Melanotic sarcoma of the common bile duct and the ampulla of Vater / by Francis J. Shepherd.

  • Shepherd, Francis J. (Francis John), 1851-1929.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Melanotic sarcoma of the common bile duct and the ampulla of Vater / by Francis J. Shepherd. 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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    of the findings as reported by the Pathologist of the hospital, Dr. Duval. Autopsy performed fourteen hours after death. In the region of the gall-bladder there is a linear scar 10 cm. in length parallel to the median line. Through the scar runs a fistulous tract which communicates with the gall-bladder and on pressure discharges bile. The inner surface of the gall-bladder appears normal. The cystic duct, opened in situ, is distorted into a shape like the letter S, apparently the result of old adhesions. The wall of the cystic duct is of normal thickness and its inner surface smooth throughout. On opening the common duct it is seen uni- formly dilated to three times its normal calibre. Its wall is some- what thinned and the rugae of the tunica propria present a marked fenestration, due probably to long continued distention. In the lower portion of the duct there is a soft, brownish-black, fungoid mass, 2.5 cm. in length, which completely occludes the lumen of the common duct and part of Vater’s diverticulum. The passage- way to the duodenum, however, is patent and normal. The tumor throughout its extent is intimately attached to the duct wall and appears to have started in the tunica propria; there is no thickening of the wall. The attachment of the growth maintains an even line 2 mm. within and along the wall as indicated to the naked eye by the pigment limit. (Fig. 1.) The tumor is confined entirely to the common duct and ampulla. Neither the pancreas nor its duct are involved in the growth. There is no similar mass found elsewhere nor were any cutaneous moles found anywhere in the body. The common duct was opened in situ over a grooved director to which on passing it down the lumen no resistence was offered, so no occlu- sion was detected by means of the probe. The growth was so soft that only after the duct had been laid open was the obstruc- tion discovered. The brownish-black mass now assumed a dis- tinct cylindrical form which bulged far over the edges of the opened duct. It was only with great difficulty it could be returned to its original place and the edges of the duct brought again into apposition. At first it seemed as if the tumor was altered blood or inspis- sated bile; its true nature was discovered, however, after a more careful examination. The melanoma on closer inspection showed innumerable densely arranged, flattened, finger-like projections;