TUMORS OF THE MAMMARY GLAND.
As it was formerly the remarkable variety of these tumors that interested the investigator, it is now the developmental history of these forms which always attracts him. But the physician who stands at the same time on a scientific and humanitarian basis, seeks a morphological solution of the question, as to whether the tumor belongs to the carci nomata, which cut off so many women while still in their full strength. He must at once cease trying to find means and ways for preventing the formation of this terrible neoplasm, as all dietetic and medicinal treatment has hitherto been vain, and he can only render assistance by the earliest possible recognition and removal of the first focus of disease, from which it play spread throughout the whole body. In the interest of the patient, therefore, it is especially important to recognize this dangerous disease early. .
Since the time that Astley Cooper first sifted and arranged the material In his unfortunately incompleted work, important progress has been made, not only in this special field, but in the great field of the knowledge of tumors, so that by exact anatomical examination of extirpated neoplasms there is very seldom a difference of opinion, and the diagnosis can usually be made with sufficient exactness. With the diagnosis in these cases, the prognosis is also given.
It might be thought entirely superfluous to go thoroughly into the anatomy and developmental history of tumors of the mammary glands, since they do not differ in their nature from tumors in other places. This is true, since it is now the generally accepted opinion that neoplasms consisting of connective tissue (fibroma, lipoma, sarcoma, chondroma, osteoma) proceed from the cellular elements of the connective tissue, and adenoma and carcinoma especially from the epithelial elements of the glands. However, the structure and peculiar physiological conditions of the mammary glands admit of so many combinations in these respects that the acquiring of knowledge without guidance is not always easy. It is certainly very seldom that a tumor forms within the breast which simply pushes the gland-tissue aside. Neoplasms are almost always from the beginning confined to the lobules of the gland; these rarely ever disappear entirely, but are changed in various ways. Most neoplasms not
only spread in themselves, but attack the neighboring gland-lobules, so that sooner or later a more or less considerable part of the gland is in volved. This peripheral extension (which, moreover, is not especially noticeable in the so•c,alled benign tumors, and often enough is entirely absent) ceases, as a rule, at a certain point in fibromata and sarcomata; the diseased portion of the gland then remains separated from the un affected part, a condensed layer of connective tissue being formed around the tumor, and it is then said to be " encapsulated." In carcinomata and in many adenomata and cyst-growths, this capsulation of the neoplasm does not take place as a rule, but the whole gland is gradually affected, or at least the greater part of it. In carcinoma the affection extends beyond the limits of the gland, forward into the skin and backward into the muscles, ribs and pleura. Then comes the infection of the lymphatic glands, followed by internal metastases. Usually there is no impor tant difference in the anatomical or clinical relations between infiltrated carcinoma of the mammary gland and carcinoma of other organs; and as fibroma and sarcoma also always contain glandular elements, often com bined with peculiar and manifold cyst-growths, so in this organ there are sometimes very carcinoma-like forms. Adenomata of the breast, also, as in other glands, have their specific peculiarities. Tumors of the breast are therefore not only interesting on account of their variety and pecu liarities, but we can find the key to their peculiarities only by the study of their developmental history.
On purely practical grounds I will first speak of the most infrequent occurring lipomata and chondromata of the mammary gland, in order not to interrupt the continuity of the presentation of fibromata, sarco mata, cysto -sarcomata, etc. So far as I know angioma and true neuroma are never developed in the breast. (The cases reported by Blebs, Pathol. Anat., Bd. I., Abth. I., p. 1194, permit the belief that the augiomata were originally developed in the skin or subcutaneous adipose tissue over the mamma.) What is known as to the relation of the blood and lymphatic vessels to tumors of the mammary gland will be mentioned under the consideration of carcinoma.