Acute non-specific pericarditis. A description of nineteen cases.

Bwmm 277 tissue does not normally occur (Davis et al., 1955). This stipulation is necessary, since benign tumours have a multifocal origin in approximately 10% of cases, but in such cases tumour cells are confined to tissues which normally contain chromaffin elements. Case 1 was regarded as malignant because phaeo-chromocytoma cells were found in a lymph node, a site which would not normally contain chromaffin elements. On the other hand, Scott and Eversole (1960) and Farley and Smith (1959) described cases where nodules of tissue completely composed of phaeochromocytoma were found in relation to the iliac vessels, and since no lymphatic tissue was present both of these cases were regarded as being tumours of multifocal origin. Alternatively , it is possible that a lymph node had been involved and had been completely replaced. If this were so it would indicate a very good prognosis in this type of case, since both of these patients were alive and well six and seven years afterwards. Another feature of Case 1 which may indicate a good prognosis is the fact that the principal metabbliite found in the urine was normetadrenaline. Robinson et al. (1964) found that the precursor dopamine was present in large quantities in the urine of a patient suffering from a malignant phaeochromocytoma and that this substance was again present in the urine when the growth recurred 11 months later. Dopamine is found at an early point on the metabolic chain leading to the production of adrenaline and noradrenaline, and it may be that its presence in the urine indicated a more primitive type of tumour and hence a bad prognosis. No trace of dopamine could be found in the urine of our patient either before or after operation. Some 10% of phaeochromocytomas are malignant, and in general the prognosis of these malignant tumours is poor (Hermann and Mornex, 1964). After initial surgical treatment there is usually a period of amelioration lasting for about a year, after which hypertension returns and soon causes death. Longer survivals have been recorded, and one of these was in a child (Cone and Pearson, 1963). In this case, six years after the removal of a tumour from the organ of Zuckerkandl, persisting hypertension led to a further exploration, when recurrent growth was found in the retroperitoneal tissues. For these reasons it was difficult to assess prognosis in our case, and in view of the doubt …