312 THE DISEASES OF THE HYPOPHYSIS 



hypophysis (without acromegaly). Among these are twelve carcinomata, 

 thirteen adenomata, 1 nine strumas, and twenty-seven sarcomata. Among 

 the carcinomata are especially worthy of mention the hypophysial duct flat- 

 celled epithelial carcinomata, described by Erdheim. These proceed from 

 the accumulations of pavement epithelium, which lie in the process of the 

 glandular anterior lobe that extends into the hypophysial peduncle, and 

 which constitutes remnants of the hypophysial duct cut off from the oral 

 ectoderm. (See Figs. 30 and 32.) Histologically they consist in epithelial 

 nests and concentric layers lying very close to each other. Erdheim compares 

 them with adamantinomata, which also originate from cut-off parts of the oral 

 epithelium, as the remnants of the rudiments of the teeth. It may be readily 

 understood that tumors of the hypophysial duct mostly lead first to a dilata- 

 tion of the sellar introitus. Then the glandular hypophysis microscopically 

 may appear normal, as in case of Bregmann and Steinhaus. 



Further, there were to be observed, according to v. Frankl-Hochwart, 

 fifteen cysts, among them the interesting case K. L., that was operated on by 

 v. Eiselsberg, and that was more accurately described by Bychowski. Finally 

 a vascular tumor of indefinite texture, three gliomata, two teratomata, 

 seven tubercles, three gummas, and one case each of steatoma, chondroma 

 and fibroma. 



A case that is very important for the pathogenesis of hypophysial dys- 

 trophy was that of a cyst of the hypophysis recently reported by Maranon. 

 It occurred in a man about forty years old with typical dystrophy. Micro- 

 scopically the hypophysis was apparently normal, and on microscopical 

 examination more than three-fourths of the glandular part was found to be 

 destroyed by an old focus of hemorrhage. 



I report another case that I observed a short time ago: 



Observation XLV. G. J., fifty-five years old, tailoi. Entered the clinic May 30, 1912. 

 Part of the history was furnished by the wife. Until ten years ago entirely normal. Then 

 marked pains in the frontal region, attacks of vertigo and lomiting. These pulled him down 

 very much, and the attacks were attended with high fever. He was confined to his bed 

 for six months, then he could again take up his occupation, but since that time his libido 

 has been markedly weakened, and finally disappeared altogether. Also complete impotence 

 came on. The axillary hairs gradually fell out. Since that time attacks of vertigo have 

 been less frequent. In the course of the year 1910 there gradually developed a swelling of 

 the thyroid and slight hoarseness. Otherwise there were no other complaints. Dec., 

 19 1 1, influenza. Remained in bed for six to seven weeks, after which there were lightning- 

 like pains and formications in the [lower] legs. Also the bones were tender. Five weeks 

 ago, according to statement, suddenly a toxic spasm in the right hand and then also in the 

 left hand. 



Markedly emaciated cachectic individual. Skin pale, dry, scaly, the visible mucous 

 membranes pale. Patient often cannot recollect well, right pupil wider than the left. 

 Reaction somewhat sluggish. Eye-grounds normal. The middle lobe of the thyroid 



1 1 have already mentioned that not every adenoma must have an increased function and lead 

 to acromegaly. 



