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 Instructor Resource
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SAGE Publishing, 2020

Chapter 7: Leadership in Public Organizations

Test Bank

Multiple Choice

1. The two dimensions in the leadership grid are ______.

a. concern for organization and employees
b. concern for production and people
c. concern for people and profits
d. concern for productivity and people
Ans: B
Difficulty Level: Easy

2. Leaders and followers should engage in a structured ______.

a. dialogue
b. monologue
c. epilogue
d. prologue
Ans: A
Difficulty Level: Easy

3. Contingency leadership stipulates that ______.

a. group effectiveness is dictated by employee commitment
b. group effectiveness is not affected by the relationship between the styles of
leadership
c. the contingent group dynamics affect the results achieved by the leader
d. the effectiveness of a group is dependent on the relationship between the style of
leadership and the degree to which the situation enables the leader to exert influence
Ans: D
Difficulty Level: Medium

4. Fiedler identified two leadership styles: the ______-oriented leader (who is quite
efficient and goal oriented) and the ______-oriented leader (who derives satisfaction
from successful interpersonal relationships).
a. organization; team
b. task; relationship
c. success; relationship
d. task; social
Ans: B
Difficulty Level: Medium

5. The traditional command and control type of leadership structure does not encourage
______.
a. risk and innovation
b. diplomacy and understanding
c. democracy and charter
d. industry and invention
Ans: A
Difficulty Level: Easy

6. All of the following are characteristics of leadership EXCEPT for ______.

a. a strong drive for responsibility and task completion
b. creativity and originality in problem solving
c. a capacity for absorbing stress
d. an untenable positive approach
Ans: D
Difficulty Level: Medium

7. The readiness of an individual or a group to perform a specific task depends on the

______ and ______ to perform the task.
a. aptitude; readiness
b. facility; enthusiasm
c. ability; willingness
d. capacity; motivation
Ans: C
Difficulty Level: Medium

8. ______ refers to the degree to which the position enables the leader to get others to
comply with his or her directions.
a. Position power
b. Task structure
c. Personal relationships
d. Compliance
Ans: A
Difficulty Level: Easy

9. A(n) ______ leadership style will be most effective in situations where subordinates
are engaged in work that is stressful, frustrating, or unsatisfying.
a. supportive
b. directive
c. participative
d. achievement-oriented
Ans: A
Difficulty Level: Easy

10. ______ are concerned with vision and judgment, whereas ______ are concerned
with mastering routines.
a. Leaders; employees
b. Leaders; managers
c. Managers; leaders
d. Managers; employees

2
Ans: B
Difficulty Level: Medium

11. According to Ancona, leadership has four specific capabilities: ______.

a. sensemaking, visioning, relating to others, and inventing new ways to get things done
b. visioning, relating to others, enthusiasm, and inventing new ways to get things done
c. inventing new ways to get things done, encouraging the heart, visioning, and
enthusiasm
d. sensemaking, visioning, relating to others, and enthusiasm
Ans: A
Difficulty Level: Easy

12. Leaders must have which of the following traits or competencies?

a. self-understanding
b. high energy
c. integrity
d. all of these
Ans: D
Difficulty Level: Medium

13. ______ leadership occurs when leaders and followers engage with one another in
such a way that they raise one another to higher levels of morality and motivation.
a. Moral
b. Transactional
c. Transformational
d. Powerful
Ans: C
Difficulty Level: Easy

14. People that possess ______ achieving styles are motivated to master their own
tasks.
a. relational
b. instrumental
c. transformational
d. direct
Ans: D
Difficulty Level: Easy

15. All of the following are dimensions of emotional intelligence EXCEPT for ______.
a. managing emotions
b. motivating oneself
c. the ability to cry
d. handling relationships
Ans: C
Difficulty Level: Medium

3
16. In the countries which score ______ on power distance, subordinates are more
likely to disagree with their leaders and desire a “consultative style” of management.
a. low
b. high
c. in the middle
d. none of these
Ans: A
Difficulty Level: Easy

