abstracts - Cancer Research [PDF]

ABSTRACTS EXPERIMENTAL STUDIES; TUMORS I N ANIMALS

Bearing of the Experimental Induction of Cancer on Our Conceptions of Its Nature and Causation, J. A. MURRAY. Glasgow M. J. 121: 1-13, 1934. The author contrasts the behavior of propagated tumors in animals and of tumors occurring naturally in man and animals. It is a commonplace of medicine that an untreated cancer progresses to a fatal termination, with rare exceptions, whereas the growth of transplanted tumors is often only temporary, sooner or later coming to a standstill, the tumor shrinking and disappearing entirely. The resistance reactions to tumor inoculation observed in animals acquire added significance when attempts are made to test therapeutic methods on transplanted tumors. One cannot be sure whether the result is due to direct effect on the tumor cells or merely to enhancement of a reaction which is present but ineffective and which has no measurable counterpart in an organism in which cancer has never arisen. The author describes the gene or somatic mutation theory as ‘ I a kinetic form of Cohnheim’s hypothesis of embryonic ‘ reets,’ now decently interred.” He points out that it is not mere hairsplitting to discusa whether the unbalanced behavior of malignant cells is due to their insensitiveness to the controlling influences which are effective on the normal cell, or to the acquisition of altered metabolic activity, against which the normal control breaks down. It is even possible that both types may be represented in different tumors. Considering the difficulty in defining the essential features of malignant disease, it is not too much to ask the medical and lay public to accept with caution the exaggerated statements that gain currency from time to time as sensational diacoveries in the causation and treatment of cancer. ‘ I If for no other reason, we ought to do so in consideration for those subjects of the disease who have exhausted the resources a t our disposal. To offer them sham weapons in their losing battle, for gain of any kind, is infamous.” F. CAVERS Disease in Relation to Carcinogenic Agents among 60,000 Experimental Mice, J. M. TWORTAND C. C. TWORT, J. Path. & Bact. 35: 219-242, 1932. This article surveys the pathological findings in about 12,000 autopaies upon mice. Most of the animak died, or were killed, before the age of one year, and practically all had received from 1 to 300 applications of some carcinogenic or non-carcinogenic agent. It was impossible to examine microscopically the organs of all animals, though certain of them in groups of mice selected for the purpose from time to time could be thus studied. The following lesions, or parasites, were found: Skin: Fleas, lice, favus, Sarcocystis, Filaria, abscess, haplosporidia, hyaline change in corium, epithelioma, hyperplasia of eebaceous cells or mast cells. Lungs and Heart: Pneumonia, abscess, Klossiella, nematode worms, Sarcocystis, primary adenoma or carcinoma of the lung, pulmonary metastases from carcinoma of the breast or skin. Breast: Mastitis, neoplasms Alimentary tract: Gastritis, enteritis, intussusception, nematodes, cestodes, coccidiosis. Liver: Cysticercus, haplosporidia, Klossiella, hyaline atrophy, fatty degeneration, infarction, round-cell infiltration, leukemias, and an unknown lesion ( ‘ I condition X l’) characteri~edby the presence of xanthoma cells and periportal round-cell infiltration apparently induced by long-continued ingestion of hydrocarbon oils. Spleen: Ascaris, haplosporidia, hyperplasia, anemia, hyaline atrophy, ‘ I condition X.” Pancreas: No definite evidence of islet hyperplasia in animals with experimental malignant tumors. 125

126

ABSTRACTS

Lymph-nodes: Leukemias, sarcoma, metastatic carcinoma, haplosporidia. Thymus: Leukemias, sarcoma, Klossiella. Urinary tract: Nephritis (usually due to Klossiella), haplosporidia, hyaline atrophy, metastatic carcinoma, vesical calculi (when the diet consisted of oats and water only). Brain: Haplosporidia, Klossiella, abscess and meningitis. Suprarenal: Haplosporidia, hyaline atrophy, adenoma, accessary euprarenals. Pituitary: Edema of pars anterior, inflammation, sclerosis of fibers of pars anterior, protozoan parasites. Thyroid: Klossiella, hyperplasia, adenoma, carcinoma, colloid goitre, hyaline atrophy, metastatic carcinoma, chronic or, occasionally, acute inflammation. Parathyroid,.: Inflammation and hyaline degeneration, almost always in conjunction with similar changes in the thyroid. The article closes with tables giving the frequency with which various organs were WM. H. WOQLOM infested by parasites or attacked by spontaneous neoplasms. Selection of Non-carcinogenic from Carcinogenic Oils, C. C. TWORT AND R. LYTH. J. Hygiene 33: 464-473, 1933. The authors present some general conclusions derived from their extensive animal experiments with mineral oil lubricants, which may be useful to those concerned with the welfare of workers who are habitually exposed to contact with these substances, with special reference to the prevention of this form of industrial cancer. Among the samples used by the authors there was found a fairly definite correlation between location of the oil field and the carcinogenic potency, between field of origin and refractive index, and between carcinogenic power and refractivity, so that when any two of these data are known it is not usually difficult to come close to the third by deduction alone. I n the selection of oils refractivity of 5560 upwards should be avoided; the lower the refractivity, the greater the specific gravity allowable, but oils of gravity 940 and upwards should be rejected. In selecting from several oils of about similar gravity, the oil with the lowest refractive index should be specified. When selecting from origin alone, users should choose according to a list given, in which oils from Russia, Pennsylvania, and Texas are listed among those with low carcinogenic potency, while the reries, in ascending order of carcinogenicity, ends with oils from Borneo and Venezuela and the Scottish shale oil, the last being the most highly carcinogenic of all those examined. The main point seems to be that lubricating oils should have a refractivity below 5520 when the gravity is above 895, or a refractivity below 5550 when the gravity is below 895. F. CAVERS Discovery of Synthetic Carcinogenic Chemicals, L. VELLUZ. La d6couverte des carbures synth6tiques canc6rig&nes,Paris m6d. 1 : 245-249, 1934. A review of the work of Kennaway and his co-workers on the structure and relationships of carcinogenic substances, sex hormones, and sterols. [See articles in Am. J. Cancer 16: 57, 1932, and 20: 48, 1934; also a review by Sannie and Truhaut (Bull. d. I’Assoc, franp. p. 1’6tude du cancer 23: 6, 1934. Abst. in Am. J. Cancer 21: 661, 1934).] H. Q. WOODARD Carcinogenic Action of Finely Divided Tar, L. CARMONA AND V. GRASSELLINO. Sull’ aaione oncogena del catrame sottoposto a diversi tratamenti fisici. Nota I. Catrame finamente suddiviso, Clin. chir. 9 (n.s.) : 749-778, 1933. Carcinogenic Action of Tar Which Has Been Exposed to Roentgen Radiation, L. CARMONA.Sull’ azione oncogena del catrame sottoposto a diversi trattamenti fiaici. Nota 11. Catrame sottoposto all’azione dei raggi Roentgen, Clin. chir. 9: 865-875, 1933. Two reports on a series of experiments in which the authors attempted t o determine whether it is possible to modify the biological characteristics of tar by subjecting it to various physical procedures. Studying the problem as propounded by Kotzareff and de Morsier (Bull. de l’desoo.

