Diagnosis.—­Considerable difficulty attends the diagnosis of lymphadenoma at an early stage.  The negative results of tuberculin tests may assist in the differentiation from tuberculous disease, but the more certain means of excising one of the suspected glands and submitting it to microscopical examination should be had recourse to.  The sections show proliferation of endothelial cells, the formation of numerous giant cells quite unlike those of tuberculosis and a progressive fibrosis.  Lympho-sarcoma can usually be differentiated by the rapid assumption of the local features of malignant disease, and in a gland removed for examination, a predominance of small round cells with scanty protoplasm.  The enlargement associated with leucocythaemia is differentiated by the characteristic changes in the blood.

Treatment.—­In the acute form of lymphadenoma, treatment is of little avail.  Arsenic may be given in full doses either by the mouth or by subcutaneous injection; the intravenous administration of neo-salvarsan may be tried.  Exposure to the X-rays and to radium has been more successful than any other form of treatment.  Excision of glands, although sometimes beneficial, seldom arrests the progress of the disease.  The ease and rapidity with which large masses of glands may be shelled out is in remarkable contrast to what is observed in tuberculous disease.  Surgical interference may give relief when important structures are being pressed upon—­tracheotomy, for example, may be required where life is threatened by asphyxia.

#Leucocythaemia.#—­This is a disease of the blood and of the blood-forming organs, in which there is a great increase in the number, and an alteration of the character, of the leucocytes present in the blood.  It may simulate lymphadenoma, because, in certain forms of the disease, the lymph glands, especially those in the neck, axilla, and groin, are greatly enlarged.

TUMOURS OF LYMPH GLANDS

#Primary Tumours.#—­Lympho-sarcoma, which may be regarded as a sarcoma starting in a lymph gland, appears in the neck, axilla, or groin as a rapidly growing tumour consisting of one enlarged gland with numerous satellites.  As the tumour increases in size, the sarcomatous tissue erupts through the capsule of the gland, and infiltrates the surrounding tissues, whereby it becomes fixed to these and to the skin.

[Illustration:  FIG. 82.—­Lympho-Sarcoma removed from Groin.  It will be observed that there is one large central parent tumour surrounded by satellites.]

The prognosis is grave in the extreme, and the only hope is in early excision, followed by the use of radium and X-rays.  We have observed a case of lympho-sarcoma above the clavicle, in which excision of all that was removable, followed by the insertion of a tube of radium for ten days, was followed by a disappearance of the disease over a period which extended to nearly five years, when death resulted from a tumour in the mediastinum.  In a second case in which the growth was in the groin, the patient, a young man, remained well for over two years and was then lost sight of.