17. For ______ cultures, successful leaders should be supportive and paternalistic.
a. individualistic
b. collectivist
c. socialist
d. all of these
Ans: B
Difficulty Level: Easy

18. All of the following were identified as cultural dimensions comprising the GLOBE
model EXCEPT for ______.
a. performance orientation
b. human orientation
c. unassertiveness
d. uncertainty avoidance
Ans: C
Difficulty Level: Medium

19. According to Gardner, what type of mind moves beyond self-interest to make
decisions based on a sense of social responsibility?
a. disciplined
b. ethical
c. synthesizing
d. respectful
Ans: B
Difficulty Level: Easy

20. According to Gardner, what type of mind is able to bring together information and
ideas from many different sources in a way that makes sense?
a. disciplined
b. ethical
c. synthesizing
d. creating
Ans: C
Difficulty Level: Easy

21. What are the five dimensions of collaboration?

a. governance, administration, autonomy, mutuality, and trust-building

4
b. governance, administration, autonomy, mutuality, and respect
c. equality, administration, autonomy, mutuality, and trust-building
d. governance, administration, equality, autonomy, and mutuality
Ans: A
Difficulty Level: Easy

22. ______ is concerned with facilitating extraordinary performance, affirming human

potential, and facilitating the best of the human condition.
a. Positive leadership
b. Collaborative leadership
c. Connective leadership
d. Servant leadership
Ans: A
Difficulty Level: Easy

True/False

1. In earlier studies of leadership, factors such as age, height, weight, and appearance
seemed to have everything to do with leadership.
Ans: F
Difficulty Level: Medium

2. Leadership is exercised by the person in the group who energizes the group, whether
or not he or she carries the title of “leader.”
Ans: T
Difficulty Level: Easy

3. Leaders tended to be more intelligent, more dependable or responsible, and more

active in social situations than others.
Ans: T
Difficulty Level: Easy

4. Relationship behavior is defined as the extent to which the leader engages in spelling
out the duties and responsibilities of an individual or group.
Ans: F
Difficulty Level: Easy

5. The situational model of leadership suggests that the effectiveness of a group is

contingent on the relationship between the style of leadership and the degree to which
the situation enables the leader to exert influence.
Ans: F
Difficulty Level: Medium

6. Achievement-oriented leadership is a style that involves consultation with

subordinates and a serious consideration of their ideas before the leader makes a
decision.

5
Ans: F
Difficulty Level: Medium

7. The successful leader stimulates resonance among those who follow.

Ans: T
Difficulty Level: Easy

8. Despite younger leaders and older leaders growing up in quite different eras, their
formative experiences with respect to leadership are remarkably similar.
Ans: F
Difficulty Level: Medium

9. Charismatic leadership in whatever its form constitutes a moral “slippery slope.”

Ans: T
Difficulty Level: Easy

10. Leadership is always provided by those in formal positions of authority.

Ans: F
Difficulty Level: Easy

11. The transactional leader exchanges rewards for services rendered so as to improve
subordinates’ job performance.
Ans: T
Difficulty Level: Easy

Essay

1. Compare and contrast the different styles of leadership. Develop scenarios where
each style might be most appropriate.
Ans: Answers will vary based on the styles of leadership and scenarios used by the
students.
Difficulty Level: Hard

2. Compare and contrast managers and leaders. What are the similarities, if any? What
are the differences, if any? Discuss, providing relevant examples where appropriate.
Ans: Answers will vary based on the examples used by the students. However, a strong
answer will utilize the information provided in the “Ways of Thinking” section of the text.
Difficulty Level: Hard

3. Explore what part power plays in leadership. Do different styles of leadership access
or use power differently?
Ans: Answers will vary based on the student’s comprehension of the material.
Difficulty Level: Hard

4. Identify and explain the various ways in which leaders establish their credibility
through their actions.

6
Ans: A strong answer will identify and explain the following: modeling the way, inspiring
a shared vision, challenging the process, enabling others to act, and encouraging the
heart.
Difficulty Level: Medium

