Cancer. 409 



their dissemination in the surrounding tissue and their metastasis, 

 and in the fact that the epithelial outgrowths do not form com- 

 pletely hollow passages, but are seen in massive proliferation as 

 solid cellular roots. The ducts of the involved structure are filled 

 with epithelium, and Uie cells show a great variety of altered shapes 

 depending upon the pressure conditions prevailing, fusiform, 

 rounded, irree:ular. etc. The connective stroma varies much in its 

 degree of development, and is sometimes found in villous masses, in 

 folds and laminated processes just as in adenomata, especially when 

 there are spaces and large cavities in the tumor {cyisto carcinoma 

 papular e). 



[The essence of the histological fault of any cancer lies in the 

 fact that in its proliferation the epithelium of the tumor does not 

 maintain its normal topographical relations, but grows tlirough its 

 limiting membrane and is found infiltrating to a greater or less 

 desfree the tissue about it, either as isolated cells or as roots or cord- 

 like groups of cells. In most cases, too, increase in the amount of 

 epithelium is recognizable not only by this infiltrative or metastatic 

 excess but by an excessive number of cells upon the surface in- 

 volved, or within the tubular spacer or the alveoli of the afifected 

 portion of the gland ; thus instead of a single layer of cells lining the 

 tubular canals of a cancerous area of endometrium, it is common 

 to find a number of layers and the tubules distended and branched 

 as the author above indicates. This excess, however, is by no means 

 an essential feature, many scirrhous carcinomata showing a mani- 

 fest reduction in the epithelial elements below^ that realized as nor- 

 mal to the original gland and to the ordinary cancers of the 

 same organ ; and in such cases one finds not only relatively few 

 epithelial areas but also no excess of layers in the tubular lumina, 

 the cells which do line such spaces being in fact themselves small, 

 atrophic or degenerative. It will be found, however, that many of 

 the cells in these have no relations to tubes or alveoli and' are clearly 

 free in the lymph spaces of the connective tissue stroma; and care- 

 ful examination of the gland-like spaces or tubes will somewhere 

 show the direct gro\vth of the epithelium into the surrounding 

 tissue beyond the proper membrane. The existence of karyokinetic 

 nuclear figures is of some value as indicating the active prolif- 

 erating state of the epithelium. 



. The editor believes that for practical purposes in microscopic 

 diagnosis of cancers of the author's two varieties, cylindrical cell 

 and glandular cell cancer, it is appropriate to recognize two types 

 according to the existence or non-existence of marked resemblance 



^ 



