Journal : Photographic review of medicine & surgery ; vol. 1., no. 1.
Philadelphia : J. B. Lippincott & Co., 1870-71.
Description : pp. -2,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Thigh — Cystic tumors.
THE case before us is that of John Gottlieb, aet. 54, a resident of Philadelphia, and a tinsmith by trade. He is a married man, father of a family, and has always enjoyed uniform health. About eight years ago he noticed a tumor growing on the inner side of the thigh, about three inches above the popliteal space. In a few weeks it attained the size of a fist, and remained so for seven years. Four months ago it began to increase, and now extends from the popliteal space to the pubes. It measures, in its greatest circumference, twenty-eight inches. The patient appears to be in the enjoyment of perfect health.
July 15, 1869. I passed a knife into the most dependent part of the tumor, and drew off thirty-five ounces of pus, looking very much like ordinary yeast. The opening was closed with adhesive plaster, and a bandage applied from the foot up to the pubes.
July 19, 1869. I laid the tumor open by an incision twelve inches long. It contained many cysts, each lined with false membrane and containing pus, the largest of these being about the size of a goose-egg. Near the upper portion of the wound and close to the pubes was a small cyst of the size, shape, and appearance of a testis. The lining membrane was two lines in thickness, studded with small gelatinous bodies, and there were also on the surface a great number of small cavities, or alveoli, which gave it a worm-eaten appearance. The alveoli were, for the most part, filled with the same transparent bodies resembling jelly. The microscopical examination, made by Dr. William Pepper, revealed small gelatinous bodies, presenting all the characters of ordinary hydatid membranes and echinococti with their the characters of ordinary hydatid membranes and echinococti with their hooklets. The thick exterior sac was the adventitious one ; the soft, large, central one, the parent cyst, contained an endogenous brood. The fluid in the adventitious cyst surrounding the true cyst was pus in a state of advanced fatty degeneration. The contents of the parent cyst were very fatty, and there was, in particular, abundance of cholesterin. This is undoubtedly a case of acephalocyst, developed in a very unusual situation, and in a broken-down, disorganized condition. The wound healed kindly, and the patient made a rapid recovery.
In conclusion, it is proper to state that the patient had been in the habit of eating pork for many years.
Gross reviewed this case for a chapter on cysts and cystomas published in the fifth edition of his surgical compendium titled, A System of Surgery: Pathological, Diagnostic, Therapeutic, and Operative, (1872), which included a a wood engraving of the photograph.