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 The fluid or semifluid contents of these cysts consist usually of
sebaceous material, cholesterin, epithelial debris, etc. Sometimes it
is thick, sometimes thin—and occasionally consists almost entirely of
mucus.
It is not uncommon to find structures in ovarian dermoids closely
analogous to, or actually resembling, mammary glands. These may
be mere nipple-like processes of skin, or completely developed
mammæ, well formed, but without ducts or gland tissue, may occupy
such a cyst. These really are pseudomammæ, because they have
no ducts. Nevertheless, glandular tissue is not always absent. This
resemblance proceeds even farther, in that in some of these ovarian
mammæ changes occur analogous to those which take place in
normal breasts.
The epiblast seems to have the power of developing mammary
glands or supernumerary mammæ in many locations—in fact, upon
any part of the body surface. About the thorax they are common;
upon the abdomen they are rarely observed; and they have been
found even upon the labia.
Sweat glands are infrequent in dermoids. Teeth are quite common.
These may vary in number from two or three up to several hundred
—may be embedded in definite sockets or simply sprout from the
cyst wall. Occasionally bone material, lodging such teeth and crudely
resembling a jaw, will be found.
Dermoids containing mucous membrane are found, especially in
connection with the ovary and with the postanal gut (i. e., the original
communication between the spinal and alimentary canals).
It is curious that under these circumstances mucous membrane is
sometimes furnished with hair, as it normally is in the stomach or
other cavities of some of the lower animals. Mucous glands and
retention cysts of these glands are also found in ovarian dermoids.
This will be more readily understood if the mutability of skin and
mucous membrane be not forgotten. The transition from one to the
other is not difficult, and we find all intermediate stages between the
two extremes—if not in man, at least in animals. This will account for
the fact that skin-covered dermoid tumors are found in certain parts
of the alimentary canal, and particularly in the pharynx. These
tumors grow also from the mucous membrane of the bowel, of the
rectum, or even of the small intestine.
Sutton has made a division of dermoids into three classes:
1. Sequestration;
2. Tubulodermoids;
3. Ovarian.
1. Sequestration Dermoids.—Sequestration dermoids occur
chiefly in situations where during
embryonic life coalescence takes place between two surfaces
possessing an epiblastic covering, although sometimes this
coalescence practically occurs late in life and by implantation.
Dermoids of the trunk occur particularly where opposite halves of
the body wall coalesce—that is, in the midline of the trunk and head.
Dermoid cysts are rarely found in connection with spina bifida, and
certain tumors spoken of as spina bifida undoubtedly are dermoids.
Anteriorly dermoids occur frequently in the scrotum, and occasionally
in the testicle. At the umbilicus they are rarely found—usually as
pedunculated tumors projecting externally. In the midline of the
thorax and neck they are most common opposite the manubrium,
dropping down behind it to invade the anterior mediastinum. Near
the hyoid bone they occur relatively frequently; about the head they
are met with most commonly at the angles of the orbits—more so at
the outer than at the inner angle. Dermoid cysts are known to
oculists as growing upon the iris or springing from the conjunctiva.
About the ear they are not infrequent; in the roof of the mouth,
especially if this be incomplete, we frequently find cysts of epiblastic
origin.
Sequestration dermoid cysts are also undoubtedly found in
connection with the dura mater, in the scalp, most commonly at the
anterior fontanelle, at the root of the nose, and at the external
occipital protuberance, where they may be confounded with
sebaceous cysts or with meningoceles. In order that a dermoid of the
dura may communicate with the skin there must of course be
osseous defect.
Sequestration dermoids upon the limbs have been mostly reported
as sebaceous cysts. They are rare, and usually associated with
antecedent injury, by which epiblastic structures are driven in and
implanted in such a way that as they develop they give rise to these
peculiar tumors. These are what Sutton calls implantation dermoids.
They are found upon the fingers and elsewhere.
2. Tubulodermoids.—These are largely connected with obsolete
canals and ducts. It is a great service which
Sutton has rendered in proving, apparently beyond the possibility of
doubt, that the central canal of the nervous system is really of
intestinal origin, and may be regarded as a disused segment of the
primary alimentary canal. He has also shown how it behaves
occasionally as do other functionless ducts, and that cysts and
dermoids in connection with it are to be thus explained. He and
others have also shown the anterior as well as the posterior
communication of these canals, and the pituitary body are to be
regarded in this light as the same formation of lymphoid tissue
around an obsolete canal which we see in Luschka’s tonsil close by,
and in Luschka’s gland at the other extreme of the canal.
 Fig. 72 Fig. 73

Solid dermoid escaping from pelvis. Congenital dermoid cyst of pelvis.

