198 



TWO CASES OF NON-ULCRRATINO 



' OIUKNTAI, SOKK 



(ell nests" 



Histo- 



pathology of 

 the growths 



Recent 

 literature 

 referring to 

 aUie<l 

 conditions 



carcinoma of the skin. Tlu' most pioiiiiiitnt feature is the presence of numerous typical 

 cell nests (Fif<. 43) which, accoriliii^ to Laziirus-Barlow' may, for all practical purposes, 

 be taken as ilia-^nostic of that condition. Leaving the clinical liistory otit of account, 

 however, it was soon evident that we were not dealing with a malignant growth. There is 

 an increase in the rete malpighi, long i)ranching colmnns of which stretch down into the 

 underlying tissues (Figs. 45 and 4G), hut there is no actual invasive process, and there are no 

 isolated masses of prickle cells. In these respects, the condition resembled a papilloma. The 

 cell nests, however, are most typical. At the centre of one of the nests (Fig. 44) there is a 

 clear glistening oval i)ody about 28/u by 18^, containing numerous grains of what is 

 undoiiljtedly ijignient. It is evident tliat there has been a hyperchondrilication of tin; 

 stratum cornemii, us the body stains in the same way as tlic liorny layer, giving rise to this 

 curious appearance, an appearance not unlike a large moUuscum itody l)ut clearer, more 

 glistening and, as mentioned, studded throughout with pigment. It is known that in the 

 negro's skin pigment granules may be traced from the stratum granulosum to the outermost 

 layers of the stratum corneum. The same is no doubt true, though to a less extent, of the 

 Egyptian. The cells of the rete show marked perinuclear vacuolation, while the papillary 

 layer of the skin is hypertrophied, or, at least, appears to be so, invading and even cutting 

 oil' and disintegrating portions of the rete, while itself invaded by infiltrating cells. There 

 are islands of cellular tissue studded about in the mass of the prickle cells (Fig. 43). In 

 these earlier sections the sub-epidermic tissue presents the appearance of a cellular 

 connective tissue undergoing inflammation and some proliferation, and does not apparently 

 conform to the descriptions, in English text-books and papers, of sub-epidermic tissue in 

 oriental sore, albeit examination with high powers of the microscope showed that the 

 cytoplasm of numerous large cells with vesicular nuclei was full of Leishman bodies. 

 These showed up best in sections stained by Van Gieson's method oi- liy lueniatin. Free 

 parasites were also visible in the dilated capillaries, in mononuclear leucocytes lying 

 amongst the cells, no doubt as a result of diapedesis, and between the cells themselves, 

 presumably in the sero-fibrinous effusion. Some of the smaller vessels in this tissue 

 showed distinct endarteritis. 



At this stage one may quote the description given by Fordyce- of the histo-pathology 

 of multiple benign cystic epithelioma. He says that under the microscope the tumours 

 are seen to be "made up of irregularly rounded, oval and elongated masses and tracts 

 of epithelial cells, corresponding to those in the lowermost layer of the epidermis, and 

 in the external root-sheath of the hair-follicle. The epithelial masses may be distinct or 

 made up of inter-conmumicating bands and tracts, in some places resembling coil-ducts. 

 Cell 'nests' are met with an in malignant epithelioma, enclosinij hnnuj, ijraiiular and ciillniil 

 lisstce. Colloid degeneration of individual cells is also encountered in the cell masses. 

 The connective tissue about the cell collections is somewhat condensed, but is not the 

 seat of any intlannnatory process." 



It must be confessed that for the most part this description applied very well to the 

 earlier sections studied, and it was found that Allan .Tamieson,-' quoting various authorities, 

 speaks of epithelial cystadenoma as a species of acanthoma, while the description he gives 

 does not differ markedly from that stated above. 



It will perhaps he interesting also to consider some of the latest utterances in English 

 or American text-books on the histo-pathology of true oriental sore. 



' Lazarus-Barlow, W. 8. (1903), Tlu; Elemcnlx of Pal/iolntfifal Anatomii ami Histologii. 

 ' Fordyce, — (November, 1894), Joiinitil of Cutnnroiis and Oenito-l'rinarn Disrasrs. 

 ' Jauiicson, W. Allan (1901), Shin Jli.ien.ies in tHlisun'.i Tcj-t Hook of ifcdicine. 



