THE THYROID AND ADRENALS. 



415 



or indurative inflammation (strumitis), and by the not very infrequent 

 association with carcinoma and sarcoma. The excitants of goitre are not 

 well understood. The growth is, as a rule, slow, but occasionally a very 

 rapid enlargement occurs as the result of a sudden increase of the col- 

 loid degeneration. In many cases even very large goitres give rise to 

 but moderate inconvenience, but they may assume great significance by 



FIG. 215. COLLOID STRCMA GOITRE. 

 The colloid material filling the alveoli is stained red. 



encroaching upon neighboring parts. Thus death may be caused by 

 pressure on the trachea, oesophagus, or on the large vessels. 



TUMORS. 



Some of the forms of goitre above described may be regarded as 

 tumors or may be associated with tumors. Sarcoma and endothelioma are 

 the most common tumors of the thyroid. 



Sarcoma, either spheroidal or spindle-celled, may occur as primary 

 tumors in the thyroid, either in otherwise normal glands or in connec- 

 tion with struma. ' Melano-sarcoma has been observed. Secondary sar- 

 comata are rare. 



Primary carcinoma, both glandular and scirrhous, occurs in the thy- 

 roid, and, particularly in the softer forms, may spread to adjacent parts 

 and occasionally form distant nietastases. Dermoid cysts are of occa- 

 sional occurrence." 



1 Consult for summary of observations on sarcoma of the thyroid, Morf, Jour. Am. 

 Med. Ass'n, April 29, 1899, bibl. 



2 For a resume of mixed tumors of the thyroid see Leo Loeb, Am. Jour Med. Sci., 

 vol. cxxv., 1903. 



