Sarcoma of the small intestine / by E. Libman.

  • Emanuel Libman
Date:
1900
Catalogue details

Licence: In copyright

Credit: Sarcoma of the small intestine / by E. Libman. Source: Wellcome Collection.

    10/24 page 316
    These data all go to show that the spindle-celled sarcomata have few or no metastases. The lymphosarcomata generally have extensive metastases, every abdominal organ and tissue being liable to invasion. The superficial lymph nodes are not generally involved. The metas¬ tases occur most commonly in the peritoneum, lymph nodes, liver, and kidney. There is a marked tendency for the growth to occur in the pelvis or for the original tumor to become adherent there. In our first two cases the growths seem to have been more extensive than in any other cases hitherto reported. A careful examination of the speci¬ mens showed that the growth extended almost entirely by continuity, or by contact. In the liver the growth extended inward from the surface, or along the vessels. The spleen and kidneys showed the same. The parietal peritoneum was implicated only by extension from the visceral peritoneum. This opposes the statements made about the dis¬ continuous growths of the lymphosarcomata, and strengthens the im¬ pression that these growths are infectious in nature, and that we are not dealing with metastases in the true sense of the word. Microscopical Examination. I shall confine myself here to a few notes of my own cases. The fourth case needs but little commentary. In the other three cases the picture was that of a typical lymphosar¬ coma. I might mention, however, the great number of large lymphatic capillaries in some of the growths, and the frequent occurrence of the growth in the lumina of these capillaries. In the first case the main growth was found in the submucosa, and through slits in the muscularis mucosae the sarcoma cells reached up between the tubules. In some places the muscularis was entirely replaced by new growth. In the mesentery, omentum, and intestinal wall the tumor seemed to pass along under the serosa. The mucosa of the intestine above and below the growth showed no particular changes. The liver showed acute degeneration and congestion. The infiltrations in it followed the vessels, and tended to surround the lobules. There was some increase of the connective tissue between the lobules in the parts of the organ which were not infiltrated. The capsule was dis¬ tinctly thickened. In the kidneys there was present a marked degenera¬ tion and congestion. In the second case the sarcoma cells could very frequently be seen in the lymphatics. The liver showed fatty degeneration and infiltration and acute congestion. The growth seemed to spread between the liver cells, and at the edge of the infiltration the liver cells were almost entirely replaced by fat, or appeared to be necrotic. Near the growth the bloodvessels were much dilated. At a distance from the growth there was a marked parenchymatous degeneration, but less fatty infiltration. In one place there were small calcific deposits. The spleen was congested and hemorrhagic. The infiltration spread
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