American practice of surgery : a complete system of the science and art of surgery . The pigment lies partly in the epithelial cells and partly in the stroma,giving the tumor a gray, brownish, or black color. 364 AMERICAN PRACTICE OF SURGERY Methods of Extension and Metastasis.—If we examine a growing carcinoma,we fintl that it is sending out at the periphery processes of epithehal cells into thetissue spaces, spaces that, as we have alnnuly seen, are to be regarded as the ulti-mate radicles of the lymph channels. This is termed extension by infiltrotion(Fig. 116). Some few carcinomata are alm
American practice of surgery : a complete system of the science and art of surgery . The pigment lies partly in the epithelial cells and partly in the stroma,giving the tumor a gray, brownish, or black color. 364 AMERICAN PRACTICE OF SURGERY Methods of Extension and Metastasis.—If we examine a growing carcinoma,we fintl that it is sending out at the periphery processes of epithehal cells into thetissue spaces, spaces that, as we have alnnuly seen, are to be regarded as the ulti-mate radicles of the lymph channels. This is termed extension by infiltrotion(Fig. 116). Some few carcinomata are almost as sharply defined at the marginsas a benign growth, but in most there is undoubted infiltration of the surroundingsoft parts, and in some this may be quite far-reaching. Sometimes, also, wefind small nodules at some little distance from the periphery, similar in appear-ance to, but quite distinct from, the primary growth. These are the resultof minute emboli of carcinoma cells within the lymphatic channels leading fromthe part. This is known as extension by Fio. 110.—Carcinoina of the Stomaoh. This specimen shows very clearly the infiltration of themuscular wall with cpitlielial cells. (From the authors collection.) Small clusters of epithelial cells may also break away from the main mass ofthe growth and be carried by the lymphatics or, occasionally, by the blootl stream,to distant parts, where they set up independent foci of disease. This phenomenonis called metastasis. In general the first manifestation of metastasis occurs in theregional lymph nodes nearest the primary growth (Fig. 117). If we examine oneof these nodes in the early stage of the process, we find small foci of epithelialcells at the periphery of the node in close relationship to the afferent lymphaticchannels and sinuses. At first, one sees the lymphoid cells between the epithelial-cell masses, but soon they atrophy and their place is taken by connective metastases in gener
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