American practice of surgery : a complete system of the science and art of surgery . d. Thus, in metastases from an epithelioma of the skin we do notso often get the formation of the epithelial pearls, and in adeno-carcinomata TUMORS AND TUMOR FORMATION. 365 the glandular appearance of the original growth is not so completely the regional lymph nodes are thoroughly infiltrated, the masses of carci-noma cells pass out by the efferent lymphatics and invade the system of nodesnext in order, or cancerous emboli may pass through the first series of nodeswithout involving them, and at
American practice of surgery : a complete system of the science and art of surgery . d. Thus, in metastases from an epithelioma of the skin we do notso often get the formation of the epithelial pearls, and in adeno-carcinomata TUMORS AND TUMOR FORMATION. 365 the glandular appearance of the original growth is not so completely the regional lymph nodes are thoroughly infiltrated, the masses of carci-noma cells pass out by the efferent lymphatics and invade the system of nodesnext in order, or cancerous emboli may pass through the first series of nodeswithout involving them, and attack those more remote. Metastasis by the blood stream is rather uncommon in the case of the carci-nomata, though it is the rule with the sarcomata. Carcinomata of the stomachand intestines, however, connnonly spread to the liver through the portal system,(Fig). 118, and carcinomata of vascular regions, like the penis, may extendthrough the blood sinuses and vessels. The new growth may directly invade thevessels destroying the wall and appearing within the lumen, or may reach the. Fig. 117.—Secondary Invasion of a Lyinph Node with Columnar-Celled Carcinoma. W^inckelNo. 3, without ocular. (From the authors collection.) blood through the lymph-vascular system. Generally speaking, emboli from car-cinomata of the gastro-intestinal tract reach the liver, those from tumors situ-ated elsewhere reach the lungs. Exceptionally, invasion may take place in adirection opposite to the course of the lymph stream—retrograde embolism. Extension of a carcinoma may also take place by implantation. In carcinomaof the kidney, secondary tumors may arise along the ureter and in the carcinoma of the ovary, secondary nodules may appear in the Fallopian tubesand in the peritoneum. In the intestine, small secondary growths may be foundin the mucosa below the original mass. In all these cases the dissemination of thegrowth appears in large part to be determined by gravity. Carcinoma in its
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