(Johannes Muller).

Formerly termed, also by Johannes Muller, carcinoma hyalinum, because of its jelly-like transparency. An alien growth, according to our observation, of very rare occurrence, which we have met with but twice; once in the mammary gland, and once again in most of the internal organs simultaneously, as almost general cancer.

The first case, which we had better means of examining, relates to a growth of considerable size, nearly that of an infant's head, of uneven, clavate surface, of a pale-yellow color, of jelly-like transparency, and withal, of notable compactness. It consisted of an aggregate of tubera, which resolved themselves into a certain number of cones, flat-sided from reciprocal compression, with their notched and ruffled bases directed outwardly, and their apices pointing to within, so that the apices of all the cones constituting a tuber converged to a common centre. The intersection between the individual tubers was occupied by a somewhat more substantial, - that between the cones by a more delicate, - membranous, whitish, areolar tissue-like bond-mass. Bloodvessels, so far as they could be traced in a not highly injected condition, ran in a direction parallel to the cones. A microscopic examination showed the parenchyma to consist of somewhat long-drawn, delicate, hyaline fibres, between which, in an almost limpid juice, lay imbedded elementary granules, nuclei, and a few scattered, elongated cells.

Without conforming to Muller's description in what concerns the presence of embryonic elements, this growth accords with it, nevertheless, so fully in other respects, as to justify us in pronouncing it to be a true specimen of carcinoma fasciculatum or hyalinum.

In the other case, the secondary arrangement of the large conical fasciculi was less orderly, and, throughout, that before depicted, the consistence more lax, the transparency the same. This latter, according to Muller, is inconstant, and it was for this reason that he afterwards substituted for carcinoma hyalinum, the appellation of carcinoma fasciculatum.

The specimens examined by Johannes Muller were of a consistency analogous to that of encephaloid. He admits, however, that in this respect variations may occur, and that firmer specimens of carcinoma fasciculatum are probably to be met with.

Cysto-Carcinoma

Cysto-carcinoma specially affects certain organs, as the ovary, the mammary gland, the testicles, bones. It is mostly a growth of considerable magnitude, and commonly concurrent with cancer in other organs. [See Cyst and Alveolus.']

Appendix

[A careful examination instituted by the author in sundry cancerous tumors, more especially of the medullary character, have led to interesting results illustrative of the development and the microscopic structure of these malignant growths. Without dragging the reader through the details of cases which seem only to represent so many stages of development, - so many links in the chain of evidence, - we shall endeavor to sum up the results in as few words as possible.

Under a magnifying power of 90 diameters, the substance of fungus haematodes exhibits a stroma consisting of two distinct webs, which appear to interlace each other in all directions. Of these, the one has the semblance of a transparent trelliswork, studded with caudate cells, elongate nuclei, and long-drawn fibres, all lying parallel to the longitudinal axis of the stroma. The gaps or meshes of this stroma are interlaced or enwreathed with what at first appears like a continuous garland of leaves, but on a closer inspection is seen to terminate in bulb-shaped extremities. Further examination shows this wreath-like tissue, which at first seemed opaque and granular, to be studded with crowds of minute nucleated cells, which, under a magnifying power of 400, are distinctly set forth as round or oval cells, many, although not all, containing one or several nuclei, others engaged in the act of elongation, others again in progress of dissilience.

In preparations representing a further stage of development, the wreathlike tissue presents certain patches much less opaque, its cells for the most part elongated, and many of its nuclei drawn out into disconnected fibres. There is good reason for regarding this portion as in a state of transition from the wreath-like tissue to the supporting stroma first described. In the next, and last, phase of development, is represented the same trelliswork, no longer thinly fibred and semitransparent, but rendered opaque by connected and dense longitudinal fibrillation. These fibred trellises are here distinctly seen to be enveloped in a hyaline structureless membrane, not closely fitting, but loose and projecting on all sides into the fenestrate gaps in conical and bulb-like excrescences. It is remarkable, that from the first period of their fibrillation, these trellis branches are observed to constitute hollow cylinders. This may be owing either to a single cell-layer being alone present within the excrescences, or else to the fact, that of a cell-mass with which the excrescence is replete, only one layer becomes fibrillated and the rest absorbed.

Although the proof is difficult, there is good reason for believing that the hollow cylinders referred to are filled with the same cancerous substance that furnishes the outer material for the excrescences.

Certain external features, analogous with the above, induced Roki-tansky to submit to a close investigation those adventitious membranes upon serous tunics, which present, with a honeycombed aspect, a free-villous surface. The process of development resembles that of the cancerous growths, only that in these pseudo-membranous formations the wreath-like tissue more frequently occurs in layers parallel to the gaps or open spaces of the primitive fenestrate layer, or in superimposed order and sometimes in thick masses, tufted with many prominent, short-necked, terminal bulbs. It will be seen, from Rokitansky's great "Essay on Diseases of the Arteries," that the intra-arterial, superimposed layers of coagula present very nearly the same structural development. (See "Die Entwickelung der Krebsgeriiste," from the "Sitzungsberichtie der math-naturw. Classe der Kais. Akademie der Wissenschaften," Marz, 1852).

In a subsequent essay on villous cancer (April, 1852), and a third on colloid cancer (July, 1852), Rokitansky has made it apparent that, with certain modifications contingent upon the general conformation of the tumors and upon the nature of their contents, the same general relations of structure pertain to these cancers likewise.

In the colloid cancer there is a similar formation of a multilocular stroma, which, however, often assumes rather a membranous fabric. This honeycombed structure contains within its cancelli, the colloid or gelatinous mass, which is for the most part connected together, so as in a manner to interlace with the said stroma, and only here and there to occur in shut sacs or cystoids, formed through the blending of the membranous framework. Rokitansky has obtained evidence, that from the walls of these shut spaces, bulbous forms arise, and that the colloid globules are formed within these, as the product of a hyaline blastema with which they are more or less replete. He seems to infer that the fibro-membranous stroma is itself but a development out of primitive hollow bulbs.

There is in this theory respecting the aforesaid formation of the encysted masses of colloid, a general withdrawal by the author of one opinion expressed in the section on cysts, namely, that in these new growths the cyst is invariably developed out of the structureless vesicle. The term cystoid would therefore be peculiarly applicable to the membranaceous cavities found in colloid cancer, as distinguishing them from genuine cysts.