(Original.) (Ahlfeld.)

The primary alimentary canal was a continuous tube lined with a

continuous layer of columnar epithelium. That portion connected with
the yolk sac develops into the intestine, the balance into the central
nervous canal. Portions of this canal are in postnatal life absolutely
obsolete; others persist in a rudimentary condition. Dermoid cysts
and dermoid tumors develop in connection with each of these. In
some there is a large central cavity; others are almost absolutely
solid. Thus we find dermoids in the coccygeal region, which have
been variously regarded as sarcomas, adenomas, etc., which are
really of origin as stated above and should be considered simply as
dermoid tumors. Most of these project outwardly; some of them arise
and develop within the pelvis. Dermoid cysts and tumors are also
met with in connection with the rectum—sometimes between the
rectum and the bladder, and between the rectum and the spine.
Dermoid tumors are also found in connection with the pituitary body.
These sometimes develop within the cranium, or, again, protrude
perhaps into the orbit, perhaps into the pharynx.
Thyroid dermoids are tumors of great interest. They develop
sometimes about the craniopharyngeal canal, which may be
detected as a small canal in the macerated sphenoid bone of a fetus,
and which before birth is filled with fibrous tissue. It connects with a
recess in the middle line and at the base of the skull, presenting in
the pharynx, which is often referred to as the bursa pharyngea. It is
around this recess that the lymphoid tissue known as the
“pharyngeal tonsil” develops. It may be thus expected that the roof of
the pharynx should be the occasional site of dermoids. It is from the
pharynx or the floor of the mouth that in vertebrates the thyroid body
arises. In higher forms it becomes dissociated from the pharynx and
shifts its position. The thyroid body is developed around the thyroid
duct, which first appears as the thyrohyoid duct, which later becomes
divided, that portion in relation with the tongue becoming the
thyrolingual duct, the remaining portion persisting as the thyroid duct.
These are present about once in every ten subjects, according to
Sutton, the canal when persistent being lined with epithelium. When
the extremities of these ducts become occluded retention cysts may
form. In the same way dermoids of the tongue are formed, similar to
those occurring on the scalp. These are frequently mistaken for
sebaceous cysts. They may be unilateral, central, or even bilateral.
The lingual duct is also of interest, because it would appear that
certain cases of epithelioma of the tongue arise along this duct, and
perforating malignant ulcer of the tongue is thus produced. Dermoid
tumors of the lingual or thyroid ducts resemble in structure the
thyroid body. The thyroid duct may also be detected in many adults
running from the isthmus of the thyroid body to the posterior aspect
of the hyoid bone, and surrounded by muscle tissue. Sometimes the
space usually occupied by this duct is represented by a series of
detached bodies known as accessory thyroids. These are not
infrequently the seat of cysts, sometimes of considerable size. (The
accessory thyroids often enlarge when the main thyroid has been
extirpated for disease.) Thus cysts in close relation to the hyoid bone
are common. Some of them grow slowly, while others grow rapidly
and contain much fluid. Many of them are unilateral, and are often
mistaken for enlargements of one lobe of the thyroid. Cysts growing
from accessory thyroids are often filled with papillomatous masses,
and are occasionally the seat of malignant degeneration.
In the omphalomesenteric duct or its remains, especially in relation
with the umbilicus, we often meet with small cysts or tumors in
infants and young children. When the duct is persistent it presents
normal intestinal structure, and, like the appendix, possesses much
adenoid or lymphoid tissue.
Another and very important form of tubulodermoids develops in
connection with the branchial clefts of the neck. Congenital fistulas of
the neck have been long known, but only comparatively recently
understood. Of the branchial clefts it is well known that the first alone
should persist, as the Eustachian tube. Occasionally, however, they
fail to become obliterated, and then we have congenital tumors or
cysts, which may, perhaps, not develop to appreciable size until
somewhat late in life; or there may be fistulous passages opening
either into the pharynx or externally, forming canals varying in length
from half an inch to two inches, secreting a little fluid because lined
with epithelium. When these become inflamed an abscess results.
When they open externally the opening is often marked by a little tag
of skin containing a fragment of yellow cartilage. These are often
referred to as cervical auricles. They open along the line of the
sternomastoid muscle. The internal openings of these fistulas
frequently form diverticula from the pharynx or esophagus. Thus it
will be seen that dermoid cysts about the neck are principally relics
of openings or ducts, which are normal in embryonic life, but which
should have been obliterated at or long before birth. Congenital
fistulas, however, may be met with in the middle line of the neck,
which are not to be confounded with branchial fistulas, but rather
with the ducts previously described.
3. Ovarian Dermoids and Teratomas.—These may be unilocular
or multilocular cysts,
usually the latter. They are lined with epithelium, and contain mostly
mucoid fluid, the inner coat being practically identical with mucous
membrane. Occasionally, however, the skin is furnished with hair,
sebaceous glands, teeth, and even nipples. The multilocular cysts
are practically an aggregation of those just described. They are
surrounded by dense capsules, often attain great dimensions, and
are made up of primary cysts resembling large cavities in a
honeycomb-like mass, which itself is occupied by secondary cysts,
and belong rather to the class of mucous retention cysts, these being
occupied by still smaller ones, which are histologically
indistinguishable from distended ovarian follicles. In these large
tumors we find in some cases hair, in others teeth, and in others
sebaceous glands, etc., the dermoid constituents being scattered
throughout. As Wilms has shown, in almost every tumor of this
character a projection may be found whose summit is covered with
epiblastic elements, which when cut in serial transverse sections will
show in its deeper portion other epithelial collections representing a
feeble attempt to develop a nervous system, or lung tissue, while
mesoblastic elements, like connective tissue, cartilage, and bone,
appear scattered throughout, as though a very crude effort had been
made to reproduce an atypical embryo.

