Chronic Lymphatic Leukemia Involving the Gastro-intestinal Tract

Abstract

THE literature concerning leukemia and allied diseases of the lymphatic system establishes the impression that any attempt to assign a clinical case to a specific category of the disease is somewhat hazardous. Especially is this true concerning diverse manifestations in various organs. Descriptions of leukemic and aleukemic deposits in the gastro-intestinal tract impress one with their marked similarity, and suggest that their differences might well be construed as variations of one fundamental disease. Accounts of these conditions by various authors have resulted in a chaotic literature, due principally to a lack of standardization of terminology and classification, the inconstancy of which is especially evident regarding leukemic deposits throughout the gastro-intestinal tract. The extreme variability in terminology associated with the classification of lymphatic tumors has resulted in the suggested use of the word “lymphoblastoma” (31), the term to include the principal neoplastic manifestations of lymphatic leukemia, aleukemia (pseudoleukemia), lymphogranulomatosis (Hodgkin's disease), and lymphosarcoma. The necessity for such an inclusive term illustrates the extreme difficulty of attempting to confine a study to any particular manifestation of lymphoid disease. Thus, a review of the literature in an attempt to determine the frequency of occurrence of a single type of case becomes extremely difficult. Some idea of the frequency of the condition may be gained from data relative to its occurrence in general autopsy material. Seventy-seven cases of leukemia were found in a recent survey (16) of 12,936 autopsies performed in the Department of Pathology of the University of Minnesota. Fifty-five of the cases were of the lymphatic type and 26 were of the myelogenous type. Two of the lymphatic leukemia cases showed local gastro-intestinal nodular and ulcerative lesions. One of the myelogenous group showed thickening of the walls of the gastro-intestinal tract, without nodule or ulcer formation. Consequently it is probably safe to state that the lymphatic leukemia type of gastro-intestinal lymphoblastoma is quite uncommon. It is for this reason that the following case report is presented. Case Report The case is that of a white male, 62 years of age, admitted to the University of Minnesota Hospital, June 4, 1929. Death occurred 73 days later. History.—The patient had been apparently perfectly well until approximately two years before admission to the University Hospital, when he began to have difficulty in urination. He had trouble in commencing his urinary flow; the stream was small and only small amounts of urine were passed at any time. His condition was neither progressive nor disabling for a period of about one year. In November, 1928, however, he developed frequency and associated nocturia, but noticed neither blood nor cloudiness in his urine.