Medical Officers of the Army of India.
25
naturally varies greatly in different instances; in some they are relatively very
large, as they must almost inevitably be where corresponding to interfascicular
areas; in others they are much smaller and include only small masses of cellular
elements, which may be either spread out in simple strata so as to form plates,
or be heaped upon one another in irregular masses. Plates consisting of a
single stratum of cells will naturally on vertical section appear as linear series
of cells, whilst the forms presented by the aggregates of other nature will
necessarily vary with the relation which the plane of the section bears to their
actual plan. A certain number of fusiform protoplasmic bodies resembling the
nuclei of typical connective tissue corpuscles may no doubt be recognised
throughout the substance of the neoplasm (Plate II., Fig. 5). The number of such
bodies in the present case was, however, very trifling, and it appeared much more
reasonable to regard them as mere persistent elements of the normal fibrous tissue
than as indices to the occurrence of any processes of development of a neoplastic
stroma. Repeated and careful examinations of very many sections treated with
numerous distinct staining reagents have only served to convince me more and
more strongly that, if any development of new fibrous elements occurred at all
in connection with the diseased process in this case, it could only have been
very trivial, and that the real stroma of the neoplasm consisted merely of dis
-sociated elements proper to the normal tissue of the part. The characters of
the specimen appear to me clearly to show that a development of adenoid tissue
is not necessarily a feature in the disease; they do not, however, indicate that
such a process may not occur in certain, or even in the majority of, cases.
The cellular elements forming the essential feature in the neoplasm vary
considerably both in size and outline (Plate II., Figs. 9—14). This is apparently
to a considerable degree determined by the varying degrees of pressure to which
they have been exposed during and subsequent to their development. In those
sites in which they have not accumulated to any great extent, where they lie more
or less separately in the spaces in which they are situated, many of them are more
or less rounded in outline, or where they present an angular contour, are of con
-siderable size and epithelioid character. Where, however, a greater accumulation
has occurred, and where, therefore, the cells within the meshes of the stroma
have come to be closely packed together, they are almost without exception
of small size and more or less angular from mutual pressure. Where the
inter-spaces in the stroma are of small size and the accumulation of such minute
Angular elements is relatively excessive, the outlines of the individual members
of the aggregate may be very hard to distinguish, and the entire mass may thus
come closely to simulate a single, large, polynucleate cell (Plate II., Fig. 11).
Such densely aggregated masses of cells, as was previously pointed out by Dr.
Lewis and myself, appear to form one of the sources from which the peculiar
concretionary bodies occurring in the discharges in cases which have passed on
into ulceration are derived. Truly polynucleated elements appeared to be en
-tirely absent, and even binucleate ones were very rare.
4