3. Teratomas.
So far the endeavor has been to limit the term dermoid to tumors
which are essentially of epiblastic formation, their location being
explained on the inclusion theory of Cohnheim. There is also a still
more complicated type of tumor, composed of tissues of both
epiblastic and mesoblastic origin, perhaps even hypoblastic. Their
consideration belongs to that department of pathology known as
teratology, which is supposed to deal especially with monsters.
Strictly speaking a teratoma refers to an irregular tumor or mass
containing tissues and fragments of viscera of a suppressed fetus
which is attached to an otherwise normal individual. Nevertheless
the term is often applied to growths which are the result of luxuriant
mesoblastic development in which neither form nor member of a
suppressed fetus is present.
 The presence of supernumerary members is largely connected
with what is called dichotomy, alluding thereby to cleavage either at
the anterior or posterior end of the developing embryo. When the
whole embryonic axis divides twins may be produced, but should
cleavage be partial we may have a monster with two heads if it be
anterior, or one with three or more limbs if it be posterior. Children
born with these deformities are usually called monsters, and the
study of such cases belongs entirely to teratology. But in certain
tumors small portions of a suppressed fetus may develop, as, for
instance, from the posterior portion of the sacrum, or within the
abdomen or thorax, or upon the neck or face, which on dissection
may contain a few vertebrae or processes resembling fingers
associated perhaps with a structure resembling intestine or liver.
This should be called a teratoma. Such tumors possess for the
pathologist the greatest value. In surgery, however, they are rare,
and there are scarcely two cases alike. The question of operation will
often arise, as it does with supernumerary limbs, and each case
should be studied upon its own merits. Sometimes they are
amenable to extirpation.
Embryonal Adenosarcoma.—Embryonal adenosarcoma is a
term given to certain teratomatous
tumors peculiar to renal and adrenal structure, which present
peculiar characteristics in the mixture of elements which enter into
their composition. At various times these tumors have been called
adenoma, sarcoma, rhabdomyoma, congenital cystic kidney, etc.
They have been also likened to the thyroid. They comprise a group
of neoplasms, always congenital in origin, which usually appear early
in life, but occasionally occur in advanced adult life. One of the most
marked specimens of this kind the writer removed from a man over
fifty years of age. Most of the specimens, however, described in
literature pertain to the young. On minute examination they often
present a strange, mixed picture of voluntary muscle elements
intermingled with epithelium arranged to imitate acinous glands, with
cystic dilatations of the true kidney tissue. They often attain
enormous size, and undergo such proliferation of mesoblastic
elements as to resemble sarcoma. Their occurrence is to be
explained only on the principles of Cohnheim’s hypothesis. When the
original Wolffian body is being differentiated from the elements about
it a confusion of the same with the excretory tubular beginnings,
which are to empty into the Wolffian duct, occurs. Thus we have the
commencement of a mixed mass which presents itself as a more or
less rapidly growing tumor, in which even cartilage or other
mesoblastic structures may be met with. It is scarcely possible that
any two specimens should yield exactly the same microscopic
picture, much depending on whether one element or the other
prevail. In a few of them there may occur also a mixture of adrenal
elements. Sometimes the renal structure itself is more or less
distinct, and rides, as it were, upon the surface of the tumor; at other
times it is entirely mixed up with it. While the condition is usually
limited to one side it may be a double affection, so that the second
kidney becomes useless and the patient succumbs. The only
treatment is extirpation.
Teratomatous tumors are sometimes found hanging in the
pharynx, attached by a small pedicle, where they may be
confounded with dermoids unless carefully examined after removal.
Many instances of this type of tumor are found in animals. Here no
false sentiment will prevent complete examination and preservation
of the specimen. They are also encountered in the sacral and
coccygeal regions.

