(4) Lymphadenoma may affect the stomach and intestines, either in the form of lymphoid overgrowths of the mucous membrane or by invasion from the exterior. In the former case the stomach presents a number of sessile and polypoid tumours, which are very numerous and closely set round the cardiac orifice and in the body of the viscus, but are scanty or even entirely wanting in the neighbourhood of the pylorus. The growths are soft, smooth, and creamy-white in colour, and are intermixed with flattened patches or vermiform elevations of lymphoid tissue. Occasionally they exhibit signs of softening at their bases (Pitt) or of superficial ulceration (Reimer). Cornil observed a gangrenous condition, while Kredel has described extensive ulceration of the cardia, which led to gangrene of the spleen. The upper portion of the duodenum is usually affected in a similar manner, and in one case it presented a growth the size of a Tangerine orange (Coupland). In the small intestine the solitary glands and Peyer's patches are greatly enlarged, and lymphoid masses are often encountered at the ileo-caecal valve and around the vermiform appendix. In the second variety the growth, which has originated in the mesenteric glands, forms a thick sheath over the intestines, and by invading the muscular coat leads to dilatation of the bowel. If the mucous membrane is involved it often undergoes extensive ulceration. Microscopically, the lymphoid tumours in the stomach consist of mucous membrane which has been thrown into thick folds and is densely infiltrated with large and small lymphocytes, which displace, distort, and compress the gastric glands. The disease is apparently due to proliferation of the normal lymphoid tissue of the part, and often leaves the submucous coat unaffected.


The two varieties differ considerably in their clinical features. The lymphoid tumours of the stomach and duodenum are equally frequent in men and women, but are rarely met with before middle age, the most notable exception being the case described by Rolleston and Latham in a male infant eighteen months old. In every instance there is a general enlargement of the lymphatic glands, of the tonsils and follicles of the tongue and pharynx, and of the spleen, accompanied by anaemia, debility, and occasionally by inflammation of the pleura. The existence of the growths in the stomach cannot be determined during life, but the disease is occasionally attended by diarrhoea, and in Reimer's case the ulceration of a tumour gave rise to fatal haematemesis. The second variety is far more common in males than in females (9:3), and is comparatively frequent in children, five out of the twelve cases which we collected being less than twelve years of age. In every instance there is complaint of severe pain in the abdomen, breathlessness, and intractable diarrhoea ; the patient becomes emaciated and suffers from oedema of the feet, and occasionally from jaundice (Coupland), and a well-marked abdominal tumour may be detected by palpation. The duration of the disease varies from five to twelve months, but in young children death may occur within the first three months (Arnott). Although some of these latter cases are undoubtedly lymphadenoma, it is probable that the majority are really examples of lvmpho-sarcoma commencing in the mesenteric elands.

(5) Myxomata occur as gelatinous semi-transparent tumours encapsuled in the wall of the stomach and covered by mucous membrane. Microscopically they are composed of elongated branched cells, which are embedded in a homogeneous transparent matrix. They are exceedingly rare, and only three instances have been recorded, including one by Hansemann. They should probably be described as myxosarcomata (Ebstein).