Cases of fibro-cellular tumor in the scrotum : with remarks / by C.R. Thompson.

  • Thompson, Charles Robert.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Cases of fibro-cellular tumor in the scrotum : with remarks / by C.R. Thompson. 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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    testicle. No cause could be assigned for its apj)earance, lie not remembering to have received any blow or injury to the pai’t. It went on steadily increasing in size, carrying the testicle down in front of it. The tumor had never given him much pain, and was troublesome chiefly from its size and weight. The bowels had always acted naturally, and micturition was effected without diffi- culty. The patient visited St. Bartholomew's Hospital, and was carefully examined. No positive diagnosis as to the nature of the tumor was pronounced; and, on account of the age of tlie patient, the little pain and slow advance of the growth, the uncertainty as to its cha- racter, and ])robable difficulty of fairly excising it, it was decided that no step could be taken to rid him of the disease. He afterwards, in the course of the following winter, was admitted into ano- ther metropolitan hospital; where, un- der the idea that the disease was a largo hernial protrusion, he was kept in bed for some weeks, with little or no diminu- tion of the tumor, and greatly to the deti'iment of his health. During the past nine mouths the tumor has steadily and rapidly increased, for some tune confining him entirely to his bed, by its great weight and size. The mass became very nodulated, and the superficial veins much distended. In August last one prominent part became red and painful, and then sloughed, giving rise to some haemorr hage ; from that time great portions of the tumor have successively become gangrenous. In September one of the distended veins gave way, and some three pints of blood were lost, but the lisemorrhage was stopped by a twisted ligature. From this tune the patient never rallied, but became gradually weaker as the tumor went on sloughing, and some oozing of blood continued, and he died on September 28th, 1850. During the last two months he had suffered much pain, chiefly in the glans penis, and about the base of the tumor; and took large doses of morphia, which, with lotions of chloride of lime to the tumor, formed the only treatment. Postmortem examination. — On re- moring the integuments from tlie base of the tumor, a dense fascia was exposed, tensely stretching over it, continuous with the aponeurosis of the exteimal oblique muscle, which it appeared to- have lifted from its insertion into the front of the os ])ubis. The tumor ap- peai-ed to have thus, as it were, pushed its way into the external ring and in- guinal canal; but tlie internal abdominal ring was free, though couqjressed and somewhat displaced by the gi-owth. The great omentum lay perfectly free, and apparently healthy; nor did the intestines present anything abnormal in situation. The tumor itself appeared to consist of two distinct portions: the upper part, or base, forming about two-fifths of the whole, was perfectly white, lobu- lated, and very tough ; and on section the edges everted gi'eatly, and the sub- stance looked fibrous and glistening: the lower part, of which some portions had sloughed, was more dense and com- pact, of darker, blood-stained colour, having somewhat the appearance and consistence of congested liver. One projecting nodule, near the part which had sloughed, appeared red and fluc- tuated, and on incision some thin jms escaped. The penis was pushed to the right sideof the tumor; was much comiiressed and wasted. Mr. Paget kindly furnished me with the following account of the microscoiiic examination of the tumor:— All the pai'ts examined consisted essentially of a tissue resembling in its minute characters the common areolar tissue. The masses were very tough,, but when dissected for the microscope they appeared composed of delicate and soft undulating filaments, variously in- terwoven. Many such filaments floated out singly from the sides of the speci- mens, like filaments of the most or ganized fibro-cellular tissue. When acetic acid was added, it made the tissue transparent, and brought into riew abundant nuclei imbedded in it, as in the fibro-cellular tissue of the cliild— nuclei that were well defined, oval, and rather elongated. In the white portions of the tumor none but the forms described were found; in the dai'k-coloured portions there were abundant products of inflam- mation infiltrated into the same tissues. In all these portions blood was foimd, as if effused ; and with it were corpus- cles exactly like inflammatory exuda-' tion-cells, elongated fibro-cells, gramdar matter in free granules, or gi-anular