EXPERIMENTAL STUDIES ; TUMORS IN ANIMALS

127

franp. p. 1’6tude du cancer 14: 112, 1925; NBoplasmes 6: 274, 1927) of expediting the appearance of tumors by using tar in a finely divided state, Carmona and Grassellino report essentially negative results. By prolonged shaking with heated agar they were able to form an emulsion in which the largest particles of t a r were the size of a red blood cell. I n several instances the emulsion remained liquid on cooling; in others i t solidified. Both the solid material ground up and the liquid were used in the experiments, being introduced subcutaneously and into various organs in a series of 56 white mice and 4 guinea-pigs. The first series of 16 animals, in which 1 C.C. of a 10 per cent emulsion was injected, all died within forty-eight hours, while control animals injected similarly with a n equal amount of non-emulsified t a r lived. The authors believe that their method of emulsification of the tar greatly increased its toxic qualities. The remaining animals, injected with 0.0125 to 0.025 C.C. of a 5 per cent emulsion, survived the experiment and were killed six weeks to two months after the injection. Autopsy findings on these animals were negative with the exception of one animal which developed a cyst at the injection site, in the subcutaneous tissue of the lobe of a n ear. This report is illustrated by photomicrographs, and a long bibliography is appended. Carmona exposed samples of tar to roentgen rays for fifteen minutes and for thirty minutes. Sixteen white mice were painted with the irradiated tar and 16 controls with non-irradiated tar every second day, then twice a week, then once a week, for a two months period. No tumors developed. However, the animals on which the irradiated tar was used became cachectic, and 11 died before the termination of the experiment. All of the controls survived in good condition. The experimental animals showed marked circulatory and degenerative changes in the spleen, liver, and lungs. Carmona concludes that irradiation of t a r according to the method used by him does not give i t any special carcinogenic properties similar to those which Kotzareff claims t o have obtained by passage of an electric current (Bull. d. l’Assoc, franp. p. 1’6tude d u cancer 14: 112, 1925), but that it does greatly increase the toxicity of the tar. JEANNETTE MUNRO

Influence of Magnesium on Experimental Cancer, P. SERBEGCU.L’influence du magnesium sur le cancer experimental, Bull. Acad. de mbd., Paris 111: 435-438, 1934. The author painted the ears of 123 rabbits with tar three times a week. I n 75 he injected into the stomach 20 mg. magnesium sulphate per kg. of body weight, daily; the remaining 48 received no magnesium. The mortality among the magnesium-treated animals was high, but all of those that survived forty days or more developed cancer, while some of the control animals did not develop cancer until seventy-three days or longer after the beginning of tarring. M. Delbet, who has claimed that magnesium exerts a prophylactic effect in experimental animals (Bull. Assoc. franp. p. 1’6tude du cancer 20: 187, 1931. Abst. in Am. J. Cancer 16: abst. p. 7, 1932), criticized Serbescu’s experiments, stating that the magnesium should be given as the chloride or other halide in order to be effective in preventing H. Q. WOODARD cancer. Attempt to Induce Tar Cancer in the Middle Ear in Guinea-pigs, V. GRIPPAUDO. Tentativi di produzione sperimentale del cancro da catrame nella bulla delle cavie, Valsalva 9: 848-855, 1933. After removal of wax from the ears of ten guinea-pigs, the author injected gasworks tar into the tympanum. Apart from inflammatory and necrotic changes, the otoscopic and histologic findings were negative, but the experiments are to be continued in the hope of throwing some light on the pathogenesis of cholesteatoma. F. CAVERS

128

ABSTRACTS

On the Presence of Nerves in Malignant Tar Tumors, GUSTAVGULDBERQ.Sur les nerfs dens lea tumeurs malignes du goudron, Bull. Assoc. franp. p. l’ktude du cancer 23: 155-171, 1934.

Opinions on the occurrence of nerves in tumors are contradictory. Some investigators hold the belief that nerves are present and that they constitute an important factor in neoplasia, while others deny both assertions. As a result of his examination of normal and tarred mouse skin, incipient tumors, and fully developed neoplasms, the author draws the following conclusions: 1. Nerves are to be found in tar papillomas and, in smaller numbers, in carcinomas. Some are new-formed, and some mere inclusions. 2. Their arrangement in carcinomas is bizarre. 3. Malignant tar tumors have no specific nervous organization. Nevertheless, an influence of some sort is suggested by the observation that papillomas and carcinomas develop more rapidly after sympathectomy, as a result of the consequent neuroparalytic hyperemia. WM. H. WOOLOM

Influence of Blocking of the Reticulo-endothelial System on the Development of Tumors in Albino Rats, R. SEORE. Influenza del blocco del sistema reticulo-endotheliale sull’ attecchimento e sullo sviluppo dei tumori nei ratti albini, Cancro 4: 236-260, 1933. The author reports a series of controlled experiments on rats, in which injections of trypan blue were used for blocking the reticulo-endothelial system. Two strains of rats were employed, one commonly receptive to tumor transplants and one refractory. Two tumors were used, a small fusiform-cell sarcoma and an osteoid sarcoma, both with records of a high percentage of takes. Five subcutaneous injections of 0.5 per cent trypan blue (1 c.c.) were given a t short intervals, some animals being injected before tumor transplantation, some after, and a few both before and after. The volume attained by the transplanted tumors was estimated by a plaster cast method. Segre found that the trypan blue did not render refractory rats more receptive to tumor transplants, though it delayed the absorption of the transplanted fragment. I n the receptive strain of rats, the percentage of tumors was the same in treated as in untreated animals. In the blocked rats, however, the transplant was palpable for a longer time, there was a longer period of latency, the tumor grew more slowly, though it ultimately attained a larger size, and the tumor-bearing animals lived longer. Fragments of tumors from treated animals were found 60 give fewer takes on transplantation than those from untreated animals. I n general the results indicate that the injection of the dye tends to increase resistance to tumor development in contradistinction to its effect on the resistance to infectious processes. Thus so-called blocking of the reticulo-endothelial system has much the same effect as under-nourishment, cold, and fatigue. Detailed tables and photographs accompany the text. A bibliography is appended. JEANNETTE MUNRO Development of Transplanted Tumors in Darkness, A. SINTINI. Sullo sviluppo di tumori da innesto nell’ oscurith, Pathologica 25: 336-338, 1933. White mice grafted with the Ehrlich adenocarcinoma were kept in the dark, but no effect was observed on the growth of the transplanted tumor. The series of animals, however, was too small to permit of definite conclusions. JEANNETTE MUNRO Action of Poisons Which Affect Mitosis in Animal Tumors. I. The Action of Cacodylate of Soda and of Trypaflavine on a TransplantableSarcoma of the Mouse, A. P. DUSTIN AND CH. GR~OOIRE. Contribution B l’ktude de l’action des poisons caryoclasiques sur les tumeurs animales. Premier memoire: Action du cacodylate de Na et de la trypaflavine sur le sarcome greffk, type Crocker, de la Souris, Bull. Acad. roy. de m6d. de Belgique 13: 585-592, 1933. This article contains approximately the same material as an earlier one [Abst. in Am. J. Cancer 20: 887, 19341, where it was said that sodium cacodylate stimulates mitosis in mouse sarcoma 180 and that agents which, like trypaflavine, generally inhibit mitosis, are unabIe to exert this effect on the tumor cell. WM. H. WOOLOM