5. What makes a good leader?

Ans: Answers will vary depending on the student’s comprehension of the material and
experiences with leadership.
Difficulty Level: Hard

7
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blood, but not of lymph—at least not to nearly the same extent;
consequently its usefulness is restricted to blood-vascular tumors.
Excision, then, is the best remedy. When this is impracticable much
can be done by galvanopuncture or ignipuncture, the cicatricial
contraction following multiple punctures leading to reduction in size
of the affected part. The enlargement of the tongue spoken of above
as macroglossia may be treated by ignipuncture or by electrolysis, if
necessary under an anesthetic, the effect of the electric current here
being not to produce coagulation, but apparently absorption of
fibrous tissue and changes which come slowly rather than by
obliterative processes.

Fig. 82 Fig. 83

Congenital lymphangioma. (Original.) Lymphangioma of lower extremity.

(Original.)
 5. Tumors of Nerve Elements.

Glioma.—Glioma is a malignant tumor developing directly from

actual nerve structure or that of the original nerve
elements, and is clinically allied to the sarcomas. It arises from the
neuroglia, and hence is confined to the central and peripheral
nervous system, mainly the former. It is most common in the brain,
the cord, and in connection with the optic nerve and fundus of the
eye. It is often extremely vascular, the vessels being sacculated, and
is usually met with in solitary form. When near the surface of the
cortex such a tumor may appear like a great convolution (Virchow).
In the basal portions of the brain it may attain considerable size. In
the cord it is rare, usually limited to the cervical region. In the orbit
and eye it may produce marked exophthalmos. It is more frequent in
the young than in the aged.
Glioma is an exceedingly malignant form of tumor, and operation
is rarely performed sufficiently early to more than prolong life.
Dissemination by continuity is the rule rather than metastasis. It kills
usually by its pressure effect on the nerve centres.
Neuroma.—True neuromas spring from the structures of nerve
trunks, which trunks may also be the site of other
tumors, mainly fibromas and sarcomas, with which neuromas may
be easily confounded. The most common nerve tumor is the
neurofibroma, which grows from the structure of a nerve sheath, its
long axis usually coinciding with that of the nerve trunk. Tumors of
this class vary greatly in size, are often multiple, and in other
instances affect nearly all the nerves in the body. They are extremely
liable to myxomatous degeneration, which will account for many of
the instances reported as myxoneuroma, etc. They attack cranial
and spinal nerves alike, and no nerve or nerve root in the body is
exempt. The sensory nerves appear more liable to attack than the
motor. The nerve least often attacked is the optic. They are not rare
upon the roots of the spinal nerves, in which location they may attain
to such size as to press upon the cord and induce paraplegia.
Multiple neuromas are often associated with molluscum fibrosum (q.
v.). There is an instance on record in which 1600 of these tumors
were found after careful dissection of the neuroskeleton, and another
in which at least 2000 were found, 60 of them involving the
pneumogastric trunks and their branches.

Fig. 84 Fig. 85

Plexiform neuroma, dissected free from Plexiform neuroma of chest wall in a

all adherent tissues. (Lexer.) young child. Illustrating its gross external
resemblance to lymphangioma. (Lexer.)

