CASE HISTORY

In 1936 the patient developed a generalised rash which was diagnosed as syphillitic and for which she received courses of stabilarse and bismurn cream at the Hospital. In Jan 1938 there was transient looseness of the bowels which recurred from time to time until 7 weeks before admission when severe diarrhoea started and the patient developed a blue line in the gums. She also began to lose weight. She was admitted as a case of bismuth poisoning 15.7.38. Examination showed a thin, pale woman with well marked bluish-black line at the gum margins, staining smooth, homogeneous and stippled. Dark blue watery stools were passed three to five times a day containing a small quantity of blood. Sigmoidscopy revealed a fungating mass of tissue in the sigmoid colon. Biopsy showed a typical adenocarcinoma. Transferred to D2 6.8.38. Operation  11/8/38; transverse colostomy. A neoplasm was felt in the pelvic colon at the level of the brim of the pelvis. 6.9.28 excision of neoplasm with end to end anastomosis. At operation a cyst in the broad ligament was also removed. Biopsy of cyst showed adenocarcinoma involving the Fallopian tube. After operation patient developed cystitis and haematuria; this cleared up. The patient was discharged 4.11.38. Readmitted 23.11.38; colostomy opening closed 25.11.38. Discharged 14.12.38. Readmitted 6.2.39 complaining of pain in the back.  10.2.39 operation; small nodule was excised from the abdominal scar. Biopsy; adenocarcinoma. Following the operation abdomen became distended and 23.2.39 an enterostomy was performed. Patient gradually became weaker and died 12.3.39.

PATHOLOGY

The specimen consists of a piece of terminal ileum which has been laid open. On the mucosal surface there are several polypoid masses projecting into the lumen. They vary in size, the largest being about 1" in diameter. The larger ones are showing ulceration, and the smaller ones show marked hyperaemia. On the peritoneal surface the nodules are marked by scars. One nodule has been sectioned and shows a white meaty appearance.