1 8 QUATERCENTENARY STUDIES IN PATHOLOGY 



epithelium, rudimentary brain substance, etc. To this belongs 

 Schwalbe's case I., which had the structure of a typical teratome, and 

 contained derivities from all three germ layers. 



Group IV. includes the most simple forms, namely, the hair-clad 

 pharyngeal pol3'pi. These usually consist of some connective tissue and 

 fat, with perhaps a piece of bone, and are covered by cutis and epidermis, 

 with hairs and glands. Thus Arnold describes the case of a girl of 13 

 years, from whose soft palate a hairy polypus was removed. The 

 polypus was mainly composed of fat, and was covered with skin, showing 

 hairs and sebaceous glands, but no sweat glands. 



As regards the site of implanation, we find that in the larger 

 proportion of recorded cases of epignathus, the attachment is either to 

 the palate or to the superior maxillary bone. This is seen on examining 

 the list of cases published by Windle. In rather over one-fourth of the 

 cases the tumour has a connection with the base of the skull. In a few 

 cases the attachment has been to the soft palate or some part of the 

 lateral wall of the pharynx. 



Of those attached to the base of the skull, the majority have no 

 connection with the interior of the cranium. However, in a small 

 number of cases the stalk of attachment has some relation to the 

 interior of the cranium. In Windle's case there was a tubular stalk 

 leading through a patent pituitary foramen into the interior of the skull. 

 In a case recorded by Hill (^'^), a branch of the internal carotid artery 

 passed through a canal to the tumour. In our own case, a large vein 

 from the tumour passed through the base of the skull to open into the 

 cavernous sinus. In two cases recorded by Baart de la Faille, the stalk 

 of the tumour passed distinctly through the pituitary foramen to obtain 

 attachment to the sella turcica. In Wittenberg's case the pharyngeal 

 swelling is continued through an opening in the sphenoid bone directly 

 into the cavity of the skull. Another variety is where the tumour on 

 the outside is connected, by a stalk through the sphenoid, with a tumour 

 inside the skull, as in a case recorded by Breslau and Rindfleisch (8). 

 Miiller {^^) describes an epignathus attached in the mouth of a foetus, 

 while quite separate from it lay a tumour in the right middle cranial 

 fossa. Finally, a case is recorded by Beck (5), where a teratome was 

 confined entirely to the pituitary fossa. Wittenberg argues that all such 

 cases are to be included among the epignathi. 



(192) 