Plexiform Neuroma.—Plexiform neuroma is relatively rare. This is a

type of nerve tumor in which all the branches of a given nerve which
are distributed to a particular area become enlarged and elongated,
the overlying skin being stretched and thin. Such a tumor seems like
a loose bag containing a number of vermiform bodies, resembling
the sensation given when palpating a varicocele. On section each of
the affected nerves reveals a quantity of myxomatous tissue
replacing the nerve sheath. They are in large measure congenital.
The skin overlying a plexiform neuroma will frequently be found to be
pigmented, variously altered in thickness, and covered with fine hair.
These growths have been frequently mistaken for lymphangioma
(Figs. 84 and 85).
Malignant Neuroma.—Malignant neuroma (so called) will generally
be found to be a true sarcoma of nerve structures, usually of the
spindle-cell variety. Traumatic neuroma is often seen in amputation
stumps, where the terminations of the divided nerves become
bulbous, attaining the size of cherry stones, the tumors being
composed of a mixture of connective tissues and nerve fiber, from
which in time the true nerve structure usually recedes or vanishes.
They form when suppuration has been profuse or healing long
delayed, and when sufficient care has not been exercised to prevent
entangling of the nerve ends in the scar of the wound. They give rise
to much pain, and often necessitate re-amputation. The bulbous
enlargement is the result of prolonged irritation in a nerve, and has
been noted around various foreign bodies.
True neuroma is innocent in tendency, though often painful. It is
the sarcoma of nerve tissue which produces signs of malignancy. A
true neuroma which causes unendurable pain should, when
accessible, be removed. It is sometimes possible to separate the
tumor mass from the balance of the nerve trunk, and thus to remove
it without excision of the nerve. At other times it is impossible to
avoid division and ensuing paralysis. Divided nerve ends should be
brought together by catgut suture, by which means it may be
possible to avoid permanent loss of function. Nerve grafting is also
resorted to for repairing such defects. Removal of painful neuromas
due to injuries to the head has more than once been the means of
curing traumatic epilepsy.

6. Tumors Derived from Epithelium.

These tumors consist of specific epithelial elements supported and
more or less bound together by a vascular connective-tissue stroma.
The only apparent exception to this statement is tumor of dental
tissue. The teeth are positively modified and petrified or calcified
epithelial products.
Odontoma.—The odontomas are tumors composed of one or
more of the dental tissues, arising either from tooth
changes or teeth in process of development. They may be divided,
according to Sutton, as follows:
1. Epithelial Odontomas.—These are provided with a capsule, and
present usually as a series of cysts separated by thin septa,
containing mucoid fluid, while the growing portions have a reddish
tint not unlike sarcoma. They are most frequent about the twentieth
year of life, but may occur at any age. They probably arise from
persistent remains of the epithelium of the original enamel organs.
2. Follicular Odontomas.—These are often called “dentigerous cysts.”
They arise in connection with permanent teeth, and especially with
the molars, sometimes attaining great size and producing
conspicuous deformity. The tumor consists of a wall representing the
expanded tooth follicle, and a cavity containing viscid fluid, with
some part of an imperfectly developed tooth, occasionally loose and
more or less displaced in location. The cyst wall always contains
calcareous material. These tumors rarely suppurate. They occur also
in animals.
3. Fibrous Odontomas.—These consist of condensed connective
tissue in a developing tooth, presenting as a tumor with a firm outer
wall and a loose inner texture, blending at the root of the tooth with
the dental papilla and indistinguishable from it. The developing tooth
thus becomes enclosed within the capsule before it protrudes from
the gum. These tumors are most common in ruminants, being often
multiple.
4. Cementoma.—A tumor of fibrous character whose capsule has
ossified or calcified, the developing tooth thus becoming embedded
in a mass of dental cementum. These tumors occur most frequently
in horses.
5. Compound Follicular Odontomas.—These are tumors containing a
number of masses of cementum resembling small teeth, or even
amounting to well-formed but ill-shaped teeth composed of all three
dental elements. In such a tumor teeth may be found in great
numbers. They occur in the human subject as well as in animals.
6. Radicular Odontomas.—These are tumors which arise after the
crown of the tooth has been completed and while its roots are yet in
process of formation. The crown, being unalterable enamel, does not
enter into the composition of these growths, which then consists of
dentine and cementum in varying proportions. They are rare in man,
but frequent in other animals, and often multiple.
7. Composite Odontomas.—These are hard tumors, bearing little or
no resemblance in shape to normal teeth, occurring in the jaws,
consisting of a conglomeration of enamel, dentine, and cementum,
presenting abnormal growth of all the elements of the tooth germ. So
far this tumor has only been found in man.
Little is said about the odontomas in general surgical literature.
These tumors, as they grow, are often regarded as due to necrosed
bone or to unerupted teeth, while fibrous odontomas have been
often regarded as myeloid sarcomas. No tumor of the jaw, especially
in young people, should lead to excision of the jaw until it has been
demonstrated that the tumor is not one of the above forms. When
diagnosticated as true odontoma its complete removal is all that is
necessary.
Papilloma, or Fibro-epithelioma.—The type of papilloma is this
common wart, consisting of a
central stem of fibrous tissue and bloodvessels covered by epithelial
projections and proliferations. Papillomas are usually sessile and
villous.
1. Warts.[14]—These are sessile papillomas, most common on the
skin, often seen on mucous surfaces, and occurring sometimes
singly, often in crops. They are exceedingly common about the
perineum, where skin and mucous membrane meet, and are
regarded as due to the irritation of specific discharges. The
papillomas occurring about the genitalia are known as condylomas.
The growths in these instances are frequently so luxuriant and
proliferative that they assume fungoid shape, and are called
mulberry growths. Warts grow slowly or rapidly according to
circumstances. Warty growths may attain enormous size and
become vascular. Late in life they are frequently the starting points of
epithelial ingrowths, and then become true epitheliomas—i. e.,
cancer. Warty growths sometimes line the buccal cavity and
complicate cases of macroglossa. They occur also in the larynx, and
when situated near the glottis may cause dyspnea and fatal
obstruction to respiration. It is claimed by some that cutaneous warts
will disappear with continued small internal dosage of Fowler’s
solution. (See Plate XXI.)
[14] Warts are by many pathologists considered as mere evidences of
hypertrophy from persistent irritation. They are here retained among the
tumors lest too much violence be done to formerly received notions.
 Fig. 86

