PATHOLOGICAL ANATOMY OF THE HYPOPHYSIS 267 



or of an atrophy, rarely choked disc. I shall return to the manifestations of 

 brain-pressure in the consideration of the subject of nonacromegalic hypo- 

 physial tumors. 



Pathological Anatomy of the Hypophysis 



I now turn to the treatment of the nature of the hypophysial tumors in 

 acromegaly. Although this subject is the most important, I have placed it at 

 the end of the long series of symptoms, because it acts as transition to the 

 subject of the pathogenesis of the disease. To-day we may state with great 

 probability that in every typical case of acromegaly there exist in the 

 anterior lobe of the hypophysis adenomata or adenocarcinomata, which in 

 rare cases are dystopic, proceeding from cut-off hypophysial cells. The 

 questions on this subject that have been energetically discussed during the 

 last decade are: Are there cases of acromegaly without hypophysial tumor, 

 or without the adenomatous changes in the hypophysis regarded as specific; 

 and, are there cases of such tumors that do not show any of the symptoms of 

 acromegaly? These questions have recently been discussed with tempera- 

 ment in a monograph by B. Fischer; I shall refer the reader to the literature 

 on the subject and shall attempt here only to bring to the front the principal 

 opinions on this subject. 



Hanau first pointed out that in the overwhelming majority of cases of 

 acromegaly, adenoma of 'the hypophysis was observed. Through the dis- 

 covery of a specific coloration, for the cell granules in the chromophilic 

 cells by Benda the recognition of the adenomatous tumors has become es- 

 sentially easier. Benda himself found in three of four cases of acromegaly the 

 cell granules in monstrous excess in the adenomatously degenerated anterior 

 lobe of the hypophysis. For most part the forms of adenoma are benign. In 

 the malignant form, which does occur, and in which growth is very rapid, the 

 cells may remain very small. In such cases under circumstances the presence 

 of these among the gland-cells can be determined only by the use of Benda's 

 stain. Such malignant adenomata were for the most part formerly regarded 

 as carcinomata. Fischer says that the other kinds of tumors, such as carcino- 

 mata, sarcomata, endotheliomata, etc., never produce acromegaly; this state- 

 ment seems to be correct except that the position of the cases of typical acro- 

 megaly in which the pathological finding points to adenocarcinoma. I refer 

 to the case of Cagnetto. Cagnetto described a large adenocarcinoma with 

 abundant secretion granules, proceeding from the glandular part of the 

 hypophysis, which led to metastases in the spinal cord; in these metastases 

 the chromophilic cells were demonstrable. Fig. 50, for which I am indebted 

 to Prof. Stoerck, shows a similar case. The hypophysis is in this respect 

 analogous to the thyroid gland, in which adenocarcinomata associated with 

 metastases and manifestations of Basedow's disease are described. If in 

 cases with malignant degeneration of the adenomata of the hypophysis the 



