An alien growth, whose cancerous nature is incontestably proved, both by its attendant cachexia, and by its frequent alliance with the cancers before discussed. Owing to the close affinity of its elementary structure with that of medullary carcinoma, we place it next in array with, or as a variety of, the latter; with which, moreover, it has in common the loose consistency, the abundant vascularity, and the proclivity, to hemorrhage and to inflammation.

So far as we know, it occurs solely upon membranes, for the most part, the pituitous, and most particularly upon that of the urinary bladder, as so-called villous muco-membranous tumor. It also, although far less frequently, affects the common integuments and serous membranes.

At the outset, it appears as a delicate, cord-like excrescence of various length, which arises out of the aforesaid textures with a seeming longitudinal fibrillation, diverging at its free extremity into branches and twigs. Hereupon, if not before, it forms into delicately membraned villi, and with this expansion of its texture, bulges at its free end into a club-like or cauliflower shape. This section of the excrescence invariably contains a whitish, or reddish white, encephaloid sap. At this point it is particularly vascular, and, in its recent state, of a purple tint.

A minute inspection shows the alien growth to consist of a fibro-mem-branous texture, densely involuted at the pedicle, and developed at the free extremity into a stroma for the reception of the imbedded encephaloid. This stroma is a delicate, structureless or striated, fine-fibred membrane, studded with elementary granules and nuclei, whilst the encephaloid sap consists of elementary granules, nuclei, and cells of every variety of form. Such excrescences not unfrequently vegetate in great numbers, either scattered or densely grouped, upon the mucous membrane of the bladder, imparting to it a long-drawn, villous aspect, - a condition ascribed by Andral to a preternatural development of the muco-membranous villi.

It is very common for them to vegetate particularly densely on a circumscribed patch, to become blended, at the pedicle and at the expanded points, into a diffuse, roundish head, furnished with a neck, which, if it contains much of the encephaloid juice, presents a uniform, pulpous consistency, and a superficial lobulation, whilst, in the opposite case, its periphery is villous.

The growth often bleeds spontaneously, and its excessive vulnerability occasions, upon very slight injury, exhausting hemorrhage.

From the above description, the medullary, cancerous nature of the alien growth is manifest, particularly its analogy with that encephaloid, medullary carcinoma, provided with a stroma. It is clearly nothing more than medullary carcinoma with predominant stroma-formation.

Villous Cancer

In all but its external form, this cancer approaches the nearest to medullary carcinoma. A very important part is here assigned to the dendritic excrescences, into which the primitive hollow bulbs, often springing from a densely reticulate germ, speedily resolve themselves; the first shoots pushing forth from their terminal bulbs secondary offshoots in the shape of slender villi, which themselves expand into bulbs, and throw out more of these embryonic excrescences from their termination, so as to constitute by degrees a more or less extensive cauliflower- or coral-shaped tumor. In other cases, a single stem arises out of a nucleus as big, it may be, as a bean, and this stem branches out into dendritic vegetations of the character above described.

Most of these excrescences end in caecal sacs, some of which may contain a structureless, or a concentrically stratified cyst.

These excrescences are often transparent, containing in their cavity only a clear fluid, whilst, externally, they grow up, as it were, into a more or less tenacious plastic mass, consisting of the same elements that compose the sap of medullary cancer. In other instances, they include a fibrous texture, within which reside elements similar to those that cling to them externally. A remarkable circumstance connected with these excrescences is the peculiar way in which they are vascularized. Both the stem of the tumor and all its individual excrescences are furnished with an ascending and descending bloodvessel, which pursues its course under the formation of frequent loops. These bloodvessels consist mostly of the primitive hyaline bloodvessel membrane, marked with oblong nuclei, sometimes also with a row of transverse oval nuclei. There may possibly be a further layer of connective tissue fibrils. A few of the excrescences have but a single ascending bloodvessel, terminating in a sort of bulb.

In rare instances, a nest of apparent excrescences displays open terminations fringed with villi, and filled with the semifluid materials of medullary cancer. Rokitansky is, however, of opinion, that these are not true excrescences, but rather lengthy developments of the fibro-cellular texture which constitutes the base of the tumor; and he believes these hollow cylinders, which seem rather to resemble the honeycomb of the wasp, to become filled, not by endogenous secretion, but by suction of the external medullary fluid.

Seat Of Villous Cancer

Its seat is more especially upon mucous membranes, and most of all that of the male urinary bladder, near the opening of either ureter; next to this, the mucous membrane of the stomach, and in particular the pyloric portion. It has been observed suspended by a pedicle from the internal membrane of the rectum, and even from that of the gall-bladder.

Secondly, it is very apt to grow extensively from the internal wall of ovarian cysto-carcinoma, where it is recognized as villous cancer, from its copious accompaniment of medullary sap. In these cases, it is often concurrent with cancerous infiltration of the lymphatic glands, about the lumbar vertebrae, and with peritoneal cancer, - representing villous cancer upon a serous membrane.

It has been observed upon the dura mater, occasionally upon the general integument (Rokitansky refers to two such cases), and even in bone, - reckoning for villous cancer those cases in which a bony skeleton is found in the shape of the wasp's honeycomb structure before described.

Lastly, it occurs in parenchymata, in the uterus, for example; and, as cancer melanodes, in the liver and in the brain.

It occurs both as a single tumor, and also concurrently with cancer of various kinds in other organs, - occasionally germinating out of those broad-based, fungus-like gelatinous cancer-masses that occur upon the inner surface of the stomach.

"The vascularity of villous cancer determines a predominant feature in its course, whether upon membranous surfaces, in the interior of cysts, or in parenchymata, namely, the frequent hemorrhage which so greatly hastens the general wasting and the fatal issue. Frequent and excessive hemorrhage from the urethra in males, from the vagina in females, furnishes strong suspicion of villous cancer affecting respectively the bladder or the uterus, whilst a microscopic examination of the blood effused will often bring to light shreds or fragments of the cancerous mass".

The same vascularity often causes a fleshy coloration of the tumor.

It is evident from the foregoing, that villous cancer is, to all intents and purposes, a malignant new growth: and not, as Andral and Louis have affirmed, an anomalous development of muco-membranous villi; nor, as others have more recently suggested, a tumor arising out of the hypertrophy of a pre-existent papilla].