Boston Medical and Surgical Journal
whether the conditions, as found post-mortem, suggested any means by which such a tumor as this could be diagnosticated from a similar growth, occupying the more usual position in the lumbar region. Dr. Tyson, in connection with the clinical history, called attention to a retro-peritoneal sarcoma, presented by him to the Society last winter, which had been mistaken by him and others, for a tumor of the kidney. Dr. Osler, in reply to Dr. Tyson's first question, stated that the only remnants of
... only remnants of sarcomatous tissue were two or three small, but very distinct, portions in the lower attached part of the tumor ; the remainder had wholly undergone this thrombotic change, and in the upper part, had become converted into a blood-cyst. This change was, no doubt, slow, with first, a destruction of the sarcomatous elements by the blood-clot, and then a slow process of necrosis. There was no evidence, in any part of the tumor, of an invasion of the coagulum by the sarcomatous elements, as is not infrequent in thrombi in other regions, as he had seen in the portal and renal veins. The chief interest in the specimen lies in the remarkable extent of the thrombotic change. Looking at the clinical aspect, he had diagnosticated the case as one of retro-peritoneal sarcoma, from its large size, its being so centrally placed, its slight movability, its distinct separation from liver, kidney, and spleen, not being placed more on one side than on the other, and from the fact that palpation in the lumbar regions gave no pain, or other evidence of kidney lesion. It was firmer above the brim of the pelvis than any other tumor he had ever examined. One remarkable feature about these tumors is their painless character ; this man complained of no pain, and in two other similar growths which he described at length, pain was not a symptom. ilecent literature.