THE PATHOGENESIS OF ACROMEGALY. 



195 



sarcoma and morphologically similar neoplasms of the hypoph- 

 ysis in acromegalia. These observations greatly outweigh in 

 number the instances recorded as hyperplasia and adenoma, 

 and, in fact, constitute the great bulk of evidence in cases 

 examined microscopically. 



"If we can show, however, that there are good reasons 

 for believing that these instances of sarcoma have been wrongly 

 interpreted and are really examples of hyperplasia, the patho- 

 genesis of acromegalia stands out clearly on a basis of harmo- 

 nious data. This is not difficult. The mistake of confounding 

 hyperplasia and even adenoma of the gland for sarcoma might 

 be very easily committed, indeed. The glandular structure 

 of the hypophysis is rather atypical, its cells are small and 

 rather densely huddled together, and the connective tissue is 

 very scanty. Consequently in an hyperplastic overgrowth the 

 appearance resembles, very closely, indeed, a sarcoma of the 

 small round-celled or lymphosarcomatous type/ 7 The author 

 then refers to several cases in which he had at first consid- 

 ered the enlargement of the pituitary as due to small, round- 

 celled sarcoma, and which, under the guidance of the idea of 

 hypersecretion, gave every evidence of hyperplasia. He fur- 

 thermore noted that "these so-called sarcomata of the hy- 

 pophysis in acromegalia are lacking in two rather predominant 

 traits of sarcoma," and remarks: "We should expect evidences 

 of metastasis and comparatively rapid growth, yet both of these 

 characteristics are absent. With the exception of a few cases, 

 the course of acromegalia is notoriously slow, gradual, and 

 chronic, and extends over a number of years. Such a course 

 in the growth of a sarcoma would be a rather striking excep- 

 tion to the rule. 



"The hypersecretion theory, as far as I am able to learn, 

 was first brought forward by Tamburini, but I feel like stating 

 it much more positively." Indeed, Tamburini had also affirmed 

 that, while one is justified in concluding that the lesion that 

 is constantly met with in autopsies upon typical cases is tumor 

 of the pituitary body, this usually assumes the form of ade- 

 noma, the next of kin to hyperplasia of the glandular tissues. 



Whether, as Marie says: "acromegaly is gigantism in the 

 adult," or "gigantism is acromegaly in the adolescent," we are 



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