TUMOURS OF THE KIDNEY.
of the kidney are occasionally seen in children, and generally occur in the form either of a sarcomatous growth or of a hydronephrosis.
Sarcoma of the kidney constitutes the ordinary form of renal cancer met with in the child. It occurs usually at an early age (the cases which have come under my notice have been all under three years old), and is usually confined to one side of the body. In the kidney, as in other or gans, the growth often reaches a very large size.
Morbid Anatomy.—The sarcoma is usually of the round-celled variety ; but the tumour often contains, in addition to sarcoma tissue, striated mus cular fibre scattered or arranged in bundles. Under the microscope these tumours are found to have a fibrillated structure, some fibres being slightly spindle-shaped, with an indication of a nucleus ; others, more elongated, with signs of transverse striation ; others, again, well-developed, with dis tinct striation. But even in the best developed fibres no sign of a sarco lemma can be seen. In some cases the new muscular and sarcomatous tissue is dispersed through the kidney substance, and the tumour is then really a tumour of the kidney. In other cases the new tissue seems to be separated from the kidney substance proper, although lying within the capsule ; or it divides the organ into two parts without, as in the other case, infiltrating its substance. It has been suggested that these growths may be derived from the remains of the Wolffiau body.
Symptoms.—No pain • seems to attend the development of these tu mours, and at first there is little interference with the general health. Consequently, the earliest sign to attract the attention of the attendants is the unusual size of the child's belly ; and the mother often complains that the belly feels harder on one side than it does on the other.
On examination, in such cases, we find a globular swelling occupying one side of the abdomen. The swelling is usually little movable, and does not descend, or moves very slightly, in inspiration. Its borders .are rounded, and there is no edge felt, as is the case with the spleen. Its substance is soft and elastic, so as to convey an imperfect sense of fluctua tion. Below, the fingers can be pressed between the lower border and the brim of the pelvis ; above, the tumour passes beneath the liver, or on the left side is continuous with the splenic dulness beneath the false ribs ; externally, the swelling reaches backwards into the loin, and there is seldom any intestinal resonanceto be detected between it and the spine.
As the tumour grows the only inconvenience felt is the weight of the mass in the abdomen. The appetite is good, often exceptionally keen, and nutrition is fairly performed. The urine is usually normal, although in some cases it may contain albumen and blood ; and towards the end it may-be scanty, with infrequent micturition.
After a time, as the size of the growth increases, secondary derange ments from pressure begin to be noticed. The earliest sign that the growth is interfering with neighbouring parts is usually an enlargement of the su perficial veins of the abdominal wall from pressure upon the vena cava. This is often followed by cedema of the lower limbs and scrotum. Sometimes the liver enlarges from passive congestion ; and dyspncea may be induced from pressure upwards of the diaphragm by the renal mass. When these signs are noticed nutrition becomes affected, and the end is not far off. The child gets thinner, and soon wastes rapidly. His appearance becomes cachectic ; aphthm develope in the mouth, and he sinks and dies. Before death the emaciation may be extreme.
These symptoms are well illustrated by the case of a patient in the East London Children's Hospital, under the care of my colleague, Dr. Donkin, through whose kindness I had several opportunities of examin ing it.
A little girl, aged two and a half years, was brought to the hospital on account of a swelling of the belly. The mother stated that she had no ticed three months before that the belly was large and hard on one side, and that a doctor had said there was a tumour of the abdomen. For a month the child had been languid and fretful, picking her nose, and moaning in her sleep. Now and then she had complained of abdominal pains, and once or twice she had vomited. The bowels were disposed to be costive, and the water was occasionally milky (from lithates).