CONTRIBUTION TO PATHOLOGY OF EXOPHTHALMIC GOITRE 



Examination of Specimens. 



The right lobe of the thyroid, which was removed at the first 

 operation, weighed 29 grammes. It measured 2| by ij inches, and 

 varied in thickness from f to i inch. The entire lobe was enlarged 

 symmetrically, and faintly lobulated. Its cut surface had a reddish-pink 

 fleshy appearance ; it did not seem to be very vascular, although several 

 moderately large vessels were seen upon the capsular surface. The 

 parathyroids had not been removed ; they probably remained attached 

 to the posterior border of the lobe. 



Microscopic Examination. — The general appearances were very similar 

 to those recorded in Case i ; there was the same tendency for the alveoli 

 to become irregularly branched, and for the lining epithelium again to 

 assume the columnar type. The sections, however, had a much more 

 patchy appearance ; areas of small, almost rounded, alveoli, alternating 

 with areas of large and extremely irregular vesicles, into which they 

 gradually merged. The lining epithelium of the spaces was high 

 columnar in type, this character being especially distinct in the small 

 alveoli. The small vesicles shewed in many instances an irregularly 

 stellate mass of colloid ; more frequently they were empty, or contained 

 a small amount of granular material which stained of the same tint as 

 colloid. The large alveoli contained much colloid matter which had 

 shrunk away from the alveolar wall ; it stained rather indefinitely, was 

 usually vacuolated, and sometimes contained desquamated cells. The 

 vessels were numerous and full of blood. Here and there throughout 

 the section were small irregular deposits of lymphoid cells, in character 

 similar to those seen in the first case. These small lymph-deposits 

 invariably contained a few scattered plasma cells, and a small number of 

 these plasma cells was also found in various parts of the section, generally 

 in relation with one of the blood vessels. 



The portion of the left lobe removed at the second operation con- 

 sisted of two fragments. The larger of these measured 43 by 30 by 11 

 millimetres, and weighed 8J grammes. It was flat and roughly oval in 

 shape, and its surface was slightly lobulated. The smaller fragment 

 measured 23 by 14 by 8 millimetres, and weighed 1*9 gramme. It was 

 about the size and shape of a small bean. The cut surface of the 



(211) p \ 



