CARCINOMA OF THE KIDNEY 71 
A case bearino; a very close resemblance to mine was reported by Seymour Sharkey* 
in 1882. 
G. R., married woman, aet. 28, emaciated, anaemic, jaundiced ; liver enlarged ; tumour 
above pubes. 
Post-morte?n. — Nodules of new growth in lungs. Liver : masses of new growth. Right 
ovary cystic, new growth in remaining portion. Kidneys appear normal. 
Histology of Kidney. — Glomeruli : the basement membrane of the capsules is sharply defined, 
and the capillaries within are healthy, but from the internal surface of the basement membrane 
rose a thick deeply-stained wall of cells, having a very clear columnar arrangement. In some of 
the larger areas of disease the earliest changes were in the epithelium of the tubules, which was 
transformed into a columnar epithelium. 
I have given a somewhat detailed account of Dr. Sharkey's case because it corresponds so 
closely with my own ; in both we have the kidneys apparently normal macroscopically, and in 
both we have considerable masses of growth in other organs. Both cases, again, are young 
subjects for malignant epithelial tumour. 
Putting aside the question of the growth starting independently in the various sites of 
disease, two questions seem to present themselves — (i) Is the condition in the kidney congenital 
and not connected with the growths at all ? (2) If carcinoma of the kidney, is the condition 
primary or secondary r 
The widespread, in fact universal, deviation from the normal in the structure of the 
glomeruli seems to favour the congenital theory. 
So far as I am aware, however, in the lower animals, and in the primitive renal tubule in 
Man, the epithelial lining consists of a single layer of cells. The increased cellular mass indicates, 
therefore, a new formation, and this is confirmed by the occasional penetration of the basement 
membrane by the proliferating epithelium. 
The character of the cells of the new growth is of interest in connection with Cohnheim's 
embryonic remnant theory of tumour formation. Assuming, then, that it is a question of growth, 
the nature of this, whether primary or secondary, arises. The extensive growth in the liver, 
lungs, etc., as compared with that in the kidney, does not of necessity prove the secondary 
character of the latter ; it seems to me, further, that if the kidney growth were secondary, that 
the epithelial growth would have been found over the vascular tuft as well as on the peripheral 
part of the capsule. 
My conclusion is, therefore, that my case is one of primary carcinoma of the kidney 
arising in the glomeruli, and possibly associated with a persistence of the epitlielium of the 
primitive renal tubule. 
* Trans. ' Path. Soc.,' London, 18S2, vol. xxxiii, p. 195. 