Papilloma of the bladder.

2. Villous Papillomas.—These are met with most commonly in the

bladder, occasionally in the pelvis of the kidney. They are identical
with chorionic villi, and occur most often singly. It frequently happens
that long, fine tufts are detached and carried away with the escaping
urine. Another form of villous growth arises from the choroid
plexuses of the lateral ventricles in the brain. These may grow and
attain a size sufficient to produce disturbance (Fig. 86).
3. Intracystic Villous Growths.—These are seen, for example, in
mammary cysts. These, of course, are lined with epithelium, which
acts here as it does in other localities, and proliferates more or less
rapidly under unknown circumstances. In dealing with paroöphoritic
cysts the presence of these growths has also been alluded to.
4. Ovarian Papilloma.—There is a form of ovarian papilloma which
partakes of the nature of a malignant tumor, in that separated
particles seem to attach themselves to peritoneal surfaces, where
they grow luxuriantly. Either this is an expression of parasitism or
infectivity, or else of the implantation of tumors, which, to the writer’s
mind, constitutes a strong argument for the parasitism of cancer.
After abdominal section, with removal of the original focus, these
growths often disappear. This affords a parallel to the instances of
cure of tuberculous peritonitis after the same procedure.
 PLATE XXI

Photographic Reproduction of Papilloma. Low

power. (Gaylord.)
 5. Cutaneous Horns.—These are also epithelial outgrowths, and are
met with in four varieties (Sutton):
(a) Sebaceous horns, quite common, arising by protrusion of
contents of a sebaceous cyst through a rupture in its wall or through
its duct, with consequent desiccation by exposure to the air, while
fresh material is consequently added at the basis so long as
sebaceous secretion continues. These growths soften when soaked
in weak liquor potassæ.
(b) Warty horns, structurally identical with the above, but growing
from warts instead of from sebaceous cysts. Both these forms are
often found about the head. Cutaneous horns are also met with in
ovarian dermoids. They are common in the lower animals and may
attain large size.
(c) Horns growing from cicatrices, especially of bones, are rare,
but a cornified condition of the cicatrix itself, with formation of scales
resembling those from horns, is not uncommon.
(d) Nail horns are simply overgrown nails, occurring on the digits
and toes of bedridden patients who never walk (Fig. 87).
 Fig. 87

Nail horns. (Original.)

