An Observation of the Effects of Erysipelas on Epithelial Cancer

Abstract

A paravertebral swelling at the sixth thoracic level occurred in the back of a child 2 years of age, following a trauma. The lesion proved on exploration to be a cellular sympathicoblastoma (sympathetic neuroblastoma) which was mistaken at the time for a sarcoma. The tumor had apparently taken its origin from the region of an intervertebral foramen and had extended into the spinal canal as well as into the spinal muscles. Apparently under the influence of Coley’s toxins the activity of the growth subsided. Ten years later, owing to the persistence of a paraplegia, an exploratory laminectomy was performed. This disclosed a relic of the former growth whose cells had become completely differentiated into ganglion, capsular and neurilemma cells. Because of the unusual circumstances which permitted a study of the lesion at two remote periods, the case illustrates particularly well what has been pointed out by others, that a sympathetic neuroblastoma may be the precursor of a ganglioneuroma.

Case Details

Personal Characteristics

Mr. M., had a small elevation on the right cheek twenty years ago, which frequently formed a scab

Clinical Characteristics

The ulcer was one and a half inches in longest diameter, one inch in the shorter, presenting an oval with irregular edges. The discharge was slightly purulent, tinged with blood. The granulations were soft and bled on the slightest touch. The ulcer gradually increased in size and depth. About november 12 he suffered from an attack of erysipelas of the face. This ran no unusual course, spreading rapidly from tip of nose over scalp to nape of neck. The efflorescence was followed by desquamation.

Remission Characteristics

As the erysipelas faded out, the desquamations following the ulcer seemed to assume a more healthy appearance. Granulations of a more normal character developed and in about two weeks the ulcer was entirely healed. The cicatrix on march 1 is slightly indurated, but smooth and firm, presenting the appearance of normal cicatricial tissue

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

He was treated for a time with ointments and lotions, also some medicine was administered without special benefit. Some benefit was derived from a lotion of zinc sulphate and salt, dissolved in water to make a mild astringent solution. The external dressing was of ichthyol and lanolin, which seemed to give relief and comfort.

Additional Notes

The author comments that he is aware that a single case from the practice of a surgeon is but of little value, isolated and alone, but it is hoped that it will stimulate others to add their experience and observations.