FATTY METAMORPHOSIS 407 



fact that in most organs showing fatty changes the quantity of choles- 

 terol and lecithin is not greatly changed. In 1902 Kaiserling and 

 Orgler described under the non-committal name of "myelin" certain 

 intracellular droplets that may be found in the cells of the normal 

 adrenal cortex, and in amyloid kidney's, pneumonic exudates, tumor 

 cells, retrogressive thymus tissue, corpus luteum, and bronchial secre- 

 tions, and which differ from fat in being doubly refractile (anisotropic) 

 when viewed through Nicoll prisms, and in staining but shghtly gray 

 with osmic acid, although taking up other fat stains well. 



As explained in Chapter i, the myelins are probably mixtures of 

 Upins, cholesterol-esters being prominent, and in many conditions in 

 which fat-like vacuoles are prominent in cells, leading to the diagnosis 

 of fatty degeneration, these substances are responsible, presumably 

 having been liberated from combination with the cell proteins in some 

 cases, in others actually being increased in the cell. This condition, 

 which Aschoff refers to as a cholesterol-ester fatty metamorphosis, is 

 especially seen in the parenchyma cells derived from the urogenital 

 anlage — ^that is, the adrenal cortex, kidnej", testicle and corpus lu- 

 teum. Aschoff states that doubly refractile droplets can be formed 

 by lecithin and phosphatids generally, oleates, cholesterol esters, cho- 

 lesterol v^hen dissolved in phosphatids or fats or fatty acids, as well 

 as by cholesterol esters dissolved in fats. Of these the most im- 

 portant quantitatively is the cholesterol ester group, -*^ and the anal- 

 yses of Windaus have shown that in pathological processes the increase 

 is much greater in the cholesterol esters than in the free cholesterol. 

 Cholesterol compounds stain different!}^ from neutral fats, being more 

 yellow than red with sudan III, and grajash rather than black with 

 osmic acid. Pathologically the anisotropic droplets are also found 

 especially in the above-named tissues, but also in tissues the site of 

 chronic inflammation, including the mucosa of the gall bladder where 

 they may be of importance in the formation of cholesterol concre- 

 tions. They are also found in the alveolar epithelium in pulmonary 

 inflammation, in atheromatous patches in arteries, in many tumors, 

 in most cells," including even the adipose tissues themselves,-^ and 

 occasionally in varied pathological tissues.'^ Perhaps the most con- 

 spicuous deposits are in the epithelium of the "large white kidnej's," 

 and in xanthomas. In Gaucher's disease there is also a remarkable 

 lipoid accumulation in the foamy phagocytic cells. ^'^ According to 

 Munk" true lipoid degeneration always means a serious injury to the 

 cell, but there seem to be many exceptions to this. Indeed, according 



26 See also Verse, Ziegler's Beitr., 1911 (52), 1. 

 " Ciaccio, Cent. f. Path., 1913 (24), 50. 



28 Cramer, Jour. Physiol., 1917 (51), xi. 



29 Pathological decrease in lipoids may also be observed, especially in the ad- 

 renal cortex, usually under the influence of toxic agents; e. g., Hirsch found a 

 marked decrease in delirium tremens (Jour. Amer. Med. Assoc, 1914 (63), 21S6). 



30 See Wahl and Richardson, Arch. Int. Med., 1916 (17), 238. 



31 Virchow's Arch., 1908 (194), 527. 



