Journal : Photographic review of medicine & surgery ; vol. 1, no. 2.
Philadelphia : J. B. Lippincott & Co., 1870-71.
Description : pp. 19-20,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Face — Neurofibroma.
NICHOLAS CONRAD, aet. 30, has a tumor of simple hypertrophic character, involving the integument of the left side of the forehead, eyebrow, and eyelid. The surface is irregularly lobed, but the skin maintains its normal characteristics of color, sensibility, and elasticity, and blends gradually with other portions of the cranial integument. The whole enlargement differs from the surrounding integument only in its hypertrophied and lobed character.
The development is greatest in the eyebrow and eyelid, the brow overhanging the cheek, and the eyelid resting on the ala of the nose.
The cranium in the left frontal region is depressed beneath the mass, the apparent excavation being due to the mechanical effect of pressure.
The tumor appears to be congenital, as it was noticed at his birth as a small protuberance on the left temple, which has ever continued to increase. At the age of fourteen years, the left eye, in which vision had been normal, began to be obscured by the growth of the brow and lid.
On elevating the left eyelid, the eye is found to be atrophied and cataractous, without perception of light. The atrophy is probably due simply to long-continued pressure and loss of the function of vision from obscuration. He suffers from slight photophobia in the other eye, but its vision is otherwise unimpaired.
The general health of the patient is good, but his intellect is naturally obtuse, and he is spiritless, inactive, and indolent.
The only available treatment would be partial removal of the redundant integument, for the purpose of checking the inconvenient development and improving the patient's appearance ; but, in consideration of his indifferent mental condition, no operative interference is advised.
The tumor is, pathologically, a fibro-cellular outgrowth, and is analogous to such cutaneous hypertrophy as is classed under the head of elephantiasis. It is, in this case, remarkable on account of its peculiar location, great size, and its congenital origin. In its lobed character it most resembles elephantiasis of the scrotum, but the tumor is less circumscribed than the disease as I have seen it in that locality, and it blends insensibly with the surrounding integument, rather as in elephantiasis of the leg.
The cause of this abnormal development cannot be determined. Cutaneous hypertrophy or outgrowth has usually its origin in inflammation, and the position of the part affected is generally pendent, inviting blood to it and suffering from its hydrostatic pressure, distending the veins and impeding the function of the lymphatics. Such pathological influences certainly exist in the leg and in the scrotum, the most frequent location of hypertrophic cutaneous development. In this tumor no such incitement to growth exists, and no local or general irritating influences appear to bear upon it.
Levis was expert in surgery of the eye and developed a wire loop that was widely used for extracting cataracts.