TESTICLE (ABNORMAL ANATOMY). 



in the testicle, more nearly resembles the 

 changes which ensue in tubercle of the ab- 

 sorbent glands. 



It has been a question whether the tuber- 

 cular matter is originally formed in the areolar 

 tissue connecting the tubuli, or in the tubuli 

 themselves. I have certainly seen this de- 

 posit in the vas deferens near the testicle, and 

 within the ducts of the epididymis. Dr. 

 Carswell has given a representation of a tes- 

 ticle containing a multitude of pale yellow- 

 coloured granular bodies of various sizes, 

 which, lie says, were obviously formed by the 

 accumulation of tuberculous matter in the 

 tubuli seminiferi. The epididymis was as 

 thick as the little finger, and its convoluted 

 ducts were obviously filled with a similar 

 deposit. I believe that tubercle may be de- 

 posited in both situations, within as well as 

 between the tubuli. Earthy matter is some- 

 times found in the testicle, generally in the 

 epididymis, the part most frequently the seat 

 of tubercle. This substance is exactly si- 

 milar to the putty-looking chalky matter 

 often observed in the lungs and bronchial 

 glands. It is highly probable that, in these 

 cases, the gland had at some former period 

 been the seat of tubercular deposit, but I 

 have not yet been able to establish this point 

 satisfactorily. 



Carcinoma. This disease occurs in the 

 testicle under the four forms of Scirrhus, En- 

 cephaloid, Colloid, and Melanosis. 



Carcinoma seldom occurs in the testicle in 

 the dense form which it commonly assumes 

 in the breast. Sir A. Cooper describes a 

 sdrrhous disease of the testicle, in which the 

 gland is invaded by a large white mass in 

 lobes or tubercles. The spermatic cord is 

 affected with a similar disease, and the glands 

 of the abdomen become converted into a 

 white solid texture, very unlike that of the 

 fungoid disease. I have a man, 52 years 

 of age, under my care at the present time, 

 with this disease of the testicle. It forms 

 a tumour about three times the natural size, 

 and is almost of stony hardness, especially at 

 the back part. There is also a large indurated 

 tumour in the spermatic cord. This affection 

 of the testicle is very rare, and is charac- 

 terised by its slow progress as well as by its 

 great induration. 



Encephaloid cancer is by far the most fre- 

 quent form of malignant disease to which the 

 testicle is liable. When first observed, it is 

 found in one or two masses amongst the 

 tubuli, which gradually become destroyed as 

 the morbid deposit accumulates. The matter 

 is very rarely infiltrated. The testicle at this 

 early period is extremely firm and hard, 

 owing, not to the solid nature of the sub- 

 stance effused, but to the excessive distention 

 of the unyielding tunica albuginea by the 

 morbid growth within. The glandular struc- 

 ture soon entirely disappears, the whole organ 

 being occupied by the new growth, inter- 

 mixed with and sustained by the septa and 

 fibrous processes from the mediastinum and 

 tunica albuginea. In some instances a thin 



VOL. IV. 



1009 



layer of the tubular structure is found ex- 

 panded around a mass of encephaloid matter. 

 At this stage the tunica vaginalis is often dis- 

 tended with serum; not, however, in any 

 considerable quantity. The tunica albuginea 

 next gives way, and a portion of the morbid 

 growth protrudes, forming a mass projecting 

 from the body of the gland ; this sometimes 

 occurs in more places than one. The epi- 

 didymis remains for some time unaffected; 

 but, as the disease increases, this part like- 

 wise becomes implicated and destroyed. In 

 one instance I found the tubes in the head of 

 the epididymis (the only part of the gland not 

 destroyed) filled with white matter which, 

 on microscopic examination, proved to be 

 carcinomatous. The scrotum in a short time 

 becomes fully distended by the diseased mass, 

 which presents the well-known appearance 

 of encephaloid cancer ; viz. a homogeneous 

 substance of the consistence of brain, and 

 easily broken down with the fingers, of an 

 opaque white colour, and variegated with 

 patches of a pinkish hue. It is sometimes 

 mixed with small cysts containing serum ; at 

 other times with yellow deposits of lymph, 

 resembling that effused in chronic orchids. 

 These small depositions of yellow fibrine oc- 

 casionally interspersed amongst the carcino- 

 matous matter, are almost peculiar to this dis- 

 ease in the testicle. I have only once observed 

 them in cancer of other parts, and that was 

 in the kidney. As the enlargement goes on, 

 the scrotum becomes adherent to the tumour 

 in one or more places, then ulcerates, and 

 allows the protrusion of the morbid mass, 

 which projects as an open fungus. The 

 scrotum admits however of great distention 

 before ulceration ensiu-s. The mass then 

 becomes less firm, and its consistence varies 

 very much in different parts, the morbid 

 matter being in some a mere pulp, or re- 

 sembling a creamy fluid. It is interspersed 

 with round or irregular patches of dark look- 

 ing coagula, and, when incised, often presents 

 in different places dark minute spots of va- 

 rious sizes, produced by coagulation of blood 

 in the vascular network usually mixed up 

 with the morbid deposit. On macerating 

 these tumours, or on pouring a stream of 

 water on them for some time, a granular sub- 

 stance, the cancerous matter, is washed away, 

 leaving behind a filamentous shreddy tissue 

 or meshes of a delicate areolar texture, which 

 may often be found connected to a denser 

 fibrous substance, the remains of the tunica 

 albuginea. The spermatic cord is often in- 

 vaded by a similar substance ; and in an ad- 

 vanced stage of the complaint, large bodies 

 of the same kind, originating in disease of 

 the lumbar glands, are found on the sides of 

 the vertebrae, reaching as high up as the dia- 

 phragm. 



Masses of a similar kind are sometimes 

 also found in the lungs. The carcinoma- 

 tous matter is often deposited in such abun- 

 dance as to form a tumour of very con- 

 siderable size ; indeed, there is no other dis- 

 ease of the testicle which occasions solid en- 



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