ABNORMAL ANATOMY OF THE LIVER. 



193 



compound mass, which assumes the form of 

 the particular part of the organ in which it is 

 placed, and is divided into compartments, 

 marking its original multiple form by septa of 

 condensed Glisson's capsule supporting dilated 

 vessels. It would appear to be this form of 

 tumour which has been described by Farre as 

 the first variety of his tubera diffusa; he gives 

 them the following character. " Tubera, ele- 

 vated at the surface of the organ, but not uni- 

 form in their figure, some rising with a regular 

 swell into a round form, others acquiring a 

 margin by being gradually depressed towards 

 the centre, forming tumours without cysts, 

 almost pulpy in their consistence, cellular in 

 their structure, and containing an opaque white 

 fluid." 



Another form of the albuminous carcinoma- 

 tous tumour is the u large white tubercle" of 

 Baillie, the tubera circumscripta of Farre, by 

 whom they are thus admirably described : 

 " Their colour inclines to a yellowish white, 

 and their projecting surfaces, slightly variegated 

 with red vessels, deviate from a regular swell 

 by a peculiar indentation at or near their cen- 

 tres, which are perfectly white and opaque. 

 They vary much in size, which depends on the 

 duration of each tuber, for at its first appear- 

 ance it is very minute, but during its growth it 

 assumes the character above described, and at 

 its maturity exceeds an inch in its diameter. 

 They adhere intimately to the liver, and their 

 figure is well defined. They commonly remain 

 distinct at the surface of the liver, but inter- 

 nally they ultimately coalesce and form im- 

 mense morbid masses which pervade its sub- 

 stance. They possess so close a cellular struc- 

 ture that the section of them at first view 

 appears solid and inorganic ; but on the edt;e 

 of the knife, by which they have been disse- 

 vered, an opaque white fluid of the consistence 

 of cream is left, and a fresh portion of this 

 fluid is gathered on it at each time that it is 

 repassed over the surface of the section. Their 

 cellular structure becomes more apparent after 

 long maceration." 



The depression in the centre of carcinoma- 

 tous tumours, although generally met with, is 

 not a necessary character of cancer. Its mode 

 of formation has been ablv pointed out by Dr. 

 Carswell, in his beautiful work on pathological 

 anatomy : " The depression is not observed 

 unless when the tumour is divided or is situ- 

 ated on the surface of an organ, as the liver, 

 where tumours of this kind are generally met 

 with. In the former case the depression arises 

 from the softer substance, after the division of 

 the tumour raising itself by its elasticity above 

 the unyielding nucleus; in the latter it is pro- 

 duced by the peritoneum adhering to the sur- 

 face of the tumour when small, and preventing 

 its development in that direction. If the tu- 

 mour does not come in contact with the peri- 

 toneum until it has acquired a considerable size, 

 it presents no such depression, or only a very 

 small one. Hence the reason why, in carci- 

 noma of the liver, we meet with some tumours 

 having a smooth globular surface, and others with 

 a central depression of greater or less extent." 



VOL. III. 



Another variety of carcinomatous tumour is 

 named the gelatin iform cancer, from (lie exis- 

 tence of a firm and jelly-like deposit winch oc- 

 cupies the cells of the tumour in place of the 

 albuminous secretion common to the preceding 

 forms. 1 have before me an interesting speci- 

 men of gelatiniform tubercle. The liver con- 

 tains a considerable number of these tumours 

 of variable size, and dispe;sed through eveiy 

 part of its structure. The smallest resemble 

 the small patches described above as the inci- 

 pient stage of carcinomatous tumour generally; 

 the largest are equal in size to a walnut. They 

 are distinctly circumscribed, and the lobules 

 immediately surrounding them are flattened 

 and compressed. In the smaller tubercles the 

 form of the lobules is quite distinct, but in the 

 larger the lobules have yielded to the peculiar 

 characters of the disease. On the surface the 

 centre of the tubercle presents an oval or cir- 

 cularly indented ring, around which the tumour 

 swells suddenly and then subsides to the cir- 

 cumference. On making a section of one of 

 these tumours, 1 found a central area of about 

 two lines in diameter, transparent, dense, and 

 apparently gelatinous, and distinctly bounded 

 by a white marginal line; the marginal portion 

 of the section forming the bulk of the tumour 

 was elastic, and rose above the central area to 

 subside gradually in the marginal line of the 

 circumference. The whole section bore a stri- 

 king resemblance to the conjunctiva affected 

 with chemosis, only that it was paler in its 

 colour, or to a beautiful flower with a single 

 large and expanded circle of petals. On exa- 

 mining a thin section with a lens of low power 

 a number of minute parallel injected capillaries 

 were seen traversing the marginal portion of 

 the tubercle towards the boundary line of the 

 area, but no vessels could be traced beyond 

 that line into the central portion. The resem- 

 blance to the petals of a flower was produced 

 by white lines which radiated from the boun- 

 dary line of the area to the circumference, and 

 divided the marginal portion of the tumour 

 into six or eight compartments. From careful 

 examination it appeared to me that the central 

 area was a single lobule expanded by the gela- 

 tinous deposition with which its tissue was in- 

 filtrated, and the marginal compartments pre- 

 sented a similar character. 



k. Medullary sarcoma. Another form of tu- 

 bercle, associated with the cancerous diathesis 

 and belonging to the carcinomatous family, is 

 medullary sarcoma, or encephalosis. The tu- 

 mours produced by this disease are larger than 

 scrofulous tubercles, and more regular in form 

 and fewer in number than scirrhous tumours. 

 Developed origin-ally in the same way with 

 scirrhus, by infiltration into the tissue of the 

 lobules, or into the vessels themselves, of the 

 peculiar greyish white and opaque substance of 

 which they are composed, they increase in size 

 and obstruct the circulation in the surrounding 

 lobules. Their internal structure is a loose 

 cellular base, filled with a soft arid brain-like 

 matter, frequently coloured with blood, or 

 containing coagula in various stages of soften- 

 ing, resulting from haemorrhagic extravasation. 



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