EXPERIMENTAL STUDIES ; TUMORS IN ANIMALS

129

Heat Therapy for Malignant Tumors, K. OVERQAARD. Uber Warmetherapie bosartiger Tumoren, Acta radiol. 15: 89-100, 1934. The author has investigated the action of high-frequency currents on tumor 180, which he inoculates into the tails of mice. The temperature of the tumor was raised to 42-46' C, and kept a t those levels for twenty to sixty minutes. In all cases the tumor disappeared. Recurrences were rare. Mitosis ceases and nuclear and protoplasmio degeneration sets in. At the higher temperatures the healthy tissue surrounding the tumor was also injured, but at lower temperatures there was no visible after-effect. The author believes that these radiations are highly selective, and that the disappearance of the tumor can be brought about at temperatures lower than have heretofore been used. CHARLESPACKARD Linkage in Transplantable Tumours, J. J. BITTNER. J. Genetics 29: 17-27, 1934. As shown by Little and Tyzzer in 1913, susceptibility or non-susceptibility to tumor implantation may be explained on the basis of mendelian laws. The genetic theory of transplantation was advanced eight years later by Little and Strong. Up to the present most of the work in this field has been done on inbred dilute brown and albino mouse stocks. The author summarizes the results of experiments with three tumors which arose spontaneously in an F1 hybrid mouse (No. 19308) which gave results indicating that tumor A required the simultaneous presence of eight dominant mendelian factors for susceptibility, one of which was linked with the dilution color factor; B needed seven factors, one being linked with dilution; C also seven factors, one linked with dilution. The susceptibility factor which was linked with the dilution color factor was evidently identical for all three tumor strains. There are two illustrations. [This work is reported in detail in the American Journal of Cancer 17: 699, 709, 717, 724, 1933.1 F. CAVERS Uber Tumor Growth and Metastasis in X-rayed Rats, J. FLAKS AND B. GRYNKRAUT. Tumorwachstum u. Metastasenentstehung bei rontgenbestrahlten Ratten, Acta Cancrologica 1: 76-83, 1934. Suckling rats received one exposure to half the dose of x-rays that had been found to bring about death in the course of seven to fifteen days. The fatal dose amounted to 1080 T (twenty minutes' exposure, 160 kv., 2 ma., 30 cm. focal skin distance, 1 mm. Furnier filter). Three days after irradiation these rats, and a number of normal controls, were inoculated with the Jensen sarcoma. I n all 150 were employed. The growth of both host and tumor was inhibited, but metastasis appeared to be favored. WM. H. WOQLOM

Comparative Study on Tissue Changes in the Incisor Teeth of the Albino Rat and Their Associated Parts, Resulting from the Growth of Carcinoma and Sarcoma Transplanted in the Region Contiguous to the Basal End of the Incisor of the Mandible, H. SATO. Sei-I-Kwai M. J. 52: 1-30, 1933. Fresh minced tumor tissues-Flexner-Jobling rat carcinoma and Jeneen rat sarcoma -suspended in a sterile saline solution were injected into white rats, extraorally, into the buccal side of the left half of the mandible internal to the masseter muscle and close to the incisor eminence, immediately beneath which the formative portions of the constantly growing incisor teeth are situated. Of 36 animals so treated, 4 developed carcinoma and 6 sarcoma. The action of the sarcomas upon the bone and dental tissues was more violent and drastic than that of the carcinomas, due probably to the greater rapidity of growth. The sarcomas also caused greater distortion of the dental tissues and displacement of the jaws than the carcinomas. I n both cases, the dissolution of the mandibular bone was brought about by osteoclasts formed by fusion of the endothelial leukocytes. I n the animals with sarcoma, the cementum and dentin of the molar roots at a region where the inter-radicular septum was dissolved, were absorbed by osteoclasts. In the case of carcinoma, no oeteoclastic absorption of the roots was observed. The growth of the incisor was retarded to a greater extent by carcinoma than by sarcoma. K. SUQIURA

130

ABSTRACTS

Technique of Taking a Biopsy in Relation to the Modification of Life Span of a Tumourbearing Animal, E. S. HUNT.M. J. Australia 1 : 686-690, 1934. The author used 180 mice in the experiments here described. These were inoculated in batches of 30 with the highly malignant sarcoma S 37. Nine or ten days after inoculation each batch was divided into groups of three animals each, two being subjected to knife and to diathermy biopsy respectively, the third serving as a control. The first attempts a t diathermy needle biopsy resulted in electrocution or paralysis, but this difficultywas surmounted by covering the indifferent electrode with cottonwool soaked in saturated salt solution. The findings lead to the conclusion that biopsy does not alter the expectation of life or the growth rate of the tumor. The incidence and extent of metastasis as found a t necropsy indicated that diagnostic biopsy is qot a serious danger from the point of view of tumor dissemination. There are two illustrations. F. CAVERS Phosphatase Balance in Tumor-bearing Animals, F. KOHLER. Uber die Bilanl; der Phosphatase im tumorkranken Organismus, Ztschr. f. Physiol. Chem. 223 : 98-104, 1934. The author studied the phosphatase content and phosphatase activity of the muscle, kidney, and blood of tumor-immune rats and tumor-susceptible rats with and without Philadelphia sarcoma No. 1. The phosphatase activity was studied by means of magnesium chloride. I n the kidneys of tumor-bearing animals only 30 per cent of the phosphatase was found to be active, while in the tumor itself nearly all of the enzyme was active. In the blood of tumor-bearing animals both the phosphatase content and phosphatase activity were found to be above normal. In animals without tumors little difference was found between those from immune and susceptible strains. The author suggests that in the tumor-bearing animal the phosphatase activator may be transferred H. Q. WOODARD from the kidney to the blood. Investigations on the Aetiological Agent of the Rous Fowl Sarcoma, ERNSTFRANKEL. Acta Cancrologica 1 : 56-59, 1934. This paper describes the repetition of previous work by the author and his colleagues, on a larger scale. Twenty-eight brains from fowls bearing the Rous sarcoma were injected into the muscle of normal chickens. In 8 adult birds, the introduction of 2.5 C.C. of brain emulsion gave rise to tumors, and in 8 six-week-old chicks the injection of 1.0 C.C. was similarly successful. These growths were visible t o the naked eye from eleven to thirtyfive days after inoculation and led ultimately to the death of their hosts. In 12 cases no tumor was produced. I n another experiment both brain and spleen from 7 tumor-bearing birds were employed. Only once was a tumor obtained from both. In but two instances was the brain successful. I n 4 no tumor was produced by either. Thus the agent may be present in the brain but not necessarily in the spleen or the blood. Metastases had never been found in brain or spleen, in the earlier experimeqts. The statement of Duran-Reynals and Murphy (J. Exper. Med. 50: 315, 1929) that the agent is bound by chicken brain but not by that of the rat was confirmed. [There seems to be some slight confusion here. In the article cited the authors say: " The evidence . . . seems to indicate that the agent . . . is bound in vitro by chicken muscle. As far as the present observation goes . . . the brain and liver . . . show no affinity for the tumor agent in vitro."] The conclusion is drawn that the Rous agent is neurotropic. Better results were obtained by inoculating tumor that had been dried after freering with carbon dioxide snow than when that dried by the usual method in a desiccator [drying agent not mentioned] was employed, WM. H. WOGLOM

