In the array of cancers we again encounter a gelatinous, colloid new growth, namely, gelatinous cancer, better known under the epithet alveolar, derived from its very frequent alveolar fabric. This texture cannot, it is true, alone mark the character of a species. It occurs, however, in gelatinous cancer so commonly, and at the same time in so exquisite a form, that under alveolar cancer nothing else is understood than gelatinous cancer.

This species occurs under two forms:

1. It presents a yellowish-gray, yellowish-red, here and there colorless, firm, jelly-like, transparent, tremulous, sizy, and when voluminous, irregularly clavate, lobulated mass. This consists of embryonic elements - for the most part a cell analogous in appearance to the pus-cell - in an amorphous colloid blastema, and of a very scanty, very delicate, fibrous texture, mostly investing the interlobular clefts. Bloodvessels enter into its composition only in very subordinate number.

2. So-called alveolar cancer - cited by Otho, in 1816, as a peculiar kind of stomach-scirrhus - cancer glelatinifornie, ardolaire of Cruveil-hier.

The growth consists mainly and characteristically of follicles (alveoli) of either very delicate, pellucid, or of more compact and massive, white, satin-like, shining fibre-texture, containing a colorless or a pale yellow, grayish, diaphanous gelatine. Sometimes the growth consists entirely of these follicles, with inconsiderable columns of fibres intervening between them. Then, again, in the deeper layers, towards the base of the new growth, we shall find the follicles separated by a copious, firm, white fibrous stroma of new parenchyma. Its quantity stands obviously in an inverse ratio to the quantity and the grade of development of the follicles. This is shown most especially from the examination of cancers of the stomach and intestines. The walls are here found considerably thickened, hard, clavate, the inner layer presenting a multitude of collateral and superimposed hemp-seed- or pea-sized follicles, the innermost of which open, collapse, and cast their gelatine upon the inner surface of the stomach or intestine. In proportion to their depth, the follicles are, with exceptional patches, smaller, whilst the densely fibroid stroma before referred to gains the ascendency. This character of alveolar cancer is frequent both in the stomach and intestines, and may be designated as a combination of the alveolar with the fibrous form.

A Closer Investigation Of Alveolar Cancer

A Closer Investigation Of Alveolar Cancer presents a fibrous texture of the parietes of the alveoli, and of the inter-alveolar substance. Along with areolar tissue-like fibrils, black-contoured granule- and nucleus-fibres, with similar fibre elements arising out of solidified blastema and uninfluenced by acetic acid, play here a great part. In the gelatine are found, besides elementary granules and nuclei, non-nucleated and nucleated cells, cells with one or with multiple cells, parent cells. Besides these, there are present spindle-shaped, caudate cells, - under certain conditions granule-cells, together with a large proportion of fat-molecule. Johannes Muller obtained out of this gelatine, by boiling, no trace of gluten. An alcoholic extract, boiled with water, contained but an inconsiderable quantity of a substance somewhat akin to ptyalin.

According to Mulder, the main constituent of alveolar cancer does not occur at all in the healthy body. We regard it as the same glutenlike substance which furnishes colloid (see Colloid), and which, as we see, constitutes numerous new growths, both benign and malignant.

Cruveilhier further distinguishes a "cancer ardolaire pultacde," the follicles of which instead of transparent gelatine, contain opaque pulta-ceous matter, in which Boutin Limousineau has detected casein. We hold this cancer to represent a transition state of cancerous gelatine to fat, with its ulterior saponaceous and emulsive combinations, partly in the act of granule-cell formation. The same transformation is witnessed in like manner in the first form of gelatinous cancer, and often affecting considerable portions of it. It is in its nature analogous with the so-called reticulum of fibro-cancerous textures.

Alveolar cancer displays, in a consummate form, all the characters assigned, under the head of "Cyst," to the alveolar texture. In its most pronounced, that is, its most fully developed state, it offers the following varieties:

(a.) The gelatine accumulates in the follicles in so excessive a degree that the walls of the alveoli, owing to the distension, become thinner and thinner until reduced to a mere residue. The heterologous mass degenerates into an almost uniform tremulous jelly, traversed by delicate membranous septa, - the residua of the alveolar walls. It is, in point of fact, scarcely to be distinguished from the first form of gelatinous cancer.

(b.) The follicles dilate with increase of substance of their walls (hypertrophy) into cysts, attaining thus to an enormous magnitude. This excessive development affects the follicles more and more, in proportion as they are more peripheral. The new growth presents an aggregate of collateral and superimposed cysts, one or more of which, at the periphery, are of immense circumference. This growth resembles the compound cystoid, inasmuch as a redundant alveolar type is common to both, a circumstance readily ascertained in the instance of alveolar gelatinous cancer from the more and more dense fibro-alveolar structure exhibited on its cut surface, in proportion as its base is neared.

The contents of the enormously developed follicles include all the variations observed in cystoids, just as their parietes are subject to the same class of diseases.

The parts most liable to alveolar cancer are the stomach and the large intestine, the serous membranes and the peritoneum in particular, the omentum (less often independently than in association with cancer of the stomach and colon), the ovary, the bones, in rare instances the kidney, the uterus, and the liver.

Wherever situate, gelatinous cancer generally enlarges, and that often in a short time, to enormous masses. Upon serous membranes, especially the peritoneum, it occurs in scattered gelatinous accumulations, in little millet- or pea-sized tubercula, or in larger masses, - soccasionally as a continuous bulky growth, which vegetates from a few points of adhesion only, if not almost free within the peritoneum.

Upon the peritoneum the first form is predominant, but not to the exclusion of the alveolar, the scattered tubercula having the character of isolated alveoli. In the ovary the cyst-like alveolar cancer is prevalent, very often as encysted dropsy of the areolar cancer-form. This form occurs also now and then in the bones.

Gelatinous Cancer

Gelatinous Cancer, and especially the alveolar, is sometimes associated with other cancers. This combination, however, with alveolar cancer, must be considered apart from the alveolar type. This type constitutes every cancer an alveolar, but not a combination with alveolar gelatinous cancer. Every alveolar cancer may be regarded as associated with fibrous cancer, by virtue of a notable fibrous inter-alveolar substance. A combination with medullary cancer is generally brought about by the medullary cancer supervening upon the alveolar, the peripherous follicles of which fill with, and are eventually overlapped by the looser encepha-loid mass; or else, the medullary cancer grows into the cavities of the alveoli. More rarely, the gelatinous cancer supervenes upon the medullary, in the cystic and alveolar form.

Pure gelatinous cancer is the least malignant of any, and, unless it prove exhausting by dint of surpassing volume, a dependent cachexia is less pronounced than in other cancers. It is very rarely the seat of inflammation and ulceration. It is for the most part solitary, although somewhat prone to extend to contiguous organs, and to scatter itself over serous surfaces, in the manner already adverted to.