Adrenal tumor of vagina secondary to malignant hypernephroma of the kidney / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927
Date:
1907
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Licence: In copyright

Credit: Adrenal tumor of vagina secondary to malignant hypernephroma of the kidney / by Alban Doran. 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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    vestigatlng another, most striking for its similarity with my own, excepting that one clinical feature, sloughing and gen- eral septic infection, was absent. Beck- ett-Avery’s patient was fifty-five years of age, alarmed on account of vaginal hem- orrhage. A polypoid mass was found at- tached to the anterior vaginal wall. It was removed, and appeared, on micro- scopic examination, to be a very vascular sarcoma. A large tumor, occupying the right side of the abdomen, was detected when the patient was in the hospital. The vaginal growth recurred in its former site, and was removed within two months of the first operation. The patient died a month later. The tumor in the abdo- men was a hypernephroma of the right kidney; the right suprarenal capsule was normal, but numerous secondary growths, some of large size, were found in the liver and lungs, and on comparing sec- tions of these growths with sections from the vaginal tumors, there could be no doubt that they were all of the adrenal type, secondary to the renal growth. Dr. Beckett-Avery read brief notes of the above case when my own was brought forward at the Obstetrical Society. In the discussion Dr. Cathbert-Lockyer re- lated how he had watched for nearly ten years a woman subject to uterine fibroid; during the last six months a renal tumor had developed. He had operated on the patient, fifty-seven years of age, a few hours before the discussion was held, re- moving the diseased kidney, the uterus and also a parovarian cyst. Frozen sec- tions showed the renal tumor to be a benign hypernephroma, an adenoma de- rived from adrenal “rests” in the kidney. Since this discussion Dr. Lockyer informs me the uterine tumor has been examined, and was found to be a fibro-myoma', in- cluding a sarcomatous patch quite free from any adrenal elements, benign or malignant. The third tumor with which this patient was afflicted, the parovarian cyst showed no evidence of malignancy of any type. Adrenal Tumors—Much has been writ- ten during the past twenty years, both in Europe and America, about “hyperne- phroma” and “adrenal” tumors. The lit- erature of the subject is now very volu- minous and hard to study. We must be careful to avoid confusing these new growths with malignant tumors of the suprarenal capsule itself, usually asso- ciated with abnormal growths of hair, and sometimes with insanity (Knowsley Thornton). In “hypernephroma,” tissue resembling that which makes up part of the suprarenal capsule takes on more or less malignant action. This tissue forms the so-called adrenal “rests” in the sub- stance of the kidney. Hypernephroma has been found • in patients of almost every age. Dr. William S. Cheesman, of Auburn, N. Y., reported in the “Annals of Surgery,” for January, 1907, a case where he removed a hypernephroma weighing four and a quarter pounds from an in- fant twenty months of age. This disease of the kidney seems very malignant; sec- ondary deposits in the lungs and liver developing early. The suprarenal cap- sules themselves do not appear to be in- volved. In the cases which I have related there can be no doubt that the vaginal growths were secondary to the renal tumors, un- less we accept a theory suggested to me by Mr. Bland-Sutton that the disease in my patient’s case was a general “lighting up” of malignant change in “rests” al- ready present in the vagina as well as in the kidney; he even expressed an opinion that the vaginal growth might have been congenital, and also the primary seat of that change. We will assume, however, that in the cases under consideration the vaginal tumor was secondary. The existence of new growths of the same type higher up the genital tract, has been recognized for some time. Dr. East- wood’s important monograph on the oc- currence in the pelvis of malignant tu- mors originating from adrenal remnants, published five years ago in the fifty-third volume of the “Transactions of the Path- ological Society of London,” remains the best summary of the subject. Excluding instances of adrenal tumors in the male genital tract, we may note Marchand’s case of adenoma of an accessory adrenal in the forward ligament of a woman aged fifty. Eastwood himself furnishes medi- cal literature with the original report of an adrenal tumor connected with the uterus. The patient was a sterile woman, aged forty-eight, who had married when
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