Primary malignant disease of the vermiform appendix.

  • Rolleston, Humphry Davy, 1862-1944.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Primary malignant disease of the vermiform appendix. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    7/38 (page 127)
    there is no proof that they are original, and, furthermore, no details are given of their microscopical appearances. In 1880 Bierhoff (8) reported a case of carcinoma of the uterus, ovary, and rectum, with metastases in the liver and spleen and also a small nodule of new growth in the wall of the appendix, obstructing its lumen and producing a distal mucoid dilatation. There is no reason for supposing the change in the vermiform appendix to be other than secondary. IJp to this time, then, no reliable proof had been forth- coming as to the existence of primary carcinoma of the vermiform appendix, but in 1882 Beger (9) brought forward the first incontestable example in a man aged 47 years, who for three and a half years had suffered from a fistula in the right iliac fossa, dating from an abscess in that situation. At an operation the fistula was found to lead directly into the appendix, which was infiltrated through- out by carcinoma, the growth projecting into the cavity of the caecum but not actually involving its walls. The patient died thirty-six hours after the operation, and post mortem the retroperitoneal glands were found to have become implicated, but there was no suggestion that the growth was other than primary. Maydl (10) in 1883 mentions, without giving details, 1 case among 20,480 autopsies at Vienna; this is the same case as those sometimes attributed to Nothnagel (11) and Ziemann (12) ; so that these three reputed instances should, therefore, only rank as one case. In the next case, reported in 1884 (13) by Draper, the ileo-caecal valve was constricted and the gut above dis- tended with faeces, the caecum was thickened and red, while the appendix at one point was dilated and its walls showed the appearances characteristic of colloid carci- noma. Though this is possibly a genuine example of the disease under consideration, the change noted at the ileo-caecal valve might be the primary growth, and the starting-point is not sufficiently certain to warrant admis- sion to the list of cases.