GLANDULAR CARCINOMATA. 185 



evolves within itself the causes of its own ultimate destruc- 

 tion. 



We are at present acquainted with adenomata of the liver, 

 mammary gland, sebaceous glands (Lupus), and the mucous 

 follicles of the rectum. It is only in the last-named case that 

 we find it hard to separate adenoma from columnar epithelioma 

 (Cylinderepithelialki'ebs). (^See below.) As for the rest, we 

 find practical means of distinguishing them from cancer, partly 

 in the manner of their development, partly in their clinical 

 history. Adenoma forms globular, sharply- circumscribed nodules, 

 which replace a comparatively small portion of the gland from 

 which they spring. Each single nodule increases by central 

 proliferation ; it tends rather to push aside than to infiltrate the 

 neighbouring parts. Adenoma of the liver actually surrounds 

 itself with a capsule. Further, adenoma is to be regarded as a 

 tolerably benign growth, which does not recur or give rise to 

 secondary deposits, though our knowledge on this point is still 

 in its infancy. 



§ 153. Glandular cancer, with its many varieties, consti- 

 tutes the natural termination of the histogenetic series which we 

 have been hitherto considering. If we imagine the independent 

 growth of the glandular epithelia waxing more luxuriant and 

 more general, the regular elaboration of the gland-tubuli being 

 more and more neglected for the sake of a proportionately more 

 rapid penetration of the interstitial and surrounding connective 

 tissue, we shall have a tolerably correct notion of glandular 

 cancer. Its individual features however demand a more detailed 

 examination. 



That the growth originates in the glandular epithelia has 

 been recently established by numerous observations. The cells 

 divide and multiply. The first result of their multiplication is 

 an obliteration of the lumina of the respective tubes and acini, 

 which are converted into solid groups of cells. These imme- 

 diately proceed to put out buds in all directions, which bore their 

 way into the neighbouring connective tissue. This is the common 

 starting-point of the many varieties of glandular cancer, the 

 more important of which will now be described seriatim, 



§ 154. Soft cancer (carcinoma medullare, encephaloides — 

 hitherto often confounded with the soft variety of alveolar sar- 

 coma) produces cancer-cells in the greatest number, though not 



