Carcinoma seldom occurs in the testicle in the dense form which it commonly assumes in the breast. Sir A. Cooper describes a scirrhous disease of the testicle, in which the gland is invaded by a large white mass in lobes or tubercles. The spermatic cord is affected with a similar disease, and the glands of the abdomen become converted into a white solid texture, very unlike that of the fungoid disease. I have a man, 52 years of age, under illy care at the present time, with this disease of the testicle. It forms a tumour about three times the natural size, and is almost of stony hardness, especially at the back part. There is also a large indurated tumour in the spermatic cord. This affection of the testicle is very rare, and is charac terised by its slow progress as well as by its great induration.
Encephaloid cancer is by far the most fre quent form of malignant disease to which the testicle is liable. When first observed, it is found in one or two masses amongst the tubuli, which gradually become destroyed as the morbid deposit accumulates. The matter is very rarely infiltrated. The testicle at this early period is extremely firm and hard, owing, not to the solid nature of the sub stance effirsed, but to the excessive distention of the unyielding tunica albuginea by the morbid growth within. The glandular struc ture soon entirely disappears, the whole organ being occupied by the new growth, inter mixed with and sustained by the septa and fibrous processes from the rnediastinum and tunica albuginea. In some instances a thin layer of the tubular structure is found ex panded around a mass of encephaloid matter. At this stage the tunica vaginalis is often dis tended with serum ; not, however, in any considerable quantity. The tunica albuginea next gives way, and a portion of the morbid growth protrudes, forming a mass projecting from the body of the gland ; this sometimes occurs in more places than one. The epi didymis remains for some time unaffected; but, as the disease increases, this part like wise becomes implicated and destroyed. In one instance I found the tubes in the head of the epididymis (the only part of the gland not destroyed) filled with white matter which, on microscopic examination, proved to be carcinomatous. The scrotum in a short time becomes fully distended by the diseased mass, which presents the well-known appearance of encephaloid cancer ; viz. a homogeneous substance of the consistence of brain, and easily broken down with the fingers, of an opaque white colour, and variegated with patches of a pinkish hue. It is sometimes mixed with small cysts containing serum ; at other times with yellow deposits of lymph, resembling that effused in chronic orchitis.
These small depositions of yellow fibrine oc casionally interspersed amongst the carcino matous matter, are almost peculiar to this dis ease in the testicle. I have only once observed them in cancer of other parts, and that was in the kidney. As the enlargement goes on, the scrotum becomes adherent to the tumour in one or more places, then ulcerates, and allows the protrusion of the morbid mass, which projects as an open fungus. The scrotum admits however of great distention before ulceration ensues. The mass then becomes less firm, and its consistence varies very much in different parts, the morbid matter being in some a mere pulp, or re sembling a creamy fluid. It is interspersed with round or irregular patches of dark look ing coagula, and, when incised, often presents in different places dark minute spots of va rious sizes, produced by coagulation of blood in the vascular network usually mixed up with the morbid deposit. On macerating these tumours, or on pouring a stream of water on them for some time, a granular sub stance, the cancerous matter, is washed away, leaving behind a filamentous shreddy tissue or meshes of a delicate areolar texture, which may often be found connected to a denser fibrous substance, the remains of the tunica albuginea. The spermatic cord is often in vaded by a similar substance ; and in an ad vanced stage of the complaint, large bodies of the same kind, originating in disease of the lumbar glands, are found on the sides of the vertebrm, reaching as high up as the dia phragm.
Masses of a similar kind are sometimes also found in the lungs. The carcinoma tous matter is often deposited in such abun dance as to form a tumour of very con siderable size ; indeed, there is no other dis ease of the testicle which occasions solid en.
largements of so great a magnitude as ence phaloid cancer. M. P. Boyer removed a testicle converted into an encephaloid tumour which weighed more than nine pounds.* The vessels of the cord undergo great enlargement in this disease. In one case which I examined, the spermatic artery was found as large as the radial artery at the wrist. Cancerous germs have also been found in the blood contained in the spermatic veins. Encepha loid cancer of the testicle occurs at all periods of life : no age, indeed, can be said to be exempt from it. There are examples on record of operations for the removal of tes ticles thus affected, within a twelvemonth after birth. On the other hand I have met with the disease as late in life as the age of sixty-four. It more commonly occurs, how ever, in the middle period of life, or between the ages of twenty and thirty.