CAHCINOMA. 241 



from the primary growth, turn out to be well-founded, it is 

 desirable to ascertain farther, the exact point at which these cells 

 are arrested, and how they give rise to the first nests of cancer- 

 cells, whether by proliferation or by infecting the adjacent lymph- 

 corpuscles. After many investigations specially directed to this 

 point, I can only say that the transformation of the lymphadenoid 

 tissue into the substance of a glandular cancer takes place very 

 simply; the trabeculae of the reticulum increase markedly in 

 length and thickness (just as in chronic induration), its meshes 

 become enlarged from ten- to twenty-fold, and are occupied by 

 the specific elements of cancer instead of lymph-corpuscles. Thus 

 the structure of the lymphadenoid tissue seems to pass directly 

 into that of the cancer, the reticulum becoming the cancer-stroma 

 while the lymph-corpuscles are converted into cancer-cells. 



Epithelioma of the lymphatic glands presents us with jDheno- 

 mena of a much more complicated order. The law regulating 

 the metastasis of morbid growths, se. that the lymphatic 

 glands nearest to the seat of disease are the first to become 

 affected, is obeyed with peculiar strictness by epitlielioma. 

 Hence in epithelial cancer of the lips, the submaxillary lymphatic 

 glands are the first to swell, in cancer of the penis or the labia 

 majora the inguinal glands, in cancer of the scalp the cervical 

 group of glands. The metastasis commonly goes no farther, as 

 the extensive disturbances operated in the mean while by the 

 primary growth usually kill the patient before any such further 

 extension can occur. 



The swelling usually begins at the periphery of the gland. 

 This becomes nodulated ; one of the nodular projections gradu- 

 ally increases in size till it incorporates the rest into itself. The 

 gland ultimately attains from two to three times its normal 

 dimensions. In a group of glands we can usually see one which 

 exhibits the first beginnings, another some intermediate stage, a 

 third the highest degree of enlargement. The biggest lumps 

 (equal to a pigeon's egg in size), nearly always contain a central 

 cyst due to softening. The smaller and smallest ones are dis- 

 tinguished by their white colour and their tough, dry consistency, 

 which contrasts sharply with that of the unaltered portions of the 

 glandular parenchyma. This normal parenchyma however, at 

 least in the neighbourhood of the smallest nodules, is normal 

 only in seeming. The microscope proves that it has already 



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