The centrifugal spread of mammary carcinoma in the parietes, and its bearings on operative treatment / by W. Sampson Handley.

  • Handley, W. Sampson (William Sampson), 1872-1962.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The centrifugal spread of mammary carcinoma in the parietes, and its bearings on operative treatment / by W. Sampson Handley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    detected nearly to the posterior axillary fold. The left shoulder was covered by this subcutaneous nodulated growth^ and was almost fixed. (P.M. Register, 1901, Ho. 59.) The other case shewed a wider distribution of skin nodules, but nevertheless the distal portions of the limbs were free. There was great wasting, and the body presented a remarkable appearance owing to numerous large (1—2 inches diameter) secondary growths in the skin. These growths occurred princi- pally on the front of the chest and abdomen, but were also present on the back, the face, behind the jaw, the eyelids, and the limbs. In the latter situation it is especially noted that the chief distribution was on the parts near the trunk. Many of the nodules on the chest were ulcerated; others were rounded and projected for nearly an inch. A large growth was situated over the sternum, and thence indefinite lines of nodules seemed to radiate in all directions. About an inch to the right side of the linea alba, and parallel to it, was a conspicuous line of nodules. In most instances the nodules were subcutaneous, and did not extend to the deeper layers of the parietes. Ho deposits were found in the lungs. (P.M. Register, 1902, Ho. 52.) The most extreme instance of widely disseminated skin- nodules I have found is one recorded by Rolleston.'^ The primary growth was a small one in the lower and outer part of the left breast, and the breast was removed, along with two glands in the left axilla, which were found to be carcinomatous. Twenty-one months after the operation a small nodule was noticed under the skin over the right clavicle. Subsequently very numerous nodules developed. A year after the first recurrence there were 105 of these, together with a mass in the right mamma. Four months later, simultaneously with the administration of arsenic and thyroid extract, the number of nodules had diminished to 78. The glands in the axillae and groins were enlarged. The distribution of the nodules is illustrated in two figures, one shewing the front, the other the back of the body. The figures afford very strong evidence for centrifugal spread, in * “A Case of Multiple Cutaneous Carcinomatosis after Carcinoma Mammje,’' by H. D. Eolleston, M.D. (Clinical Society’s Transactions, vol. xxxiv., 1901, p. 206.)