Central myxo-sarcoma of the right superior maxilla : removal of entire maxilla and portion of malar bone / by John L. Neilson.

  • Neilson, John L.
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: Central myxo-sarcoma of the right superior maxilla : removal of entire maxilla and portion of malar bone / by John L. Neilson. Source: Wellcome Collection.

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    were brought into position, and retained by interrupted silk sutures, hare¬ lip pins, and adhesive straps. The cavity was not stuffed with pledgets of lint. The patient reacted rapidly, and before he was removed from the table was able to hold a slate and write half a dozen sentences in a firm hand. His convalescence has been rapid, five-sixths of the incision heal¬ ing by first intention : vision is not impaired ; there is no great deformity, and articulation, though muffled, is quite distinct. Macroscopic Appearances_There remained but the framework of the maxilla, the thinner portions having been so completely destroyed and re¬ placed by the growth that the point of origin could not be determined. Where the tumour had been under pressure it was extremely firm, non- vascular, and cut crisply; where it had protruded into the free cavities, it was lobed, foliated, and cauliflower-like in appearance, and was rela¬ tively more vascular and less dense in structure ; no point of ulceration except upon surface of external mass, where it had been abraded mechan¬ ically ; section of the foliated masses, in the line of axis, presented, in gross appearance, the aspect of a section of the brain, the body of the convolution being nearly white, and the edge gray or mahogany coloured. Microscopic Appearances.—Surgeons Jones and Ayres have cut, on the freezing microtome, stained and mounted, scores of sections from various portions of the tumour, and found it to be composed of every form of developmental protoplasmic body imbedded in a scanty mucoid, some¬ times delicately fibrous stroma, and, at rare intervals, containing calcare¬ ous concretions. Dr. Beyer, Assistant Surgeon U. S. Navy, kindly consented to make a critical examination and drawings of some of these sections, and his remarks are appended :— “ The tumour is built up of numerous protoplasmic bodies, which being roundish or spindle shaped, and sending offshoots in all directions, freely inosculate with each other, and produce a protoplasmic reticulum, such as is seen in developing embryonal subcutaneous tissue. The points of inter¬ section of this reticulum are the above-mentioned elements—very often compact masses of living matter of the size of nuclei, either homogeneous, shining, or granular. In numerous places the offshoots of the elements are not protoplasmic, but slightly fibrous, indicating a more advanced stage of development of the myxomatous tissue. The meshes of the reticulum are filled with a pale, jelly-like, apparently homogeneous basis substance, re¬ fracting light very little, and filled with small, irregular protoplasmic bodies, apparently isolated, to wit, in no connection with the protoplasmic reticulum. The myxomatous tissue is traversed by a number of parallel, rather broad, bundles of fibrous connective tissue, which, perhaps, is the original fibrous tissue of the mucous membrane involved. “ The protoplasmic reticulum, with the myxomatous basis substance, fills the interstices below the bundles, and is spun around the bundles themselves. In many instances the bundles have lost their fibrous struc¬ ture, and are rather protoplasmic in nature; indeed, it occurs that one and the same bundle is partly fibrous and partly protoplasmic. By the latter change either broad protoplasmic strings are produced, being in connection with the surrounding protoplasmic reticulum ; or the bundle is split up into a number of small spindles, closely packed together, exhibit¬ ing the features of a so-called spindle-celled sarcoma. In numerous places the basis substance incloses bright granules of fat—so do also the proto¬ plasmic bodies of the reticulum, indicating a rather localized fatty degene¬ ration.