796 J. P. SIMQNDS 



cells, and not accompanying any one of the physiological or pathological 

 states with which hyperplasia is associated. The size of a strumatous 

 hypophysis may vary from a slight increase over the normal size up to 

 five or more centimeters in its greatest diameter. The -shape is usually 

 oval, and the surface is smooth and regular except where it is subjected 

 to pressure, especially by bone. A struma may cause pressure atrophy of 

 the bone with enlargement of the sella turcica. It usually grows upward 

 in the direction of least resistance, pushing the dura mater before it and 

 pressing upon the under surface of the brain. The larger strumas may 

 also bulge forward and, by pressure upon the optic chiasm, cause bitenp 

 poral hemianopsia. 



The surfaces made by sectioning a struma of the hypophysis are darker 

 red in color than the normal anterior lobe. The appearance is homo- 

 geneous ; that is, there are no nodular masses present. The posterior lobe 

 is. usually flattened and atrophic but not otherwise changed. A struma 

 is not adherent to the selTa turcica ; its capsule is intact and not invaded 

 by the cells of the growth. 



All of the usual cell types of the anterior lobe are present in a struma ; 

 but, as a rule, one type predominates. There are thus, eosinophil cell, baso- 

 phil cell, and chief or chromophobe cell strumas, according to the type of 

 cell that is present in greatest numbers. The arrangement of the cells 

 is that of the normal anterior lobe, that is, usually in the form of solid 

 cords, occasionally as alveoli. Colloid is usually not abundant. Blood 

 vessels are, ordinarily, numerous and are frequently surrounded by cells 

 with an alveolar arrangement. 



It is a question whether a struma of the hypophysis is a true tumor, 

 any more than a struma of the thyroid is a tumor of that gland. It seems 

 more likely that a struma is a hyperplastic, rather than a neoplastic con- 

 dition a sort of superhyperplasia. 



Neoplasms of the Hypophysis 



Adenoma. These are sharpy circumscribed epithelial growths within 

 the anterior lobe of the hypophysis. Nothdurf has described one such new 

 growth in the posterior lobe. They are spherical or oval in shape, so that 

 on surfaces made by sectioning they appear as round, sharply defined 

 areas, usually lighter in color than the remainder of the anterior lobe. They 

 vary in size from masses too small to be seen upon gross examination up to 

 several millimeters in diameter. The largest in Kraus'(c) series of 25 ad- 

 enomas, measured 6 by 7 mm. These adenomas may be single or multiple. 

 In 6 of Kraus' cases there were two; in two cases, three; and on one case 

 there were five such masses in the anterior lobe. These adenomas, as 

 pointed out by Lowenstein, are almost always in the periphereal portion of 



