PATHOLOGICAL ANATOMY AND HISTOLOGY 785 





caseous. Microscopically, there is caseation, with surrounding capsule of 

 connective tissue and round cell infiltration. Giant cells are only very 

 rarely present. In other instances the anterior lobe, or even the entire 

 hypophysis, is diffusely infiltrated with round cells, with scattered irreg- 

 ular patches of necrosis. 



Satisfactory details as to the clinical manifestations and associated 

 pathology are not given in many of the reported cases of gumma of the 

 hypophysis, Gummas or scars believed to be due to healed gummas in 

 other organs are recorded in the reports of the 26 cases as follows: 

 meninges, 4 times; 

 skull, 



nose, 5 



including the 

 times; liver, 6 

 times ; various bones 

 other than the skull, 

 twice ; kidneys, twice ; 

 adrenals and vagina, 

 once each. Polyuria is 

 reported as a symptom 

 twice (Goldzieher, and 

 Berge and Schulmann) ; 

 in each case the gumma 

 was in the posterior 

 lobe. "Marasmus" of 

 two months' duration 

 was present in Sokoloff s 

 patient. Partial blind- 

 ness is mentioned once 

 (Chiari). 



Syphilitic changes 

 in the hypophysis usu- 

 ally occur late in the 



course of the disease. Simmonds'(^) patient, however, was a man 78 years 

 old, who acquired syphilis only 4 months before death. In addition to the 

 gumma of the hypophysis, there were multiple gummas in the lungs in 

 which spirochetes were demonstrated. 



Luetic infections of the hypophysis are more frequent in congenital 

 than in acquired syphilis. In 16 congenitally syphilitic newborn, Sim- 

 monds(&) found luetic changes in the hypophysis 6 times. In the congen- 

 ital form of the disease the alterations in the hypophysis are usually a dif- 

 fuse proliferation of connective tissue (Simonds, Simmonds(fr), Schmorl). 

 (See Fig. 3.) More rarely they appear as localized growths of connective 

 tissue with necrosis at the center, miliary gummas (Simmonds(^), and 

 Schmorl) ; or there may be larger gummas (Chiari, and Verse). In one 

 newborn syphilitic infant Schmidt found necrosis of a large part of the 



fig. 3. Congenital syphilis of the hypophysis. Marked 

 proliferation of connective tissue in the anterior lobe. 

 Magnified 110 times. 



