3 gm. per cent, hematocrit of 44 voIumes per Warthin [7] in 1901. He described them as cent, tota leukocytes 9,600 per cu. mm. with structures containing smooth muscIe and eIastic 4g per cent neutrophiIs, 25 per cent Iymphocytes, and fibrous trabecuIae which project toward g per cent monocytes, 14 per cent eosinophils and the hiIum creating irreguIar Iobules. BIood 3 per cent basophils. The urinalysis was essentiahy vesseIs enter the capsule and hiIum and comnormaI. ResuIts of seroIogy were negative. Results municate with sinuses which accompany the of examination of stoo1 for occuIt bIood and paratrabeculae. IntertrabecuIar stroma mainIy consites were negative. BIood chemistry data included tains Iymphocytes, but aIso a few neutrophiIs, a urea nitrogen concentration of 16 mg. per cent and glucose concentration of 104 mg. per cent. monocytes and eosinophiIs. Structures reA roentgenogram of the chest showed a right hiIar sembIing MaIpighian bodies are present but, caIcihcation and, just above this, a rounded density unIike the spIeen, there is no arterioIe present which resembIed either a neoplasm or an aneurysm. in the foIIicIe. The main function of these An esophagogram and esophagoscopy reveaIed gIands, according to Lewis [?I, is phagocytosis extrinsic pressure on the upper third portion of which is more active than that of the spIeen. the esophagus by a firm mass posterior to it. His When these structures form tumors, they may eIectrocardiogram reveaIed norma findings. reach a fairIy Iarge size; the tumor reported After initia1 medica examinations were comby Grimes was 14 by IO by 8 cm. They are pIeted, the patient was seen by the surgica1 service quite vascuIar and are suppIied with bIood by and surgica1 expIoration was advised. On May 4, 1956, through a right posteroIatera1 thoracotomy, neighboring Iarge vesseIs. They appear to . _ American Journal of Surgery. Volume IOI, June 1961 816
H
EMOLYMPH tumors of the mediastinum
M.D.,
Giant
HemoIymph
Node of the Mediastinum
FIG. I. Hemolymph node showing fibrous trabecuIae and predominance of smaII round cells with an occasional Iymph foIIicIe. (Original magnification X 120.)
FIG. 2. Hemolymph node iIIustrating bIood vessels entering tumor and sinuses fiIIed with blood. (OriginaI magnification X 240.)
a tumor measuring 7 by 6 by 4 cm. was removed
I and 2.) The pathoIogica1 diagnosis was giant hemoIymph node.* The first follow-up visit was March 2, 1957. The patient was re-examined and found to be entireIy free of symptoms reIative to dysphagia. His weight remained constant and he was eating soIid food. An inguina1 hernia found at this time was repaired without complication. From June 14, 1957, through JuIy 14, 1959, the patient was seen on five separate admissions. He had no compIaint of dysphagia and examination faiIed to revea1 a recurrence. He was found to have arterioscIerotic heart disease with right bundle branch bIock, functiona capacity (grade 2) and moderateIy Iimited activity. There were no aberrations of the hemogram on any admission and eosinophils varied from z to 8 per cent.
from the right posterior side of the superior mediastinum. This tumor was situated above the azygos vein and posterior to the esophagus. SeveraI Iarge bIood vesseIs entered the capsuIe which were ligated before removing the mass. PostoperativeIy, the Iung expanded we11and the patient was ambuIant in a few days. He was discharged from the hospital on May 24, 1956. The pathology section reported that, grossly, the tumor was we11encapsulated, IobuIated and soft, and measured 7.0 by 6.0 by 4.0 cm. The coIor was pinkish red and cross section showed it was divided by fibrous septa. MicroscopicaIIy, the capsuIe was we11 defined and moderateIy vascuIar. There was no eIastic tissue or smooth muscIe tissue. The tumor was divided into irregular Iobules by fibrous trabecuIae. The capsule was pierced by bIood vesseIs. AIong the trabeculae were communicating sinuses fiIIed with blood ceIIs and lymphoid eIements. The Iymphoid tissue was predominantIy made up of smaI1 mature Iymphocytes. There were scattered atypica1 centers that resembled Malpighian bodies. Other cells present were eosinophils, poIymorphonucIear Ieukocytes and occasiona Iarge mononucIear ceIIs. (Figs.
SUMMARY
There have been six previous cases of giant hemoIymph node of the mediastinum reported * SIides were reviewed by D. A. C. Broders and the diagnosis corroborated.
