VIII, B, 3 Gilman : Axillary Teratoma 233 



Occupying the right axilla and limiting considerably the movements of 

 the arm in all directions is a tumor measuring about 12 centimeters in 

 diameter, with a general spherical fonn. The growth as a whole is soft 

 and elastic and is movable, although evidently attached to the apex of 

 the axilla and upper portions of the chest wall; is not tender nor painful. 

 The skin over the mass is more or less adherent in several linear areas, 

 one of these on the external surface being reddened and inflamed. The 

 vessels of the skin over the growth show great distention and considerable 

 venous stasis. The tumor evidently contains fluid under considerable 

 tension, and over the posterior portion of the wall of the cyst gives a 

 sensation as though considerable fibrous thickening had taken place with 

 probably a deposition of some mineral salts. 



Under chloroform anaesthesia, an oblique incision was made over the 

 tumor and the skin and subcutaneous tissues were stripped back from the 

 cyst wall proper. The growth shelled out readily over nearly the entire 

 surface, difficulty being experienced only in the apex of the axilla where 

 the artery, several branches of the vein, and most of the nerve branches 

 were enveloped in the fibrous capsule of the cyst and over the fifth rib, 

 the periosteum of which was intimately connected with the wall. 



The wound was closed with a cigarette drain and the child, although 

 having taken the anaesthetic badly, made an uninterrupted recovery. 



The tumor was sent to the pathological laboratory, and was 

 examined by Dr. B. C. Crowell, whose report follows : 



Specimen consists of a mass of tissue removed from the right axilla. 

 This is irregularly globular in shape, and measures about 12 centimeters 

 in diameter. There are some fibrous tags on the outer surface, and it is 

 apparently cystic, being formed of larger and smaller cysts, some as large 

 as 4 or 5 centimeters in diameter. A small portion of the fluid of the 

 cyst was aspirated immediately after the specimen was received, and was 

 seen to be clear and yellowish in color. The specimen was fixed intact, 

 and after fixation was divided into two equal portions. The cysts of 

 which it is made up are filled with a partially coagulated greenish fluid 

 (after fixation). On removal of this fluid, one large cyst measuring 6 

 centimeters in diameter and other smaller cysts are seen; the walls of 

 these are smooth and pale, and the larger cysts have thin walls. Across 

 one of the larger cysts stretches a band of soft, gelatinous tissue about 

 2 centimeters in diameter. At the periphery of one-half of the cut section 

 are seen numerous small cysts in the wall of the mass, these being 

 separated by a pale tissue. Some of these cysts have a clear content, and 

 in some it is yellowish and rather firm, and again in others of a deep 

 red color. 



Microscopically, sections taken from the walls of the cysts are seen to 

 contain numerous fibrous connective tissue, muscular and adipose elements 

 irregularly arranged, and in their midst are numerous, very thick-walled 

 blood vessels. One small portion of a lymph node is also seen in one 

 section imbedded in the wall. There are also numerous small cystic 

 spaces, some of which are filled with blood and others filled with a pink, 

 gelatinous material. The walls of these smaller cysts are formed by 

 very low, flat, epithelial cells, the nuclei of which are rounded in many 

 places. There is also considerable leucocytic infiltration of different parts 