4. Tumors of Connective-tissue Type.

Lipoma.—Lipomas, or tumors composed of fat, are the most

common of the neoplasms. Their normal type is the
ordinary adipose tissue of the body, and may be divided into the
encapsulated and the diffuse, the former of which are surrounded by
fibrous tissue. The diffuse lipomas are those which have no capsule,
and where the pathological collection of fat merges into that normally
present—in other words, they are not circumscribed.
Subcutaneous Lipomas.—Subcutaneous lipomas are perhaps the
most common of all, and are usually irregularly lobulated and
encapsulated, adherent rather to the skin than to the deeper tissues.
Usually but one is found in an individual, though instances of multiple
lipomas are not rare. They develop sometimes to enormous size,
cases being on record where the tumor has even weighed one
hundred pounds. They may be met with at any point on the surface
of the body. The lobules often burrow between the muscles, and
those found in the palm of the hand penetrate even beneath the
palmar fasciæ. They are sometimes markedly pedunculated, and
often hang by a small stem. The diffuse subcutaneous lipoma is
most common about the neck, in the groin, and in the axilla.
Subserous Lipomas.—Subserous lipomas are mostly retroperitoneal,
and large tumors of this character, mistaken for ovarian, have been
successfully removed by operation. They also occur in the hernial
canals and spaces. They develop beneath the peritoneum covering
the intestines, and in this location give rise occasionally to
intussusception. Here in their pathological development they have
the general form and significance of appendices epiploicæ.
Subsynovial Lipomas.—Subsynovial lipomas occur about various
joints and tendon sheaths; within the knee they assume a distinctive
type which has been called lipoma arborescens, where they take on
a dendritic appearance and arrangement. Submucous lipomas are
rare. Intermuscular fatty tumors are occasionally met with, an
interesting variety being that which develops between the masseter
and buccinator muscles. Intramuscular forms rarely occur, as well as
a variety known as parosteal, which arises in connection with the
periosteum. Fatty tumors also occur within the spinal dura, as well as
outside of it within the spinal canal, and more or less lipomatous
alterations are common in connection with spina bifida.
Lipomas are ordinarily easy of recognition, save when deeply
located. The subcutaneous forms are intimately related with the
overlying skin, and have a dough-like consistence which is usually
pathognomonic. Tumors, suspected to be fatty, in the middle line of
the back or cranium are always to be viewed with suspicion, as they
are often connected with congenital meningeal protrusions.
An encapsulated lipoma when thoroughly removed will not return.
Mixed forms of fibrous and fatty neoplasm are occasionally seen,
and are referred to as lipoma fibromatosum or fibroma lipomatosum,
according as one or the other tissue predominates. These growths
are innocent in their character, but call for thorough extirpation. They
frequently give rise to considerable discomfort or pain, and are called
lipoma dolorosa.
Fibroma.—Fibromas are tumors composed of fibrous tissue,
which, when of pure type, are found to be not so
common as was formerly supposed, the majority of tumors hitherto
roughly grouped as fibromas containing either muscle tissue or
sarcomatous elements, which takes them out of the category of pure
fibroma. A typical fibroma is ordinarily dense, and is composed of
wavy bundles of fibrous tissue whose cells are long and slender and
closely packed together, the mass being permeated by distinct
bloodvessels.
Fibroma occurs most commonly in the ovary, the uterus, the
intestine, the gum (epulis), in nerve sheaths, and in the skin in the
form of so-called painful subcutaneous tubercles and molluscum
fibrosum. There is also a fibrous tumor of the skin, known as keloid,
sustaining to fibroma the same relation that exists between exostosis
and osteoma.
Painful subcutaneous tubercle is a sample of pure fibroma in the
shape of a small, flattened, pea-like tumor which never attains great
size. It is situated loosely in the subcutaneous structure and may
form a visible prominence. Insignificant as it would thus appear, it
becomes the seat of exasperating pain, particularly when touched or
handled, which may radiate to considerable distances. The etiology
of these growths is unknown.
In the ovary, the uterus, the intestine, and the larynx true fibrous
tumors are pathological curiosities rather than common lesions.
 Fig. 74

