CASE HISTORY

The patient was admitted in May 1948 for biopsy of a pigmented papilloma of the hard palate, (s.48/790), which proved to be a malignant melanoma. It was treated with large doses of x-rays and radium. He was readmitted in October 1948 for a diathermy cauterization of the growth which was again biopsied (s.48/1522). No secondary deposits were present then after extensive examination. On 20.6.49 he had an x-ray examination of his chest which revealed multiple secondaries. He remained well until 10 days before admission when he had sudden onset of severe headaches and personality changes. On examination: he was confused; a small ulcer was seen on his hard palate; no abnormal signs were present on neurological examination and nothing abnormal was detected in the chest or abdomen. He became comatose, developed signs of pneumonia at both bases and died.

PATHOLOGY

Two specimens have been mounted- the bladder and the left kidney. The bladder has had the front wall removed to expose a large cauliflower-like tumour arising somewhere at the base and largely filling the bladder. The bladder itself is hypertrophied and shows trabeculation. The left kidney has had its front portion removed to show that there is gross hydronephrosis. The pelvis is greatly dilated and there is tumour in it about 2 cm above the junction of the pelvis with the ureter. There is another deposit in the ureter just below the junction and there is tumour filling and obstructing the lower end of the ureter. All these tumours have a rather papillary appearance.