Puncture will aid in diagnosis, a jet of air showing the nature of the malady. Aneurismal goitres are at times reducible a third or two-thirds, but not more. L. R. Petit (Revue de Chin, Feb., Mar., May, June, 'SO).
With general hyperplasia there is ab sence of all these features, the organ is generally firm and enlarged, and there is a history of gradual development. Where the enlargement is of the colloid or gelatinous type certain observers as cribe to it a more doughy feel.
In the nodular forms of benign goitre it must be remembered that in a very large number of eases we have to deal with quite a series of different conditions. Some of the nodules may be firm and fibroid, others again, of various sizes, may present purely parenchymatous changes either of the colloid or of the adenom atolls type, while, further, here and there throughout the gland some of the larger rounded nodules may present more or less evidence of fluctuation and, in short, may be cystic. Where such cysts are present, it may be laid down that we have always the indication of a previous and existing condition of par enchymatous hyperplasia or adenoma at the region where the cyst has developed.
Following points noted in diagnosis of a polyeystic tumor of the thyroid: The rounded form, not at all recalling that of the thyroid in its normal state; the tendency to ascend, whereas hyper trophied lobes of the thyroid tend to descend. To assure one's sell of its con nection or otherwise with the trachea, the head is extended as far as possible to immobilize the larynx and trachea.
A movement is then made to raise the tumor. If even a slight displacement takes place the tumor is enucleable with out the trachea coining into great dan ger. Sometimes, however, the trachea is so softened that several rings can be dragged with the tumor, so that caution is necessary. Tillaux (Revue Gen. de Clin. et de Th6rap., Sept. 26, 'SS).
As between the benign and malignant goitres, the main point of distinction is the rapid progressive growth of the latter form. But, here, warning must be given that haemorrhage into a goitre—a not infrequent occurrence — may lead to rapid localized enlargement. Such
largement, however, is of sudden opment, and after its first appearance it remains stationary; it is not progressive. Malignant tumors of the thyroid, though rare, are inure common in men than in women, and usually develop from pre-existing goitres. R. N. Wolfen den (Med. Press and Circular, Dec. 12, 'SS).
Case of a man with a tumor of the neck of five years' standing. It was soft, solid, slightly lobulated, and occupied the whole space between the sternum and the thyroid cartilage. A parenchy matous goitre was diagnosed, but, on re moval, the growth was found to be a fatty tumor, adherent to the anterior wall of the trachea. Alex. F. Matveieff (Brit. Med. Jour., Sept. 12, '91).
Case of woman who has had a tumor in the neck for a number of years. It has gradually increased in size. It is hard, dense, lobulated, and apparently fixed, although it is not adherent to the skin. The patient has a peculiar stri dent croupy cough, labored respiration. and swallows with some difficulty. Enu cleation was performed. The patient re covered promptly after the operation. The tumor was a sarcoma of the thyroid. George F. Shears (Clinique, June 15, '98).
As between the cancerous and the sar comatous goitres the distinction has been made that carcinoma tends to affect the surrounding lymph-glands and is pecul iarly liable to have associated with it metastases in the bones, whereas sarcoma of the thyroid undergoes more local ex tension with a tendency to invade and ulcerate into the trachea, as again to in filtrate the skin and cause extensive malignant ulceration of the neck.
In some rare cases, it should be men tioned, where there is a localized goitrous enlargement confined to the isthmus, my experience would show that there is a danger of the condition's being over looked. The same is true with regard to retro-cesophageal accessory goitres. Thus, in paroxysmal dyspncea affecting more especially females, any possibility of such localized enlargement should be borne in mind.