Retro-pharyngeal sarcoma / by F.I. Knight.

  • Knight, Frederick I. (Frederick Irving), 1841-1909.
Date:
1878 [i.e. 1879]
Catalogue details

Licence: Public Domain Mark

Credit: Retro-pharyngeal sarcoma / by F.I. Knight. 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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    — 2 — could not be determined at that time. There was no ulceration, and no enlargement of lymphatic glands. The situation of the growth was almost identical with that of a fibroid reported by Voltolini^, which also had a broad attachment, and which apparently did not recur after removal by the galvano-caustic loop. It was decided to re- move the growth in our case by the same means, after prelimi- nary tracheotomy. Dr. Homans did tracheotomy the next day. Instead of using a simple platinum loop, I had the extremity of Mackenzie's guarded wheel ecrascur fitted to Voltolini's han- dle, and protected on the posterior aspect by hard rubber. Nothing could have been more satisfactory than the opera- tion, the growth being quickly removed close to the jjharyngeal wall with but little hemorrhage. It was of the size of a small horse-chestnut, encapsulated, and its cut surface about half an inch in diameter. We had hoped that, notwithstanding its rather soft feeling, it, like Voltolini's, would prove a fibroid. But it was pronounced by Dr. Cutler, and afterwards by Dr. Fitz, to be a small-celled spindle sarcoma. Dr. Cutler's report of the microscopic appearance of the growth after hardening was as follows: It was composed of moderately small spindle cells, lying singly in a very small amount of intercellular substance. These cells were in many places arranged in bundles, which intersected each other in all directions. In a few places large numbers of round cells of me- dium size were found, and occasionally star-shaped cells were met with. By far the greater number of cells were spindle shaped. The growth was a spindle-celled sarcoma. In a few days it had grown to almost its original size, and so it has remained for nearly two years, with a certain amount of shrinkage in the past year. The patient has continued to wear th-e tracheal tube, has had no difficulty in swallowing, and in fact little annoyance but from the tube, excepting occasional aphonia when she has taken cold. Ordinarily the voice has been very good when the tracheal tube was stopped. Both Dr. Homans and myself felt that it was better to wait for more urgent symptoms before undertaking a radical operation, which would not only endanger life, but involve the risk (with a growth so lia- ble to recur, if life were saved), of increasing the discomfort of the patient.