Keloid of external ear: a, dense tissue of skin; b, fibrous connective tissue; c,

epidermis. (Klebs.)

Epulis.—Epulis means any tumor growing upon the gum. The term
was formerly applied in an indistinct and too comprehensive way,
although it is still retained in literature. But pure fibromas do spring
from the fibroösseous structure of the gum and alveolar process.
They are covered with the gingival mucous membrane and seem to
spring from the periodontal membrane. They seldom attain large
size, and then only by neglect. By the pressure of such tumors teeth
may be separated and distortion of the mouth produced. They
should be promptly extirpated.
Keloid.—Keloid is a fibrous neoplasm arising mainly in cicatricial
tissue, which is essentially fibroid in structure. It is a neoplasm which
often follows the general outline of the scar in which it grows,
consists in elevation of the surface, ordinarily quite smooth,
sometimes of a delicate pink from the dilated vessels which it
contains. Keloid is the bête noir of surgeons, as it frequently
complicates and disfigures scars which have at first been
satisfactory, and since it indicates a condition which it is discouraging
to deal with, because when it is removed there is usually recurrence
of growth within a few months after cicatrization. It often occurs in
stitch-hole scars and upon the site of extensive burns, and may be
observed after puncture of the ears for ear-rings, and has also been
observed in scars left by smallpox, acne, etc. It is more prevalent in
the colored race than in the white. In negroes multiple keloid tumors
are often seen, occasionally in large numbers. Their explanation is
unknown, and it may be that some trifling injury has preceded each
individual tumor (Fig. 74).
The treatment of keloid will be considered in the chapter on the
Surgical Diseases of the Skin.
Desmoids.—This term has been applied to tumors of a certain
clinical type which arise from the fibrous structures, usually of the
abdominal wall, and produce neoplasms like the fibromas of other
parts of the body. The use of the term should be restricted to those
tumors which proceed primarily only from muscles, tendons, and
aponeuroses, or perhaps from ligamentous and periosteal tissues.
These tumors are usually single, attain sometimes considerable size,
grow slowly, rarely involve other structures, and not infrequently
develop to such an extent as to encroach upon either pelvis or the
abdomen, or both. They have been known to attain to the weight
even of ten pounds or more. They are usually more or less
encapsulated, and are firm and dense in structure. Under the
microscope they have the general appearance of cellular fibroma.
Sarcomatous elements may be met, while they occasionally undergo
cystic degeneration. Their occurrence may be explained, at least in
some instances, on the embryological theory of Cohnheim.
Fig. 75
 Multiple enchondromas.

The treatment of desmoids consists in their complete extirpation.

