Secondary Dissemination Research Articles

THE SURGICAL TREATMENT OF TUBERCULOSIS OF THE GENITO-URINARY TRACT, INCLUDING THE KIDNEYS, BLADDER, TESTICLES AND SEMINAL VESICLES

The genito-urinary tract is seldom alone the site of tuberculosis, and primary genito-urinary tuberculosis probably never occurs. The frequency with which pulmonary tuberculosis, active, quiescent or healed, is found in careful routine postmortem examinations for tuberculous lesions indicates that a high percentage of adults have or have had pulmonary tuberculosis. It is generally accepted that tuberculosis of any part of the genito-urinary tract is hemotogenous in origin. The high incidence of pulmonary tuberculosis in necropsy records would seem to indicate that the lungs act as the primary focus for the secondary dissemination through the blood stream. It is well known that in cases of active progressive pulmonary tuberculosis the disease is usually not confined to the lungs. Besides other parts of the body, the genito-urinary tract may be affected. In 500 necropsies on tuberculous subjects, Krzywicki1found 5 per cent. with involvement of the genito-urinary tract. Fowler and Godler

Unusual Cardiac and Cerebral Metastases in Melanosarcoma

Clinical interest in cases of generalized melanosarcoma often becomes focused upon the extensive metastases in one or more organs. The primary neoplasm, if cutaneous, may have been forgotten by the patient or may show a relatively insignificant appearing recurrence at the site of the original tumor, which too often has been as much incised as excised, while the subcutaneous nodules and especially the luxuriant growth of the secondaries on hepatic soil are the outstanding features. Even at autopsy, the gross pathological picture may be such as to lead to serious misinterpretation of the primary site. There can be but little doubt that many of the reported instances of melanoblastomas arising in situations other than the eye and the skin are thus to be explained. The case here presented is illustrative of the way in which the emphasis falls upon the secondary dissemination in cutaneous melanotic sarcoma. In addition, it presents an unusual coincidence of interesting features. The history of the case and the clinical findings failed entirely to indicate the extensive visceral metastases, and nothing in these suggested the remarkable meningeal involvement. A neoplastic nodule on the floor of the fourth ventricle, which had ruptured through the ependyma, did not influence the clinical findings sufficiently to attract attention. As for the heart, a moderate aortic regurgitation led a member (Dr. George R. Herrmann) of the Internal Medicine Staff to suggest the possibility of secondaries upon the aortic valve cusps, but this possibility was not taken seriously, and that the entire myocardium was studded with neoplastic nodules was unsuspected.