EXPERIMENTAL STUDIES ; TUMORS I N ANIMALS

131

Immunity in Rous Fowl Sarcoma and Its Bearing on the Problem of the Nature of Normal and Cancerous Growth, M. J. A. DES LIQNERIS. Publ. So. African Inst. Med. Res. 6: 1-193, 1934. From several thousands of experiments with the Rous sarcoma, made over a period of more than four years, the author selects several series concerned with the development of immunity phenomena. The dependence of these phenomena on individual and racial peculiarities is strongly insisted on. All the reactions obtained were apparently reactions against substances, cells, and cell products, which showed some divergence from the normal cells and cell products of the reacting bird. The alterations inherent in the development of tumor cells out of normal cells are sufficient to stimulate the organism to specific anti-action, the degree of which is proportional t o the degree of foreign character possessed by the injected material. It is, for instance, stronger in guinea fowls than in fowls (the injected material being always necessarily of fowl origin). Most of the author's findings and deductions are, as he states, similar to those published by other writers, and need not be further summarized here. However, he reports experiments which seem to justify his conclusion that the Rous agent is not of extrinsic origin. In Leghorn and in Black Minorca fowls with filtrate tumors the respective tumor sera were so highly strain-specific that, although they strongly inhibited filtrates prepared from their own tumors or tumors of birds of the same strain, they were practically as indifferent as normal serum for filtrates from tumors in birds of a different strain. That is, there was no indication of the production of an antibody against a virus or similar agent of extrinsic origin. If such an agent were present, one would expect some anti-action against it in a fowl bearing the Rous sarcoma. The explanation of Murphy, who also rejects Gye's hypothesis of an extrinsic agent, is more in accordance with the author's findings and interpretations. He is, however, unable to accept this explanation in its entirety. In his opinion the idea of the production, by the cells of a fowl injected with cell-free tumor filtrate, of the actual agent, seems to contradict fundamental biological principles. He suggests, as a modification of Murphy's hypothesis, that the agent, being in an intermediate between the living and the dead, combines with some part of the protoplasm of a congenial normal cell. This combination constitutes a new alienated living protoplasm, capable of metabolizing, of increasing at the expense of the normal cell protoplasm, which becomes a food supply for this tumor protoplasm. Finally the whole cell is taken up by tumor protoplasm, and becomes a malignant tumor cell. This paper is illustrated by numerous diagrams exhibiting the results of the experiments reported in terms of the sizes of the tumors on a graduated scale, and there is an F. CAVERS extensive bibliography. Immunological Studies on Transplantable Sarcoma of Fowls and Rabbits, T. ASAKURA. Sei-I-Kwai M. J. 52: 431-455, 1933. Anti-serum and anti-organ extracts were obtained from the blood, spleen, and lymph nodes of horses immunized with aqueous extracts of chicken sarcoma. Fresh minced tumor tissues-Kato rabbit sarcoma and Jensen rat sarcoma-were mixed well with the anti-serum or anti-organ extracts and allowed to stand for two hours a t 37" C. From 0.25 to 0.5 C.C. of each mixture were then injected into rabbits or rats subcutaneously. The extracts were found to exert very slight inhibitory effect upon the growth of rabbit K. SUQIURA and rat sarcoma. Effect of Enzymes on the Pathogenicity of the Rous and Fujinami Tumour Viruses, ANTOINETTE PIRIE. Biochem. J. 27: 1894-1898, 1933. Identification of the enzyme in pancreatin (Merck) which inhibits the agents of the Rous and Fujinami fowl sarcomas was attempted by incubating tumor filtrates with solutions of the separate enzymes for two hours at 37", and then injecting the mixtures into chickens. The effort did not meet with success. The inactivating substance was adsorbed by alumina B (Grassmann: Neue Methode der Enzyme Forschung, Bergmann, Munich) a t pH 4.0 together with lipase; neither was it protease or carboxypeptidase.

132

ABSTRAOTS

It was impossible to determine whether the nitrogen remaining in the purest obtainable preparation of tumor virus was a constituent of the virus or not. WM. H. WOGLOM Anomalous Crystallization of Sodium Chloride in Blood Serum from Healthy Fowls and KILIAN. Anomale Kristallisation des Those Bearing the Rous Sarcoma, V I L ~ M Natriumchlorids im gesunden und sarkomatischen Blutserum, Acta Cancrologica 1: 22-28, 1934. There have been many attempts since the appearance of Ord's book on colloids, in 1879, to employ his work as a basis for serum diagnosis. Ord showed that colloids in evaporating media change fundamentally both the form assumed by crystals of mineral salts and the rapidity with which these separate out. In general the procedure has been to dissolve salts in normal or abnormal serum, evaporate, and to regard the differing crystal forms thus obtained as indicators of discrepancies between the colloids of the two samples. The author employed serum from fowls bearing eighteen-day-old Rous sarcoma. Three dilutions were made with physiological sodium chloride solution, and lo-'. Two C.C. of each sample were then evaporated in watch glasses over 46 per cent sulphuric acid, the water-vapor pressure of which is 7.7 mm. at 20" C. It is essential, in such work, that the fluids be kept absolutely quiet. After evaporation was complete, at the expiration of eleven to eleven and a half hours, the watch glasses were photographed. There was a constant and a striking difference between the arrangement of crystals obtained from the serum of normal fowls and of those from fowls with sarcoma. The former appeared as small cubes, usually solitary, and grouped in a circle at the middle of the watch glass. In the case of sarcomatous birds the sodium chloride separated out in concentric circles of crystals or fine granules, often enclosing a t the center some incomplete or fused cubes. The circles broadened with increasing dilution, and at 10' there were more of them and the outermost one had a serrated border. WM. H. WOGLOM The Water Content of Tumors, N. OKUNEFFAND TAMARA NASARB~KOWA. Uber das Wasser des Tumorgewebes, Ztschr. f . Krebsforsch. 41 : 28-37, 1934. Fragments of human tumors from a number of sites, and of the Ehrlich mouse carcinoma, were dried to constant weight over different concentrations of sulphuric acid (10-100 per cent) or, in other words, under various pressures of water vapor. In order to study the process more in detail, additional samples were weighed a t intervals (one, two, three, etc., up to forty-eight hours). In another series of experiments the material was dried in an incubator running at about 100". Finally, the reversibility of the process was investigated by weighing dried tissues that had been returned to an atmosphere saturated with water vapor. Normal human muscle, breast, and skin served as controls. In conformity with the assertions of other investigators, neoplasms were found to have somewhat more water than normal tissues. The water loss for neoplasms was the same as that for the controls. Both tumors and normal tissues contained closely and loosely bound water, and there was certain evidence of a difference in this respect between the two, though the discrepancy was not diatinct enough to allow a positive statement. Water loss was reversible only within narrowly restricted limits, for when 80 per cent of their water had been given up tissues regained only 18 per cent in an atmosphere saturated with water vapor; thus some 60 per cent was irreparably lost. Here there was a clear difference between tumor and control, the former taking up less water than the latter, and an interesting comparison might be drawn between this property and the diminished tolerance of neoplaems toward water deprivation. For the reluctance of new growths to take back lost water there is no explanation at present, and it can only be suggested that, over and above any specific properties of tumor colloids, structural differences in them and variations in the proportions of their mineral constituents may perhaps play some part. WM. H. WOGLOM

EXPERIMENTAL BTUDIES ; TUMORS IN ANIMALS

133

Metabolism of Normal and Tumour Tissue. XI. The Measurement of Respiratory Quotient, Respiration and Glycolysis with the Aid of the Constant-volume Difierential Manometer, FRANK DICKENS AND GUYDRUMMOND GREVILLE.Biochem. J. 27: 1479-1486, 1933. The authors have devised a special vessel of new design to be employed in conjunction with their constant-volume differential manometer, already described (Biochem. J. 27: 213, 1933). The apparatus, in brief, permits the use of a less dense and therefore more sensitive manometer fluid and of a larger volume of bicarbonate solution, so that even with highly glycolydng tissues the glycolysis remains nearly constant throughout, instead of being repressed toward the end of the experiment in consequence of a lowered pH brought about by insufficient bicarbonate. The conditions are strictly comparable with those of the Warburg two-vessel method; but whereas Warburg’s technic gives only the oxygen consumed and the total carbon dioxide produced by respiration and glycolysis, the method now described gives the true respiratory quotient and the true aerobic glycolysis, respiratory carbon dioxide, and oxygen uptake. Furthermore, all measurements are carried out on the same piece of tissue. The new vessel is pictured and the necessary calculations fully set forth in the article under consideration, to which the reader is referred for technical details. WM. H. WOQLOM Studies in Tissue Metabolism. IV. A Comparison of Muscle and Tumour Glycolysis, E. BOYLAND AND c. A. MAwsoN. Biochem. J. 28: 1409-1416, 1934. The authors prepared active glycolysing extracts from rat muscle which gave lactic acid with glycogen, hexosemonophosphate and alpha-glycerophosphate +pyruvate. It was not possible to obtain glycolytically active extracts from Jensen sarcoma or to increase its metabolism of phosphates by the addition of hemolytic agents. The optimal pH for glycolysis in muscle was about 7.5, and the optimal phosphate concentration about M/30. The glycolysis of Jensen sarcoma was unaffected by the presence or F. CAVERS absence of phosphate, and the optimal pH was about 8.0. Action of Monobromacetic Acid and Its Esters on Lactic Acid Production and on Growth in Normal and Neoplastic Tissues, J. BRIsou. Action de I’acide monobromacdtique et de ses esters sur la fermentation lactique et la croissance des tissues normeux et cancdreux, Gas. hebd. d. sci. mdd. Bordeaux 54: 817-818, 1933. The author studied the effect of monobromacetic acid and its esters on lactic acid production of rat tumors and normal rat tissues in vifro and in vivo He found that the acid in N/1000 to N/3000 concentration prevented the anaerobic production of lactic acid by the kidney in vitro almost completely; doses of 2 to 10 mg. of monobromacetic acid by mouth produced 65 per cent inhibition of lactic acid production by the kidney in vivo without altering the organ histology. In rats with Jensen rat sarcoma and Walker rat carcinoma lactic acid formation by the tumors was inhibited 35 per cent and 60 per cent respectively, and the histological picture of the tumor was changed without alteration in its rate of growth. These experiments are considered to prove that lactic acid producH. Q. WOODARD tion is not essential to tumor growth. Chemico-serologic Fractionation and Specificity of Carcinoma Extracts, H. LEHMANNFACIUS.Chemisch-serologische Fraktion.ierung und Spesifitat von Karzinomextrakten, Ztschr. f. Immunitatsforsch. u. exper. Therap. 82: 99-123, 1934. Alcoholic extracts of normal and carcinoma tissues were separated into phosphatid and fatty acid fractions, and the fractions were tested serologically on rabbits. The fatty acid fraction was found to be similar serologically to the fatty acid fraction of human heart extract. The phosphatid fraction of the carcinoma extract could be separated into two parts, one of which was strongly flocculated by specific carcinoma phosphatid antiserum, and the other by fatty acid antiserum. A number of serological properties of the different fractions are described in detail. H. Q. WOODARD

