Epulis.
—Epulis means any tumor growing upon the gum. The term was formerly applied in an indistinct and too comprehensive way, although it is still retained in literature. But pure fibromas do spring from the fibroösseous structure of the gum and alveolar process. They are covered with the gingival mucous membrane and seem to spring from the periodontal membrane. They seldom attain large size, and then only by neglect. By the pressure of such tumors teeth may be separated and distortion of the mouth produced. They should be promptly extirpated.
Keloid.
—Keloid is a fibrous neoplasm arising mainly in cicatricial tissue, which is essentially fibroid in structure. It is a neoplasm which often follows the general outline of the scar in which it grows, consists in elevation of the surface, ordinarily quite smooth, sometimes of a delicate pink from the dilated vessels which it contains. Keloid is the bête noir of surgeons, as it frequently complicates and disfigures scars which have at first been satisfactory, and since it indicates a condition which it is discouraging to deal with, because when it is removed there is usually recurrence of growth within a few months after cicatrization. It often occurs in stitch-hole scars and upon the site of extensive burns, and may be observed after puncture of the ears for ear-rings, and has also been observed in scars left by smallpox, acne, etc. It is more prevalent in the colored race than in the white. In negroes multiple keloid tumors are often seen, occasionally in large numbers. Their explanation is unknown, and it may be that some trifling injury has preceded each individual tumor ([Fig. 74]).
The treatment of keloid will be considered in the chapter on the Surgical Diseases of the Skin.
Desmoids.
—This term has been applied to tumors of a certain clinical type which arise from the fibrous structures, usually of the abdominal wall, and produce neoplasms like the fibromas of other parts of the body. The use of the term should be restricted to those tumors which proceed primarily only from muscles, tendons, and aponeuroses, or perhaps from ligamentous and periosteal tissues. These tumors are usually single, attain sometimes considerable size, grow slowly, rarely involve other structures, and not infrequently develop to such an extent as to encroach upon either pelvis or the abdomen, or both. They have been known to attain to the weight even of ten pounds or more. They are usually more or less encapsulated, and are firm and dense in structure. Under the microscope they have the general appearance of cellular fibroma. Sarcomatous elements may be met, while they occasionally undergo cystic degeneration. Their occurrence may be explained, at least in some instances, on the embryological theory of Cohnheim.
Fig. 75
Multiple enchondromas.