Knoepp in the literature. An additiona case is reported in which the patient was subjected to surgica1 removal and has survived four years. REFERENCES I. GRIMES, A. E. Giant hemolymph node of the Ieft chest. Tboracic Surg., 31: 349, 1956. 2. LEDERER, M. EnIargement of hema nodes. Arch. Int. Med., 31: 364, 1923. 3. LEWIS, T. Structures and functions of the hemo-
and Uhrich
4.
3. 6.
7.
Iymph gIands and spleen. Cited by Pemberton, D. deJ., Broders, A. C. and Maino, V. J. [a]. PEMBERTON, D. DEJ., BRODERS, A. C. and MAINO, V. J. Giant hemoIymph nodes. Report of two cases. S. Clin. Nortb America. 20: 1147. IQGO. ROBERTSON, W. F. The prev&tebraI‘hen%ymph glands. Lancet, 2: I 152, 1890. SYMMERS, D. Primary hemangiolymphoma of the hema nodes: an unusua1 variety of a malignant tumor. Arch. Int. Med., 28: 467, 1921. WARTHIN, A. S. The norma histoIogy of the human hemoIymph glands. Am. J. Anat., I: 63, 1901.
Hemolymph
Node
of the Mediastinum
LOUIS F. KNOEPP, M.D. AND EDWARD C. UHRICH,
From tbe Veterans Administration Louisiana.
Hospital, Alexandria,
Alexandria,
Louisiana
progress in a benign manner but have been known to metastasize to para-aortic regions.
are CASE REPORT rare. Up to 1956, Grimes was abIe to V. R., a sixty-five year old coIored man, entered coIIect onIy five cases and added one of his the Veterans Administration HospitaI in Alexown [I]. As far as one can teI1, no other cases andria on ApriI 2, 1956, complaining of nocturia, have appeared in the Iiterature up to the case nervousness and dyspnea and dysphagia of two presented herein. Of previousIy reported cases, years duration. At the beginning, ordy semisolid two reported by Symmers [q in 1921 and one food could be swahowed, but the dysphagia progressed during the Iast month to the point where by Lederer [2] in 1923 expired, but the two the patient couId toIerate only liquids. Food apreported by Pemberton, Broders and Maino [4] peared to stick in the upper part of the esophagus. and the one by Grimes a11 survived surgery. PhysicaI examination reveaIed a we11 deveIoped The anatomy of the hemoIymph gIands was and we11 nourished man, who did not appear first described by Robertson [y] in 1890. They acuteIy III. His bIood pressure was r5o/go mm. Hg are found in sheep, buIIocks and human beings. and he was afebrile. There was no clinica cardiac In the Iatter, they normaIIy reach a size of enIargement and no suggestion of thrih or murmur. 2 to 6 mm. and lie in the prevertebra1 areas He had small hemorrhoida tags. Other positive of the neck, thorax and abdomen. They usuaIIy findings were limited to the fundi which showed are Iocated near Iarge bIood vessels from which narrowing of the arterioles, but otherwise norma appearing discs. they derive their blood suppIy. The microscopic Laboratory findings showed a hemogIobin of study of these gIands was first reported by I I .3 gm. per cent, hematocrit of 44 voIumes per Warthin [7] in 1901. He described them as cent, tota leukocytes 9,600 per cu. mm. with structures containing smooth muscIe and eIastic 4g per cent neutrophiIs, 25 per cent Iymphocytes, and fibrous trabecuIae which project toward g per cent monocytes, 14 per cent eosinophils and the hiIum creating irreguIar Iobules. BIood 3 per cent basophils. The urinalysis was essentiahy vesseIs enter the capsule and hiIum and comnormaI. ResuIts of seroIogy were negative. Results municate with sinuses which accompany the of examination of stoo1 for occuIt bIood and paratrabeculae. IntertrabecuIar stroma mainIy consites were negative. BIood chemistry data included tains Iymphocytes, but aIso a few neutrophiIs, a urea nitrogen concentration of 16 mg. per cent and glucose concentration of 104 mg. per cent. monocytes and eosinophiIs. Structures reA roentgenogram of the chest showed a right hiIar sembIing MaIpighian bodies are present but, caIcihcation and, just above this, a rounded density unIike the spIeen, there is no arterioIe present which resembIed either a neoplasm or an aneurysm. in the foIIicIe. The main function of these An esophagogram and esophagoscopy reveaIed gIands, according to Lewis [?I, is phagocytosis extrinsic pressure on the upper third portion of which is more active than that of the spIeen. the esophagus by a firm mass posterior to it. His When these structures form tumors, they may eIectrocardiogram reveaIed norma findings. reach a fairIy Iarge size; the tumor reported After initia1 medica examinations were comby Grimes was 14 by IO by 8 cm. They are pIeted, the patient was seen by the surgica1 service quite vascuIar and are suppIied with bIood by and surgica1 expIoration was advised. On May 4, 1956, through a right posteroIatera1 thoracotomy, neighboring Iarge vesseIs. They appear to . _ American Journal of Surgery. Volume IOI, June 1961 816
H
EMOLYMPH tumors of the mediastinum
M.D.,
Giant
HemoIymph
Node of the Mediastinum
FIG. I. Hemolymph node showing fibrous trabecuIae and predominance of smaII round cells with an occasional Iymph foIIicIe. (Original magnification X 120.)