134

ABSTRACTS

Comparison between Cancers in Plants and in Animals, H. HAMDI. Le cancer des plantes compare aux cancers du rdgne animal, Acta Cancrologica 1 : 48-51, 1934. As crown gall cannot be transmitted by implantation of cells but only by inoculation of B. tumefaciens; as its cells may differentiate out to form normal plant tissues (cambium, etc.); as it is the result of continuous irritation by the responsible organism and not of independent proliferation by its own cells; and as it exerts no deleterious effect upon the health of the plant, it cannot be regarded as analogous to the neoplasms of animals. It is merely an excrescence due to bacterial infection. WM. H. WOQLOM

T H E CANCER CELL; ETIOLOGICAL THEORIES

Histologic Study of Cancer in the Human Being. Part 11. On Abnormal Cell-Division, T. OTA. Jap. J. Obst. & Gyn. 17: 194-202, 1934. An abstract of Part I of this paper will be found in Am. J. Cancer 21: 397, 1934. There it was stated that malignancy does not necessarily vary directly with the number of chromosomes. I n the present communication the author takes up the question of abnormal cell division, to which nothing new is added. WM. H. WOQLOM

Properties of Cells from a Melanotic Tumor Cultivated in uifro,N. G.CHLOPINAND W. ZYMBAL. Uber das Verhalten und die Verwandlungen melanotischer Geschwulstelement im Explantat, Acta Cancrologica 1 : 60-75, 1934. The authors cultivated in eritro a melanoblastoma that developed from a mole in a man of twenty-nine years. Realising that it would be unsafe to generaliae from one case, they apply their conclusions only to the neoplasm which they examined. This they declare to have been a cataplastic carcinoma, since its cells were but poorly differentiated. They look with no favor on modern attempts to derive the melanoblastoma from neural ectoderm. WM. H. WOQLOM Infective Theory of Cancer, W. N. MANN. Guy’s Hosp. Reports 84: 157-159, 1934. The author’s brief discussion leads him to the conclusion that tumor growth is a sign that there has been some upset in the external conditions which control growth and differentiation-within its own potentialities-throughout life. No clinical or experimental findings are reported. F. CAVERS

Soil Magnesium and Cancer, P. DELBETAND ROBINET. Terrains magnesiens e t cancer, Bull. Acad. de med., Paris 111: 415-429, 1934. The authors present further evidence of the same type as that presented in a long series of articles on the subject, to show that there is an inverse ratio between the magnesium content of the soil and the cancer incidence in a given region. [See, for example, absts. in Am. J. Cancer 16: abst. p. 544, 1932, and 17: 484,1933. The opposite view has been advanced by Sartory et al. (Abst. in Am. J. Cancer 17: 1077, 1933).] H. Q. WOODARD

Radiant Energy; Cancer, F. M. HARTSO&. Military Surgeon 74: 177-179, 1934. A compilation of some current views on cancer and the so-called mitogenetic radiation. F. CAVERS I

GENERAL CLINICAL OBSERVATIONS ; BLOOD STUDIES

135

GENERAL CLINICAL OBSERVATIONS; BLOOD STUDIES

Sites of Election for Metastases, HERMANN STAHR. Zur Ortswahl der Metastasen, Centralbl. f. allg. Path. u. path. Anat. 60: 193-196, 1934. Metastases, whether of bacteria or of cancer cells, develop only in tissues previously damaged by edema, hemorrhage, necrosis, etc. For the infectious disorders the significance of this trauma is well established; for malignant disease, not yet. Such a conception appears well founded, however, in the latter case also, and it should unquestionably be tested by animal experiment. WM. H. WOGLOM Metastatic Carcinomatous Deposits in Cervical Lymph Nodes, Associated with Fungal Infection, R. DE NUNNO. Su di un caso di blastoma delle glandole linfatiche, Riforma med. 49: 1052-1060, 1933. Two years before hospital admission a man of thirty-five had noticed rapidly increasing enlargement of the right upper cervical lymph nodes. The liver was slightly enlarged, the spleen of normal size. Biopsy of a node showed complete replacement of the normal architecture by a tumor consisting of epithelioid cells, with some horny pearls, embedded in connective tissue. I n various places there were masses of plasma and mast cells, sometimes mixed but more often in separate groups. The picture was that of metastatic squamous-cell carcinoma, associated with infection. The patient had since childhood suffered frequently from toothache; all the remaining lower teeth were carious, and showed root abscesses on radiography. Sections of the lymph nodes stained by the Rio-Hortega and Mallory methods revealed the presence of a branching mycelium. A filtered triturate of another node was cultured, and an abundant growth of similar fungal mycelium obtained; the same mycelium was found in pus from an extracted tooth. The author then injected emulsions of the lymph nodes into rats and guinea-pigs. The rats lived for many months, and on being killed showed no signs of infection. The guinea-pigs died within a few days, and showed lymph nodes and liver nodules containing the mycelium. The patient became increasingly cachectic and died a few days after being taken from the hospital; necropsy was not permitted. The author interprets this case as one of primary bronchial carcinoma, there being only a slight hilar shadow to substantiate this diagnosis. The cervical node metastases he believes were secondarily infected by the fungal organism, which was in its turn probably a secondary invader of the dental abscesses. There @refifteen good photomicrographs. F. CAVERS Disappearance of Tumor Metastases in Uremia, I. PHILIPOVICI (PHILIPOWICZ). Verschwinden von Tumormetastasen bei Uramie, Zentralbl. f . Chir. 61 : 626, 1934. A forty-one-year-old man had a superficial tumor at the site of an old osteomyelitis. Two months after amputation of the leg and dissection of both inguinal regions, metastases to the cervical and supraclavicular lymph nodes were observed. Following an attack of uremia the swellings in the neck disappeared spontaneously. No histologic study was made of the original tumor or any of the enlarged lymph nodes, so that the exact nature of the lesions is not known. There are no illustrations BENJAMIN R. SHORE Influence of Tissue Injury on the Development of Tumors, H. LUTZELER.Uber den Einfluss der Gewebsschadigung bei der Geschwulstentstehung, Deutsche Ztschr. f . Chir. 243: 310-317, 1934. The forty-year-old patient reported by Lutzeler had received an injury of the right forearm eighteen years previously from a portion of a grenade. A small hard mass deep in the tissues resulted from this injury, but only recently had it increased in size. At the time of admission to the hospital the mass measured about 10 cm. in diameter. Histologic study of the surgically excised tumor showed it to be a spindle-cell fibrosarcoma composed of collagenous fibers, young connective tissue, and many giant cells. The arm was amputated, but no follow-up of the case is given.

