﻿472 MARSHALL,. 



sebaceous glands are enlarged. Glogner (Virchow's Archiv. (1902), 168, 44:! i 

 notes in addition a reduction in the connective and elastic tissue fibrils in the 

 large nodules, and the occurrence of occasional pigment cells and free erythro- 

 cytes in the tissues. He did not find plasma cells but found mast cells and a 

 few giant cells. He also encountered a lymphocytosis in the blood of 30 to 50 

 per cent of the patients. Plehn (Mense, Handbuch der Tropenkrankheiten (1906), 

 2, GO) states that the hair follicles and sweat glands are unaffected, that the 

 cutis is infiltrated with cells, chiefly plasma cells, and that the nodule presents 

 the histologic picture of a granuloma, which can be distinguished from syphilis 

 ( 1 ) by the fact that in yaws the primary affection is in the epithelium, in 

 syphilis it is in the cutis, (2) in yaws the oedema is greater and there is no 

 periarteritis nor endarteritis, (3) the infiltrating cells are of a different char- 

 acter in yaws, and there are no signs of necrosis in this disease. He found no 

 giant cells. 



The most detailed description is that given by L'nna. (Die Histopathologic 

 der Hautkranlcheiten. Orth's Pathologische Anatomie, Berlin (1894). Ergan- 

 zungsband 2, 503.) He quotes Pontoppidan (Yaics und Framboesia (1882), 201) 

 as stating that the primary seat of the affection is in the prickle cell layer of 

 the epithelium. Unna's description is based upon the study of a large, full- 

 grown dry yaws nodule. The nodule rose abruptly from the level of the skin. 

 The epithelial overgrowth began at the border and rapidly increased -in extent 

 within the limits of the nodule. The papilloe were not more numerous, but 

 were ten or twenty times as long as usual. There was marked hyperkeratosis 

 with accumulations of a many-layered, horny covering. Acanthosis led here, as 

 in condyloma, to the formation of prickle cell masses, principally as interpapillary 

 projections, while the superficial layer of prickle cells was reduced, and occasional, 

 minute haemorrhages escaped through into the crust above. Epithelial mitoses 

 were infrequent. At the periphery, the granular layer was reduced, with crust 

 formation from fibrin and leucocytes, at other places -the granular layer was 

 increased in thickness. Fibrin and leucocytes were found also between the 

 deeper epithelial cells. The chief change in the cutis was a solid, cellular infiltra- 

 tion consisting chiefly of beautiful, large plasma cells. These surrounded like a 

 mantle the epithelial projections and spread in thin lines into the separate 

 papilla?. Beneath the epithelial growths they spread oxit into a uniform layer with 

 processes extending laterally and downwards. The processes accompanied par- 

 ticularly the greatly dilated veins and were not directly related to the epithelial 

 structures. The lumi-na of the sweat glands were dilated, and the epithelial lining 

 swollen, while the hair follicles and hair shafts were unaltered either in the 

 deeper tissue, where the plasma cell accumulation occurred, or while penetrating 

 the acanthomatous part at the surface. At no place was there evidence of plasma 

 cell degeneration, the tumor representing the purest type of plasmoma tissue. 



The spindle cells of the cutis were enlarged, but not appreciably increased in 

 numbers. Except for the usual rarefaction around the plasmoma foci, there 

 was no progressive nor regressive change in the interstitial collaginous and 

 elastic tissue. There was no appreciable increase in mast cells. 



The pigment, which was heaped up in the basal prickle cells at the periphery 

 of the nodule, spread in streams between the cells of the hypertrophied epithelial 

 portion. The streams surrounded nuclei and entire, unaltered epithelial cells, 

 producing appearances like pigment cells. There were other "pigment cells" of 

 the same structure with two or three nuclei according to the number of epithelial 

 cells which were surrounded by the pigment stream. 



"All in all the structure of the fromboesial nodule is simple: a marked epithe- 

 lial growth with hyperkeratosis accompanied by plasmoma formation in the cutis. 



