The Medical and scientific archives of the Adelaide Hospital. No. 6 (for the year 1926.)

  • Adelaide Hospital (Adelaide, S. Aust.)
Date:
1927
Catalogue details

Licence: Public Domain Mark

Credit: The Medical and scientific archives of the Adelaide Hospital. No. 6 (for the year 1926.). Source: Wellcome Collection.

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    (e) Malignant Growth surrounding the Left Bronchus, posssibly of Ovarian Origin. {Under the care of Dr. de Crespigny, Honorary Physician.) C. M., a female, cet. 36, was admitted under the care of Dr. de Crespigny on 10th February. The patient was very drowsy. Her husband stated that nine weeks before she had become sick with a ‘ ‘ cold on the chest.” Three weeks before admission she had become worse, and had been in bed since. During the last two days she had become a great deal worse, and complained of pain in her chest. Her temperature was 98.8° F., pulse rate 126, and respirations 28 to the minute. She was a fat woman with shallow breathing. Her lips and finger tips were cyanosed. There wTas only a slight respiratory excursion of the chest. The percussion note was resonant on both sides, but no breath sounds could be heard anywhere in the left lung. On the right side the breath sounds were high-pitched, and expiration was prolonged. Her urine contained almumen and blood. She died two days later. The rest of the physical examination showed nothing noteworthy- Autopsy No. 28/26 showed on opening the left pleural cavity an outrush of odorless air. The left lung did not collapse, and was white in appearance, being partially overdistended with air. There was some interstitial emphysema in some of the septa of the lower lobe.. Posteriorly above and behind the left bronchus was a large, firm, whitish, malignant growth more than 2in. in diameter in certain directions, but irregular in shape. It embraced the left bronchus, particularly above and behind, for 2in. of its length, constricting- and congesting the lumen and infiltrating the wall though without obvious ulceration. Below the bronchus were several soft walnut- sized deposits in carbon-pigmented glands. A small infarct was present near the apex of the lung behind. The right lung was engorged and without deposits. Fatty tissue only seemed present in the region of the thymus gland. The growth was attachedl to the inner side of' the arch of the aorta. In both ovaries were several soft malignant deposits from a grain of wheat in size to three-quarters of an inch. There was a secondary deposit on the seventh left rib 2in. in front of the angle. Microscopically, the growth consisted of medium-sized, rather spheroidal, cells in columns or groups with numerous mitoses and much necrosis. The vessels were tliin-walled in places, suggesting a sarcoma, though a stioma often surrounded the spaces. There were other areas where the cells resembled much more those of a carcinoma. In the ovaries were deposits of cells forming localised nodules infiltrat¬ ing at their edges and presenting an appearance like that of the so- called embryonal carcinoma. It is possible that the ovarian growth was primary, and that an early metastasis had occurred near the bronchus and had grown more rapidly than the parent. (/) Carcinoma of the Lung and Malignant Endocarditis. {Under the care of Dr. Hone, Honorary Physician.) K. C., a married woman, at. 39, was admitted on the 29th of July. Three months before she came into hospital she had had painful swellings on the backs of her arms and legs. These disappeared in a few days. Soon afterwards she complained of cough, and the doctor called in to see her found physical signs indicative of fluid in the right pleural cavity. This cleared up in a few days. Then two or three Aveeks before admission mental symptoms led to his being called in'