SARCOMATOUS PROLIFERATION (SARCOMA OF RIB)

JOHN H. OUTLAND
1915 Journal of the American Medical Association  
The question as to how long cells which are malignant or potentially malignant can remain in the body without manifesting any tendency to grow, proliferate or metastasize is one of great interest which may throw considerable light on the entire subject of malignant tumors. Paterson1 describes a case of gastric cancer in which he operated two years after the onset of symptoms. He found an inoperable carcinoma at the pylorus and Fig. 1.-Tumor, painted with iodin. did a gastroenterostomy. The
more » ... terostomy. The patient continued in good health for six years, without any symptom of extension of the growth or metastasis. Here we have a known cancer which was present for eight years in a spot richly supplied with lymphatics, with no tendency to manifest the ordinary nature of a cancer. Hertzler2 has told us of a case of cancer of the breast in which he operated fifteen years ago. The patient has been under observation repeatedly in the interval. At the fourteen-year period she had had no metastasis or extension when she reported for examination. Nine months later she had a small recurrence in the upper end of the scar. The following case, which deals with a sarcoma, is in line with these cases : Summary.-Man, aged 36, received a trauma which resulted in the appearance of two small tumors over the region of the ninth rib. These tumors had been present sixteen years, when a sarcoma of the rib beneath them resulted. On removal, these tumors were seen to be sarcomas of the same structure as the sarcoma of the rib. History.-The man, a farmer, was first seen by us Oct. 3, 1913. Family history was not significant. Personal history was negative for syphilis, rheumatism, tonsillitis and typhoid. At the age of 14, the patient was kicked in the right knee l>y a horse, sustained a fracture, and has had an ankylosed knee ever since. At the age of 19 he fell across a log, lighting on the right side of his chest in the axillary line. 1. Paterson, in Murphy's Clinics, iii, No. 1. 2. Hertzler. A. E.: Personal communication to the authors. The injury was slight, but within a week or so two small lumps appeared under the skin at the level of the ninth and tenth ribs in the midaxillary line on the right side. They have always been painless, and have never grown sufficiently to notice ; in fact, so far as the patient has noticed, they have always remained exactly stationary in size. They have been movable, the size of plums, and soft in consis-Fig. 2.-Same as Figure 3, with the tumors split open. tency. His physicians, including ourselves, have always told him they were lipomas. Nine months ago, without previous injury, he noticed that a hard lump had appeared over the ninth rib on the right side just under these old tumors. It was much larder, somewhat painful and not movable under the skin. It grew slowly at first, but has grown very rapidly during the last three months. Examination.-Temperature, 98.5; pulse, 86; blood pres¬ sure, 120; leukocytes, 6,000; heart and lungs, no abnormali-Fig. 3.-Photomicrograph of tumor on rib. ties. There is a hard mass, about 4 by 5 inches, over lower ribs on the right side. It is dense and adherent to the ribs. Two smaller masses in the same locality, movable under the skin, feel like lipomas. Operation.-Oct. 3, 1913, under gas-ether anesthesia, by the ordinary method, no attempt being made to use the negative pressure cabinet or intratracheal insufflation, a mass was
doi:10.1001/jama.1915.02580140027009 fatcat:3bckawlzarcttfllyot6mq25xi