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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![fourth in September of the same year ; a fll'tli sprang up, and was removed in Feb- ruai-y 1833 ; a sixtli in May; in a seventh operation, in June of the same year, three tumours were removed; but from the same spot two more arose, and tliese grew rapidly, and the patient died. Now, if, as I think there need be no doubt, all these cases were examples of the proliferous cystic disease of the breast, they prove such an inveterate tendency to recm'rence in this disease, as is scarcely surpassed by any even of the malignant tumours. Unfortvmately no examination of such a case has yet been made after death ; so that it is not possible to say whether the more charactei'istic features of malignant disease existed, such as the concurrence of similar disease in internal organs. Mere repetition of growth, I need hardly say, does not justify us in calling a tumour malignant; especially in the in- stance of a tmnour in which clusters of cysts are prone to grow together ; for the repetition of growth may be due merely to the jjecuharity of the cysts growing in succession, and not, as they usually do, together and commensm-ately. 3. I have said we may not justly regard these recurring cystic growths as examples of malignant disease; yet the fact liad better be here inserted, that their mode of growth may be imitated by genuine can- cerous diseases. Cancerous growtlis may be found in cysts under at least two different circum- stances,—namely, in cysts that of them- selves appear innocent, and in cysts pro- duced within cancers. Of the former mode of growth we have examples sometimes in ovarian cysts. WeU-marked cancerous growths, usually of the medullary or the alveolar form, may grow from their walls; and herein is the best—perhaps the only ixnexceptionable— instance of the transformation of an inno- cent into a malignant tumour. The second mode of production of intra- cystic cancers is best shown in some exam- ples of medullary tumours of the testicle. In these* we may see a repetition, so far as the outline plan is concerned, of tlie intra-cystic production of thyroid gland. The great mass of the medullary disease includes smaller masses, completely incap- suled with fibro-cellular tissue, and com- monly presenting a lobed and laminated form, at once remmding us of the intra- cystic mammary glandular growtlis, and justifying the application to them of the principles of Dr. Hodgkin's theory of the growtli of cancers. * As in Mus. Coll. Siirsf., No. 2,390. In these medullary testicles the intra- cystic medullary growths have us\ially filled tlie cysts and coalesced with their walls. In rare cases one can discerTi how tlie growths spring up as s]oheroidal, or as pe- duncidatcd, branching, and grouped, pro- cesses from the interior of the cysts. This condition is peculiarly well shown in a esse of cancer of tlie clitoris, inwliicli the whole of that organ is occupied or concealed by a cancerous mass inclosing several dis- tinctly walled cysts, which are half filled witli small, soft, and lobed cancerous intra- cystic growths.* A further consideration of tliis matter would be out of place in lectures on inno- cent tumours. 4. I proceed to the consideration of the cutaneous prohferous cysts,—i. e., of cysts on whose inner walls a tissue grows having more or less the sti'ucture and the produc- tive properties of the skin. Instances of these in a perfect state arc rare. In the large nifijority of cases the cutaneous structure, if it were ever pre- sent, has degenerated or disappeared ; and we recognise the relations and import of the cysts only through their containing epidermal and sebaceous materials, of which the production is apecuhar attribute of the tissues of the skin. Among tlie parts in which these skin- bearing cysts may be found are some that have no natural connection with the skin. Thus (a) they are frequent ui the ovaries ; one or more Graafian vesicles enlarge and * Museum of St. Uartholomew's, Ser. xxxii. 39. Rokitansky gives to cases of this kind the name of cysto-carcinonia, and draws a just parnllel be- tween them and the instances of cysto-sarcoma. (Pathol. Anat. i. p. 391.) Cysto-sarcoma he re- gards, nearly following Miilfer herein, as a com- bination of sarconia with cyst-formation. The cases included by him and Muller (On Cancer, p. 170) under the name, cannot be all enclosed in the groiips which I have brought near together. (I.) Some are cases in which simple cysts are found within solid tumours : tliese are named cysto-sarcoma simplex; and such as these will be mentioned or referred to as varieties of fatty, fibrous, fibro-plastic, and cartilaginous tumours, in all of which the formation of cysts may ensue. (2.) The cysto-sarcoma proliferuni, if it be cor- rectly described as constructed of cysts con- tained in a solid tumour, and contniniiig younger cijsts in their interior, 1 have never seen. The c'as -to which Muller refers as exemplifying it, and which is figured by Sir A. Cooper (Illustra- tions, p. 41, pi. iii.) was, I believe, an instance of prolifeiouR glandular cyst in the mammary gland. (3.) The cysto-sarcoma phyllodes is a pro- liferous glandular cyst of the breast, and is espe- cially exemplified by the cases in which the ir\tra cystic growths are firm, lobed, peduncu- lated, an<l clustered, and in which many cysts are close-set in the breast. But in tliis disease there is, I think, no solid tumour in which the cysts are set: they appear to be themselves the primary disease, the solid growths within tUcin beimr secondary fonnrtior.s ; and if this be true, they cannot properly be grouped with the exam- ples of Miiller's cvsto-snrcoma simplex.](https://iiif.wellcomecollection.org/image/b21475398_0032.jp2/full/800%2C/0/default.jpg)
