Reprinted from the Montreal Medical Journal, December, 1894. 
CASE OF PRIMARY CARCINOMA OF LIVER.* 
Professor of Pathology, McGill University, Montreal, and Pathologist to the Royal 
Victoria Hospital. 
J. G. Adami, M.A., M.D. 
During the last session of the Society I brought before 
the Montreal Medico-Chirurgical Society a case of true 
adenoma affecting the liver of a woodchuck, and arising 
primarily, as its structure amply demonstrated, from the 
parenchyma of that organ, j- 
I have now to describe you a case of very similar nature 
in the human liver, only here the adenoma has taken on a 
malignant character and secondary growths have developed 
elsewhere. 
The specimen was obtained at a post-mortem made at 
the Royal Victoria Hospital on September 4th. The sub- 
ject from whom it was obtained, J. 8., aged 45, entered the 
hospital under Dr. Stewart, complaining of weakness and 
loss of flesh, with pain and swelling in the abdomen. He 
had been addicted to good living and excessive use of 
alcohol and there was a doubtful specific history. About 
a year before admission there had been a violent attack of 
jaundice, from which patient gradually recovered. 
The liver dulness extended from the fifth rib to two 
* Read in abstract before the Montreal Medico-Chirurgical Sgpiety, Nov- 2nd, 1884, 
t Vide this Journal, Vol. xxiii., p, 55, July, 1894, 2 
inches below the costal margin, the edge was sharp, while 
the anterior surface presented a nodular mass the size of 
the list, movable with the liver. 
This lump in the right side, noted now to be in connec- 
tion with the liver, was first observed five months ago. 
Without dwelling fully upon the condition of the other 
organs it may be added that there was much ascites. The 
patient was tapped twice and each time a blood-stained 
ascitic fluid was removed containing both red and white 
corpuscles and urea ; it was highly albuminous. 
With this history a diagnosis was made of cancer of the 
liver. The autopsy fully confirmed this diagnosis. 
In connection with the liver within the substance of the 
right lobe was the large pale-coloured mass seen in the 
specimen handed round. Upon the surface were several 
semi-transparent nodules of new growth in the capsule, but 
upon section the only recognizable focus of new growth 
within the organ was the one large well-defined mass. This 
mass was 10.5 cm. broad and 14 cm. long sharply separated 
off from the surrounding liver tissue; it was placed anteriorly 
at the left extremity of the right lobe and to the left of the 
gall bladder. This last was greatly thickened and pressed 
to the right by the growth. Upon opening it was found 
to be full of thick brownish-grey pultaceous mass of mixed 
pus and bile, with such intense staining power that even 
now upon November 2nd the nail of my left index finger 
is stained from exploring the gall bladder of this case upon 
September 4th. In this mass lay several soft small facetted 
gall stones, wdiich easily crumbled and broke down when 
handled. Two larger and firmer stones lay at the opening 
of the cystic duct and appeared to completely block it. 
The great omentum was greatly thickened and of a deep 
blood-stained tint, very nodular and brittle. The small in- 
testines presented -numerous semi-transparent nodular 
growths upon their serous surfaces. There were further 
numerous small nodules scattered through the mesentery 3 
and imbedded in the fat. There was no sign of new 
growth anywhere within the intestinal tract. 
Beyond oedema of the lungs and interstitial nephritis 
there was little calling for additional remark. 
Upon microscopic examination the new growths here de- 
scribed were typically carcinomatous, of the medullary type;. 
The great size of the mass in the liver, as compared with 
the minute nature of the nodules elsewhere, appeared to 
indicate that in the liver was the primary growth, and micro- 
scopic examination proved the correctness of this suggestion. 
More especially towards the growing free surface the 
mass could be seen to be composed of characteristic liver 
cells, large, tending to be cubical and pigmented, possessing 
a tendency to be arranged in an alveolar manner. Else- 
where, deeper down in the tissue, the cells became smaller 
and the collections were separated off from each other by 
well formed fibrous stroma. In parts there was a tendency 
for the cells to be arranged around a central lumen. 
The sections, in fact, possessed all the characteristics of 
an adenoma, or new growths of the liver tissue which had 
taken on malignant characters. This malignancy was 
further demonstrated by the abundant new growths in the 
abdominal cavity. 
Primary carcinoma in the liver may be of three types: 
1. Generalized carcinoma, the cirrhosis carcinomatose, 
of Peres. 
2. Localized carcinoma orginating from the liver cells 
proper. 
3. Localized carcinoma originating from the smaller bile 
ducts. 
A fourth form, not truly hepatic, invades the liver after 
primary origin in the larger bile ducts. 
x «/ o O 
Here in this case we are dealing with the second form, 
that is to say, with a true liver cell cancer, which is of 
sufficient rarity to be placed on record. 
Finally, it is interesting to observe the relationship that 
in this case appears to exist between the inflammatory dis- 4 
turbance of the gall bladder, which dated back a year, and 
the cancer which has arisen in close juxtaposition to the 
inflamed bladder. The suggestion is that some relation 
exists between the two. It is noticeable that the gall 
bladder itself exhibits no cancerous growth ; it is only 
chronically inflamed, but immediately outside it, in the 
region that is of congestion and over nutrition of the tissue 
has originated this new growth.