The histology of twenty-nine cases of primary neoplasms in the kidney / by H.B. Allen and T. Cherry.

Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: The histology of twenty-nine cases of primary neoplasms in the kidney / by H.B. Allen and T. Cherry. 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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    fibrillar tissue with numerous cells, chiefly spindle, but partly rounded. This tissue is evidently highly vascular, and lines of blood corpuscles may still be found in it. Within the alveoli there are masses of cells with bold nuclei. To this extent the tumour resembles carcinoma ; but the cellular masses are not as a rule sharply defined from the alveolar walls. Fine fibrils penetrate the masses of cells, and embryonic vessels with blood corpuscles are also found among them. At the margins of many of the alveoli there is a distinct transition between the alveolar walls and the alveolar contents, the cells in the wall becoming plumper and more numerous, though still having distinct intercellular substance between them, and finally merging into the cellular masses within the spaces. In many areas also the alveolar formation is not well marked, and the cells, though plump and multitudinous, are not closely applied one to another, and in such parts embryonic vessels are in immediate relation with the cells. The kidney substance has been converted into a fibrillar substance, with spindle cells and dilated capillaries full of blood corpuscles, and with relics of tubes and tufts, of which the epithelia are decidedly active. Near the tumour tissue, tubes may be found lined by active epithelial cells with deeply-staining nuclei, afterwards losing their basement membrane, and swelling into club- shaped masses of epithelium; and at all parts of the section a series of such swollen lines of epithelium merge into the alveolar formation. The retro-peritoneal growth is not alveolar, but is lympho-sarcomatous, with a finely fibrillar mesh, in which cells of varied type are crowded together wdth embryonic vessels running among them. This densely cellular substance is intersected by more open tissue consisting of spindle or branched cells, with a fine fibrillar matrix ; but, as in the renal growth, the two types of tissue are distinctly continuous one with the other, and are in no way comparable with the separate epithelial and connective tissue elements of true carcinoma. 27. Malignant adenoma (endothelioma), with sarcoma of stomach (active). This kidney, from a man aged 58, contains an oval growth 10 cm. long, 7‘S cm. broad, and nearly 6 cm. thick. At the upper and lower ends of the growth the renal tissue is still distinct. On section the tumour is well defined, and partly encapsuled ; its cut surface is lobulated, soft, finely pitted, with patches of old haemorrhage and caseous softening. A few distinct cysts are present in its substance and at its margin. A section has been cut, including a mass of hardened fibrin and patches of the soft tumour substance around. In some of the soft areas there is only a delicate fibrillar mesh, containing a variable number of endothelial cells, some of them small, others swollen into huge rounded or irregular plaques. Such a simple tissue is traversed here and there by rudimentary tubules, some destitute of cells, others having an im- perfect endothelial lining. But other widespread areas are much more characteristic; these show a marvellous imitation of renal tubes, lined or filled by cells, and supported by delicate fibrillar tissue. With tubules and cystic spaces, bounded by a basement membrane, lined or filled with active epithelioid cells, there is a close resemblance to malignant adenoma or carcinoma. But closer examination shows that the whole tissue is mesoblastic. The cells within the basement membrane are epithelioid, not epithelial. The basement membrane is fibrillar, and connected with the fibrils of the support- ing tissue, or even with outrunners of epithelioid cells in this tissue. When most of the cells have fallen out of the tube or cyst-like space, the remaining elements may be seen rising in epitlielioid fashion on the inner surface, with outrunners prolonged along the basement membrane, and others become