PARTIAL HYPERTROPHY OF THE BREAST.-ADENOMA AND ADENOMA.
So far I never seen a tumor of the mammary gland which, on histolog ical analysis, admitted absolutely no other designation than that of a partial and glandular hypertrophy, a purely circumscribed adenoma. It was a long time before I met with a case that corresponded nearly to what other authors had described as true partial hypertrophy of the mamma. It is therefore more as a concession which I make to the systematic complete ness of this work, that I describe here the following cases; they should, perhaps, be brought in at other places (under fibroma, adeno-sarcoma, etc.) There are two entirely different groups of these so-called adenomata.
Fibrous Lobulated Adenoma.
The following figure gives a good idea of the appearance of the section of such a tumor, only the lower part is compact and fibrous; the largest, upper part, consists of lobes and lobules which are held together by loose connective tissue containing fatty tissue. The lobules feel in the breast of the patient firm and finally granular. Microscopic analysis shows that the centre of each lobule contains some partly dilated acini, though its prin cipal mass consists of a firm fibro-sarcomatous tissue, as is always found in the fibro-sarcomata occurring in young persona. If one imagines the fatty tissue, which is replaced in the more central parts of the tumor by loose bundles of connective tissue, absent, and the fibromatous tissue, which surrounds the single gland lobules, to be continuous, the tumor would in no wise differ from the ordinary fibro-sarcoma of the mamma.
I have no doubt that this tumor corresponds to what Forster saw, and of which he has made a teased preparation (Fig 30).
So lobular and gland-like seemed the tumor which I saw, that I could not prove that the acini found therein were pathologically newly-formed. A short time ago I saw a very similar tumor, in an unmarried woman, about 30 years old, with poorly developed breasts; there had formed a large number of hard, granular nodules, which varied in size from that of a pea to a bean, and part of which had in the course of the last few weeks become confluent. After the extirpation, the single hard nod ules looked exactly as shown in Fig. 29; between them there was corn pletely normal tissue. It would seem right to me to describe these cases as multiple lobular fibroma, which they are, anatomically speaking; though, if we must absolutely have a partial hypertrophy of the mamma as a form of tumor, these tumors must be classed as such.
I cannot give a clinical picture of these two cases. I am convinced that almost all that has been said of the course and origin of fibro-sarcomata will also apply to these cases. • The Soft Cysto-adenoma.
I have seen two cases, which, if we cannot relegate them simply to the crate-sarcomata, must be so described. At all events I have done this with one case, when recording it, for I found in my collection a tumor designated as " cysto-sarcoma," which answered to the histological pecu liarities which will shortly be mentioned, though I could not find the pro per clinical history, which had unfortunately become detached from the label of the bottle containing it.
In examining the tumor, without knowing where it came from, one might imagine that it was from a mucous polypus of the rectum or uterus. It is very remarkable that the acini of the mammary gland distend to such long drawn-out hollow spaces with mucous contents; that they are all clothed with a many-layered, manifest, cylindrical epithelium is less striking, because I have seen the same thing in proliferating cysto-sar coma. The distension is generally similar; it leads to irregular hollow spaces, into which, as may seem at first glance, papillary growths are forming. On closer analysis, it is soon found that these papillary growths are nothing else than the somewhat enlarged partitions between the acini. It is in miniature a similar developmental process to that occurring in cysto-sarcoma, except that the interstitial tissue here is not markedly ex uberant; not, or at least in only a few places, sarcomatously degenerated (the vascularisation therein had become somewhat richer, though the bundles of connective tissue remained most important), and that the dil atation was equally diffused in all the acini, while in proliferating cysto sarcoma, the excretory ducts become disproportionately dilated. Beige], under the description "Sarcoma Adenoides mammas," and lianig, under " Cysto-sarcoma proliferum," give an illustration which corresponds tol erably well to the above. A second case belonging here I have already described under " tubular cysto-adenoma of the mamma" (Arehiv. f. Kl. Chirurgie, Bd. I, p. 649). In this case there was as much difficulty in the clinical as in the anatomical diagnosis. I here quote from my former description: A short time ago (July, 1865) I extirpated a tumor from the right breast of a young married woman of about 24 years of age, who had never been pregnant; the tumor was about the size of a hen's egg, was immov able in the gland, felt lobular and uneven, and caused moderate pains which radiated to the arm of the affected side; it had developed in the course of one year. My diagnosis was uncertain; although the local ap pearances were strongly in favor of carcinoma, the age of the patient was against it. It certainly was not a sarcoma. When I extirpated the tumor, I found it in intimate connection with the glandular tissue, and on the cut surface a solid mass filled with cavities from the size of a millet seed to that of a pea, from which a pulpy, granular, yellowish substance could be easily removed, and I could not yet reach a definite opinion; it might be a collection of small, caseated foci of inflammation (so-called tubercu losis of the mammary gland), or an atheromatous formation of peculiar form, or again carcinoma with spots of softening. Microscopic examin ation alone could differentiate." The patient now, 14 years after the operation, is perfectly well, and there has been no recurrence.