FIG. 2. Hemolymph node iIIustrating bIood vessels entering tumor and sinuses fiIIed with blood. (OriginaI magnification X 240.)
a tumor measuring 7 by 6 by 4 cm. was removed
I and 2.) The pathoIogica1 diagnosis was giant hemoIymph node.* The first follow-up visit was March 2, 1957. The patient was re-examined and found to be entireIy free of symptoms reIative to dysphagia. His weight remained constant and he was eating soIid food. An inguina1 hernia found at this time was repaired without complication. From June 14, 1957, through JuIy 14, 1959, the patient was seen on five separate admissions. He had no compIaint of dysphagia and examination faiIed to revea1 a recurrence. He was found to have arterioscIerotic heart disease with right bundle branch bIock, functiona capacity (grade 2) and moderateIy Iimited activity. There were no aberrations of the hemogram on any admission and eosinophils varied from z to 8 per cent.
from the right posterior side of the superior mediastinum. This tumor was situated above the azygos vein and posterior to the esophagus. SeveraI Iarge bIood vesseIs entered the capsuIe which were ligated before removing the mass. PostoperativeIy, the Iung expanded we11and the patient was ambuIant in a few days. He was discharged from the hospital on May 24, 1956. The pathology section reported that, grossly, the tumor was we11encapsulated, IobuIated and soft, and measured 7.0 by 6.0 by 4.0 cm. The coIor was pinkish red and cross section showed it was divided by fibrous septa. MicroscopicaIIy, the capsuIe was we11 defined and moderateIy vascuIar. There was no eIastic tissue or smooth muscIe tissue. The tumor was divided into irregular Iobules by fibrous trabecuIae. The capsule was pierced by bIood vesseIs. AIong the trabeculae were communicating sinuses fiIIed with blood ceIIs and lymphoid eIements. The Iymphoid tissue was predominantIy made up of smaI1 mature Iymphocytes. There were scattered atypica1 centers that resembled Malpighian bodies. Other cells present were eosinophils, poIymorphonucIear Ieukocytes and occasiona Iarge mononucIear ceIIs. (Figs.
SUMMARY
There have been six previous cases of giant hemoIymph node of the mediastinum reported * SIides were reviewed by D. A. C. Broders and the diagnosis corroborated.
Knoepp in the literature. An additiona case is reported in which the patient was subjected to surgica1 removal and has survived four years. REFERENCES I. GRIMES, A. E. Giant hemolymph node of the Ieft chest. Tboracic Surg., 31: 349, 1956. 2. LEDERER, M. EnIargement of hema nodes. Arch. Int. Med., 31: 364, 1923. 3. LEWIS, T. Structures and functions of the hemo-
and Uhrich
4.
3. 6.
7.
Iymph gIands and spleen. Cited by Pemberton, D. deJ., Broders, A. C. and Maino, V. J. [a]. PEMBERTON, D. DEJ., BRODERS, A. C. and MAINO, V. J. Giant hemoIymph nodes. Report of two cases. S. Clin. Nortb America. 20: 1147. IQGO. ROBERTSON, W. F. The prev&tebraI‘hen%ymph glands. Lancet, 2: I 152, 1890. SYMMERS, D. Primary hemangiolymphoma of the hema nodes: an unusua1 variety of a malignant tumor. Arch. Int. Med., 28: 467, 1921. WARTHIN, A. S. The norma histoIogy of the human hemoIymph glands. Am. J. Anat., I: 63, 1901.