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
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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![of the cysts, either outwardly or iuto their cavities. In these Tilli he traced the de- velopment of cysts. In their natural state, they may be described as filiform or clavate processes, often branching and bearing bud-like projections, and composed of dimly-granular substance, in which are imbedded minute nucleated cells. In this cystic disease, vesicular bodies may be seen scattered among the cells in the villi, which bodies are distinguished from the cells by their pellucidity, their larger size, and double contours ; but, from the cells to these, every gradation may be so traced as to leave scarcely a doubt that the vesicles are derived from cells deviating fi'om theh* normal characters. Thus in some of the cells the contents are seen lighter and less granular; in some they have en- tirely disappeai'ed, without increase of size; and then, when their contents are thus become uniformly pellucid, and they have acquired the character of vesicles, the cells appear to grow, wliile their walls become stronger, and they acquire such a size that they are recognised as very small cysts, similar, in all but their size, to those which are visible to the naked eye. Now, though this formation of cysts has been traced by Mettenheimer only in the villi which grow on the cysts themselves, and therefore, so to speak, only in the production of the cysts of the second and later generations, yet there can be Kttle doubt that the first cysts in the diseased chorion are formed in its own villi after the same manner. For the villi borne on the cysts are, in all essential characters, Hke those natural to the choi-ion ; and the cysts of all generations are equally like. The whole process may, therefore, be probably thus described : —Certain of the cells in the proper villi of the chorion, deviating from tlieir cell-form, and increasing dispropor- tionately in size, form cysts, whicli remain connected by the gi-adually elongated and hypertrophied tissue of the villi. On the outer surface of the new-formed cysts, each of which would, as it were, repeat the chorion and surpass its powers, a new vegetation of villi sprouts out, of the same structure as the proper villi of the chorion. In these begins again a similar development of cysts; and so on ad tnfinilum. Each cyst, as it enlarges, seems to lead to the wasting of the cells around it; and then, moving away from the villus in which it was formed, it draws out the base of the villus, which strengthens itself, and forms the pedicle on which the cyst remains sus- pended. Such is the account of the minute struc ture and formation of the cystic disease of the chorion; and perhaps no instance could afford a better confirmation of the production of cysts by the enormous growth of elementary cells, or a better type of the capacity of cysts thus formed to produce structures resembHng those in the abnormities of which themselves ori- ginated. A similar capacity is among the characters of aU the cysts of which I shall next have to speak. 2. I pass now to the consideration of the cysts that are proliferous with vascular growths from their internal surfaces.* The first group of them may include those that bear glandular growths—the glandular proliferous cysts, as we may call tliem, because the minute structure of the substance growing into them is, in its perfect state, exactly comparable vdth that of a secreting or vascular gland. Such cysts form part of the group to which the name of sero-cystic sarcoma was given by Sir B. C. Brodie, who first clearly distinguished them.f They are also ]Dart of those which furnished to Dr. Hodgkin the chief gi'ounds for his well- known theory of the formation of solid tumours—a theory which, in regard to at least these growths, has good foundation. The chief seats of the formation of glandular proliferous cysts are the mam- mary and thyroid glands. Their history in the thyroid, in which their formation scarcely passes the bounds of health, is amply illustrated in the often cited works of Prerichs and Rokitansky, to which, as well as to the paper by Mr. Simon;}: on the natural structure of the gland, I must, for brevity's sake, refer. * It may be well to refer to the fact that ab- normal gtowths upon natural free surfaces com- monly atfectthe same forms as will be described in the following^ account of the growths in cysts. The chief forms are three—namelv, 1st, that of groups of slender, small, and pedunculated bodies; 2d, that of larger round pendulous masses; 3d, that of nearly level, slightly ele- vated layers, such as granulations. Thus, for groups of pedunculated leaf-like processes, we have («) the growths that are so frequent in chronic rheumatic diseases of joints, from some of which Miiller draws his account of lipoma arborescens; (/>) many wartv cancerous growths on the skiu, which appear iike cancerous over- growths of the papillae; (c) similar growths in the larynx about the vocal cords. Of the larger round, pedunculated masses, growing on free surlaccs, instances exist in the medullary can- cers of the urinary bladder, the polypi of the intestines and stomach, the pendulous out- growths of the skin. And of the flatter, and more nearly level layers, the condylomatous outgrowths of skin, the epithelial cancers of the stomach and intestines, and the cheloid growths often aflord examples. However, there is no more in this resemblance than another instance of the tendency of the growths in cysts to imi- tate those on natural parts. t The disease is admirably illustrated by the specimens in the Museum of the College, and in those of St. George's, Guy's, and St. Bartholo- mew's Hospitals t Philosophical Transactions, 1844, part ii.](https://iiif.wellcomecollection.org/image/b21475398_0027.jp2/full/800%2C/0/default.jpg)
