Tuberculosis of the tunica vaginalis testis, with a clinical and pathological report of two cases : from the Surgical Out-Patient Department of the Royal Hospital for Sick Children / by Harold J. Stiles.

  • Stiles, Harold J. (Harold Jalland), 1863-1946.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Tuberculosis of the tunica vaginalis testis, with a clinical and pathological report of two cases : from the Surgical Out-Patient Department of the Royal Hospital for Sick Children / by Harold J. Stiles. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and distended with a firm, fleshy, greyish pink, bulging tissue, evidently tubercular, but presenting no macroscopic areas of softening. The vas deferens looked healthy. Occupying the centre of the tubercular mass in the processus vaginalis was a small fissure-like canal, surrounded by soft granulation tissue. Microscopic preparations were made from complete transverse slices of the organ at various levels. The appearances of a section through the middle of the testicle are well seen in Plate XIII. It will be seen that the testis, epididymis, and vas are all quite healthy, and that the tumefaction was due, so to speak, to a natural injection, obliteration, and distension of the cavity of the tunica vaginalis with a solid tubercular tissue. The followmg points may be noted regarding the character of the tubercle:— 1. The individual tubercles are well developed and numerous; the giant cells are well formed, and two, three, sometimes more, occupy the same follicle. 2. There is an entire absence of caseous softening. 3. The small-celled or inflammatory zones of the tubercles are poorly represented or entirely absent, their place being taken by a young fibroblastic connective tissue. It would appear, therefore, that in this case we have to deal with a tubercular tissue that has no tendency to undergo degenerative softening, or to set up any degree of inflammatory reaction around it; indeed, it possesses qualities which charac- terise a tubercular tissue endowed with the power of spon- taneous healing,—such, for example, as that which leads to ankylosis in the natural cure of a tubercular joint. This fact is worthy of mention, now that we know that tlie abdominal tuberculosis has been recovered from. I do not wish to infer, however, that cure would have resulted spontaneously in tlic case of the tunica vaginalis, because the various irritations to which the part is liable would favour a slow but certain advance of the disease, ending in the invasion of the testis, epididymis, and cutaneous structures. So far, however, the tunicu allDuginea has formed a successful barrier against the invtision of the testis. Although the epididymis is, like the testicle, liealthy, it would no doubt have become involved earlier tlian the latter, in consequence of the relative thinness of its capsule.