Journal : Photographic review of medicine & surgery ; vol. 2., no. 2.
Philadelphia : J. B. Lippincott & Co., 1871-72.
Description : p. 13-15,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Neck — Tumors, adipose.
IN the accompanying illustration is exhibited a fatty tumor of the neck, removed from a man 57 years of age, by Prof. Agnew, at the surgical clinic of the University of Pennsylvania, held October 11th, 1871.
This tumor had been growing for twenty-one years, and during the past two years with great rapidity, having increased as much in size during this time as in any previous ten years. At the time of removal it was nearly spherical in shape, measured twenty inches in circumference, and was attached to the neck, posterior to the right sterno-cleido-mastoid muscle, by a pedicle which could be compressed to very small dimensions. It was freely movable, was not sensitive to the touch, was somewhat lobulated, and had a doughy or semi-elastic feel. It had at no time been the seat of pain, and gave rise to inconvenience only on account of its weight, size and the deformity which it produced. No other similar growth could be discovered in any portion of the body. The subject of this growth had always enjoyed good health, and no hereditary tendency to similar growths could be discovered. He ascribed the origin of the tumor to a boil, which, after the cessation of the inflammatory symptoms, was followed by an induration terminating in the production of this mass. It was removed by an elliptical incision made about two and a half inches from the base of the pedicle, and dissected from the surrounding tissues. It was found not to extend beneath the deep fascia, but to be closely attached to it by strong bands of connective tissue.
Although the tumor itself was but slightly vascular, yet the vessels in its sheath were so much enlarged as to render the application of several ligatures necessary. When closed, the wound was about six inches in length, and extended in a nearly vertical direction posterior to the sterno-cleido-mastoid muscle. It healed rapidly, and the patient left the ward in a week from the time of operation. The weight of the tumor was four pounds and nine ounces.
These growths consist of masses of fat, differing in no respect from the normal adipose tissue of the body. Sometimes they are diffuse and possess no clearly defined boundaries, but usually they are distinct, and enveloped by a limiting membrane or capsule. Diverse views are entertained by different pathologists in regard to the nature of this enveloping membrane of fatty tumors.
According to Bence Jones, " the vast local deposits of fat, called fatty tumors, depend chiefly on the existence of a cyst in which the process of oxidation is at its lowest point."
Mr. Paget says: "Fatty tumors are, I believe, always invested with a capsule or covering of connective tissue, and of these capsules, since they exist with most of the innocent tumors, I may speak now once for all. The capsule, then, of such a tumor is usually a layer of fibro-cellular or areolar connective tissue, well organized, and containing blood-vessels proportioned to the size of the tumor. It appears to be formed of the connective tissue of the part in which the tumor grows, increased and often strengthened, in adaptation to the bulk and other conditions of what it incloses. It grows with the tumor, invests it, and at once connects it with the adjacent tissues, and separates it from them; just as, e.g., similar connective tissue does each muscle in a limb. Its adhesion to both the tumor and the parts around it is more intimate than that of its layers or portions to one another ; so that when such a tumor is cut into, it may be dislodged by splitting its capsule and leaving some of it on the tumor and some in the cavity from which the tumor is extracted. This, at least, can be easily done, unless the tumor has been the seat of inflammation, which may thicken the capsule and make all its parts adherent to one another, and to the tissues on either side of it."
This very clear description of the nature and character of the limiting membrane of fatty growths would seem to lead to the inference that it was the result of the pressure of these tumors upon originally normal connective tissue, producing an increase in the functions of this tissue, and consequently an hypertrophied development of it.
This much seems to be proven, that in no instance is a fatty tumor surrounded by a true fluid-secreting cyst, but that whenever present this capsule is always composed of connective tissue, still possessing, however much it may vary in density and mobility, the characteristics of this tissue, and of this alone. This capsule gives off partitions, which ramify through the tumor, dividing it into lobes, and which carry with them the blood-vessels for its supply.
Advantages have been claimed for the internal use of alkalies, with a view of causing the dispersion of fatty tumors, but although there have been a few authenticated cases of the disappearance of them under the long-continued use of liq. potassae, in large doses, yet they have generally returned on a cessation of the remedy, and even temporary improvement by this agent has been so extremely rare that few will be disposed to resort to it. Operation, therefore, which is usually attended with little or no danger in these cases, seems to offer the only means of effecting a permanent cure.