ADENOMA (TRUE HYPERTROPHY) AND CYSTO-ADENOMA.
The differentiation of adenoma from many other tumors of the breast is unusually difficult. If the development of the gland-vesicles with for mation of hollow spaces be regarded as the most important, thing for the establishment of adenoma or true hypertrophy of the gland, still this cannot take place without a simultaneous growth of new connective tissue with vessels, else there would only be an interlacing cell-proliferation in the form of branched cylinders and terminal bulbs, which could not exist without formation of vessels Vessels grow, but never alone, in the epithe lium, for they need surrounding supporting tissue, however slight it may be. Now since the pathology of a new growth is important, because the relation of the different tissue elements to one another is more or less of a deviation from the normal type, it happens that in adenoma at ne time the epithelial elements, at another the connective tissue with the vessels is more prominent, not only in all tumors, but also in different parts of one and the same tumor When the newly-formed onnective tissue near the epithelial glandular elements ,omen o complete physio logical and at the same time excessive development the expression " false," " incomplete hypertrophy," or " elephantiasis " is used. If the
newly-formed connective tissue remains for the most part in the earlier stage of development, we use the expression adeno-sarcoma." If the growth of the epithelial elements is especially great, and if they are larger, more varied in form than they normally are, then the purely anatomical differentiation from carcinoma in certain cases becomes very difficult, be cause we scarcely dare set up a strict claim to an adenoma of the breast developing after an embryonal type, since immediately both hollow spaces and secretion make their appearance in the young acini, and this is not the case every where even in the development of the gland at puberty, but occurs first in the development accompanying the first pregnancy. As in many similar cases in the domain of pathology, we find in such a dilemma more support in the course and clinical appearances than in the (as Heinrich Meckel used to say " limited") anatomical analysis.