Owing to the kindness of my friend, Mr. H. Gray, 1 have recently had the opportunity of examining a remarkable specimen of Been chocele. The gland was greatly enlarged,—to five or six times its natural magnitude,— and altered in form, one lateral lobe being raised up higher than the other, and the surface being somewhat uneven and nodulated. On a section being made, the exposed surface presented a reddish glossy aspect, somewhat resembling that of certain forms of malignant disease which are undergoing softening : there was no appearance of distended cavities ; in fact, the structure to the eye exhibited less of the cellular arrangement than is usual. Micro scopic examination confirmed the impression derived from simple inspection. — But little of the natural secreting structure remained, the vesicles being destroyed, and their secretion, though still present in some quantity, being certainly diminished. Some traces of the epithelium of the cavities were perceptible ; but there was no special cell growth indicative of any adventitious formation ; a few large cells or globules only, varying in size from to in. diameter, existed in some of the remaining cavities : these evidently consisted of aggregations of oily molecules and drops not manifestly enclosed by any en velope. The blood-vessels were prodigiously and universally enlarged ; some of those which were capillaries in structure were from two to three times their normal diameter, and irre gularly dilated and varicose ; they were every where clustered over with minute oil drops ; which formed so thick a coating to many of them, that they appeared as white cylinders by direct light. Some parts of the gland pre sented to the naked eye a whiter aspect than others ; and in them it was seen that the de posit of oily matter along the vessels, and the destruction of the glandular tissue, had pro ceeded to the greatest extent. In some places there were masses of ossiform deposit.
The morbid alteration now described ap proaches most nearly, I think, to the vascular and aneurismatic bronchocele ; but the exten sive destruction of the glandular tissue, and the copious deposit of oily matter, show that there must have been some grave derangement of the nutrition of the gland. The case oc curred in a female (mt„ 75.), who died with cirrhosis of the liver and ascites ; the kidneys contained numerous small cysts, and there were two fibrinous blocks in the spleen.
Adventitious formations.— Cystic formation within the thyroid is next described by Pro fessor Hasse ; and regarding it as depending on the development of new cysts within the gland, and not on the perverted or ex cessive action of its own natural vesicular cavities, it will fall under our third head. I am, however, rather in doubt whether most cases of cystic formation in the thy roid do not belong to the second category, and are not dependent on the development of any adventitious structure. Prof. Hasse says, " cystic formation within the thyroid gland is one of the most frequent causes of goitre. It occurs both by itself, and in con junction with other kinds of degeneration, and constitutes the largest and most unsightly of all tumours. Cysts of every variety and size, either solitary or in congeries, are en countered in every part of the thyroid gland ; an entire lobe, nay, the greater portion of the whole organ, being sometimes engaged in cystic development. The surrounding tex ture is seldom healthy, being generally com pressed, flabby, and bloodless. The cysts are, for the most part, isolated. Occasionally, how ever, they abut one upon another, so as to form a single multilocular capsule. Here, as elsewhere, they are composed of two mem branes ; namely, an external filamentous, and an inner serous, one. The external membrane is either smooth, or sends forth bands which attach it closely to the rest of the texture ; in many instances it partially, if not wholly, ossifies. The sac contains a limpid fluid, or a number of secondary hydatids*, or, again, a jelly-like substance, but more commonly a yellowish or whitish crystalline pulp, consist ing almost wholly of cholesterine crystals with phosphate and carbonate of lime. In
some instances the cyst accidentally inflames and becomes atrophied ; in others it gradually fills with earthy matter, and is transformed into a hard calcareous nodule. Cysts occur in the thyroid gland, in both sexes, and nearly at all ages ; more frequently, however, in females after the prime of life." A remarkable case of cystic formation in the thyroid is mentioned by Andral. He states that the whole organ was converted into a cyst with bony walls filled with a honey-like fluid. He seems to recognise both the cystic and melicerous degeneration as further stages of the per verted or excessive action which occurs in simple hypertrophy, and justly refers to the case of the ovary as exactly analogous, the cysts of which, filled with various products, originate, in all probability, in Graafian vesicles, which undergo an abnormal development.
Prof. Hasse has never met with tubercles occurring in the thyroid. Prof. Louis makes no mention of such an occurrence, nor does M. Papavoine in a table which he gives of the seat of tubercle in various degrees, drawn up from the examination of the bodies of fifty children.
Sauten has observed that persons affected with extensive bronchocele seldom or never become subjects of phthisis.
Carcinomatous growths rarely affect the thy roid. Eight cases in 8289 of deaths occur ring from cancer in Paris, are ascribed to this part.* The disease is sometimes primary, sometimes secondary, or the result of invasion from some neighbouring affected part.
Encephaloid or scirrhus in several of their varieties have been known to occur in the organ, but no example of colloid in it has yet been detected : of course cysts filled with melicerous contents must not be confounded with the loculi of real colloid, to which they bear some resemblance. Primary cancer in the thyroid usually exhibits the characters of scirrhus, secondary those of encephaloid: in the first case the disease is usually infiltrated, in the second of the tuberous form. Ence phaloid here, as elsewhere, often grows rapidly, and attains a large size. It seems to ob literate entirely the natural appearance of the gland. It is often of the homatoid variety, in which there is sometimes softening in the centre of the mass, causing rupture of vessels and extravasation of blood. Occasionally black pigment is accumulated within its texture in varying amount, " Medullary cancer of this gland must not be confounded with that of the lymphatic glands of the neck, which often simulates goitre." Enlargement of the Vessels. — The last kind of morbid degeneration, which the thy roid has been observed to undergo, is that to which the term vascular or aneurismatic bronchocele has been applied. It is de scribed as follows by Professor Hasse,—" All the blood vessels are much amplified, the veins in particular forming very dense, capacious, often knotted, plexuses, and the whole texture consisting apparently of a dense coil of vessels. The substance of the gland has almost en tirely lost its granular character ; it is flabby and dark red. After death the tumour col lapses considerably, and can only be restored to its original size by artificial injection. The walls of the arteries and veins are attenuated, the dilated membranes of the vessels contain considerable clots, and capacious cavities are found filled with black coagulated blood. Vascular:bronchocele affects the entire gland; principally, however, one or other lobe. It occurs most frequently in females after the prime of life, and is, like simple hypertrophy, marked by periodical augmentation and de crease. This general dilatation of blood-vessels must not be confounded with the exuberant vascular (malignant) growth termed fungus hwniatodcs, to which the thyroid gland is also subject." In the foregoing description we have clearly set forth the condition of an organ, the walls of whose vessels have, from loss of their natural tonicity, yielded to the impetus of the current of blood, and being thus enlarged and distended, have pressed upon the essential structure of the gland, and caused it to become atrophied.