Lectures on tumours, delivered in the theatre of the Royal College of Surgeons of England / by James Paget, F.R.S.

  • James Paget
Date:
1851
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Licence: Public Domain Mark

Credit: Lectures on tumours, delivered in the theatre of the Royal College of Surgeons of England / by James Paget, F.R.S. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    Simple or barren cysts—Their tjeneral charade s and varieties—Moden of ori- yin : (a) lit/ e.rjJansion or enlartjenieiit of natural spaces or areolcP : (b) Iji/ dilata- tii-n of succnli or parts of ducts; (o) l/y deveiopnient and growth of ntio formed nuclei or celts. Illustrations of the third ■mode of origin; in cysts in the kidnei/. Probable deduction concerning the origin of solid tumoti, s. Varieties of barren cysts:—Gaseous: Serous; in the neck, breast, gums, Hcc.: SitTiovial ■• Mucous; A'abofhian, Cow- perian, S^'c.: Sanguineous : Oleaginous : Colloid: Seminal. The Ci/sts, or Cystic Tumours, to wliicli I shall devote this lecture and the next, form a very numerous grovip,-and have only or b:irely these characters in common —namely, tliat each of them is essentially a cyst, sac, or bag, filled with some sub- stance which may be regarded as entirely, or for the most part, its product, wheiher as a secretion, or as an endogenous growth. . We may conveniently arrange cysts under the titles simple or ban-en, and compound or pi'oliferous ; the former containing fluid or unorganised matter, t!ie latter containing variously organised bodies. Among the simple or barren cysts, of wliich I will speak to-day, we find some that contain a flidd like tliat of one of the serous membranes ; such are certain mam- mary cysts, and those of the choroid plexus : some are full of synovia-like fluid, as the enlarged bursse : others are full of blood, or of colloid, or some peculiar ab- normal fluid: while others, forming the transition between the barren and the proliferous cysts, contain more highly oi'ganic secretions, such as milk, or mucus, or salivary or seminal fluid. These se\ eral forms we may arrange with names appro- priate to their contents ; as serous, syno- vial, mucous, sanguineous, colloid, salivary, seminal, and others. Among the cysts, whether barren or proliferous, it is probable that at least three modes of origin may obtain. 1st. Some are formed by the enlargement and fusion of the spaces or areolsE in fibro- cellular or areolar or other tissues. In these spaces fluids collect and accumulate ; the tissue becomes rarefied ; and, gradually, the boundaries of the spaces are levelled down and walled-in, till a pei-fcct sac or cyst is formed, the walls of which con- tinue to secrete. Thus are produced the bursse over the patella, and others ; and to this we may refer, at least in some cases, the formation of cysts m tumours, and, pei'haps, in other parts. 2dly. Some cysts are formed by dilata- tion and growth of natural ducts or sac- culi; as are those sebaceous or epidermal cvsts which, formed by enlarged hair-fol- licles, liave permanent openings. Such, also, are certain cysts containing milk, that are formed of enlarged portions of lactife- rous tubes ; sucli tlie ovarian cysts formed by distended and overgrown Graafian vesicles; and such appear to be certain cysts formed of dilated portions of blood- vessels shut off from the main streams. 3dly. Many—and perhaps the great ma- jority of cysts, such as those of the kid- ney, the clioroid plexuses, the chorion, and the thyroid gland—are formed by the enor- mous gro'ivtli of new^-formed elementary structures having the characters of cells or nuclei, which pursue a morbid com'sefrom their origin, or from a very early period of their development.* It might, on some grounds, be (JesLrable to classify the cysts according to their re- spective modes of formation; separating the secondary cysts, as those have been called which are derived by growth or expansion of normal parts, from the pri- mary, or, as they might be called, the autogenous cysts. !But, at present, I believe, such a division cannot be made ; for of some cysts it is im])ossible to say in which method they originate, and, in some instances, either method may lead to an apparently similar residt. Thus, some sebaceous or epidermal cysts are clearly * This third method of cyst-formation is wholly denied bv Rnich (Ilenle and Pfeufer's Zeitschr. fur rationelle Medizin, especially B. viii. p. 91). Hut the evidence of his papers is weak in coninarison with that of the later publi- cations bv Rokitaiisky and Mettenheimer, and is not consistent with the cases of secreting and proliferous cysts. It is enough, however, to make one, in many rases, cautious in decidiujr. without special cxiimin ition, wliether the finst or the third of the enumerated modes of formation have been observetl. Hnich refi^rs to a paper by Kngcl, \n the Zeitschr. der Wie ler Aerzte 1841), Bd. i., winch I rearet to have been unable to read, but which seems, by his account, to contain much valnahle information on both cysts and fibrous tumours.