Cyst of the common bile-duct

Abstract

THE BRITISH JOURNAL O F SURGERYin its long diameter, and about 23 in. in its short diameter. It was bluishwhite in colour and uniformly firm in consistency. It showed in places nodular cxcrescences, whirh had a faintly ycllow colour. On one surface of the tuniour there was evidence that the growth had a thin fibrous capsule. ~IICROSCOPICAL l'IrcD,rlvcs.--'rhe tumour is composed mainly of fibrous tissue, scattered through which are bundles of non-medullatcd nerve-fibres and numbers of large multipolar nerve-cells. Fig. 368 shows a low-power microphotograph of the tumour tissue stained with cresyl violet. Under high magnification (Fig. 369) the large multipolar nerve-cells of the tumour are secn to have a ring of well-defined, peripherally-placed Nissl granules. The fibroblast nuclci are of a long oval shape, showing some irregularity in their contour.In this microphotograph can also be seen a few neurilenimal sheath-ccll nuclei, distinguished by their round or short-oval shape.Occasionally a nerve-cell can be seen undergoing division, and here and there are small collections of lymphocytes lying free in the tumour tissue. With Cajal's gold sublimate stain it is evident that there are large numbers of bundles of non-medullated nerve-fibres running through the tumour and that the main tumour mass is an intimate mixture of neoplastic non-medullated nerve-fibres and fibrous tissue. A silver impregnation picks out differentially the sheath-cell and fibroblast nuclei. With ammoniacal silver oside the fibrous tissue bundlcs do not impregnate deeply, suggesting that thc fibroblasts are somewhat immature. With Weigert's stain small medullated nervc-fibres can be seen running through the tumour in all directions.Processes can be seen arising from the poles of these nuclei.Our thanks are due t o Dr. I. H. Erb, Pathologist to the Hospital for Sick Children, Toronto, for his help.