210 



A CASE OF rARASITIC ORANl'LOMA 



Histological 

 characters 



No parasitp-s 

 found in the 

 papules 



This count showed that it was not fur removed from tliu normal, except that the 

 mononuclear leucocytes were somewhat increased. Tlie fieces (if the ])atient were also 

 examined for tiie presence of intestinal parasites, but with negative results. 



The papules were repeatedly punctured for the purpose of ascertaining whether 

 parasites had yet appeared in them, hut the results were negative. 



HiSTO-PATHOLOOY 



Portions were excised from the edge of the granuloma and from several of the papules, 

 and fixed by various methods, viz., formol-alcohol, mercuric chloride, and alcohol. 

 Sections were cut, and suitably stained for the purpose of demonstrating the presence of 

 parasites and any pathological changes apparent. 



Tile histological changes were more or less constant in tlieiu all, and were 

 characterised by the presence of vertical epithelial columns extending downwards to 



varying depths as far as the deiniis. 

 These downgrowths of rete (Fig. 52) 

 appeared to be very characteristic, 

 and contained a few cell nests and 

 isolated masses of cell infiltration. 

 In the dermis there was present a 

 very well-marked cell infiltration 

 consisting of aggregations of cells of 

 the large round cell type. Poly- 

 morphonuclear leucocytes and 

 lymphocytes were also in evidence 

 and a large number of eosinophile 

 leucocytes. Scattered irregularly 

 throughout the dermis were pale 

 cellular areas which, under a high 

 power, were seen to consist of 

 collections of large mononuclear 

 cells, many of which were vacuolated 

 and lying in a homogeneous matrix. 

 The sebaceous glands and hair 

 follicles shared to a slight extent in 

 this cellular infiltration. The large mononuclear leucocytes were carefully searched for 

 the presence of phagocyted Leishman bodies but with negative results, nur were 

 any free parasites present. Some of the sections showed the presence of bacilli and 

 diploccocci. 



Some points of interest present themselves in this case, which, from a clinical point of 

 view, differed somewhat from the cases of Leishman nodules described by Balfour and 

 Thomson. In their cases the lesions were more of a keloid character and did not exhil)it 

 any tendency to ulceration. The pathological changes were more or less identical, and for 

 this reason one feels inclined to consider the papular growths described in this case as 

 evidence of Leishmaniosis although parasites were never found in them. 



Ferguson and Richards' have recently described cases of parasitic granuloma in Lower 

 Egypt. These observers met with two varieties, a flat and a warty form, and in many 



' Ferpuson, A. R., and Richards, O. (July, 1910), "Parasitic Granuloma." Annals of Tropical Medicine 

 nnil PiirimU>lnri)i. 



-Section of papule from can,^ in which developmenCAl fonns of 

 LelnhnHm brdifs wpre found 



