Gall-stones and diseases of the bile-ducts . cre-tion in the gall-bladder as a precancerous is, however, a curious fact, and one worth bearingin mind, that although cancer of the gall-bladder isnearly always complicated with gall-stones, thisassociation is quite exceptional when primary cancerarises in the common bile-duct or the ampulla. The relations of the stones to the cancer vary agreat deal; in some the walls of the gall-bladder aregreatly thickened and the calculi are nested togetherin the centre of the mass (Fig. 39). In other casesthe gall-bladder is filled with a semi-pu
Gall-stones and diseases of the bile-ducts . cre-tion in the gall-bladder as a precancerous is, however, a curious fact, and one worth bearingin mind, that although cancer of the gall-bladder isnearly always complicated with gall-stones, thisassociation is quite exceptional when primary cancerarises in the common bile-duct or the ampulla. The relations of the stones to the cancer vary agreat deal; in some the walls of the gall-bladder aregreatly thickened and the calculi are nested togetherin the centre of the mass (Fig. 39). In other casesthe gall-bladder is filled with a semi-pultaceous massof soft white growth, and the gall-stones are irregu-larly distributed through it. In a specimen of thiskind I found eighty-six almost pure cholesterin cal-culi, resembling square lumps of spermaceti. The 122 DISEASES OF THE BILE-DUCTS growth in this instance was so soft that it could bescooped out of the gall-bladder as if it were other instances the cancerous walls of the gall- Liver Gall-stones Tumour ofgall-bladder. Fig, 39.—A cancerous gall-bladder in section (Museumof the Middlesex Hospital). bladder are thick and tough, and firmly contractedon a set of gall-stones which completely fill it; yetthe organ is free from adhesions and mobile. Onthe other hand, it may be tightly contracted on a CANCER OF THE GALL-BLADDER 123 solitary gall-stone, and the growth so infiltrate the liverthat there is no obvious indication of the limit betweenthe gall-bladder and the hepatic tissue (Fig. 40).
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