On the pathology of Paget's disease of the nipple / Louis A. Duhring and Henry Wile.

  • Duhring, Louis A., 1845-1913.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology of Paget's disease of the nipple / Louis A. Duhring and Henry Wile. Source: Wellcome Collection.

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    Buscli (LangenbecBs Archiv, Bd. xxi. p. 673) maintains that the begin¬ ning of destructive epithelial cancer is, in many cases, simple epithelial proliferation on the outer surface of the skin ; that the collection of epi¬ thelial masses about the nipple may cause retention of secretion, and under circumstances lead to cancer. The manner in which chronic cutaneous inflammation of the nipple leads to the development of cancer is still a subject of dispute. Butlin (Med. Chirurg. Trans., vol. lx. p.. 153) concludes that after a time the epithelial lining of the lactiferous ducts became affected, and that the disease travelled along the larger ducts reaching the smaller ducts and finally the acini which became dilated, filled with proliferating epithelium that, at length, escaped into the surrounding tissue. Thin (Brit. Med. Jour., May, 1881) believes that the cancerous formation is the result of an ab¬ normal development of duct epithelium, and that the skin affection is secondary “ to a destroying agent extending from the mouths of the lacti¬ ferous ducts into the surrounding papillary layer.” “The development of malignant papillary dermatitis of the nipple is suggestive of the escape of a fluid through the mouths of the ducts, which possesses the corrosive qualities of cancerous epithelium.” He regards the new formation as a duct cancer, and believes that “ cancerous changes are developing in the ducts long before they give rise to sufficient indurations to produce a pal¬ pable tumour.” As to the microscopic appearance of the tissues of most of the cases thus far presented, there is a striking similarity. Butlin (Med. Chirurg. Trans., vol. lix. p. 108) presented two cases, and in one of them the mucous layer of the epidermis had undergone proliferation and thicken¬ ing, and the corium and subcutaneous connective tissue were indurated and infiltrated by small round cells. The lactiferous ducts were found widely open and distended, not lined by cylindrical epithelium, but con¬ taining large masses of epithelium of a squamous and glandular type. Some of the ducts were seen completely filled, so as to present the appearance of sections of tubes in tubal nephritis. The immediate vicinity of the ducts was also the seat of a small round cell infiltration, which Butlin claimed has some relation to the proliferation of the duct epithelium. Waldeyer ( Virch. Archiv, Bd. lv. p. 124) also speaks of the intra-acinous granulation growth in connection with the development of the epithelium in the formation of cancer. Butlin (Med. Chirurg. Trans., vol. lx. p. 153) presented two other cases of cancer of breast, preceded by eczema of the .nipple and areola, in which there were observed in the cutaneous tissues changes similar to those of the two previous cases, and in addition, a dipping down of the epidermis into the cutis, and the presence of a few cell nests, giving the thickened portions the appearance of an epithelioma. In the.tissue of .the gland the partition walls of the acini and ducts were