A study of metastatic carcinoma of the stomach : report of a case of primary carcinoma of the testicle, secondary involvement of the vena cava inferior, metastases in the lungs, stomach, and falx cerebri / by John S. Ely.

  • Ely, John S.
Date:
1890?]
Catalogue details

Licence: Public Domain Mark

Credit: A study of metastatic carcinoma of the stomach : report of a case of primary carcinoma of the testicle, secondary involvement of the vena cava inferior, metastases in the lungs, stomach, and falx cerebri / by John S. Ely. Source: Wellcome Collection.

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    land (L), of 89 cases of carcinoma primary in the mamma, collected from the records of the Middlesex Hospital for the years 1867 to 1875, men¬ tion is made of only one metastasis in the stomach. Torok and Wittels- hofer (2), in reviewing the records of the Vienna Pathological Institute, between the years 1817 and 1879, found reports of 366 cases of carcinoma of the mamma, of which there had been formation of metastasis in 220, but in only 8 was the stomach a site. Again, among more than 600 cases of carcinoma in all locations autopsied at the Berlin Pathological Institute, Grawitz (3) was able to find record of metastasis in the stomach in only 31. These statistics suggest the frequency of metastatic carci¬ noma of the stomach to be about 1.1 per cent, of all cases of cancer. Beside these statistics, there ^are in the literature more or less full records of 13 cases of metastatic carcinoma of the stomach. To a hasty review of these I ask attention, since from their study it is possible to deduce an explanation of the mode of production of metastases in the stomach, the truth of which is confirmed by the present case. I. The earliest observation of metastatic carcinoma of the stomach, of which I am able to find record, is reported by Cohnheim (4). The primary tumor (scirrhus) was located in the breast, and many metastases are reported in different organs, among others in the stomach, where fourteen small cancer¬ ous masses were found scattered along the greater curvature near the pyloric extremity. II. In 1876 Weigert (5) reported an exceedingly interesting case of epithe¬ lioma of the leg, not diagnosticated until after death, when metastatic growths were found distributed along the course of the pelvic and lumbar lymphatics and in nearly all the abdominal and thoracic viscera. The widespread distribu¬ tion of the secondary tumors received explanation by the discovery of rupture into the vena cava inferior of a cancerous mass situated about the right supra-renal capsule, the infectious material thus finding entrance to the circu¬ lation. The metastasis in the stomach was situated at the fundus near the greater curvature, was about an inch in diameter and had ulcerated through the mucous membrane. III. To the cases already cited four others were added by Grawitz (6) in 1881. In the first the primary tumor was an ulcerated epithelioma of the oesophagus. Two metastases, the only ones in the body, were found in the stomach. The first, about the size of a goose egg, ulcerated on its surface, was situated near the oesophageal orifice, involved all the coats of the stomach, and was con¬ nected with enlarged and cancerous lymph glands in the neighborhood. The second—smaller—lay near the first on the lesser curvature. There was in addition a simple ulcer of the stomach. IV. In the second case the oesophagus was again the site of the primary tumor (epithelioma, ulcerated), which had penetrated into the pleural cavity, causing fatal pleurisy. Near the oesophageal opening was a large carcinoma¬ tous mass, ulcerated, involving all the layers of the stomach wall. Besides this, the only other metastasis was a small tumor in the liver. V. Grawitz’s third case is one of primary encephaloid carcinoma of the testicle. The stomach was dilated and on its anterior wall, midway between the fundus and pylorus, was a round metastasis about the size of a “plum,” slightly ulcerated, occupying the mucous and submucous coats, and freely movable on the muscular. A second metastasis, smaller, on the greater curvature near the first, occupied the submucous coat only. Many meta- 1 One of these had previously been reported in detail by Cohnheim (see Case I.).