here referred to. The same may be said of the cases between ten and twenty years of age. The reported cases in childhood have been subjected to criticism, and none can be positively accepted as arising after birth. It may be noted that Steiner and Neureutter failed to find this condition among two thousand autopsies on children, although it was specially looked for. 1 The cases below the age of ten years are as follows: 2 1. Thomas Williamson's case. It is curious to find that in nearly all the references to this case it is spoken of as "Wilkinson's.' So often is this repeated that a reference to this case as "Williamson's" by Le Vaillaint was at first thought to apply to another case. This was in an infant apparently healthy at birth. In a few days vomiting and emaciation began. These continued, and death occurred at the end of five weeks. At autopsy, the pylorus was found to be hard and indurated, with the orifice so contracted as scarcely to admit a probe. The mucous coat was slightly thickened, while scarcely a trace of the muscular tunic was observable. The submucous tissue was much hypertrophied and indurated; it seemed to be the only tissue between the mucous and serous coats. There is no note regarding the histological character of the growth. Doubt is expressed whether this was a case of cancer or of simple hypertrophy. 2. Cullingworth's case 3 was in an infant. Vomiting began when the child was ten days old. This, with constipation and emaciation, continued for twenty-nine days until death. Autopsy showed a much dilated stomach nearly filling the abdominal cavity. The wall was hypertrophied, especially toward the pylorus, from the surface of which a small pear-shaped tumour an inch long arose. This was soft and ulcerating. It completely filled the pyloric orifice. The growth was examined by Dreschfield, and proved to be a cylinder-celled epithelioma. Welch 1 considers that the tumour was probably congenital. 5 3. Kaulich's case was in a child aged a year and a half, with an abdominal tumour, but whether primary or secondary in the stomach is not positively known. 1 Prager Vierteljahrschrift, vol. lxxxix., p. 77. 2 London and Edinburgh Monthly Journal of Medicine, 1841, vol. i., p. 23. 3 British Medical Journal, 1877, vol. ii., p. 253. 4 Loc. cit. 5 Prager med. Wochenschrift, 1864, No. 34, p. 269. CHAPTER II. CANCER OF THE STOMACH IN THE young. INTRODUCTION-CANCER OF THE STOMACH IN CHILDHOOD; ANALYSIS OF THE RECORDED CASES-CANCER OF THE STOMACH IN THE SECOND DECADE; ANALYSIS OF THE RECORDED CASES-CANCER OF THE STOMACH IN THE THIRD DECADE; REPORT OF CASES-PECULIARITIES OF CANCER OF THE STOMACH IN THE YOUNG. Introduction.-Thirty years of age is a convenient dividing line below which we may consider cancer of the stomach as occurring in the young. The first three decades may be divided into two periods, one to the twentieth year, the second from the twentieth to the thirtieth year. Cases occurring during the first period are clinical and pathological curiosities. Those, however, of the latter period are of more interest, since, though a small fraction of the total cases, they comprise a fairly constant percentage and show fairly uniform symptoms. While writers of a generation ago, as Bamberger and Niemeyer, held that gastric cancer could be left out of consideration in the diagnosis of obscure cases in the young, later authors recognise the occurrence of a certain definite percentage at this period of life. In Welch's table of 2,038 cases the percentage was 2.8. Among 1,069 other cases1 there was a percentage of 2.3. So that among a total of 3,257 cases there were 2.5 per cent. below the age of thirty years. In our series of 150 consecutive cases 6 of the patients were under thirty years of age-4 per cent. I. Cancer of the Stomach in Childhood. The extreme rarity of gastric cancer at this period is shown by the fact that there are only six cases on record below the age of ten years. The literature contains so many allusions to cases without a definite reference that there may be other instances than those 1 Statistics of Kohler, 319; Ott, 444; Reichert, 70; Canstatt, 70; Hahn, 166. here referred to. The same may be said of the cases between ten and twenty years of age. The reported cases in childhood have been subjected to criticism, and none can be positively accepted as arising after birth. It may