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.

    6/38 page 126
    and firm, with several small, hard tumours in its walls and a perforation near the base. He concluded that it was affected with primary malignant disease ; but since micro- scopical evidence was, of necessity, wanting the case must remain doubtful. Twenty-seven years later, in 1865, Prus (2) described an appendix almost identical with that found by Merling, with the addition of a soft, sessile, haemorrhagic tumour about the perforation, but this case, again, cannot rank owing to absence of any histological examina- tion. For the same reason the four cases published by Rokitansky (3) in 1867 as instances of primary carcinoma must be excluded. These four patients died from other causes, and at the autopsies the appendix, in every case, was transformed into a cyst-like swelling, with fibrous walls and gelatinous contents, traversed by a delicate fibrous network. These were assumed to be examples of a stenosing colloid carcinoma, but, as suggested by Elling (4) and others, their characters are quite compatible with the view that the condition was one of cystic dilatation or mucocele of the vermiform appendix. A similar reticu- lated condition of the walls was met with in an appendix described by Latham (5) in which there was no suspicion of new growth. An interesting feature of these four cases is that the ages of the patients averaged 65, an age, as will be seen, that is more than double the average in the accepted cases [vide p. 8). The next reputed instance of primary carcinoma is Kolaczek’s (6) in 1875, in which an abscess was opened in the right iliac fossa and never healed. At the autopsy there was carcinoma of the caecum communicating with the fistula; the base of the appendix opened at the site of the ulcerated caecum. There is thus no reason for the assumption that the car- cinoma was other than primary in the caecum. Leichen- stein (7) in 1876, among 154 cases of primary carcinoma of the intestine, excluding those of the rectum, men- tioned three involving the vermiform appendix, but, as he states that it is “ a collection of published cases together with the records of pathological institutes and hospitals/’
    digitised image 1
    digitised image 2
    digitised image 3