Gall-stones and diseases of the bile-ducts . emarcation between an adenoma and acancer, for in all forms of cancer arising in the duct-system of the liver from the beginning of the bile-canals to the ampulla in the duodenum the groundplan underlying their structure is tubular. Rind-neisch, in reference to this kind of cancer, writes : The peculiar intention which is expressed in thewhole foundation advances to a delusive imitation ofa tubular gland. TI13 tubular arrangement may be well seen insome intrahepatic cancers, and especially in meta-static deposits in the lungs. Although carcinoma may
Gall-stones and diseases of the bile-ducts . emarcation between an adenoma and acancer, for in all forms of cancer arising in the duct-system of the liver from the beginning of the bile-canals to the ampulla in the duodenum the groundplan underlying their structure is tubular. Rind-neisch, in reference to this kind of cancer, writes : The peculiar intention which is expressed in thewhole foundation advances to a delusive imitation ofa tubular gland. TI13 tubular arrangement may be well seen insome intrahepatic cancers, and especially in meta-static deposits in the lungs. Although carcinoma may arise in any part of theexcretory apparatus of the liver, it is more common 120 DISEASES OF THE BILE-DUCTS in the gall-bladder than in the main ducts; it will beconvenient to study its leading features as mani-fested in this organ. Cancer of the gall-bladder.—This disease has inrecent years attracted a large amount of attention;this is in a measure due to its intimate associationwith gall-stones, though this fact has been Fig. 38.—Section of an adenoma of the liver showing- the tubularstructure (after Paul). The cavities were filled with greenfluid. Cancer may arise in any part of the mucous mem-brane of the gall-bladder, and, like this diseasewhen it attacks the intestine, may project into thecavity as an exuberant fungating growth, or infil-trate its walls and spread directly into the subjacenthepatic tissue. Occasionally the disease may belocalised to the fundus of the gall-bladder, and bud-like processes of growth will perforate its walls andthe cells from the surfaces of these buds}i willgive rise to general cancerous infection of the peri-toneum. CANCER OF THE GALL-BLADDER 121 It is not uncommon for the gall-bladder to be im-plicated and infected with cancer of the liver bothprimary and secondary; it requires a little care todiscriminate between primary cancer of the gall-bladder infiltrating the liver and cancer of the liverimplicating the gall-blad
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