Case of malignant fibro-cellular tumour involving the ileum / A. B. Buchanan, M.D.

  • Buchanan, Andrew Bogle.
Date:
[1864], [©1864]
Catalogue details

Licence: Public Domain Mark

Credit: Case of malignant fibro-cellular tumour involving the ileum / A. B. Buchanan, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    some pathologists an adenoma; but a lymphatic adenoma, or glandular tumour, is in reality not different from a fibro-cellular tumour developed in a tissue where there are no lymphatic glands ; for the simple reason that the lymphatic gland is itself, botli in its solid and fluid elements, a connective tissue formation. Thus, I examined in succession under the microscope a common adenoma of the neck, which I recently extirpated; a fibro-cellular polypus of the ear; and a portion of the tumour we are now considering; and I found it quite impossible to distinguish one from the other, either from the stroma, or from the form or size of their cells. Whether this tumour has been developed origin- ally from the lymphatic glands, could only be determined by a careful investigation of the early history of the case; and I think that the evidence is rather against this supposition than in favour of it. 1 found my opinion on the confluent character of the tumours, which do not appear to be composed of separate nodules; and on the absence of sympathetic engorgement of the mesenteric glands opposite the jejunum, in which situation these are most abundant, but where they only seem to be implicated accidentally at points where a secondary new formation has occurred. At all events the question is of little importance, as it does not affect the real nature of the tumour. A point of more consequence is that this tumour is malignant, which we shall see presently to be proved by its indiscriminate mode of growth, and spontaneous chronic ulceration. I think that only one other hypothesis is possible: might the formation not be tubercular ? Now, tubercle begins with miliary knots, with tubercles; and though we could see this tissue in many places in its earliest stages, there were nowhere tubercles present. There was no friable cheesy infiltra- tion, and the mesenteric glands were not affected separately, but merely involved here and there in a definite number of solid continuous tumours. Moreover, the elements of the growth were not tubercular; the shrivelled nuclei and fatty detritus of tubercle were not to be detected, even at points where the develop- ment was most advanced. Everywhere, on the contrary, were well foraied, fertile cells; small in size, no doubt, but such as would be capable of vigorous and independent propagation. The mode in which a malignant growth invades a tissue, can only be judged of by careful observation of the first stages of its development in that tissue. In the case before us, the comparative immunity enjoyed by the muscular layer of the bowel, while imbedded between two thick and rapidly increasing morbid masses, induced me to devote some attention to the encroach- ment of the disease upon this layer. That muscle is more slowly implicated than connective tissue in a cancer, is generally granted. It is also admitted that it sometimes undergoes fatty