A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
The probability of the embolic nature of many secondary tumors was
early suggested in the history of embolism. Rapidly growing tumors
were known to be capable of perforating the walls of adjacent
blood-vessels, especially veins, and to continue growing along the
course of such vessels. The possibility of the detachment of portions
of these tumors and their transfer along the course of the circulation
was an inevitable inference from the results of experimentation with
foreign bodies. Cancerous emboli were thus recognized as a possible
variety, and their distribution was subject to the same laws as those
governing emboli otherwise constituted. Multiple nodules were
frequently found in the lungs in connection with tumors growing into
the inferior vena cava, while multiple nodules in the liver were
usually associated with tumors of the gastro-intestinal canal or other
regions whose vessels formed a part of the portal circulation. The
readiness with which portions may be detached after death from the
soft masses projecting into the interior of veins suggests the ease
with which particles may be {113} separated during life. The
experiments already referred to show that isolated fragments of tissue
serving as emboli may grow in the place of their reception, and it is
presumable that the resulting growth takes place under the same
conditions as those prevailing at the place from which the embolus
started. The question whether the secondary tumor arises from the
reproduction of elements transferred from the primitive disease, or
whether these excite a characteristic, specific growth of the cells in
the place of their retention, may still be regarded as open. The
experiments favor the former view, and they alone are capable of
satisfactorily determining the point in question.
The secondary nodules, whatever may be their method of origin, present
the peculiarities of the primitive growth. If the cells of the latter
are pigmented, those of the former show the same peculiarity. If the
structure of the primitive tumor contains bone, cartilage, or squamous
epithelium, the secondary growths show like characters, though they
may be present in the heart or other organs where such tissues are not
present as normal constituents. So constant and characteristic is this
feature that the structure of the tumor is usually as well displayed
in the examination of the secondary as of the primitive nodule.
Indeed, the structural peculiarities of the growth may be more
characteristically shown in the former in those instances where the
primitive tumor has undergone degenerative changes obscuring its
histological features.
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