A sarcoma of the naso-pharynx / by William K. Simpson.

  • Simpson, William K.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: A sarcoma of the naso-pharynx / by William K. Simpson. 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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    Remembering the fact that at the pre- vious examination I had detected adenoid growths, which showed a tendency to bleed, I was quite sure that the hemor- rhages had their origin in the adenoid mass. This was confirmed by further ex- amination. and by local application, which 1 made to the growths, which produced a very severe hemorrhage. The growth at this time presented a somewhat different aspect from that noted at the previous examination; it was con- siderably larger and somewhat paler ex- cepting the inferior border, which was almost entirely in a condition of super- ficial erosion, with slight sloughing ap- pearance, presenting more or less a bleed- ing granular surface. These hemorrhages continued at irregu- lar intervals, but being quite thoroughly controlled by the application of adrena- line through the anterior nares, until January 15th of the present year, when the patient concluded to have the adenoid mass removed. From the appearance of the growth, and from the great tendency to copious bleeding, and from the general appear- ance of the patient, which was rather cachetic, I had come to the conclusion, and had so informed the patient, that the growth was more than an ordinary ade- noid growth, and was probably sarcoma- tous in nature. On January 15, 1903, under cocaine and adrenaline, I undertook the removal of the growth by the means of a large Gott- stein curette. The operation was success- fully performed, and I was able to remove the mass almost in its entirety, and much to my satisfaction, with practically no hemorrhage, which latter fact I attribute to the marvelous hemostatic effects of the adrenaline solution. From the hemorrhagic nature of the growth, and from the previous hemor- rhages produced by manipulating it, I ex- pected and prepared myself to meet with an alarming hemorrhage at the time of operation, and was very much relieved that none supervened. Aside from the previous hemorrhages which had originated from the growth, I had noted in previous examinations that all of the naso-pharynx, and of the post pharyngeal wall, down into the oro- pharynx, presented a very livid and some- times a very bluish appearance of the mucous membrane. The gross appearance of the mass re- moved did not differ very much from the appearance of an ordinary adenoid growth. The major portion of it was rather firm in consistency, but the infe- rior dependent portion was rather soft, presenting a hemorrhagic surface above alluded to, but there was nothing in its gross appearance which would positively stamp it as being sarcomatous. I submitted the growth for microscopic examination to Drs. Thatcher and Tuttle, pathologists at the Presbyterian Hospital, and here append their report: Microscopic Examination.—“Much lym- phoid tissue, few groups of glan alveoli, some fibrous connective tissue, and many patches and strands consisting of rather large cells with rounded and oval nuclei, containing less chromatin than leuco- cytes, presenting many mitoses. The out- lines of these groups are, as a rule, not perfectly sharp, but in some fields give a distinct alveolar impression. They are found not only in the lymphoid tissue, but also in the fibrous connective tissue. In the latter situation they appear to con- tain more chromatin. Some areas are ex- tremely vascular. Looks very much like sarcoma.” In further conversation with Dr. Tut- tle, he told me that he had shown the growth to another pathologist, whom he considered the best authority on new growths, and that he had reported that the growth would certainly have become malignant had it not been removed. He considered it on the border line of a variety of sarcoma. Although the con- census of opinion of those who examined the growth was that it was probably a form of sarcoma, at the same time there were some points about the growth which made a definite result somewhat obscure and puzzling. The question of recurrence naturally came for consideration, but it was the opinion of those who examined the growth that the chances were against such a recurrence taking place. The subsequent history of the case has been most favorable from all points; the aural symptoms have much improved; there have been no recurring hemor- rhages, excepting a slight ichorous dis-