The surgical anatomy of the breast and axillary lymphatic glands, considered with reference to the morbid anatomy and treatment of carcinoma : with a note on the 'nitric acid method' of demonstration : (from the Surgical Laboratory of the University of Edinburgh) / by Harold J. Stiles.

  • Harold Stiles
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: The surgical anatomy of the breast and axillary lymphatic glands, considered with reference to the morbid anatomy and treatment of carcinoma : with a note on the 'nitric acid method' of demonstration : (from the Surgical Laboratory of the University of Edinburgh) / by Harold J. Stiles. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    consists in a further branching and budding out of the ducts into the surrounding tissue. The stroma of this new parenchyma is derived from the fibrous elements of the surrounding subcutaneous tissue, the fat lobules of which remain imbedded in it. At puberty, therefore, and for several years after it, the mammse, although to external appearances well developed, contain a relatively small amount of gland tissue wliich in reality represents merely the excretory ducts (Plate L, fig. 1), from which the true secreting acini have yet to be developed by a still further process of budding of flask-like diverticula around the ex- tremities of their final ramifications. The development of the peri- pheral part of the gland in this reticular fashion allows of the increase in size and relatively much greater development of parenchyma which takes place during pregnancy. The evolution consists in the increase both in the number and size of the gland lobules to such a degree that the peripheral processes and lamellae are so expanded that they become approximated, and cause more or less complete absorption of the intervening fat. In this way the fully evoluted mamma comes to possess the completely parenchymatous appearance of other secreting glands which are, and always have been, functionally active. After a variable period of functional activity the changes of involution set in by which the organ returns to its resting state. The process is characterized by an extensive atrophy of the parenchyma, and a more or less abundant development of fat cells in the persistent stroma. The breast does not return to its original virgin condition, so that one has generally no difficulty in distinguishing a nulliparous from an involuted multiparous mamma. In the latter (Plate I., fig. 2) the corpus mammae is looser in texture, irregular, and broken up, owing to the large amount of fat in the stroma. The retro-mammary tissue has undergone a fatty transforma- tion, so that the breast is separated from the pectoral fascia by a layer of fat of greater or less thickness. The peripheral processes are large and more widespread, so that the differentiation into body and processes is less marked. After the menopause the gland lobules undergo more or less complete atrophy, so that sometimes only the ducts remain. Small cysts (involution cysts), generally multiple, and varying in size from a millet seed to a pea, are not unfrequently met with in atrophied breasts. They are generally tlie result of degenerative changes in the pre-existing lobules rather than a simple dilatation of the ducts. They are, therefore most numerous upon the deep surface of the organ where the gland lobules are most abundant. They contain a serous or mucoid Iluid, either colourless, yellow, brown, or bluish-green. When three or four such cysts are closely aggregated, and the intervening and surrounding tissue condensed, the condition gives rise to clinical signs closely resembling “ scirrhus,” and may call for a diagnostic incision before the surgeon can determine whether or not the breast should be excised. Tlie cystic condition, however.
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