be noted that Steiner and Neureutter1 failed to find this condition among two thousand autopsies on children, although it was specially looked for. The cases below the age of ten years are as follows: 1. Thomas Williamson's case. It is curious to find that in nearly all the references to this case it is spoken of as "Wilkinson's." So often is this repeated that a reference to this case as "Williamson's" by Le Vaillaint was at first thought to apply to another case. This was in an infant apparently healthy at birth. In a few days vomiting and emaciation began. These continued, and death occurred at the end of five weeks. At autopsy, the pylorus was found to be hard and indurated, with the orifice so contracted as scarcely to admit a probe. The mucous coat was slightly thickened, while scarcely a trace of the muscular tunic was observable. The submucous tissue was much hypertrophied and indurated; it seemed to be the only tissue between the mucous and serous coats. There is no note regarding the histological character of the growth. Doubt is expressed whether this was a case of cancer or of simple hypertrophy. 3 2. Cullingworth's case was in an infant. Vomiting began when the child was ten days old. This, with constipation and emaciation, continued for twenty-nine days until death. Autopsy showed a much dilated stomach nearly filling the abdominal cavity. The wall was hypertrophied, especially toward the pylorus, from the surface of which a small pear-shaped tumour an inch long arose. This was soft and ulcerating. It completely filled the pyloric orifice. The growth was examined by Dreschfield, and proved to be a cylinder-celled epithelioma. Welch + considers that the tumour was probably congenital. 4 3. Kaulich's case was in a child aged a year and a half, with an abdominal tumour, but whether primary or secondary in the stomach is not positively known. 1 Prager Vierteljahrschrift, vol. lxxxix., p. 77. 2 London and Edinburgh Monthly Journal of Medicine, 1841, vol. i., p. 23. 3 British Medical Journal, 1877, vol. ii., p. 253. 4 Loc. cit. 5 Prager med. Wochenschrift, 1864, No. 34, p. 269. 4. Kuhn's case. This is referred to by Williams, who considers it to be probably adeno-carcinoma of congenital origin. 5. Widerhofer's case was in an infant sixteen days old, and was possibly secondary in the stomach. 2 6. Ashby and Wright's case was in a child aged eight years, who was admitted to the hospital complaining of distention of the abdomen. There was neither vomiting, tumour, nor tenderness. Some months later there was tenderness, and a tumour was felt to the right of the navel. Pain was present. Death followed rapidly. Autopsy showed the duodenum, transverse colon, and stomach matted together. The stomach was dilated, its walls thickened, and the pylorus just admitted the forefinger. On the cardiac side of the pylorus were two small growths the size of peas, and on the duodenal side there was an irregular cavity, the walls having been destroyed by new growth. Microscopical examination showed the growth to be columnar epithelioma. From the description it would be difficult to say positively that the growth was primary in the stomach. Some resemblance to malignant disease of the stomach is borne by hypertrophy of the pylorus in infants, an affection which Thomson, of Edinburgh, has studied with special care. As already noted, Williamson's case is thought by many writers to have been simple hypertrophy. The course may be rapid and simulate malignant disease, as in a case reported by Pitt, in which death occurred in seven weeks following continuous vomiting and emaciation. Rolleston and Hayne have reviewed the reported cases, seventeen in number. An interesting case is reported by Batten," at the age of eleven weeks, in which the stomach peristalsis was visible and the pylorus could be felt. Under careful feeding the child improved for some months, subsequently dying from broncho-pneumonia. Autopsy verified the diagnosis. 5 II. Cancer of the Stomach during the Second Decade.This is of greater clinical interest, although so rare that we can find reference to or reports of only thirteen cases. The 2 Jahrb. f. Kinderheilk., alt. Reihe, Bd. ii., p. 194. 3 The Diseases of Children, second edition, p. 99. Transactions of the Pathological Society of London, 1892, p. 63. 5 British Medical Journal, 1898, vol. i., p. 1070. |