Human Model for Studying the Bare Area of the Liver with Special Reference to the Metastatic Potential of Lung Cancer Metastases-Juniper publishers
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Abstract
The medical masters of yester years noted the great
importance of the actions of Nature in their writings. For instance,
Julius Cohnheim was emphatic that autopsies “are all in a manner
experiments instituted by nature, which we need only rightly interpret
to get a clear idea of the causes, laws of growth, and significance of
the tumour.” Indeed, as Nature has it, there is a “bare” area of the
liver. Moreover, this area is adjacent to the right adrenal gland.
Furthermore, as Bourne depicted, the position of the adrenal gland is
probably not fortuitous but related to some evolutionary factor.
Therefore, in line with my other practical papers, it is hypothesized
that, in cases of right lung cancer, a block containing hepatic and
adrenal deposits should be obtained. Then, special staining of the
individual lymphatic and blood vessels should be carried out. In all
probability, this process will reveal the routes of spread, especially
with reference to the interconnections of the individual metastases
present in both the liver and the adrenal gland. In other words, the
metastatic patterns will confirm or confute the concept of the
potentiality of hepatic metastasis in terms of being able to progress
further to the adrenal gland.
Recently, in a wide-ranging review [1], I documented
the views of notable medical masters whose vintages were 1847, 1870,
1889, and 1897. To exemplify, Julius Conheim [2] was coherent. In his
own words, autopsies “are all in a manner experiments instituted by
nature, which we need only rightly interpret to get a clear idea of the
causes, laws of growth, and significance of the growth.”
Growth of the liver type occupies a special niche
because that organ possesses the anatomically distinct “bare area” [3].
Moreover, the right adrenal gland is adjacent to this particular area.
Furthermore, as Bourne surmised [4], the adrenal gland’s position in the
human body is probably not fortuitous but related to some evolutionary
factor.
Factor of anatomical dimension is the method of
performing the autopsy. On this account, I instituted the mono-block
formalin-fixation method [5]. This method perfected the procurement of
nicely interconnected tissues from the neck to the pelvis. See For
instance, it was on this account that my paper on the pancreas was
succinct in that: its invasion by lung cancer “is due not to mere direct
extension but to discontinuous true lymphatic metastasis”[6]. In fact,
as I added, “This result demonstrates the value of reconsidering the
ways in which lymphatic spread of cancer may occur.”
In the 1970s, there was considerable interest in the
possibility of the one metastasis producing another metastasis. Thus,
Hoover and Ketcham [7], who entitled their paper “metastasis of
metastases,” demonstrated
it in experimental animals. Next, Roth’s associates
[8] documented at operation the “known metastases
originating from other metastatic foci.” Other investigators
came to the same opinion about this form of metastasis
[9,10].
Metastasis was studied elsewhere with special
reference to the cases of cancers adjacent to the skull and
brain [11]. There was also the paper in which the large
expanse of tissues between the stomach and the ovary was
examined for the presence of lymphatic pathways [12].
It is in this manner that I am persuaded that, in cases of
right lung cancer, a block containing both the bare hepatic
area and its adrenal metastatic counterpart should be
obtained. Thereafter, the now available special staining
technique should be used to differentiate between any
utilized lymphatic vessels or blood vessels. In other
words, the metastatic potential of metastases will, in all
probability, automatically manifest their possible roles in
the important right lung-liver-adrenal axis.
Nature has so anatomically arranged the bare area
of the liver and the contacting adrenal gland that the
new special staining technique [13] will clarify the
interconnecting positions, i.e., the invading cancer cells
cannot but give clear evidence of their respective foot
steps. Such pathways are best delineated during lymphatic
permeation. This will no doubt confirm or confute the
theory of metastases producing their own individual
metastasis. Incidentally, as regards the adrenal gland per
se, its selectivity during metastasis has been traced to
lymphangiogenesis [14]. Perhaps, this applies also to the
intervening liver or to sequential combination of both the
liver and the adrenal gland.
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