They should not be allowed to attain large size because their
removal may entail a serious weakening of the abdominal wall.
There should be such plastic rearrangement of abdominal protecting
membranes as to reduce the resulting weakening to a minimum.
Psammoma.—Psammoma is a term applied to a form of hard
fibroma met with in the dura mater, in which there has occurred a
petrefaction of some of the cells—i. e., a deposition of calcareous
salts, which gives it a gritty or sandy appearance.
Chondroma.—The true chondroma is a tumor composed of
hyaline cartilage. It occurs in the long bones, usually
in relation with epiphyseal cartilages, and is often noted during the
earlier years of life. While it is usually a solitary tumor, multiple
chondromas are often seen, especially upon the hands. These
tumors are often encapsulated and form deep hollows, in which they
rest. Unless pressing upon nerve trunks they are painless and slow
of growth. They are exceedingly dense and hard, and ordinarily
immovable. Mucoid softening (i. e., cystic degeneration) is common,
and the softened areas may give rise to fluctuation. There may be
coincident calcification or ossification in any of these growths. It is
noted as a curious circumstance by Sutton that their tissue
resembles histologically the bluish, translucent, epiphyseal cartilage
seen in progressive rickets.
To the small local hypertrophies of cartilage which are seen
especially about joints, about the laryngeal cartilages, and the
triangular cartilage of the nose, are given the term ecchondroses.
They are most common in the knee in connection with rheumatoid
arthritis, and occur as prominences along the margins of the joint
cartilage. They may project to such an extent as to be detached by
accident, after which they become movable and floating bodies in
the joints. Many of the floating cartilages or bodies found in joints are
detached ecchondroses, which may be smoothed off by attrition, and
may be found singly or multiple, even several hundred existing in
one joint.
Chondromatous changes as occurring in sarcomatous tumors
have been alluded to. It seems to be easy for connective tissue to
form hyaline cartilage, and mixed tumors may thus be seen in
connection either with sarcoma, fibroma, or other forms.
Treatment.—The treatment of chondroma is solely operative. Unless
the integrity of a member or a limb be compromised, such a tumor
can usually be shelled out from its location, but requires that the
matrix be completely extirpated; all of which may call for the use of
powerful bone instruments. At other times amputation is the only
measure which may relieve from deformity, pain, and disability. The
ecchondroses occurring within joints necessitate incision and
evacuation, with the most rigid aseptic precautions, with or without
drainage. When practised according to modern technique this is
almost invariably successful. In former times many lives were lost
because of septic infection.
Osteoma.—Under the head of nomenclature I have already
endeavored to distinguish as between exostosis, or
irregular bone outgrowth, and osteoma, as a distinct tumor which is
composed of bone tissue, with the subvariety odontoma, or tumors
of dental origin and structure. Osteoma is regarded by some as
ossifying chondroma, for it is nearly always found near epiphyseal
lines, and is always covered by hyaline cartilage when thus found.
Nevertheless it is not invariably such. We speak of compact or ivory
osteoma and of a cancellous form. The former is identical with the
compact tissue of the shafts of long bones, and may occur
anywhere, but is most common about the cranium, at the frontal
sinus, the external meatus, and the mastoid process. Osteomas
growing into the frontal sinus of oxen form large, lobulated, bony
masses, sometimes weighing several pounds, and as dense as
ivory. Some of these tumors growing into the cranial cavity have
been regarded as ossified brains. Osteomas in connection with the
external auditory meatus may partially obscure this channel and
cause deafness. They constitute ivory-like growths, which
sometimes defy the finest steel instruments with which the surgeon
can supply himself.
 Fig. 76

Double osteoma of the skull. (Musée Dupuytren.)

Cancellous osteomas grow in the cranium as well as in the long

bones, and, like the compact forms, only occasion pain by pressure
upon nerve trunks.
Exostoses.—Exostoses are classed by Sutton as—
1. Those formed by ossification of tendons and their
attachments. There should be excluded from this group such natural
or evolutionary processes as the supracondyloid process, the third
trochanter of the femur, etc. Over or around such exostoses bursæ
will form to mitigate as much as possible the effect of friction. Such
an outgrowth is known as an exostosis bursa; it is most frequently
seen on the inside of the femur immediately above the knee.
2. Subungual exostoses, occurring usually beneath the nail of the
big toe.
3. Exostoses due to calcification of inflammatory exudations,
including the rare condition known as myositis ossificans.
 PLATE XVII
FIG. 1

Round-cell Sarcoma. (Low power.)

FIG. 2
 Spindle-cell Sarcoma. (Low power.)

When a true osteoma is once thoroughly removed there is no

tendency to recurrence. Thorough removal, however, calls
sometimes for serious and often mutilating operations, which may
become dangerous when the growth involves the curve of a rib or a
large portion of the skull. At other times amputation is rendered
necessary. Special forms require special treatment.
Sarcoma.
—Formerly this name implied a fleshy tumor, and was made to cover
many different conditions. Now sarcoma means a tumor composed
of immature mesoblastic or embryonic tissue in which cells
predominate over intercellular material. Sarcomas are sometimes
encapsulated; they merge into and infiltrate the surrounding tissue
and disseminate widely, and have usually these propensities and
characteristics to such a degree as to constitute malignancy. For the
laity sarcomas and carcinomas are together included in the
comprehensive term of cancer; for the surgeon they constitute but
one form of cancer. Sarcomas are classified, according to the shape
of their cells and their disposition, into—
A. Round-cell;
B. Spindle-cell;
C. Myeloid.
To these are added other varieties mentioned below.