tissue, usually, hard, tumors, skin, occur, breast, seen and connective

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Carcinoma.— Carcinomata, or cancer in the true sense, are tumors composed of a more or less dense connective tissue framework, hold ing in its meshes epithelial cells. These exhibit much diversity of type and arrangement, so that several classes are recognized. (1) Epitheli oma. This is the form which commonly occurs on the skin, at the muco-cutaneous junctions, such as the lips, about the nose and eye, and on the mucous membranes covered with squamous epithelium. as the mouth, oesophagus and cer vix of the uterus. On the face a slowly grow ing form known as Jacob's or rodent ulcers is sometimes seen which may last for years and is rarely fatal. On the skin or lip epithelioma be gins as a warty protuberance which soon ulcer ates and gradually extends in size until a sore with hard irregular base and edges, and foul bloody discharge, is formed. (2) Cylindrical celled carcinomata. These occur in the stomach, intestines and uterus. (3) Carcinoma simplex. This displays great irregularity in the shape of its cells and is the commonest form attack ing the internal organs. If the connective tis sue is in excess, the dense, hard scirrhus car cinoma results; whereas if the cellular elements preponderate, the tumor is termed a medullary cancer or carcinoma molle.

About 80 per cent of the tumors of the female breast are carcinomata. The disease is rare before the age of 35, is most common be tween 45 and 55 and in women who have borne children. The negro race is much less suscep tible. It begins as a hard nodular mass not painful to pressure, which soon becomes firmly fixed to the tissues and causes retraction of the nipple. The axillary lymph-glands are invaded early and can usually be felt as small hard nodules. In neglected cases the skin over the tumor ulcerates and there is a foul discharge. The arm becomes swollen and useless, and pain of neuralgic nature is usually present. 'The bones, liver, pleura and brain are often at tacked secondarily.

Carcinoma is usually disseminated by the lymph stream and promptly invades the lym phatic glands. According to Birch-Hirschfeld the following are in order of frequency the organs most often primarily attacked: Uterus, external skin, female breast, stomach, rectum, oesophagus, ovary, testicle, external genitals, prostate and bladder, pancreas, kidney, intes tine, bile ducts, liver, bronchi. It is a disease of mature life and is not often seen before the age of 30.

Intermediate Ade nomata correspond in general structure to nor mal glands, but either do not secrete or are unable to discharge the secretion through the gland ducts. They grow slowly, but may reach a large size, particularly if distended by accu mulated secretion. In this case they are termed cyst-adenomata, and the oftentimes huge ovar ian cysts belong to this class. Many goitres

(q.v.) are adenomatous tumors. Adenomata are in themselves benign, but are prone to take on carcinomatous tendencies and then become very malignant. They occur in the breast, the ovary, the thyroid gland, the kidney, salivary glands, stomach, intestines and uterus.

Endothelioma.—This tumor springs from the cells lining the blood vessels and lymph spaces and has much in common with both the carcinomata and sarcomata. Endotheliomata differ greatly in their virulence, but at times behave much as do sarcomata. They occur in the membranes of the brain, the pleura and peritoneum, the salivary and lymph glands. Growths of the parotid gland are frequently of this type.

Benign is a growth composed of bundles of fibrillar con nective tissue. Two main types, the hard and the soft, occur. Fibromata frequently appear in young adults and may arise in any part of the body containing connective tissue. They are often seen in the skin, mucous membranes, the breast, in fibrous membranes, nerves and the gums, and are often associated with other forms of tissues in complex tumors. They are usually well encapsulated and may be single or multiple. Ordinary warts and moles and some nasal polypi are fibromata. One form not infrequent in women arises in the sub cutaneous tissue, gives rise to severe attacks of pain and is calledpainful subcutaneous tu bercle. Keloid is a form occurring in scars, which is most common in negroes and is very hard to eradicate.

Myxoma.— This tumor is made up of tissue embryonic in type and called mucous tissue. Myxomata are soft and elastic, grow slowly and are usually considered benign, though they have a tendency to recur and sometimes undergo sarcomatous change. They frequently occur as (see POLYPUS) in the nose, where they rise se to chronic catarrh, and are also found in glands such as the parotid and breast the subcutaneous and submucous tissues and the sheath of nerves. Myxomatous tissue is often found in mixed tumors.

Lipoma.— Fatty tumors are among the com moner growths and are composed of lobules of fat held in a stroma of connective tissue. They are most often seen in middle life, and the skin of the back or shoulders is a favorite site. They may be multiple and sometimes occur as diffuse fatty enlargements about the neck. The yellowish patches often seen about the eyelids in old persons are a form of lipoma called Xanthoma, Osteoma.—Osteomata are composed of bone and usually originate in bone, periosteum or cartilage, though they may spring from other types of connective tissue. They grow slowly, are benign and are often multiple. A special form known as odontoma or dentigerous cyst develops from the germ of the permanent teeth.

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