Tuberculous occlusion of the oesophagus, with partial cancerous infiltration / by William Pepper and D. L. Edsall.
- Date:
- 1897
Licence: Public Domain Mark
Credit: Tuberculous occlusion of the oesophagus, with partial cancerous infiltration / by William Pepper and D. L. Edsall. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![The oesophagus: patulous aiici normal as high up as the level of the arch of the aorta. Above this point and to the junction with the pharynx—to a point just beneath the vocal cords—the lumen had entirely disappeared and its situation could not be traced. The sur- rounding tissues and oesophageal walls had formed a band of firm fibrous tissue about a half-inch in thickness and one and a half inches in breadth. The whole mass was firmly bound to the vertebrae. The larynx: the ary-epiglottic folds were thickened and oedematous. Cricoid cartilage thickened. Pathological diagnosis: tuberculosis of the larynx, cervical glands, oesophagus (?), and lungs, deglutition-pneumonia. Upon microscopic examination of the lungs was found the confirmation of the macro- scopic diagnosis. At the apices was great thickening, with obliteration of many of the air-spaces, and thickly scattered throughout the tissue were many collections of round- and giant-cells, a few of which masses were becoming cheesy iu the centre. In the lower lobes catarrhal pneu- monia, with occasional miliary tubercles. The sections of the growth from portions taken from the junction with the normal mucous membrane show at once cancerous tissue in a general fibrous tissue-basis. The fibrous tissue is exceedingly dense, arranged in bands with a little areolar tissue between the bands, and in this areolar tissue and about the cancer-nests there is a marked, often quite dense, round-cell infiltration, here and there somewhat in clumps, but not characteristic. The epithelial cells are, at the periphery, almost entirely in cancer-nests, in some places irregularly scattered and seem- ingly remnants from the oesophageal mucous membrane. BeloAV the free edge there is not so distinct an arrangement in nests of cells, but there are long tongues of cancerous tissue extending into the here still more compact fibrous tissue. There is an extremely large number of pearly bodies in and near the cancer-nests and prolongations; in a few of the nests a good deal of formless debris, or a goodly number of round-cells among the e])ithelial. In numerous places there are well- defined clusters of round-cells, with sometimes a few rather irregularly arranged ei)ithelial cells in or near the centre, sometimes a distinctly formed nest at this point. Sections from deeper within the general mass show, at the end toward the free edge, the process in much the same condition as in the deeper portions of those described—the can- cerous tissue mostly in the form of prolongations, with many pearly bodies ; much fibrous tissue, irregularly arranged ; and still much round- cell infiltration, though not so dense as in the free edges. This ceases rather sharply, and the fibrous tissue beyond is arranged transversely and in distinct bands, separated by areolar tissue, all freely infiltrated with round-cells, but showing almost no cancerous tissue. In some sec- tions there are no epithelial cells, separate or in groups; in some one or two small nests, and in some three or four, but never a large number. But the round cells here, and more especially on the lateral borders, assume a more interesting character. They are frequently collected in small, dense masses, sometimes not well outlined, but occasionally well defined and irregularly round, with an occasional giant-cell near or be- yond the periphery of the group. Some of these tubercle-like masses are undergoing fibroid change. Many are situated at a distance from the cancerous tissue, so that they do not seem dependent upon its irritant action for their formation, and they are largely at the lateral borders.](https://iiif.wellcomecollection.org/image/b21988638_0008.jp2/full/800%2C/0/default.jpg)
