A case of sarcoma of the small intestine : with a note on the significance of 'rebound pain' in certain abdominal inflammatory conditions / by J.M. Elder.

  • Elder, John Munro, 1859-
Date:
1904
Catalogue details

Licence: In copyright

Credit: A case of sarcoma of the small intestine : with a note on the significance of 'rebound pain' in certain abdominal inflammatory conditions / by J.M. Elder. 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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    The surface is smooth and glistening except for an area of 2.5 x 5.0 C.M., where it is adherent to intestine, a portion of which has been removed in area 3. x 6. C.M., and for a small area of adhesion which has been broken down. Near the centre of the former portion are two openings .5 C.M. in di'am., through which a probe may be passed for several C M. [These openings before operation had connected the interior of the tumour with the lumen of the gut.] The smooth surface shows several large blood vessels arising from the intestine. The tumor shows five distinct nodular elevations with a base of I .5 C. M. and height of about .5 C. M. The color of the surface is dark bluish with several gray areas. On palpation the tumor consists of firm masses of tissue corresponding to the gray areas while other portions are soft and give distinct fluctuation. On section the tumor shows a grayish substance more or less mottled in places by brownish areas. This substance is glistening on the cut surface, has an indistinct appearance of lobulation, is firm and on strong pressure exudes a quite clear fluid resembling serum. In places this is stained with blood. The greater portion of the tumor is cystic, spaces being found which measure 2 C. M. in diameter, and others of smaller size. These cysts contain red blood clot. The walls of the cystic por- tions are ragged and necrotic and surrounding tissue has a brownish tinge and is quite friable. Many of these cysts communicate with each other and with the two openings in the portion of intestine described above. Mic. Kxam. Sections were cut through the edge of the tumor next the intestine. The mucosa is that of the small intestine and appears normal. The basement membrane is intact and nowhere do the glands appear distorted. The submucosa is of normal thickness and appear- ance. The layers of the muscularis are seen to be separated in the form of the letter Y. Between the branches is a small mass composed of spindle shaped cells bound together by a very delicate reticulum. In this region individual muscle fibei’s are seen separated by columns of these spindle cells. External to the muscularis the tissue is composed of a mass of these spindle cells, while here and there the tissue has some- what of a fibrous appearance. Other portions corresponding to the firm, gray areas show solid masses of spindle cells. The diameter of these cells is approximately 15- 20 M. M., and the length several times as great. Pathological Diagnosis : Spindle-celled Sarcoma. Probably arising from the intermuscular connective tissue.”