136

ABSTRAUTS

The second patient reported was a twenty-nine-year-old man with a fibroma of the anterior abdominal wall developing five years after a kick in the stomach by a cow. Histologic study of this tumor showed it to be composed of adult connective tissue with a large amount of hyalin. The article is illustrated with a photograph and two photomicrographs. BENJAMINR. SHORE

J. M. A. Georgia 23: 24-25, 1934. Cancer in the Young, A. F. SAUNDERS. In adults, the organs most frequently involved by carcinoma, in the order named, are the stomach, uterus, breast, and liver, while the kidneys, eyes, bones, brain, and meninges are the sites of over half of the tumors occurring in childhood. In 1914, less than one per cent of all cancer deaths occurred below fifteen years of age. The majority of tumors in children are of connective-tissue origin. Those occurring in the first two years W. S. MACCOMB of life, however, are frequently of the mixed-cell type.

Is Cancer Curable? J. P. LOCKHART-MUMMERY. Med. World, London 37: 223-225, 1932. This paper consists of abstracts from a lecture delivered by the author before the Royal Sanitary Institute and published also in its Journal (J. Roy. San. Inst. 53: 92, 1932). He cites 215 cases of cancer of the rectum studied microscopically. Not a single recurrence has been observed in early cases [though the period of observation has not exceeded four years]. Early cases of breast cancer and of uterine cancer have also shown a high percentage of operative cures (80 to 90 per cent). It is obvious then that the high mortality commonly observed is to be attributed to late diagnosis and treatment. The author advocates more extensive public propaganda and decries the objection that such publicity creates a cancerphobia. If people can be made to understand the tremendous importance of early treatment, a great step will have been taken toward diminishing the cancer death rate.

The A B C of Cancer, CHARLES F. GESCHICKTER. I. Lesions of the Skin, Clin. Med. & Surg. 40: 291-293, 1933. 11. Lesions of the Oral Cavity and Jaws,ibid. 40:340-344, 1933. 111. Tumors of the Soft Parts, ibid. 40: 401-405, 1933. IV. Tumors of Bone, ibid. 40: 458-461, 1933. V. Tumors of the Breast, ibid. 40: 574-577; 631-634, 1933. VI. Tumors of the Lymphatic System, ibid. 41: 171-174; 216-219; 316-319, 1934. VII. Tumors of the Thyroid Gland, ibid. 41: 365-368, 1934. General discussions of the more obvious aspects of the neoplasms described. Congenital Sacral Tumors, B. SZENDI. Uber kongenitale Steissgeschwiilste, Arch. f , Gynak. 154: 538-547, 1933. True congenita1 tumors of the sacral region must be differentiated from cystic spina bifida, abnormalities of the vertebral column, inguinal hernias, and many types of scrota1 swelling. Of the monodermal tumors, myxofibromas, lymphangiomas, and gliomas are the most common. All forms of dermoid tumors are found in the sacral region ranging from simple epidermoid cysts to the more complex teratoid growths. A congenital sacral tumor hindering birth was observed once in a series of 21,450 births. In this case a tumor measuring 30 x 32 om. was attached to the sacral region of a stillborn infant. Histologic study showed it to be a teratoma with areas of carcinomatous and sarcomatous degeneration. One photograph of the gross specimen is included. R. SHORE BENJAMIN Dennoid.Cystsand Fistulas of the Coccygeal Region, R. C. FERRARI.Quistes o fistulas dermoides coxfgeos, Bol. y trab. SOC. d. cir. d. Buenos Aires 18: 758-767, 1934. This is a summary of a paper submitted to the Buenos Aires Surgical Society but considered too long to be read and reproduced, since it contained 91 illustrations and a bibliography of 91 references. It was based on 142 cases operated upon between 1918 and 1934. In 28 cases operation was followed by recurrence. The operations included

UENERAL CLINICAL OBSERVATIONS ; BLOOD STUDIES

137

74 simple extirpations and 65 extirpations with resection of the coccyx, while in 3 cases incision and curettage were done. Ferrari considers that the ideal operation is extirpation of the tumor with resection of the coccyx, because it is impossible a t operation to determine whether the coccyx should or should not be removed in order to prevent recurrence. There are three illustrations. F. CAVERS Cystic Schwannoma of the Sacral Plexus, R. T. FRANK.Am. J. Obst. & Gynec. 27: 593-599, 1934. Frank reports the case of a thirty-year-old patient who was admitted to the hospital because of increasing pain in the right iliac fossa and in the lower lumbosacral region of the same side. A diagnosis of ectopic gestation had been based upon dizziness, faintness, and fainting spells complained of recently, together with the presence of a cystic resistance in the right pelvic region. There were numerous areas of deep pigmentation on the trunk. Pelvic examination showed a flattened, resilient mass over the right sacra-iliac synchondrosis. Neurologic examination demonstrated that the patient could not stand with her feet close together and that she had a tendency to fall to the right and backward. Exploratory laparotomy disclosed a thin-walled, cystic retroperitoneal mass attached to the right pelvic wall. As it was impossible t o remove this mass intact, the cyst was opened, five to six ounces of clear amber fluid were evacuated, and the cyst wall was dissected away from the underlying nerves of the sacral plexus. The patient made a good postoperative recovery but neither the general nor local symptoms were modified by the operation. Histologic study of the excised cyst showed it to be composed of medullated and non-medullated nerve fibers and islands of cells with palisaded nuclei of glial origin. This cyst was classified, therefore, as a cystic schwannoma, such as occurs with more frequency a t the origin of the spinal nerves close to or within the vertebral foramina. A careful study of the literature has revealed only 16 other pelvic tumors described as neurofibromas, neuromas, or neurinomas with or without accompanying von Recklinghausen’s disease. The majority of these tumors were solid, but a few showed larger or smaller cavities resulting from the breaking down of tumor tissue. In only one instance was the cystic cavity lined by a smooth, glistening membrane. Drawings, photomicrographs, and abstracted histories of the 16 reported cases are included. BENJAMINR. SHORE Congenital Lipoma, A. JACOBI. Arch. Pediat. 51 : 78-94, 1934. I n this paper, reprinted from the same journal of fifty years earlier (1884), five cases of congenital lipomas are reported, three of the cases being associated with other developmental defects, namely, hydrocephalus, spina bifida, and gigantism of a member. Congenital lipomas are apt to be diffuse, and not encapsulated. W. 8. MACCOMB Instance of Plasmocytoma within a Tuberculous Cavity, DAVIDPERLA.Arch. Path. 17.: 279-280, 1934. Brief unillustrated report of a case with pulmonary symptoms and a mass in the abdomen. Autopsy disclosed a primary carcinoma of the cecum with metastases to both lungs, the brain, and the thyroid. A large fleshy tumor composed of plasma cells was found in one lung, apparently situated within a tuberculous cavity. The other nodules in the lungs were definitely adenocarcinomatous metastases from the cecum. Plasmocitoma di una ghiandola Plasmocytoma of an Inguinal Gland, P. G. FRATTINI. inguinale, Cancro 4: 191-197, 1933. I n a man of sixty-five a single, slowly growing inguinal node was found a t biopsy to be composed almost entirely of plasmocytes, many of them moderately atypical. The growth was ill defined, and there was invasion of the surrounding tissue. There was no change in the circulating blood and no other nodes were involved. . No inflammatory features were observed. The author believes the process to be of a malignant nature. The ultimate history is not given. Photomicrographs are included.

