DOI: 10.7925/drs1.ucdlib_280822
title: Glandular tumour of the neck

description: Watercolour medical illustration depicting a tumour. It has the alternative reference number 2041 and P9 on the front. There is no Richmond Hospital Museum reference. The artist's name is in the bottom right corner 'J. Connolly'. The typescript note on the back begins 'Glandular Tumour of the Neck'.
description: Scope and content: The full typescript note on the back reads 'Glandular Tumour of the Neck – Professor R.W. Smith gave the following account of a tumour removed after death from the neck of a female aged 64. The patient who was the subject of this disease, stated, that twelve years before the date of her admission (September 1853) into the Richmond Hospital, a small moveable and painless tumour formed upon the right side of her neck near its centre; its growth was very slow; at the end of four years it was not larger than a small egg; at that period she came into hospital for a short time, but I do not know what opinion was entertained of the nature of the tumour; no attempt, however, was made to remove it by operation. From year to year it gradually enlarged, and several smaller tumours formed along the upper part of its circumference; these contained fluid, and were punctured upon several occasions. The great bulk of the original disease was solid and hard, and gradually acquired an uneven surface. When she was admitted into the hospital, in September last, the tumour was larger than a full-sized orange, remarkably firm to the feel, nodulated and immovable in a vertical direction, although it could be rather freely moved transversely. Around its base were numerous cysts, evidently containing fluid; they were now of considerable size, and along with the solid portion of the tumour, constituted a morbid growth, which reached upwards to the mastoid process, and forwards to the middle line of the neck; there was now also severe pain, especially distressing at night, and some dyspnoea from the interference of the tumour with the motions of the larynx. These cysts were punctured from time to time, by which the size of the tumour was much diminished, and the pain and distress of breathing relieved. A consultation was held upon the case, when it was decided not to attempt the removal of the disease by operation, as the tumour evidently had some very deep attachments, which would most probably have rendered the completion of the operation impossible. The skin was also so thin, and so closely united to the surface of the tumour, that it would have been necessary to have removed so great an extent of it, and not more than half the wound could have been covered. The advanced age of the patient, and her disinclination to submit to operation, were also considered, and, along with the other circumstances which have been mentioned, led to the decision against attempting it, although in all probability the disease was not of a malignant character. Upon this point I was unable to form a positive opinion, but was inclined to believe in the non-malignant nature of the tumour from the slowness of its growth, the absence of any evidence of contamination of the system, the unimpaired state of the woman's health for so long a period, and from the circumstance that, although the cysts, after having been punctured, suppurated and formed ulcers upon more than one occasion, yet these ulcers healed favourably, and never showed any tendency to produce fungous growths. For some time before death the pain was excessively severe; and upon one occasion a protracted attack of vomiting occurred, which, however, completely yielded to treatment. Towards the end of December, suffocative catarrh established itself, under which the patient sank, and died a few days since. Upon examination after death, the tumour (which was covered by the sterno-mastoid muscle) was found to have passed down among the deep structures of the neck, and to have become closely adherent to the upper part of the carotid artery; it reached upwards to the mastoid process, and was continuous with the parotid gland behind the angle of the jaw. In consequence of the destruction of its cystic portion by suppuration, as already mentioned, it was not much more than half as large as it was when the woman was admitted into the hospital. The structure of the tumour was carefully examined by Dr Lyons. It was found to present a strong fibrous basis, in parts hard, dense, and shining; a large number of loculi existed in it, varying in size from a couple of lines in diameter to half an inch; they were filled with a soft, granular matter, varying in colour from pink to red, and having very much the appearance of mashed strawberries. Under the microscope there was observed an abundance of granular matter; bodies of the size of small cells, isolated and aggregated; quantities of corpuscles; also blood-vessels; free and nucleated cells, some isolated, others grouped in various ways. The next element, found in abundance, showed what the nature of the tumour was, viz., masses of a tubular appearance, filled interiorly with cells. These masses were evidently the broken-down tubes of a glandular structure, existing through the strawberry-like mass, leaving no doubt that the tumour originated in the cervical glands, which subsequently were broken down by the infiltration of various matters. In one portion there existed a calcareous structure, a form of degeneration to which these tumours are liable. – January 7th, 1854.'
description: Numbering/sequence: Original reference number: 2041.