Primary carcinoma of the pancreas in an infant aged seven months

Lymphosarcoma was found in a new-born infant by L'Huillier (1904), and in a girl aged four years by Litten (quoted by Ewing, 1928). Todd (1818) reported a case of a girl aged fourteen years, who having been ill for some months with pyrexia and digestive disturbances, became deeply jaundiced and died. Post mortem, the pancreas appeared scirrhous, and the head of the gland was converted into a solid tumour mass which obstructed the common bile duct, causing gross distension of biliary and hepatic ducts. Rokitansky (1842) and Wedl (1866) both describe a scirrhous condition of the pancreas in new-born infants, but in Wedl's case the mother had syphilis, so that the condition was probably syphilitic and not malignant. Battersby (1844) reperts a case of carcinoma in a fourteen-year-old child, and Herringham (1894) in a two-year-old child, but no details of the case are given and in none of these five cases is there any histological confirmation of malignancy. There are five recorded cases of pancreatic primary carcinema in childhcod in which histological evidence of malignancy has teen obtained. Bohn's case (1885) was an infant aged six months who was found to has-e an abdominal tumour and developed jaundice six weeks before death. Microscopy of the tumcur. which was situated in the head of the pancreas, showed that it had a finely meshed alx-eolar structure in the spaces of which were clusters of medium-sized cubical epithelial cells. There were secondary deposits in the lix er and in the glands at the portal fissure. Kuhn (1887) reported a case in a girl aged two years. This child had been ill for about nine months and then developed oedema of her legs and diarrhoea. An enlargement of the liver was found and she died from pneumonia. Post mortem the pancreas was found to be almost completely' replaced bv a reddish tumour, and there were secondarv nedules in the lix-er. Histology showed that the tumour was a cylindrical celled adeno-carcinoma. Simon's (1889) case was a thirteen-year-old boy, whose symptcms were anorexia and diarrhoea w-ith jaundice eight weeks before death. The whole gland w ith the exception of a small part of the tail, was inxolxed in a tumour mass, the histology of which was identical with Kuhn's case. Bandelier (1896) reports a similar case. Stewart and Stewart (1915) had a case in a nine-year-old boy, in whom pain, anorexia and constipation followed a blow on the abdomen. The child was well-nourished and the only abnormal clinical finding was an irregular mass situated in the left upper abdomen. At operation a tumour of the tail of the pancreas was revealed, the rest of the gland being hard and irregular. A few reddish lymph nodes were seen along the upper border of the pancreas, but there was no other evidence of secondary involvement in the abdomen. Only partial autopsy was performned but microscopically the tumour was found to have a fibrous tissue framework occupied by islets of closely packed cells showing mitotic figures and necrosis. The tumour was named medullary carcinoma of the pancreas.