LIPOMA.
In the few cases which have been described as lipoma of the female breast there is a doubt whether they really originated in the connective tissue binding the lobules together, or whether they were developed be hind or near the gland in the loose cellular tissue, and thence pushed the gland before them; in a few cases this seems certainly to have occurred. This was so in a case which I saw and which has been reported by Carl Hegetschweiler: Agatha St., thirty-four years old, admitted February 14, 1865; was entirely well until six years ago. At that time, while sawing wood, she felt a pain in the right breast just above the nipple, and at the same time noticed a tumor at that spot; the pain soon passed away, but the tumor grew constantly. In March, 1863, she was confined, and the swollen breast had possibly more milk than the healthy one, though she did not nurse her child from it at first, chiefly because the nipple was flattened by the tumor, and the child could scarcely get hold of it. The growth continued to increase, becoming especially large at each men strual period. The condition of the breast at the time of admission is shown in Fig. 12.
The tolerably dark-colored nipple with the areola lay as nearly as pos sible at the most dependent portion of the enormously enlarged mamma, which felt nodular, large-lobed, partly soft and partly firm and elastic. The length from the upper portion to the nipple was 17.2 inches. The skin over the tumor contained dilated veins, was thinned but did not adhere to the neoplasm. The lymphatic glands were not enlarged, and the general condition of the not very strong, though well-nourished woman, was not at all disturbed.
Since scarcely anything else than diffuse hypertrophy and cysto-sarcoma of the breast attain such enormous size, I thought it must be one of these conditions or perhaps a combination of both. After the extirpation on February 16, which consisted in amputation of the mamma, with removal of all superfluous skin, I found that it was a giant lipoma. Ex amination showed that the mammary gland itself was pressed flat by the tumor and was pushed evenly forward. Unfortunately the tumor was not weighed, or, if it was, its weight was not noted. It had clearly devel
oped behind the breast, and in front of the fascia of the pectoralis muscle. The wound healed well.
Astley Cooper saw a case very similar to this. The lipoma weighed fourteen pounds five ounces, and the mammary gland lay in front of it. The incision for the operation was thirty-two inches in circumference. The preparation is in St. Thomas's Hospital Museum in London. Vel peau mentions three cases, the third of which was similar to that above described. The tumor developed behind the right breast of a young woman (age not given) of somewhat delicate constitution, and in three and a half years grew to enormous size; it was spherical, 19.65 inches in circumference, reaching, when the patient stood erect, downward to the crest of the ilium and on account of its weight (4+ pounds) it was some what pediculated. The nipple lay below and to the outer side, and had no firm connection with the tumor. Though in the beginning it is said that the tumor was made up of a mixture of fatty and hypertrophic glandular tissue, no glandular tissue could be found by the microscope in that part which was supposed to be mamma and which contained in spissated milk (?). In V elpeau's first case, the tumor was as large as two fists; in the second, as large as a hen's egg. Birkett, Erichsen, and Gross do not mention lipoma of the mamma at all. Of the cases of Por talupi and Lebert (Becourt), mentioned by Hegetschweiler, it is very doubtful if they had any connection with the mamma.
Since, in the later years of life, after atrophy of the glandular tissue, the whole texture of the mamma is changed into fatty tissue, and there is no denying the possibility of the interacinous connective tissue forming fatty tissue, it is very remarkable that lipoma is so seldom formed within the mamma. There is no case known in which the glandular was in cluded in the lipomatous tissue.
The cases which have hitherto been observed up to the end of the twen tieth year, did not occur in especially fat and strong women, but rather in slender women. The growth was of moderate rapidity, still not so very slow when its size at the time of operation is considered. The diagnosis can seldom be made positively.