CHAPTER IV.

NEW FORMATIONS.

It is difficult to give a perfectly exact definition of the class of new formations; for we shall exclude from it many productions which are not found in the healthy organism, and shall include in it some which are but the result of the action of parts normally existing. Thus, we shall not mention the excessive production of fat-cells, which takes place in general obesity, as an instance of new formations, while we shall consider as such the distension of a sebaceous follicle into an encysted tumor. This defect, however, is common to all arrangements. Nature presents us readily with distinct types of different classes; but rarely, if ever, does she define and separate her groups by any exact limitation, and the /rigid taxonomist wearies himself in the search for that which does not exist. The idea which is conveyed in the term "tumors," seems, in a general way, most descriptive of the class now before us, which may be said to include all new prominent or otherwise apparent local growths. The character of growing excludes tuberculous and other deposits, and concretions. We shall follow, in the main, the arrangement of the various kinds of new formations which Rokitansky has adopted, endeavoring to set forth their distinctive features as far as possible, and yet recognizing the frequent insufficiency of any structural or chemical peculiarities that we can observe-to explain, or even diagnose, the essentially different natures of different specimens we may meet with.

(1.) Fibrous Tumors.-These constitute a group with tolerably wellmarked structural characters, but shading, almost imperceptibly, into other species of very different nature. They are essentially made up of fibres, more or less closely resembling those of areolar tissue, but appearing, in very various stages of development, in different specimens. Sometimes the fibres are tolerably distinct and separate; more often so interlaced and blended together, or so imperfectly evolved, that they cannot be made out as such. Sometimes the nuclei, with which the structure is loaded, seem to be simply imbedded in a granulo-homogeneous blastema, the whole forming a dense solid mass; sometimes the blastema is divided into fibres, very similar to those of organic muscle; and sometimes, again, but more rarely, the blastema is broken up by fibrillation into bundles of filaments, identical with those of white fibrous tissue. Yellow elastic fibres are not unfrequently mingled with the white, and seem to be developed from the elongated nuclei. Much difference is observed in the chemical behavior of tumors of this class. Those which consist of fully developed fibres yield gelatin, while from those

which consist of muscle-like fibre, or of an undivided blastema, none can be obtained.1

Fibrous tumors differ much in their degree of connection with surrounding parts; sometimes they are quite blended with them by continuity of tissue; at others, they are easily enucleated. They have

Fibro-fatty tumor. The upper figure shows fat-cells imbedded in fibrous tissue; the left lower one represents a fat-cell capsulated by fibres; and the right some separate fibres.

very few vessels indeed; so few, that it is matter of surprise how some large masses maintain their vitality. These tumors develop themselves in very different parts of the body, usually in such as normally contain

1 This is Vogel's statement; but we have certainly obtained abundance of gelatin from tumors consisting of undivided blastema.

much fibrous tissue. The uterus is one of their most common hábitats, which probably depends on the similarity between the undeveloped muscular fibre of the organ and their own structure, so that a slight alteration in the conditions of nutrition might cause the common blastema to take the form of fibrous tumor, rather than of uterine fibre. Several fibrous tumors may exist in the same organ; but it is rare that they coexist in separate organs. They are not liable commonly to any great degree of change. Inflammation may occur, characterized by injection and softening of the part, and probably by the presence of exudation corpuscles in it. Cretification is not unfrequent, and may either commence indifferently at any part, proceeding until the whole is converted Fig. 50.

Fig. 51.

