A case of primary melanotic sarcoma of the liver / by Sheridan Delépine.

  • Delépine, Sheridan, 1855-1921.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: A case of primary melanotic sarcoma of the liver / by Sheridan Delépine. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    emaciated, notwithstanding good diet, tonics, &c. The slight gain in weight also, as I will point out, rather supports than invalidates this statement. The fact that, notwithstanding the general distribution of the disease all over the organ, a great number of portal vessels have escaped, and that the morbid changes in most instances begin in the lobular capillaries or intra-lobular veins, is against the view that the irritant was brought to the organ through the portal vessels ; whilst it would be almost preposterous to hold the view that mere passive congestion might be sufficient to lead to such changes as those above described. We are therefore driven to the conclusion that the irritant must have been elaborated by the liver itself. The proofs of this are not wanting, but the most striking is found in the fact that the most altered of the three vessels is evi- dently the hepatic vein at its origin. Now the hepatic vein (as well as most other veins) must be considered to be not only a vessel carry- ing blood away from the organ, but also a channel collecting pro- ducts which have been added to the blood during its circulation through the capillaries of the organ. It therefore seems probable that if any abnormal product happened to be manufactured by the hepatic cells, the first vessels to suffer would be the intra- lobular capillaries, and that the disease would have a tendency to extend more rapidly in the direction of the blood-flow than in any other direction. But as the blood-current is soon retarded or stopped, the extension backwards of the process would, of course, be possible also very early (this explains how a number of branches of the portal vein and hepatic artery have become affected). Against this view one can set the fact that all the lobules of the organ are not affected ; but, on the other hand, it can be said that the same difficulty would arise in a number of cases where inflam- matory changes take place, whilst the remarkably even distribution of the disease all through the organ is very much more striking than the escape of a few parts. It must be remembered that although the organ had reached the enormous weight of lb lbs 11 oz. (i.e. nearly five times its normal weight), yet it had not lost its °TTtwill be noticed that I have attached little importance to the Staphylococcus found so abundantly in the vessels. My reasons for doine so are the following : , Tl The micro-organisms are found in the most superficial parts