486
The following is the history of the case :-The body of an unknown male Chinese, aged about 30 years, was brought to the Public Mortuary for examination. It was that of a well-built man, of fair nourishment. Beyond the presence of well developed post-mortem lividity, nothing abnormal was found in the skin and subcutaneous tissues. There was no increase of pigmentation of the skin, such as found in cases of Addison's Disease. The pericardium was normal. The heart was pathological, the left ventricle being greatly hypertrophied with incompetence of the aortic and mitral valves. The aorta showed advanced atheroma and an atheroma- tous ulcer was situated about one inch beyond the aortic valve. The lungs, apart from hypostatic edema, were normal. The gastro-intestinal tract was also normal. The liver weighed 3 pounds and was in a condition of fine cirrhosis. pancreas and both kidneys were like wise cirrhotic.
The
The left hypochondriac region was occupied by a firm mass of apparently newly formed tissue. The left kidney was not involved in the mass. Ou careful dissection it was found that this tissue was in reality new growth, and had involved in its meshes, the tip of the left lobe of the liver, the tail of the pancreas, and the capsule of the spleen. The growth had evidently no tendency to down- ward extension and, as already mentioned, the left kidney was quite free. upper extensions of the growth terminated in the diaphragm.
The
On palpation, the mass was hard and fibrous like. It was firmly adherent to all adjacent structures.
With difficulty, the contents of the left hypochondriac region were reinoved en masse, and the tumour more carefully examined.
On section, the cut surface of the new growth had a variegated appearance. Several dense bands of white fibrous tissue traversed the growth, apart from these, the tumour appeared to be made up of a delicate meshwork of connective tissue. The fibrous stands forming the meshes sprang from the stouter bands already mention- ed. In the dense bands of fibrous tissue vessels of considerable calibre were found. In the more delicate meshwork, there was evidence of extensive vascularisation, Enclosed by the fibres forming the delicate meshwork, were areas or islands of softer consistence and variable colour. Ou palpating these islands of tissue, some had a jelly-like consistence; others were soft and friable and appeared to be com- posed of degenerated tissue. The colour of these areas also varied. Some were decidedly yellow; others of a reddish brown tint. To the naked eye, the islands of a reddish brown colour, appeared to be areas of softening with fatty degener- ation and hæmorrhagic infiltration.
The tumour was distinctly encapsulated by dense fibrous tissue. Although the liver, pancreas, and spleen were firmly bound to the mass of new growth, there was no evidence of invasion of these organs by the growth.
Each organ was simply sealed to the growth by the surrounding dense connective tissue.
ation.
l'ieces of the new growth were preserved in spirit for microscopic examin-
The spleen was fibrous, and showed evidence of old malarial infection, The central nervous system was normal. There was slight hydrocephalus. Nothing of the nature of metastasis was found in the body.
Microscopic Examination of the Tumour.
The coarse bands were composed of extremely dense connective tissue with few nuclei The capsule surrounding the growth was of similar construction. Leading from these bands were finer strands of connective tissue which formed a network These were full of small vessels and capillaries. The bands of this delicate stroma enclosed the acini like spaces already referred to. These spaces varied extremely in size. They were filled with large, flat, polygonal cells. They were epithelial in character, varied much in size and contained yellow pigment. In some of the spaces, most perfectly developed cells were found. These resembled morphologica ly the type of cell found in the cortex of a normal supra-ren i gland. Many of the cells were found to show active division, and the karyokinesis was of the regular and irregular type.