Treatment.—All these forms of epithelial outgrowth call for radical

removal, which implies complete extirpation of the membrane or
tissue from which the growth occurs, after which, if effected, there is
no recurrence. If some be left there is tendency to recedive.
Mucous Polyp.—Similar papillary and often pedunculated
epithelial tumors frequently hang or project from
the mucous membrane—e. g., the rectum. The pedicle really
projects from the submucosa. Between the layers of the overgrown
mucosa are found altered glands. So long as the growth of these
polyps is toward the exposed surface they are innocent and wellnigh
harmless, unless they attain fair size; but so soon as they grow
inward and the boundary of the submucosa is transgressed they
assume malignant aspects at once. Such transformation is by no
means rare, and constitutes a strong argument for their prompt
removal.
Goitre; Struma.—Pathologically the various enlargements of the
thyroid known as goitre or struma constitute
essential neoplasms. (See chapter on Regional Surgery of the
Neck.) In this condition either the epithelial or the connective tissue
may be primarily at fault.
1. Struma Parenchymatosa Nodosa.—This includes also the colloid
and the cystic varieties, and refers to an enormous overproduction of
the epithelial elements (parenchyma) in distended alveoli, where
they often undergo colloid softening. So marked are these changes
in numerous instances that multiple cysts (minute or large) result.
The collective volume of such altered tissue may be very large.
2. Struma Fibrosa.—This presents itself in the way of dense
enlargement of the thyroid, the stroma being the tissue now involved,
even to the extent of causing much of the alveolar structure to
disappear or become obliterated. In this condition calcification is
common, and calcareous concretions or patches are often found.
Even benign tumors of the thyroid show occasionally a tendency
to metastases. Cases are on record of benign goitre causing general
metastases, and even of metastasis without noticeable thyroid
enlargement. These occur most often in the bones, less frequently in
the lungs and other organs. They are more common when the goitre
has undergone colloid changes. The reasons for these changes are
unknown.
In either form hemorrhages are common, with their resulting blood
cysts or their solid residue, in which case pigment is usually found.
Both forms are often accompanied by enlargement of the vessels,
and sometimes these become enormously dilated and constitute an
almost insuperable obstacle to successful removal. (See
Thyroidectomy.)
Ovarian Cystoma.—The cystomas of the ovarian region assume
two types: (1) Glandular cystoma, and (2)
papillary cystoma.
1. Glandular Cystoma.—The glandular type produces the multilocular
forms, with numerous small and large cavities, filled with fluid which
varies in color and appearance within wide limits, having usually the
consistency of mucus or thin pus, and containing a small number of
cylindrical epithelial cells. The cyst wall may contain tubular glandlike
structures reaching into the surrounding connective tissue.
2. Papillary Cystoma.—The papillary type presents projections into
cavities of papillomatous outgrowths from their walls, which are
covered by cylindrical epithelium, which latter also lines the cavities.
It is most common in the parovarium.
It is rare to find a pure type of either variety; both forms are usually
blended. Malignant transformation, of the latter type especially,
occurs easily and insidiously, and explains many disappointments in
result.
Adenoma and Fibro-adenoma.—Adenoma is a tumor whose
type is the normal secreting
gland, from which it differs in being an abnormal outgrowth or
product, but particularly in that it has no power of producing the
secretion peculiar to the gland tissue or type from which it grows.
The adenomas occur for the most part as circumscribed tumors in
the mammæ, parotid, thyroid, liver, and in the mucous membranes
of the bowels and the uterus. They may be single or multiple; in the
intestine they are usually multiple. In certain locations (e. g., the
mammæ) they attain enormous dimensions, and in the ovary tumors
of this character may be met with weighing forty or fifty pounds. The
true adenoma shows no tendency to infection of neighboring
lymphatics, and gives rise to no secondary deposit, and when it
causes death it is usually because of size or pressure upon
important organs. It displays a marked tendency to cystic alteration,
while the relative proportion of epithelium and connective tissue or
stroma varies within wide limits. In some cases, in which the former
is small in amount, the preponderance of the latter has caused the
use of the term adenosarcoma, which is really a misleading name.
The distinction between adenoma and true carcinoma is in some
respects but slight, and this fact will account for the conversion which
many innocent gland tumors seem to undergo from one into the
other. As soon as the epithelial cells lose their regularity of
disposition and collect in groups, or make their way outside of the
acini into the tissues, then the change from the benign to the
malignant tumor has begun, and the entire clinical aspect of the case
has altered. This change may be the result of external irritation, of
such tissue changes as pregnancy and lactation, or of the undefined
changes which advancing years seem to produce. (See Plate XXII,
Fig. 2.)
Adenoma occurs in the breast as cystic adenoma or fibro-
adenoma. The former often attains large size, is encapsulated, the
acini are much dilated, while from the walls of the epithelium-lined
cavities frequently project papillomatous processes, forming what
are called intracystic growths. Cystic adenomas grow slowly,
produce atrophy of mammary tissue by pressure, occur after puberty
until the menopause, and rarely give rise to pain until they become
large. As they grow they distort the breast until it may become
pendulous. When the growth of connective tissue, peculiar to the
tumor in that it is rich in nuclei, forms well-marked partitions between
alveoli, the growth is called pericanalicular adenofibroma, which may
assume a tubular or an acinose type. When the alveoli and ducts are
themselves invaded by ingrowth of this tissue, then we have the
intracanalicular adenofibroma, which constitutes a growth sometimes
bordering on the malignant. When the arrangement of epithelial cells
in the acini and ducts becomes irregular and atypical, then malignant
transformation has begun.
 PLATE XXII
FIG. 1

