THE three cases reported herein are presented because of the unusual complication in connection with lymphoblastoma. Each of the patients showed signs of definite renal insufficiency which decreased with roentgen therapy to the renal areas (Table I). The explanation for the striking improvement in the renal function of our three patients is not entirely clear. The symptoms and findings may have been obstructive phenomena and, therefore, spontaneous improvement followed shrinkage of the lymphoblastomatous tissue by radiation therapy with subsequent relief of obstruction. A second possibility is that the symptoms were caused by infiltration or direct extension of the disease into the kidneys and that they improved subsequent to irradiation over the kidneys themselves. A third possibility is that retrogression of the diffuse disease process by roentgen therapy may have brought about remission of a toxemia secondary to lymphoblastoma, with partial or complete restoration of normal renal function. Report of Cases Case I, a woman, 21 years of age, first registered at the Clinic on July 9, 1936. She had been well until three years previous to admission, at which time she had had intermittent attacks of watery diarrhea for three to four months. In October, 1933, a mass had been discovered in the left posterior cervical region and the patient was found to have a mild anemia. Early in 1934 weakness, malaise, and easy fatigability developed. The mass in the neck gradually increased in size and was excised in June, 1934, at which time a diagnosis was made of Hodgkin's disease. About 18 months prior to her first admission to the Clinic, the patient noticed a rise in temperature to from 101° to 102° F. each evening but it always dropped to normal by the following morning. Six months previously, a widening of the mediastinal shadow had been noted in the roentgenogram of the thorax and she had been given three roentgen treatments over the chest. She had been in bed for six weeks before coming to the Clinic, because of weakness, photophobia, anorexia, nausea, and vomiting. She had lost 22 pounds (10 kg.) in weight in the six months previous. On physical examination at the Clinic, the patient's blood pressure was 92 mm. of mercury systolic, and 60 diastolic, her temperature 99.2° F., and her pulse rate 110 beats per minute. The cervical, axillary, and inguinal lymph nodes were enlarged bilaterally. Percussion of the chest revealed no increase in mediastinal dullness. A firm tender mass was palpated in the right upper quadrant of the abdomen. Enlargement of the spleen could not be demonstrated by palpation. Urinalysis revealed nothing of significance except pus (grade 1). A diagnosis of Hodgkin's disease was made and a thorough course of roentgen treatment was given.
No takes yet. Share an insight, caveat, or question.
Odel et al. (1938) studied this question.