524 TUMORS. 



ter of myeloma or cancer. This fact was recently corroborated 

 by the accurate investigations of A. W. Stein. Papilloma of the 

 uterus may cast off portions of its substance with the menstrual 

 discharges. This occurred in the case of the woman who passed 

 the shreds illustrated in Fig. 217. Shreds of tissue may also be 

 passed with the urine, if papilloma of the bladder be present. 

 Papillary tumors combined with adenoma sometimes appear in 

 other mucous membranes, and they are always more difficult to 

 eradicate and more prone to change into a malignant type than 

 simple myxo-adenoma. 



MICROSCOPICAL STUDY OF PAPILLOMA OF THE LARYNX. 

 BY Louis ELSBERG, M. D., NEW-YORK.* 



All other laryngeal tumors together occur less frequently than papillo- 

 mata. Of three hundred and ten cases of intralaryngeal morbid growths 

 that have come under my observation, I believe one hundred and sixty-three 

 to have been papillomatous, although the diagnosis, many times, was made 

 clinically only *. e., without microscopical examination. 



The tumor, the size of a coffee-bean, which is the subject of my study, was 

 removed by evulsion from the anterior portion of the vocal band of a woman 

 thirty-six years old. In sections examined with low powers of the microscope 

 a central mass of connective tissue is seen, abundantly provided with large 

 blood-vessels, mainly veins and capillaries, some choked with blood. Taper- 

 ing prolongations extend from this mass outward toward the periphery of the 

 tumor and the papillae, and terminate in a large number of minute, finger-like 

 ramifications. The central mass, with its prolongations, is invested with a 

 thick stratified epithelium, the lowest portion of which i. e., the one nearest 

 the connective tissue is a row of columnar epithelia, the main mass 

 cuboidal, and the peripheral portion flattened epithelia. The latter exhibit 

 in some places irregular erosions, which produce a rather jagged outline. 

 Corresponding to the papillae, the epithelial layers form rounded protrusions, 

 the valleys between the papillae representing the main mass of epithelial 

 structure. 



Higher powers of the microscope (500-600 diameters) show the fibrous con- 

 nective tissue in the central portion of the tumor to be made up of interwoven, 

 longitudinal, and transverse delicate bundles of fibers, the relatively thinner 

 bundles being nearer the periphery. Most of the papillae contain predominantly 

 the variety of connective tissue called myxomatous. Within the connective- 

 tissue bundles are seen numerous plastids, either single or in chains, either 

 roundish or oblong and fusiform, which are the so-called connective-tissue 

 corpuscles. In the myxomatous portion the fibers are more delicate than in 

 the fibrous, and are in many instances arranged in the shape of a delicate 

 net-work, at the nodes of which small, oblong nuclei are met with, while the 

 meshes contain either a finely granular basis-substance or globular plastids of 

 varying size. The blood-vessels, which, as before mentioned, are very numer- 

 ous and very large, wind their way between the bundles, and some of them 



* Abstract from the author's essay, " Archives of Laryngology," vol. i., 1880. 