Fibromyoma of Uterus. (Low power.)

FIG. 2
Fibro-adenoma of Breast. (Low power.)
 PLATE XXIII
FIG. 1

Epithelial Pearl Formation in Squamous Epithelioma. (Middle power.)

FIG. 2
 Malignant Adenoma of Rectum. (Middle power.)

Fibro-adenoma occurs also in the breast as a small tumor,

encapsulated, usually superficially placed, movable in its site, often
multiple; most common between the twentieth and thirtieth years of
life; often painful, especially during menstruation; tender upon
pressure. Both forms may occur in young men. A form of fibro-
adenoma in which fibrous tissue is greatly in excess, which never
attains great size, is common in the breasts of unmarried women. It
gives rise to much pain and distress, but is clinically not malignant.
(See Plate XXII, Fig. 2.)
Adenoma occurs frequently in sebaceous glands as:
1. Sebaceous Cysts.—Sebaceous cysts are generally known as
wens. These tumors commonly begin as retention cysts, the ducts of
the sebaceous glands becoming occluded. But in many cases there
is no occlusion of the ducts, and their secretion may be easily
expressed. They occur wherever sebaceous glands abound, but
especially upon the scalp. They are usually multiple, vary greatly in
size, are easily movable over the bone, and are intimately related to
the skin, while the duct orifice is frequently recognized by a black
spot, after removing which sebum can be expressed. These cyst-
adenomas are encapsulated, and can be easily shelled out of their
matrices, save when inflamed, in which case they are often
astonishingly adherent. Their contents consist of pultaceous debris
resembling old epithelial scales, fat, cholesterin, etc. The contents of
these cysts are very prone to decompose, and they become as
offensive as anything with which the surgeon has to deal.
Putrefaction may be independent of inflammation or coincident with
it. When irritated these gland cysts become inflamed and may
suppurate, suppuration being tantamount to cure by spontaneous
processes. They may also ulcerate, without suppurating, and form
foul-smelling ulcers, or give rise to cutaneous horns.
 Fig. 88

Multiple atheromatous cysts (wens). (Lexer.)

2. Sebaceous Adenomas.—These arise from the sebaceous glands,

which are lobulated, like those about the nose and ear. Adenomas
from this source are extremely liable to ulceration, may undergo
calcification, and are often mistaken for epithelioma because of the
fungous ulcerations to which they give rise.