Another species of tumour seems to be composed almost entirely of fatty
matter insinuated amongst extended and delicate cellular substance, and
has been therefore termed adipose. It is surrounded by a cyst of dense
cellular tissue, and to this it loosely adheres; its bloodvessels are
few, and it is of an inactive and innocuous character. It is generally
lobulated, and often attains a large size. It is not only irregularly
prominent on its outer surface, but in its whole circumference, and
its lobuli often insinuate themselves to a great depth amongst nerves,
bloodvessels, and other important parts; owing to this circumstance
they frequently prove a source of the greatest inconvenience from
their bulk, for of themselves they are neither hurtful, nor possess
any disposition to involve those parts with which they are in contact.
This tumour is found only in the cellular and adipose tissues. From
its loose connection with its envelope, it admits of ready removal by
operation. A tumour of this kind is here represented, which, but for
this circumstance, owing to its awkward situation under the tongue,
could not by any possibility have been extirpated. It is fully larger
than an orange, and had caused very great suffering. It is not so much
lobulated as fatty tumours generally are. The adhesions of adipose
tumours are, however, rendered firm and more numerous by pressure or
external stimulants—in fact, by whatever induces inflammatory action
in its substance or in its surrounding connections; and from this
cause the extraction is often rendered exceedingly difficult. The skin
becomes thickened and of a red hue, and the tumour itself is much more
vascular. From this cause it is apt to assume a new mode of action,
and to change in structure and in character, invariably for the worse.
I have removed a few tumours, originally of this benign species, but
which had apparently degenerated and assumed a malignant action. In
one, distinct indurated bands radiating from a central mass of the same
kind, are discernible. In two others, as a consequence of pressure,
condensation and ultimate softening had occurred. The largest alluded
to was removed from betwixt the shoulders of a soldier, and had borne
the pressure of his knapsack for eight or ten years. It was attached by
a thickish neck, presented the common lobulated appearance of adipose
sarcoma; but its external surface, its feel, and section, were very
different.
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