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
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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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    tlie breast tissue tliat has been left behind play in the production of recurrence?” Surgeons are not agreed on this point, and herein lies the difference of opinion that exists regarding the necessity of removing the entire breast in all cases of carcinoma. Mr Butlin,^ in arguing against radical operations as a sine qua non, says,—“Certainly in the majority of instances there is nothing to lead one to believe that the new growth arises in the outlying lobules of the mammary gland, or in any remains of the paren- chyma of the gland.” Heidenhain,^ on the other hand, in a very admirable paper, read before the German Congress of Surgeons in Berlin in 1889, maintains that in carcinoma of the mamma there are proliferative changes in the lobules throughout the whole gland, which must be looked upon as the direct forerunner of cancer (“ das mittelbare Vorstadium der Krebsentwickelung ”), and that sooner or later will pass into typical cancer. My own observations on the causes of recurrence of cancer of the breast lead me to take up an intermediate position. I hold that when cancer manifests itself in breast tissue which has been left behind, the disease originates in the majority of cases from pre-existing cancer cells derived directly or indirectly from the original tum.our, and occupying the lymph spaces or lymphatics of the stroma. In other words, “ recurrence ” in breast-tissue which has been left behind originates in the same way as “recurrence” in the tissues extrinsic to the mamma and in the axilla. While admitting that recurrence may originate from the epithelium of mammary acini which hasjoeen left behind (just as the original tumour has arisen from mammary epithelium), I maintain that it does not necessarily do so ; ^ on the' contrary, I believe it to be a quite exceptional cause of recurrence. I am familiar with the various conditions which Heidenhain® refers to as existing in the acini and lobules, botli adjacent to the tumour and to the “ surgeon’s cut-surface.” The conditions which he looks upon as pre-cancerous present histological appearances which are very different from those of cancer proper. In the case of many breaste they are not only altogether absent, but when they do occur the most careful examination of all parts of the organ fails to detect the transi- tional stages of their development into cancer ; moreover, these so- called pre-cancerous conditions are also met with in breasts which are the seat of chronic mastitis, cystic disease, etc. I would therefore advocate that the principle which should underlie all operations for carcinoma of the mamma (or carcinoma wherever situated) is the complete removal, not only of the tumour and the organ in which it lies, but also of as much of the surrounding tissues as is likely to contain the lymphatic spaces and highways along which ^ The Operative Surgery of Malignant Disease, ]1. 378. 2 “ Ueber die Urpachen der lociden Krebsrecidive nacb Amputatio Mamma?,” Verhandlungen der Deidschen yesellschaft fiir Chirurgie, Berlin, 1889. 3 Log. cit.
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