THE DIGESTIVE SYSTEM. 581 



is usually dense and hard ; secondary atrophy of the parenchyma regu- 

 larly occurs. It may be associated with chronic inflammatory processes 

 in the vicinity of the organ, and obstruction of the pancreatic duct. 



Tuberculous Inflammation. Larger and smaller tubercles and tuber- 

 culous cheesy nodules are occasionally found in the pancreas in con- 

 nection with acute general miliary tuberculosis or with tuberculous in- 

 flammation in some other organ, particularly with that of adjacent 

 lymph -nodes, the lungs, and the intestine. 



Syphilitic Inflammation. Chronic interstitial pancreatitis is frequently 

 found in congenital syphilis of the new-born. The fibrous tissue is in- 

 creased with atrophy of gland parenchyma, but the islands of Langerhans 

 persist. ' It is not definitely established whether or not a similar lesion 

 may be caused by acquired syphilis. Gummata are very rare in the pan- 

 creas, but have been described in congenital syphilis in very young chil- 

 dren. 



TUMORS. 



Carcinoma is the most common and important of the tumors of the 

 pancreas. It may be primary or secondary. Primary carcinomata are 

 most frequently found in the head of the organ, but may occur in other 

 parts. 2 The hard or scirrhous form is most common, but occasionally 

 soft and succulent and gelatinous forms are found. They are liable to 

 involve adjacent parts by continuous growth, and may form metastases 

 in the liver, adjacent lymph-nodes, etc. Secondary carcinoma in the 

 pancreas may occur in carcinoma of the stomach, duodenum, and of the 

 gall ducts and gall bladder. As a result of carcinoma of the pancreas, 

 aside from the extension of the growth, there may be pressure on the 

 ductus choledochus, with jaundice; or on the pancreatic duct, with cys- 

 tic dilatation ; or pressure on the duodenum, with stenosis of the gut ; or 

 pressure on the vena cava, or portal vein, or superior mesenteric vein, 

 etc., with disturbances of the circulation. 



Cysts. These are mostly due to dilatation of the pancreatic ducts. 



1. The entire duct may undergo a uniform cylindrical dilatation. 

 With this cylindrical dilatation we sometimes find associated small sac- 

 culi. 



2. There may t>e sacculated dilatations at some points in the ducts. 

 These dilatations form cysts of large size, as large even as a child's head. 

 Their walls frequently undergo degeneration and calcification. These 

 cysts often, become filled with blood, and may then be mistaken for 

 aneurisms. 



3. The small branches of the pancreatic duct may be dilated so as to 

 form a number of small cysts. These cysts are filled with serum, mucus, 

 pus, or a thick, cheesy material. 



Cysts of the pancreas may result from trauma, inflammatory closure 



1 For a study of the pancreas in congenital syphilis see Pearce, Am. Mod., December 

 26th, 1903. 



For recent bibliography of primary carcinoma of the pancreas see Baldwin, Phila- 

 delphia Med. Journal, December 22d, 1900, bibliography. 



