Carcinoma of hernial sac

CASE

REPORTb

CARCINOMA

OF HERNIAL

SAC*

LOUIS H. BARETZ, M.D. BROOKLYN, N. Y.

U

R. the

aged sixty-seven, Jewish HospitaI,

admitted February

1928, with the compIaint ing ” in the Ieft groin. l

FIG.

positive findings were as follows : GenitaIia : A hard, irregular, noduIar growth is present in the Ieft groin, about the size of a Iarge waInut. It is not tender. With finger in the left inguina1 ring, a definite impuIsc is feIt on slight cough and with increased coughing a mass is visibIe and easiIy reducible. This is apparentIy not associated with the hard mass above noted. Recta1 Examination : ModerateIy enlarged No suspicious areas. No BIumer’s prostate. sheIf. Abdomen : SIightIy tympanitic. Otherwise negative. Urine: S.T. Albumin. Sugar w B c B p ($c~,qara;o~,&hyaline negative. casts. Oct. . . . . . Impression: (I) Tumor of spermatic corcJ; (2) inguina1 hernia; (3) adenoma of prostate. Operation: February 20, 1928, under spinal anesthesia. Incision paraIIe1 to and 2 cm. above Poupart’s ligament 8 cm. long. Findings: After carefu1 dissection, the hard mass was somewhat freed from the surrounding tissues. It was found to be cIoscIy adherent to the rock hard, irreguIar and spermatic cord, noduIar. Further dissection reveaIed the masses to be IocaIized in a Iarge hernia1 sac, the walls of which were thick, tough and fibrous. Deep paIpation of the sac gave a feeIing of shot-like masses throughout. The testis was atrophied and a moderate amount of hydroceIe fIuid was present in the tunica. The vas was isoIated from the cord and found to be normaI. The sac was incised and the examining finger found the sac Iining covered entireIy with shot-Iikc noduIes. ExpIoration through the internal ring found the same condition existing throughout the peritonea1 cavity. Procedure: Herniotomy and remova of adherent spermatic cord and testis. UsuaI hernia1 repair. Laboratory Report: Macroscopica : The specimen consists of testis and adjacent tissue; one portion shows a thickened mass, section of which shows noduIar thickening and the inner Iining of remaining portion is studded with

to 19,

of “sweII-

I.

Past histoq~ was negative except for a Ieft inguina1 hernia of forty-eight years duration. The patient aIways wore- a truss and was never inconvenienced. Present illness began three months previousIy with a smaI1, hard, painIess sn_eIIing in the Icft groin, n-hrch ’ mcreased ’ in size some\yhat. One month Iater, a second hard noduIe appeared near the first and within the preceding month, both sweIIings have fused and grown sIightIy Iarger. There was sIight difficuIty in starting the stream. NJ-ct-uria z times; no diurna1 frequency. No Ioss of weight. Appetite good. No gastrointestina1 compIaints. No venerea1 history. Examination: Patient is weI1 preserved for

age and

appears

to be in good

health.

* Presented

the Brooldyn

before

The

Urologica

692

Society,

LIarch

12, ,929.

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SF.,X,IS

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VII,

NC,. j

DretzkaPmMammary

grayish n.hite, firm irreguIar nodules. Microscopical: Solid mass consists of adenocarciThe

diagnosis

American


IY

693

carcinoma of to the hernia1

series subsequently was folIon;-up examinations

(2) because of the error in diagnosis it may pro\ c oi‘ \.aiue in further cases of similar naturc~.

was therefore extension

AN UNUSUAL RECURRENT MAMMARY WITH

PATHOLOGICAL

LEO DRETZKA, DETROIT,

T

Journal

\\-ere made and revealed a gratluall~ increasing Blumer’s shelf. The patient became increa.+ ingIy weaker and died in a few months. This case is reported (I) :IS n unique form 01 carcinomatous extension in a her&al sac; and

110111;1.

the peritoneum with sac. A gastrointcstina1 Frequent negatkc.

Tumor

UMORS of the breast containing muscIe tissue are exceedingly rare. A careful review of the Iiterature reveals essentiahy no definite reports of authentic cases. Ewing refers to Ieiomyoma of the nippIe and skin and mentions the publications of Virchonand SokoIow in 1873 and Niklas in 1889. The breast contains very littIe smooth muscle tissue outside of the blood-vessel waIIs, but if the histoIogy of the duct and its acini is recaIIed, it will be remembered that there is a single Iayer of IongitudinaIIy arranged unstriated muscle fiber between the epitheIia1 basement membrane of both ducts and n&i and the underlying Iaver of delicate connective tissue consisting of bipolar and steIIate ceIIs. Beneath this is the eIastica connective-tissue Iayer which surrounds a11 ducts and some acini. In the wall of the duct outside of the elastics is a thicker Iayer of unstriated muscle which disappears when the acini are reached. The nipple aIso contains a considerable number of unstriped muscIe fibers. It is possibIe to have a few strands of striated muscIe in a11 epitheIia1 tumors of the breast, but this is part of the stroma rather than of the neoplasm. As a rule, the common benign tumors of any organ consist of the kind of tissue

M.D.,

TUMOR

OPINIONS F.A.C.S.

MICH.

which normally predominates in that organ. For exampIe, we have gliomns of the brain, Ieiomyomas of the uterus,

adenomas of the Iiver and thyroid, and adenofibromas and fibroadenomas of the breast. The breast contains principally epithelial and connective tissue together with bIood and lymph vesseIs, branches of the intercostal nerves together with some sympathetic fibers, and a small amount of unstriated muscIe. Angiomas and Iymph-

* Submitted for pubhcntion .2lnrch j’,

1929.