CYLINDROMA. 209 



Cylixdroma (Appendix). 



§ 173. The question concerning the essential character of a 

 tumour, termed by Henle siphonoma, by Billroth cylindromaj by 

 Meckel tubular enchondroma, by Friedreich tubular sarcoma, 

 by Forster and its most recent investigator Koster mucous 

 cancroid, presents itself among all discussions concerning the 

 fundamental nature of cancer and sarcoma, as an enio-ma of 

 equal interest and difficulty which chance has thrown in the way, 

 now of one, now of another inquirer. The number of names 

 which have been applied to this growth, show clearly enouo-h 

 that the different observers differ widely in their views concernino- 

 it. Are we justified in assuming that all the cases which have 

 been examined are really identical ? In fiivour of this assump- 

 tion we have the fact of their common situation in the region of 

 the fiice, particularly in the orbit and surrounding parts ; while 

 the circumstance that the earlier observers devoted their chief 

 attention to the most singular and not to the most essential 

 constituents of the growth, may go some way towards explaining 

 and excusing their differences of opinion. 



Those singular constituents are certain ^Mij-aline bodies" of 

 considerable size, which may readily be isolated by teazing with 

 needles. We are struck first of all with the strangeness of their 

 outward form. Together with perfect spheres, we find specimens 

 of a more cylindrical shape ; others again which are club-shaped 

 and cactiform. The hyaline chains often seem to diverge from 

 a common centre. I cannot now review the manifold hypotheses 

 concerning the mode of origin and flirther development of these 

 bodies, hypotheses in which the prevalent histogenetic theories 

 are for the most part mirrored. I will only say that BillrotFs 

 view, according to w^hieh they are perivascular sheaths of mucous 

 tissue or fragments of such sheaths was the most generally adopted 

 one, until Koster recently showed, from a very careful study of 

 the development of the tumour as a whole, that the hyaline 

 globes, cylinders, etc., were the product of a secondary, hyaline 

 metamorphosis of the cellular trabeculse of a cancroid growth of 

 the lym]3hatic vessels. He believes that we have to do in all 

 cases with a cancroid proliferation of cells taking place in the 

 lymphatic networks of the affected part. The endothelia of the 

 lymphatics proliferate ; the canals are blocked by cellular cords 



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