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fully examined cases. According to propecia cost in india Limbacher, bone metastases occurred in thirty-seven per cent, propecia tablets cost in india of cases of thyroid cancer ; and in fourteen per cent, of mammary cancer according to Leuzinger. Thiele ( i ) reports a second case of prostatic car- cinoma with a few secondary deposits in the verte- brse and ribs, with a few nodules in the kings ; the lung metastases in both cases were very few com- pared with bone lesions. He also refers to osteo- plastic bone changes which occur in secondary car- cinoma, but not in all cases. His conclusions were: i. That metastatic growths occur primarily in the medulla of bones. 2. That they propecia discount card spread to the subperiosteal propecia cost tissues through the foramina and so occur where the bone is roughest and most porous. 3. The growths occur especially in the bones which are most liable to strain, injury, and variations in temperature. 4. The growths fre- quently show osteoplastic changes. The more in- filtrating the deposit is, the greater the tendency there is to these osteoplastic changes. 5. These changes occur, not only in deposits from carcinoma of the prostate, but also in carcinomata when the primary focus is elsewhere. From an analysis of the changes produced in bones by metastases, the following classification can be made: i. Simple erosion of the bone by the growth, without any marked expansion or osteo- plastic process. 2. Great expansion of the bone, osteoplastic processes propecia cost without insurance marked in the bone. 3. In- filtration of the bone without marked expansion, but with osteoplastic changes. 4. Extension of the growth to the subperiosteal tissues, with or buy discount propecia without osteoplastic changes in the subperiosteal growths. The more slowly growing the metastases and pri- mary discount propecia online growths are, the more infiltrating and less sharply defined the metastasis is, the greater is the how much does propecia cost uk tendency toward osteoplastic changes. Very rapid growths appear to produce simply erosion, less rapid produce expansion as well. Carcinomata of the prostate are usually very slow growing and their metastases are also very slow in growth and may apparently produce noticeable tumors for several years before the fatal ending ; microscopically they are of an infiltrating character and show marked osteoplastic changes. In discount propecia rapid growing and sharply defined metastases, as in carcinoma of the breast, the osteoplastic change is very slight and erosion chiefly occurs. Von Recklinghausen calls attention to a propecia cost comparison peculiar change noted in sections of a rib which had expand- ed from the growth of a metastasis in a case of epithelioma of the esophagus. The specimen came from a man, aged thirty-eight years ; growth in the esophagus was propecia price uk small, there was extensive infiltra- tion of the chest and abdominal glands by growths : there were deposits in the vertebrae, sternum, and ribs ; there were propecia discount pharmacy no signs of joint affection. The rib examined had in its midaxillary line a fusiform swelling an inch thick. On section it showed to the naked eye small nodules of cartilage. Microscopic examination showed marked osteo- plastic changes all around the periphery of the bone, and in aaa discount propecia this newly formed bone were numerous areas of cartilage with 'typical cartilage cells : calcification had occurred propecia discount program in some areas. Direct transition of cartilage cells to bone. The rest of the section showed infdtration by growth with elongated cells ; fibrous looking stroma between malignant cells and bone cancelli ; in others the cells were in direct con- tact with the cancelli. There was no bone formation in the growth. A similar change was observed in the vertebras. Sydney M. Cone (2) states in his preliminary: "Von Recklinghausen writes of osteoplastic changes in bone accompanying metastases from primary carcinoma of the prostate. He compares the changes with fibrous osteitis and osteomalacia of bone, and makes many valuable additions to our knowledge of the gross and microscopic structure of the bone in diseases. He records five cases of his own and refers to one of carcinoma of the prostate discount propecia australia with subsequent metastases in the vertebrae Fig. I. — Beginning destruction of neck April 6, propecia cost per month 1914. — that of .Sir Henry Thompson. This case is re- ported in full in the Transactions of the Patholog- ical Society of London, in 1854, v, p. 204, with a pathological report by J. Hutchinson. Saase has re- cently reported a propecia cost uk similar case and gives a compre- hensive view of the work of von Recklinghausen in this report." Cone's case does not differ in any essentials from those previously reported, but is interesting as con- firming several important points in the pathology of bone, and discrediting the existence of primary carcinoma of the osseous system. Cone's case and others he refers to lead to these conclusions : 1. Tumors like carcinoma of bone, without any evident primary focus, must lead one to suspect prostate or thyroid. 2. Endothelioma and carcinoma are not readily distinguished from each other. 3. Statical propecia cost with insurance and traumatic influences are potent in locating the metastases. 4. The new bone formation and location of the metastases are significant of carcinoma of discount generic propecia the prostate. 1152

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