Glioma retinae : with report of five cases / by Christian R. Holmes.

  • Holmes, Christian R. (Christian Rasmus), 1857-1920.
Date:
[1902]
Catalogue details

Licence: In copyright

Credit: Glioma retinae : with report of five cases / by Christian R. Holmes. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    On one side the tumor cells have worked their way through Petit's canal into the posterior chamber and forced the iris forward on that side, so as to produce a wide curvature, and a deepening of the posterior chamber. Some of the cells have found their way into the filtrating angle of the anterior chamber, which is not occluded. The iris is atrophic, and near its insertion shows some widely dilated vessels. The cornea is normal. The sclera is attenuated owing to long intra-ocular pressure. Poste- riorly, near the optic nerve entrance, it is traversed by vessels showing a large increase of nuclei in their vicinity. This tumor is exceedingly vascular, the large size of the ves- sels being a prominent factor. Part of the tumor seems to be strictly confined to the choroid, and by a pedicle extends inward into the vitreous space, which is completely filled by the tumor mass. The large mass occupying the vitreous space has a characteristic appearance on section of deeply- stained portions around the vessels, and is less stained at more remote points, this being a result of removal of por- tions of the tumor from nutrition derived from the vessels. The growth of the tumor is likewise dependent on the growth of the vessels, around which the cells of the tumor arrange themselves, thus producing the alveolar or tubular form of tumor. The cells forming the tumor are all of the round- celled, non-pigmented variety. The entire retina has been obliterated, save the cystic frame- work close to the ora serrata. That which originally—taking into consideration the age of the patient, 3 years—may have been a glioma, on spreading to the clioroid—either by con- tinuity of tissue or by direct introduction of cells of the tumor through the venous circulation—aroused this to excessive cellular activity, and so introduced the sarcomatous element which has completely masked the original picture, thus pro- ducing the glio-sarcoma of Virchow. From this report the question might arise, whether or not this was a case of glioma, but tlie age of the pa- tient, the rapidity of the growth, and above all, the early clinical picture, leave not the slightest doubt that the tumor primarily was a glioma, eventually assuming the sarcomatous type.* Dr. II. J. Whitacre reported as follows upon tlie re- * The report, however, shows how very important it is to pull the globe well forward when enucleating, and to cut the nerve at the very apex of the orbit so that if possible, we may extend beyond that part of the nerve which may be infiltrated with cancer cells. In this case I resected the nerve far back, but the disease had ex- tended further. Still, by subjecting the nerve to extra stretching, T might have socurod moro.