into a calcareous mass; or it may be in great measure limited to the peripheral stratum, which it thus converts into a kind of shell, inclosing the rest. The calcareous degeneration affects tumors of very different size, and does not bear any relation to the age of the growth. Melanic matter is sometimes deposited abundantly in fibrous tumors. Cyst-like cavities, filled with clear fluid, are occasionally found in fibrous tumors, constituting thus a fibro-cystic variety. Another results from their combination with adipose tissue, of which we have figured a specimen. The form which fibrous tumors assume is mostly the spherical, with a more or less nodulated exterior. If, however, they grow near a free surface, they are very prone to become pedunculated. It is probably from this tendency, together with subsequent wasting of the peduncle, that fibrous tumors are occasionally found free in the cavity of the uterus. In a case which came under our notice, there was no trace of peduncle. The tumor, of large size, had greatly distended the uterine cavity, and had very slight connection with the parietes. The size which fibrous tumors sometimes attain is very considerable, some have weighed as much as thirty-five or thirty-nine pounds. Between proper fibrous tumors and instances of mere hypertrophy of the integument, there exist, or may occur, every intermediate variety. In proportion as the texture of the formation becomes dense, it is more abundantly permeated by vessels, so that some of these growths are highly vascular. Of this

kind is the rather rare Keloid tumor, a specimen of which we have lately had an opportunity to examine. It was situate on the back, was well defined, of a red color before removal, but pale after. It had much the

appearance of a thick red cicatrix, as if formed by a kind of transformation of the skin itself. The structure, under the microscope, appeared as a dense woof of fibrous tissue, resulting from a pretty thoroughly fibrillated blastema. Acetic acid brought into view numerous nuclei, all more or less elongated, some quite passing into streaks, as if about to form nucleus fibres. A good deal of free, oily matter was diffused through the mass. Another specimen we have lately examined consisted of a fibrillating but undivided blastema, imbedding numerous nuclei, for the most part elongated and streaky. It involved the corium of the skin, but the epidermis passed evenly over it. It was very remarkable that the deeper layers of the epidermis consisted of vertically elongated cells and nuclei, while the upper layers were of the usually flattened shape. This probably depended on the abnormal fibrefying tendency having affected the cell growth on the free surface of the basement membrane. Tegumentary tumors, as they are termed by Mr. Simon, seem to be properly included in the class we are considering, as they consist essentially of an increased growth of fibrous structure.

We may here allude to a group of tumors, for which Mr. Paget proposes the name of Recurring Fibroid. They are almost identical with common fibrous tumors, both in their naked-eye aspect, and in their microscopic characters, but show a remarkable tendency to return after removal. It is an extremely important and interesting circumstance, that the later produced tumors approximate much more in appearance and in behavior to the malignant character, than the original one. In one of Mr. Paget's cases, the last production was hardly to be distinguished by the naked eye from encephaloid (and, indeed, we doubt if it was different), though it still consisted of the same elongated fibre-cells. The chief pathological interest of these tumors consists

in the circumstance that they form a kind of transition between the socalled innocent and the malignant formations. According to our belief, the circumstance of structural resemblance to fibrous tumors, is no hinderance whatever to the possession of malignancy. A caudate cell may have this fatal gift as well as any other kind.

Epidermic and epithelial tumors constitute a well-marked class of new formations, which are of very frequent occurrence, and much practical interest. Warts and callosities of the skin are minor instances of this group, and consist simply in thickening of the epidermis, produced by accumulated layers of its scales. As an increased flow of blood to the part must take place, it is not surprising that the papillæ of the corium beneath should, in some of the more advanced cases, become hypertrophied and elongated, so as to project upwards into the little tumor. In condylomata, mucous tubercles, and similar vegetations, which are apt to form about the orifices of mucous canals, under the irritation of syphilitic and other discharges, the surface is commonly observed to be lobulated or papillar, the interior marked by a vertical striation, while some vascular ramifications extend up into each papilla. The structure of these is beautifully figured by M. Lebert. The surface of each papilla, as shown in his plates, is formed by a layer of closely imbricated epithelial scales; while the deeper parts consist of either less flattened cells, or, according to our own observation, of nuclei, lying close together in a granulous and amorphous blastema. This interior nucleated granulous tissue, we believe, is continued downward to the base of the growth, and encroaches on the corium of the skin; for we have never been able to observe any clear demarcation between the vascular loops and the surrounding cell formation. Almost the very same description applies to those tumors which are most common on the lips, and whose cancerous nature one has often too much reason

to suspect. These attain a much larger size, and are more manifestly vascular than the preceding, and their papillæ are more branched and grouped together, so that the surface resembles somewhat that of a