PATHOLOGICAL ANATOMY 239 



develop downward and penetrate the entire sphenoid bone to the pharynx, as 

 in a case of Hansemann and in one of my cases, or develop upward and com- 

 press and displace the organs at the base of the brain, as well as the nerves 

 and venous sinuses situated upon both sides of the sella turcica. This has 

 been variously described ; in one of my cases the development was upward and 

 also, to a slight degree, downward. The tumor invariably develops from the. 

 anterior lobe of the gland, and in a few cases has been described as simple 

 hyperplasia of the gland. In other instances, adenoma or struma hyperplastica 

 of the gland is directly mentioned. Besides these, in still other cases, prolif- 

 eration, softening, cysts or connective tissue hyperplasia have been found. 

 Finally, in a great number of cases the tumors have been regarded as malig- 

 nant. Among these, isolated cases of gliomata have been mentioned. Claus 

 and van der Stricht found a lymphadenoma. The majority of malignant 

 tumors of the pituitary gland have been found to be sarcomata. Sternberg 

 has laid particular stress upon the fact that in the six cases of malignant 

 acromegalia which were known up to the time of the publication of his mono- 

 graph, the tumors were all sarcomata. In the meantime Gubler, in a ease 

 of malignant acromegalia histologically investigated by Hanau, and I myself 

 in at least two cases, found tumors of the hypophysis which were similar to 

 the malignant variety, and which upon superficial examination might also 

 have been looked upon as sarcomatous. But we recognized the tumor cells 

 as originating from the epithelium of the hypophysis, and designated these 

 tumors as hyperplastic, and eventually as malignant adenomata. Hana^^ ex- 

 pressed the suspicion that in the cases described as sarcomata the same ade- 

 nomatous form of tumor was really present. I was able to demonstrate in 

 my four cases that the character of the tumor was in the main the same, and 

 that its origin could be found in the glandular epithelium of the anterior lobe 

 of the pituitary body. I wish to lay special stress upon a fact (also noted 

 by Tamburini) that in at least three of my cases, a large part of the tumor 

 consisted of a very peculiar form of epithelium, the "granular cells," which 

 correspond to the so-called chromophilic cells of Plesch. These are the cells 

 which are looked upon as the essential functionating cells of the normal gland. 

 I presume that in every case of hypophysial tumor the hyperplastic prolifera- 

 tion of the cells is the basis for a neoplasm, and that, in the further course, a 

 malignant degeneration of the tumor starts in these cells ; or a malignant pro- 

 liferation of other tissue elements may replace this primary new formation 

 and so destroy it. 



When we consider the supposed importance of the hypophysial tumor in 

 the clinical picture of acromegalia, we must admit that it is by no means 

 free from objections. Several hypotheses in marked contrast to each other 

 may be mentioned. The most extreme (in one direction) assumes that the 

 tumor of the hypophysis is only a symptomatic enlargement of the organ 

 which may be markedly developed, slightly developed, or entirely absent. In 

 opposition to this is the conception that an abnormal function of the hypophy- 

 sis is the sole cause of the disease. A more conservative view ascribes the 

 disease to a primary anomaly of the " blood-vessel glands," among which the 

 hypophysis is to some extent implicated. 



