A Case of Lymphosarcoma of the Intestine

Case Report The patient was a boy aged 1Oj years admitted to the Royal Hospital for Sick Children, Glasgow, on Sept. 29, 1944. Tonsillctomy at the age of five years and measles and chickenpox in early childhood were the only items of note in the history, and he was an active, intelligent boy before the present illnes which began some six weeks before -death with pallor and listsness, accompanied by pain in the knees and face. A fortnight later he had a single transent attack of abdominal pain without vomiting, of which there are no available particulars. His face shortly afterwards began to swell, and x-ray examinaton revealed tumour-like nodules in the skul. From about mid-September onwards he was confined to bed suffering from headache, sleeplessness, anorexia, and weakness. The bowels were regular throughout, and there was no dysuria. On admission to hospital he was a pale, emaciated, acutely ill child with marked muscle wasting, loss of tendon jerks, and pitting oedema of the ankles. The abdomen was swollen and tense, the superficial -eins were dilated, and a large, firm, nodular mass, tender to palpation, was present in the hypogstrium and right iliac fossa. The kidneys and spleen could not be defined but the smooth edge of the slightly enlarged livr was palpable below the costal margin. No shdting dullness was elcited, and thre was no visible peristalsis. The lungs and heart wer normal. Soft swellings were found over the vertex of the skull and in the lower jaw. Tere was a right-sided facial paralysis and the left eye was sLightly proptosed. Both pupils reacted to light and on accommodation, and the fimdi were normal. His blood on the day after admission had 58 per cent. hmogobn, a red cell count of approximately 5,000,000 per c.mm. of blood, and a leucocytosis of some 16,000 per c.mm. Ring staining was the only abnormality in the red cells. On differential count neutrophile polymorphs numbered 57-5 per cent., lymphocytes 33 per cent., monocytes 6 per cent., and immature cells of myeloblastic type 3-5 per cent. The urine was examined several times and showed merely a trace ofalbumin, with a few granular casts and eucocytes. The bowels wereregular. Therewasrapiddeterioration in the child's condition with increasig asthenia, and death occurd five days after admission.