A STUDY OF MISTAKEN DIAGNOSES
Journal of the American Medical Association
gland idiopathically hypertrophiée!, such glands do not Appear to be any more prone to malignant tumor forma¬ tion than under other conditions. In several cases the axillary lymph-nodes were found to be enlarged. In the majority of these eases, there was some acute inflamma¬ tion of the mammae which readily accounted for the in¬ volvement of the lymph-nodes. In several, however, there was no recognizable acute inflammation of the mamma?. Even in such cases, the lymph-node enlarge¬ ment was of a
... arge¬ ment was of a fibrous (chronic inflammatory) character. In no case has there been any metastatic formation of the hypertrophie mammae. GENERAL SUMMARY 1. Of the seventy reported cases of diffuse hypertro¬ phy of the female mamma), in eighteen the enlargement occurred during gestation; most of the others occurred aboul the time of or soon after puberty. 2. Of the seventy cases, sixty-two were bilateral. 3. Fifty-eight per cent, of the cases not associa led with gestation developed between the ages of 11 and 1(5 ;l|id 10 per cent, during the ages of 14 and 15. -I. The etiology of the condition is obscure. It is very probably^\^v . to the action of the same hormones that produce the physiologic enlargements. 5. Pathologically, (be condition is a simple diffuse hypertrophy, involving both glands and connective ele¬ ments. Tbc ¡niTease-in Ihe gland elements occurs prin¬ cipally in the cases occurring during gestation, whereas the connective tissue increase usually predominates in those not associated with that condition. The process appears to be essentially an exaggeration or continuai ion of the enlargements that affect the gland normally at puberty and during gestation. 6. The weigh! of the glands varies from 1% to (if pounds, the average per gland of all cases being 17 pounds. In one instance, one of the glands weighed f>4 pounds and both glands, 124 pounds. In two in¬ stances the combined weight of the two glands exceeded the weight of the remainder of the body. 7. In cases associated with gestation, lactation is. as íi rule, normal. In those hypertrophies not associated with gestation the glands seldom functionate, even after pregnancy. Dubuquc and Jefferson Streets. ABSTRACT OF DISCUSSION Dr. A. S. Warthin, Ann Arbor, Mich.: I should like to B.sk Dr. Albert whether this woman was able to throw lier mammary glands over her shoulder; a similar hypertrophy "f the mammary gland is often seen' in Hottentot women, who are able to throw their breasts over their shoulders and suckle their children, who are curried in slings on their backs. J should also like to know to what type of man this woman corresponded. Did she have any features that go with the Aitslraloid typo or Negroid typet Would there be any anthropologie interest in this case as an instance of re¬ version ? Dr. James J. Tehuii.i., Galveston: Was there any pain associated with the condition? I remember seeing specimens I l'uni a somewhat similar case in the early part of this year. Tin» patient, a girl aged about eighteen, had what Mas diag¬ nosed as dill'use virginal hypertrophy of the breast. Both breasts enlarged but did not weigh more than two pounds each. One breast had to be removed, however, on account of excessive pain, the cause of which was never discovered; hut on removal of the first breast, the pain disappeared and tlie other breast gradually grew smaller in size. Sections pre-sented an appearance practically identical with that of the . i ¡mis in Dr. Albert's case. Dr. Greer Bauoiiman, Richmond, Va.: I saw a case in November, 1003, with Dr. George B. Johnson, in a young white woman. The left breast weighed lO'/i pounds; the right 7%. The microscopic findings were almost the same as those in Dr. Albert's case-a true hypertrophy of the mamma-nonfunctionating, except that there was not so much dilatation of the acini and very little fat. Dit. Henry Albert, Iowa City, Iowa: The patient was not able to throw her breasts over her shoulders. 1 did not see the patient; but I made careful inquiry of the clinician as to any peculiarities suggestive of reversion and was informed that there were none; nor did her parents present any unusual appearance. There was no pain except that which may be readily explained by the enlarged size of the breast. In the reported cases, however, there are a number associated with severe pain, and in a few instances pain was present from the beginning of the process. A patient whom I saw three or four weeks ago presented considerable enlargement of the mammary glands. A diag¬ nosis of diffuse hypertrophy was made. The process began about a year ago, but it was only during the last three months that the pain had become extreme. On examining the glands microscopically after removal we found nothing but fatty and a little fibrous connective tissue. One of the ruses in the literature contains a reference to the fact that the hypertrophy was not due to glandular, but to fatty increase.