JEANNETTE MUNRO

138

ABSTRACTS

Studies on Tumor Formation: Kidney in a Teratoma, G. W. NICHOLSON.Guy’s Hosp. Reports 84: 140-156, 1934. The author describes in detail a teratoma containing kidney tissue. In the available literature he found two similar cases, which he regards as authentic, though too briefly described. The tumor which he reports was an ovarian neoplasm that had been in the hospital pathologic section for many years, the case history being unknown. The tumor was of microcystic triphyllic type, consisting mainly of mesenchymal and nervous tissues. Around the cysts there was keratinized stratified epithelium with hair follicles and eebaceous and sweat glands. In one cyst, containing epidermal and gastrointestinal tissue, there was a mass of metanephric tissue consisting of lobules containing Bowman’s capsules with glomeruli and tubules. On this interesting finding the author bases a general discussion of the tissues and organoid structures found in teratomas. F. CAVERS There are four illustrations. Case of So-called Conjugal Carcinoma, V. GONNELLI.Un caso di cancro genitale coniugale, Sperimentale, Arch. di biol. 87: cxcvii-cic, 1933. A man of sixty-Eeven had recently noticed a swelling on the lower surface of the glans penis, which had now become ulcerated and was found on biopsy to be a squamous-cell carcinoma. Total amputation was done. Two years before the patient noticed this tumor his wife had died of inoperable cervical cancer, extending to the portio and vagina. The husband denied having had intercourse with his wife during the four years of her illness. The author regards this as a clearly established case of direct transplantation of F. CAVERS cancer cells from one person to another. ‘

Transplacental Transmission of Malignant Melanoma from Mother to Child, E. HOLLAND. Transmission d’un carcinome mblanique de la mere 4 l’enfant par voie transplacentaire, GynBc. et obst. 28: 524-527, 1933. A woman of twenty had a pigmented tumor, diagnosed as melanocarcinoma, excised from the thigh. Two months later there was local recurrence, and block excision of the involved skin and enlarged inguinal nodes was done. Two months after this the patient married, and she was first seen by the author in the eighth month of pregnancy. There were numerous black nodules in the skin of the abdomen, thorax, and neck, and extreme ptosis of the left eye. The lower segment of the uterus waB occupied by a large, diffuse, soft mass, evidently the placenta, which prevented engagement of the fetal head, necessitating cesarean section. The child seemed to be healthy. The placenta was riddled with melanotic nodules, and when the mother died, two months later, melanomatous metastases were found in the peritoneum and abdominal organs. The child survived for eight months, becoming increasingly cachectic before death; numerous melanotic nodules appeared in the skin, and necropsy showed metastases in the liver and other abdominal organs. There are four illustrations. F. CAVERS Unusual Case of Disseminated Sarcoma in a Child, E. PRITCHARD AND D. H. HALER. Arch. Dis. Childhood 9: 125-131, 1934. A boy of four years was brought to the hospital because of increasing abdominal enlargement and difficulty in breathing. The liver was greatly enlarged and was uniformly smooth, but there was no evidence of ascites or of an intestinal tumor. A blood examination showed over 5,000,000 erythrocytes, 112 per cent hemoglobin, and 7200 leukocytes (polynuclears 47 per cent, eosinophils 2, neutrophil myelocytes 10.4, lymphocytes 37.2). On the third day the temperature rose and with it the respiration and pulse rate. The clinical signs of bilateral pleuritic effusion and basal lung collapse were verified on radiography, and the child died fourteen days after admission. At necropsy there was found a large, white, cauliflower-shaped tumor in the cecum but not obstructing the ileocecal valve. Numerous nodules were scattered in the large intestine, liver, spleen, pleura, and intra-abdominal and intrathoracic lymph nodes. The cecal tumor and the nodules consisted of small-cell sarcoma. Probably the case was one of primary metastasizing sarcoma of the cecum, but the blood picture and the extensive lymph node involvement suggested the poseibility of an abnormal borderline condition between

QENERAL ULINIOAL OBSERVATIONS ; BLOOD STUDIES

139

diffuse sarcomatosis and the aleukemic stage of a myelogenous leukemia. There are five illustrations. F. CAVERB

T w o Remarkable Malignant Tumors, R. G. J. P. HUISMAN.Over twee merkwaardige maligne tumoren, Geneesk. Tijdschr. v. Nederl. Indiij 73 : 1481-1483, 1933. The first of the author’s patients was a thirty-two-year-old Javanese man with an enormous spindle-cell sarcoma occupying the whole right cheek, operated upon but with fatal outcome. The other patient was a thirty-year-old Javanese with a large abdominal tumor, found a t operation to be a seminoma arising in an undescended testicle in the abdomen. JOHANNES P. M. VOGELAAR

Angioblastoma Following Removal of a Calcified Cyst, G. VILLATA. Angioblastoms secondario a cisti calcificata asportata, Cancro 4:261-265, 1933. A woman of sixty-eight noticed that a small tumor of the cheek, present for years, was beginning to grow and showed slight ulceration. A calcified fibroma without any sign of malignancy was removed. Five weeks after the operation a large polypoid, ulcerated mass had arisen from the granulations. This tumor, on section, was found to be composed of thin-walled blood vessels, angioblasts, and many atypical reticulohistiocytes. X-ray therapy was ineffective. JEANNETTE MUNRO Fibroma of the Abdominal Wall,D. MOSTO,A. T. SALVATI AND J. ZIMMAN. Fibroma de la pared abdominal, Bol. y trab. Boo. de cir. Buenos Aires 18:813-814, 1934. A brief account of a fibroma resected from the upper half of the rectus abdominis in a woman of twenty-three, who had first noticed it a year previously but could not recall any trauma to this region. There are two photomicrographs. F. CAVERS Hots on Malignant Disease, J. H. ROBINSON.Med. Press & Circ. 188: 199, 1934. The author fails to make clear the meaning of his curt statements about cancer in general or the real nature of the case he briefly reports. The latter may have been one of F. CAVERS ohorionepithelioma. Alkuli Reserve of the Blood in Cancer Patients, A. RAKOW. Uber die Alkalireserve des Blutes bei den Tumorkranken, Ztschr. f. Krebsforsch. 41:38-43, 1934. The alkali reserve was determined by van Slyke’s method for blood taken fasting from 85 tumor patients, 2 patients without malignant disease (gumma of the head, chronic purulent mastitis), and 10 normal persons. The findings suggested a tendency toward alkalosis, more distinct in proportion with the degree to which the disease had advanced. This mild alkalosis is no unexpected finding, for quite apart from its report by many other investigators, displacement of the acid-base balance toward the alkaline side might be expected even upon purely theoretical grounds. Thus it is only necessary to recall the favorable influence of an alkaline medium upon glycolysis, cell division, and growth, and the important r8le played by alkalies in buffering the tumor cell. There is no means of ascertaining a t the present time whether this shift in the acidbase balance is primary or secondary, but in any case it is too slight to possess either WM. H. WOGLOM diagnostic or prognostic significance.

Behavior of Potassium and Calcium in Tumors and in the Serum of Patients with Tumors, H. GUTHMANN, H. WINKLER AND N. GRZIMEK.Beitrlige zum Carcinomproblem VII. Das Verhalten des Kaliums und Calciums im Tumor und im Serum des TumortrLgers, Arch. f. Gynllk. 155: 185-196, 1933. Studies of the potassium and calcium content of the blood serum and tumors were made on patients with carcinomas of the cervix uteri. The calcium content of the blood serum of these patients was only slightly decreased in amount, while the potassium was definitely decreased. This was found to vary proportionately with the size of the pri-

140

ABSTBAUTS

mary tumor. An increase in the potassium-calcium quotient was found to correspond with retrogression of the malignant process after intensive irradiation. It seems possible that a definite relationship exists between the potassium and calcium content of tumors BBNJAMIN R. SHORE and their capacity for growth. DIAGNOSIS AND TREATMENT

