1010 



largements of so great a magnitude as ence- 

 phaloid cancer. M. P. Boyer removed a 

 testicle converted into an encephaloid tumour 

 which weighed more than nine pounds.* The 

 vessels of the cord undergo great enlargement 

 in this disease. In one case which I examined, 

 the spermatic artery was found as large as 

 the radial artery at the wrist. Cancerous 

 germs have also been found in the blood 

 contained in the spermatic veins. Encepha- 

 loid cancer of the testicle occurs at all periods 

 of life : no age, indeed, can be said to be 

 exempt from it. There are examples on 

 record of operations for the removal of tes- 

 ticles thus affected, within a twelvemonth 

 after birth. On the other hand I have met 

 with the disease as late in life as the age of 

 sixty-four. It more commonly occurs, how- 

 ever, in the middle period of life, or between 

 the ages of twenty and thirty. 



Carcinoma has, in some few instances, 

 been found to originate from the tunica va- 

 ginalis, the glandular part of the testicle re- 

 maining for some time unaffected. Cases of 

 the kind have been recorded by Sir E. Homef 

 and Sir A. Cooper. The other two forms of 

 cancer, colloid and melanosis, have rarely been 

 observed in the testicle. A preparation of the 

 former disease is contained in the Museum 

 of Guy's Hospital. The organ is enlarged 

 to four or five times its natural size, but pre- 

 serves its oval form : there is scarcely any 

 trace of the natural structure remaining, its 

 place being supplied by colloid matter. Cru- 

 veilhier has related the case of a man who 

 died of melanosis affecting the hand, lungs, 

 heart, stomach, and other parts. There was 

 a deposit of the same character in each tes- 

 ticle. 



Cystic Disease. The cysts developed in 

 the substance of the testicle and constituting 

 this disease vary very much both in number 

 and size, and in the appearance of their con- 

 tents. They may be only two or three in 

 number, or they may exist in a countless 

 multitude and occasion considerable enlarge- 

 ment of the organ. They vary in size from 

 that of a millet seed to the dimensions of a 

 pigeon's egg. At an early period they gene- 

 rally consist of smooth and slightly vascular 

 cysts, closely adherent, and containing a 

 transparent light-coloured fluid. In other 

 cases the fluid is thick, viscid, and highly 

 albuminous, and sometimes tinged with blood. 

 I have never succeeded in detecting sperma- 

 tozoa in the fluid. Sometimes a small lo- 

 bulated growth arises from the walis of the 

 cyst, and increases until it is partly or wholly 

 filled and obliterated. The cysts usually in- 

 crease at the expense of the secreting struc- 

 ture of the testicle, which disappears or be- 

 comes much displaced. In some instances 

 the tubular structure forms an expanded 

 layer over the morbid mass. When inflam- 

 mation takes place, fibrine is effused be- 

 tween as well as within the cysts, and be- 



* Revue Medicale. Nov. 1839. 

 t Observations on Cancer, p. 125. Anatomie 

 Pathologique, liv. xix. pi. 3, 4. 



TESTICLE (ABNORMAL ANATOMY). 



comes organised ; so that the tumour is 

 partly solid and partly composed of cysts 

 containing fluid. After some time, the sur- 

 faces of the tunica vaginalis become more or 

 less adherent, and in old cases the tumour is 

 intersected with fibrous bands. In several 

 specimens of the disease I have noticed small 

 masses of enchoridroma interspersed amongst 

 the cysts. In sections the little pearly-looking 

 masses appear as if contained within the cysts. 

 They are however developed between them, 

 and are closely connected with their walls. 

 The occurrence of enchondroma in these 

 cystic tumours has scarcely been noticed by 

 pathologists. There are several specimens 

 in the Museum of the College of Surgeons. 



Fis. 653. 



Portion of the section of a testicle in the Museum of 

 the College of Surgeons, with numerous masses of 

 enchondroma between the cysts, of the exact size. 



a. a. enchondroma. 



One of the specimens of cystic disease in this 

 collection measures five inches in its largest 

 diameter, and three inches in its smallest. 

 Sometimes small lobulated growths arise 

 from a part of the walls of the cyst, and in- 

 crease until the cavity is partly or wholly 

 filled and obliterated by them, in the same 

 manner as in cystic disease of the mamma. 



The mode of origin of these cysts has not 

 been satisfactorily made out. It has been 

 supposed that they are formed of dilated and 

 obstructed seminiferous tubes ; but as in cer-> 

 tain cases the tubular structure exists in the 

 form of a layer spread over the morbid mass, 

 it is clear that the disease could not have 

 originated in this way. This morbid change 

 is evidently quite distinct from the little cysts 

 so commonly developed in the head of the 

 epididymis : indeed this part is rarely affected 

 in cystic affections of the testicle. The dis- 

 ease is considered by some pathologists to be 

 of a malignant character. After removal of 

 a testicle thus diseased, tumours of a carci- 

 nomatous character have afterwards appeared 

 in the lumbar glands and other parts. Mr. 

 Caesar Hawkins showed me several prepara- 

 tions of cystic sarcoma of the testicle which 

 had been removed by operation where this 

 happened, and it occurred also in a case 

 which came under my own observation. The 

 unexpected result in this instance led me to 

 pay attention to the matter, and I am now 

 quite satisfied that the cystic disease may be 



