24
Scientific Memoirs by
another and their subsequent resolution into their constituent fibres, the
appearances being similar to those present towards either extremity of the con-
tinuous stratum. This process of interposition of masses of granulation-tissue
and the consequent dissociation of the normal dermal elements necessarily gives
rise to very considerable thickening, and it is to it along with the constantly
increasing thickness in the accumulation of continuous granulation-tissue above,
together with the associated epidermal hypertrophy, that the gradual increase
in prominence of the affected area of the skin is due.
Beneath the layer of modified dermal tissue the sections included fat-lobules
of the subcutaneous areolar tissue, which, like the structures above them, showed
in varying degrees distinct evidences of invasion by granulation tissue. In the
lobules immediately abutting on the dermis masses of the neoplasm in the latter
spread continuously into the substance of the lobules, dissecting the fat-cells
apart from one another, pressing upon them in varying degree, and ultimately
obliterating and replacing them entirely throughout considerable areas. Scat-
tered and, so far as the sections were concerned, isolated patches of various
size were also scattered throughout the lobules in varying numbers. In many
cases these seemed to be related specially to the adventitia of the larger lobu-
lar vessels; in others, however, they appeared to he scattered at random among
the fat-cells. Even in the very deepest portions of the specimen such isolated
patches of neoplasm could in many places be recognised in the lobules (Plate
III., Fig. 2).
Examinations of similar sections under higher microscopic powers confirmed
the information attainable by means of low ones and revealed additional points in
regard to structural details. The essential feature in the diseased area was clearly
shown to consist in an accumulation of lymphoid and epithelioid cells among the
normal tissue elements. When Dr. Lewis and I previously studied the subject,
we were inclined to regard the morbid process essential to the disease as one in
which a development of tissue of an adenoid type occurred. Now, however this
may be so in certain cases, it most certainly is not necessarily the case in all,
for in the present one there was no evidence of the development of any new
stroma—of any new fibrous network. The most careful examination of sections
both before and after brushing showed nothing, save an accumulation of
lymphoid and epithelioid elements between the normal connective tissue struc-
tures of the dermis and subcutaneous areolar tissue, together with the results of
associated processes of epithelial hypertrophy. As has been already pointed
out, the morbid process in the dermis consisted essentially in a simple opening
out and dissociation of the normal tissue elements by masses of pure granulation-
tissue. The ultimate result of any such process must naturally be, where it
advances sufficiently far, to replace the dense connective tissue of the dermis by
one consisting of a stroma of separated, but persistent fibres including dense
masses of cellular elements. The size and form of the spaces in the stroma