When we observe the cut surface of these tumors we seldom find them entirely homogeneous; as a rule they contain more or less ramifying fissures, filled with a little sero-mucous fluid which coagulates on the addition of acetic acid.
More rarely we see a few roundish cysts, as large as a pea, near the fissured spaces.
When we make larger sections for examination with low powers, it is easily seen that these fissures are nothing more than the somewhat wid ened and very much lengthened branched excretory ducts of the gland, the walls of which are closely adherent to the fibromatous masses, just as the veins and lymphatic vessels in other fibromata are inseparably con nected with the fibromatous tissue. With a higher power it is seen that the cylindrical epithelium often lies against the wall in many layers.
In the contents of these fissures are found a few mucous degenerated cells, and fine granules disposed in a clear homogeneous substance. The tumors of this kind which I have examined were all in unmarried women or in women who had not borne children; the least clustered developed acini were unchanged, filled with roundish epithelial cells, and here and there were places in which the terminal vesicles were dilated.
At the same time the epithelia assumed gradually the form and situa tion of cylindrical epithelium; in the centre of the small cyst spaces lies a fine granular substance, in which we can differentiate a central globule and a peripheral layer; in the latter, we recognize with a higher power degenerated mucous cells, which before were completely lost in the mucus. What conditions are necessary for such a secretion will be mentioned later in the section on cyst formations. It may be said here that in the development of the already mentioned fissure spaces, and the small cysts from the terminal vesicles, there is doubtless an anatomical relation, and eventually a transition to the cysto-sarcoma, which will be spoken of later.
Symptoms and fibromata usually come on unnoticed and without pain. As a rule they are first pointed out to the physician when they have attained the size of a large hazel-nut or a walnut; they are then nodular, hard, very movable inside the gland, and are painless or only very slightly painful on pressure. Occasional adherence to nerves may, in a few cases, be the cause of excessive painfulness of such small tumors. I have never known these tumors to exist before the age of puberty nor after the fortieth year; they most frequently develop between the sixteenth and twenty-fifth years. But it is not therefore to be con cluded that small tumors of this kind seen in patients after the twentieth year, exist during or after the development of puberty, since the recog nition of the very beginning of such unusually slow-growing neoplasms is very difficult even for the physician, especially when the smaller nodules form deep in the gland.
It is very probable that by far the largest part of the tumors which Velpeau describes as " tumeurs adkoides," tumors which are also de scribed in literature as tumeurs fibrineuses, tumeurs squirrhoides, tumours fibreuses (Cruveilhier), tumeurs par hypertrophie partielle (Vidal), chronic mammary tumor (Cooper), pancreatic tumor (Abernethy), belong here, as also a few sarcomata and adenomata. According to Velpeau's sta
tistics, these tumors are most usually found in unmarried or sterile women. From Velpeau's statistics we obtain: GO on the left side, 59 on the right, 3 times in both breasts.
Tile growth of these fibromata is an unusually long one, and indeed there are cases in which the duration can scarcely be determined. For five years a childless woman, now in the middle of her thirtieth year, and who has had such a nodule in her right breast for ten years, has visited me annually, and I cannot say that it has undergone any change in the time mentioned. According to other authors, pregnancies cause an enlargement of such growths for some time, followed by a period of in activity. Most of the tumors which I have seen (and the number which I see in consultation is considerable) seldom attained the size of a hen's egg, and most of them were smaller; not infrequently, however, there are several in one breast or in both breasts. Only once have I had the opportunity to see such a tumor, in an eighteen year old girl, which reached the size of a goose's egg, when it was extirpated by B. von Lan genbeck, and found to be not nodular, but uniformly round. Velpeau states that of 131 cases seen by him, in only 65 was the tumor as large as a nut or hen's egg. Whether the statement that 34 were " de la gros seur de la tkte," and later 2 " comme la tete d'nn foetus" is to be taken as exact, or whether they were not cases of sarcoma and cysto-sarcoma, is very difficult to determine. It has already been remarked that small, fissure-like, smooth-walled cysts, seldom spherical, with thin mucous con tents and arising from the single gland-lobules;are found in these fibro mata; they are never entirely filled with fluid and form no essential but only an occasional accompaniment of these tumors.
A priori, it certainly would not be so improbable that such a fibroma should remain stationary for years, and that the fibromatous tissue should then change in some way to the form of soft sarcoma-tissue, with coinci dent dilatation of the gland-ducts, acini or gland clusters, and with the formation of a large quantity of secretion in the hollow spaces. So far as I know such a change of an adeno-cysto sarcoma has not hitherto been observed; furthermore, it seems that the more malignant infectious forms always have such a beginning. It may happen, however, that fibrom atous nodules, which remain painless for years, without noticeably in creasing in size, may become changed into carcinoma. The statements of many women are so explicit in this respect that we can scarcely doubt it. If this is not so, we would be forced to believe that the primary tumor was a carcinoma, which had remained unchanged for years, though this would contradict everything that we know of carcinoma. I have else where (Arch. f. Path. Anat., Bd. XVIII., p. 78) described a case anato mically in which I believed that I could recognize such an occurrence from examination of the preparation; still, I confess that at the time I made the examination the important part taken by the' epithelial elements of the gland in carcinoma had not been rightly determined, but it would be very difficult to explain the case in any other way.