THE VERMIFORM APPENDIX. 31 



in one process, and the result, in whatever stage encountered, 

 has been termed a retention cyst, hydrops, or mucocele. The 

 term retention cyst indicates the origin and is, therefore, cor- 

 rectly applicable to all stages, but it would appear rational to 

 differentiate between a hydrops and a mucocele as being different 

 stages. Where the overproduction of mucus or even definite 

 myxomatous changes predominate, the term mucocele seems 

 more appropriate, while that stage in which the mucosa is de- 

 stroyed and the cyst filled with a transudate would more appro- 

 priately be denominated a hydrops. 



It is to be remembered that, according to the position of the 

 occluded portion, the whole or any part of the appendix may be 

 converted into a cyst. Probably the largest described is that 

 of Guttmann, which was 14 centimeters long and 21 centimeters 

 in circumference. 



The peculiar character of the contents of a true mucocele along 

 with some unusual features in the epithelial changes have sug- 

 gested in some cases the possibility of tumor formation. As 

 already mentioned, Virchow considered his case as one of colloid 

 degeneration, and Stengel has reported a case in which he con- 

 sidered the possibility of colloid carcinoma. He also mentions 

 the cases of Rokitansky, Draper, Vimont, and Baillet as possess- 

 ing histological features suggestive of neoplasms. No case, how- 

 ever, has been recorded, as far as I can ascertain, with indubit- 

 able neoplastic features. The extreme mucoid degeneration of 

 the mucosa with desquamation of the epithelium and the myx- 

 omatous degeneration of the fibrous tissue form a picture readily 

 mistaken for a tumor, without the actual presence of tumor 

 formation. I believe it to be a retrogressive rather than a pro- 

 gressive metamorphosis. 



Congenital diverticula of the appendix have been described, 

 especially by Hedinger, but the chance of as rare a lesion as a 

 mucocele occurring in an appendix with a congenital diverticulum 

 seems remote; on the other hand, in a mucocele all the factors 

 necessary for the formation of acquired diverticula may be at 

 hand. 



The case here to be reported (number 1403) was discovered 

 in the necropsy of a male Filipino, 40 years old, who had died of 

 pulmonary tuberculosis, and in whom there was no evidence of 

 abdominal tuberculosis. 



The vermiform appendix was 4.5 centimeters long, occupied 

 its noiTnal position, and there were no surrounding adhesions. 

 At its origin from the caecum on the side opposite the mesentery 



