Chorio-epithelioma malignum / by F.A.L. Lockhart.

  • Lockhart, Frederick Albert, 1864-
Date:
1908
Catalogue details

Licence: In copyright

Credit: Chorio-epithelioma malignum / by F.A.L. Lockhart. 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.

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    Tlaultain^^ thinks t3mt many cases of cure may be explained by the blood being poured out aroimd the neoplasm and cutting oif its nourishment by pressure. Marchand recognizes two forms of chorio-cpithelioma, viz: the typical and atypical. The fonner is characterized by the presence of syncytial masses, sending oft branches in various directions, thus forming a net- work, the strands of which are covered with nuclei and in whose meshes are clear cells which vary in number. In the atypical variety, the cells are irregular and compact, with very large deeply stained nuclei, and, while multinuclear cells are present tliere are no continuous plasmodisd masses. Symptoms.—Chorio-epithelioma may begin very insidiously by bring- ing out symptoms of some very different malady, as is seen in the case reported by Biisse.^® This patient had a fatal hemiplegia and the autopsy revealed the presence of chorio-epithelioma affecting the right Sylvian artery, ^vith secondary deposits in the liver, spleen and right heart, the genitals being quite free from the disease, although the patient had suf- fered from a miscarriage six months previously. Usually, however, it is uterine hemorrhage which first attracts attention, d'his bleeding is marked by its severity and its resistance to treatment, even curettage be- ing of but very evanescent benefit. The blood loss rapidly impairs the patient’s health; she loses weight and tlje skin becomes waxy. Between the haemorrhages, there is a discharge wliich may be either serous, sero- s:mguineous or smoky, and which has a foul odour. Local pain is either entirely absent until the later stages of the disease or else but slight. The patient may have chilis, fever, vomiting, cough, purulent expectora- tion, haemoptysis, nervous affections, etc., wliich are produced by the metastases, or in the case of tlie chills and fever by sepsis. Examination of the patient, where the uterus is the primary site of the disease, reveals that organ to be enlarged, but the amount of this ten- largement varies, it rarely, however, being bigger than a foetal head at term. The surface may be either nodular or else smooth and even. Per vaginam, the cervix may be felt to be soft and the os, to be so patulous as to ]>ermit the entrance of the examining finger into the uterine cavity, where one may find a mass of soft, spongy material, resembling placental tissue. T'his growth is usually situated on the anterior or posterior wall of the uterus, near the top of the fundus While exploring the cavity, the finger may remove a fragment of tissue for microscopic examination. Pigmentation of the skin, which is so often seen to accompany the usual forms of malignant disease, so far has not been recorded in chorio- epithelioma.