Problems of piagnosis and Therapy of Cancer, L. SCH~NBAUER. Einige Probleme der Diagnostik und Therapie beim Karainom, Wien. klin. Wchnschr. 47: 546-650, 1934. Schtlnbauer discusses the early diagnosis of cancer and especially those methods which have been devised for the serological recognition of malignancy. He has used the method of Links (Med. Klin. 30: 166,1934. Abst. in Am. J. Cancer 21 :684,1034) on the blood serum of 210 patients; there were only three errors and sixteen unverified cases. The author believes that certain reactions in the blood serum give a better indication of the outcome in cancer patients than do the histologic characteristics of the tumors themselves. BENJAMIN R. SHORE Recent Advance6 in the Aetiology, Diagnosis, and Treatment of Cancer, C. A. JOLL. Bristol Med.-Chir. J. SO: 201-232, 1933. The author points out that in England there me about 75,000 cases of cmcer per annum, while there are about 26,000 doctors in private practice, giving an average of three case8 apiece. Hence unless the student of medicine, undergraduate or postgraduate, receives special instruction in the diagnosis of cancer, little progress can be made, however great the resources available in the hands of the cancer expert. The building up of the diagnostic tripod-clinician, radiologist, and pathologist-is the product of years of concentrated and continuous effort, and can never be duplicated to the degree which would permit of more than a limited number of really efficient diagnostic centers being formed for the whole country. F, CAVERS Disease Prevention and the Control of Cancer, W. D, STOVALL.Wisconsin M,J. 33: 119-123, 162, 164, 1934. This is a general discussion of the early diagnosis and treatment of cancer, especially as organired in Wisconsin. The author stresses the fact that the diagnosis of cancer requires the services of a clinician and that the disease cannot be controlled by lay education. Pathologists, radiologists, and physiaians are required to determine whether or not a tumor is malignant, to recogni~iesuoh a possibility early, and to decide upon the type of treatment best suited to the individual case. In this disease the practice of medicine on the individual is the only method of control; preventive medicine and clinical medicine are united. BPNJAMINR. SHORB

Biopsy in Suspected Cancer, W. C. MACCARTY.Canada Lanoet & Pract. 82: 156-167, 1934.

The author points out that four functions are served by biopsy-differential clinical diagnosis, research, prognosis, and the direction of treatment. The first and last of these are at present of the greatest practical importance. The risk of removing tissues is almost nil when it is done by an experienced surgeon, but the excision should only be done if the surgeon is himself capable of performing a radical operation in case a malignant condition is found, or is in close proximity to one who can complete the operation. Ae a rule, biopsy should not be done on doubtf ons situated near the epiphyaeal line where the immediate and ultimate in children, nor should it be undertaken in an operative risks are greater than the danger of cancer. The author’s long experience has led him to prefer the fresh tisah method of examination. F. CAVERS

DIAQNOBIB APPD 'BU5ATA6ENT

141

hth~bglcalExamination of Twmoure, H.R. DARLING.M. J. Australia 2: 607-608, 1933. Under this misleading title the author enunciates the following beliefs: biopsy is dangerous, allowing dissemination of malignant cells; operative results [rather ancient statistics given] of breast cancer seem to indicate that the patients would have been better off without operation, since the natural duration of the disease is about four years; cancer should be made a notifiable disease in order that public health officials may direct treatment and an effective follow-up system. All these are highly debatable propositions, requiring more than mere dogmatic statements of opinion. Aa no references are given, the ideas set forth are apparently original with the author. F. CAVERS

-

The Cronin Lows Serum Reaction for Malignancy, J. PATTERSON AND J. ADLER. British M. J. 2: 1063-1066, 1933. Modified Bendien Serologic Teat: Correspondence, E. C. LOWE,W. G. LISTONAND W. 0. KERMACX, R. E. JONES AND D. L. WOODHOUBE, E. N. ALLOTT. Ibid. pp. 1188-1190. A paper by E. Cronin Lowe (Abst. in Am. J. Cancer 18:419,1933)on results obtained by a modification of Bendien's precipitation reaction was followed by a somewhat desultory correspondence regarding certain points in the technic of the test (See Abets. in Am. J. Cancer 19:879, 1933). The interest aroused by Lowe's paper has now taken the more useful course of repetition of the test by other writers, Patterson and Adler have twice repeated the test, the second time after having been provided by Lowe himself with very full technical details, with special reference to points of procedure regarded as likely to cause discrepancies in the results. They tabulate the reactions obtained in their second series of trials, comprising 20 cases of proved carcinoma and 35 of various non-neoplastic diseases. In the 20 cases of malignancy the reactions obtained were as follows: frankiy malignant, 5; presumably malignant, 1; frankly non-malignant, 6; presumably non-malignant, 1; impossible to classify, 7. In the 35 non-malignant cases the reactions obtained were: frankly non-malignant, 17; presumably non-malignant, 3;frankly malignant, 9;presumably malignant, 4;impossible to olwify, 2. Of 5 cases in the nop-malignant series in which the patients showed marked hyperpiesia, 4 gave 8 frankly malignant reaction. In these authors' hands, therefore, the test has been of no diagnostic value. They point out that, even if the protein estimation is itself capable of the highest degree of accuracy, the reaction involves a somewhat crude and insufficient form of lipoid extraction, followed by a fractional reaction of a type which can sustain no claim to being capable of providing knifesdge partition of protein. They therefore feel justified in aesuming a critical attitude towards figures which depend for their significance upon minute differences in protein deposits-in some cases amounting'to 0.05 mg. of protein. Moreover, an arbitrary standard has been chosen upon which to fix the reagent to be applied. If one number is moved to right or left of the Bendien scale, the ratio becomes numerically quite different and may soon become reversed in regard to the sign of the numerrrtor-denominator difference; that is, a serum showing a non-malignant reaction when sssociated with one Bendien number may show a malignant reaction with the next. Lowe,who disclaims the prefixing of his name to the Bendien test as modified by him, rugge~tethat the high degree of clinical and reaction non-correspondence in the findings of Patterson and Adler may be due to some fault in technic. In his experience of about loo0 cases he has found that negative operative and histologic findings are not invariably aorreot, and mentions three cmes in which the serum reaction was apparently contradicted by biopsy or operation but proved later to be correct. In some cases considerable time must elapse before the observations can be finally evaluated. Liston and Kermack sttate that they have been unable to confirm the usefulness of the modified Bendien reaction in their examination of 20 normal and 45 cancer sera. Jones and Woodhouse, on the other hand, report that during the past nine months they have used this reaction in 220 cases, and that out of 161 in which the clinical diagnoah waa satisfactorily established they found correspondence in 132, or 81 per cent correct results. Of the ceses of correspondence, 82 were sera from malignant cases

142

ABSTRACJTS

covering almost every stage of the disease, while 50 correct negative reactions were given by patients in whom the possibility of malignancy was excluded as far as possible. In the 29 cases of incorrect serum reactions, 14 sera were from malignant and 15 from nonmalignant cases. Allott reports a short series of 13 cases, in 4 of which the reaction was incorrect. F. CAYERS

.

Serological Test for Cancer, W.MOPPETT. M. J. Australia 1 : 681-685, 1934. The author redescribes experiments previously published by him (Abst. in Am. J* Cancer 18:397, 1933) on the migratory movement of cells of mouse sarcoma (S 37) in uitro towards the blood of normal and tumor-bearing mice and that of normal and cancerous individusls. He has now extended his observations on the behavior of the same mouse sarcoma towards the whole blood of SO individuals, some normal, some with inflammatory lesions, some with demonstrated or suspeoted cancer. Sinae it would be dedrable to detect new growth a t an early stage, when it comprises asy l/lOOO of the body weight, the sensitiveness of the test was increased by using larger quantities of blood, 0.3 C.C. taken from a vein. Since the increased sensitivity gave reaction with inflammatory Conditions, the migratory responses were graded as sero, slight, medium, strong, and very strong. Slight and medium responses were apparently related to inflammatory conditions, strong ones being ohsracteristic of cancer. Two experiments were done with known cases of cancer as an initial trial, and 4 of the following 48 cmes were excluded becauee it was impossible to form a clinical opinion. The remaining 44 gave 27 correct and 17 incorrect results. This ratio of reliability i s low (60 per cent), but several errors appeared to be avoidable in the light of further experience. Three were reoorded before the need of grading the response was realized. Four advanced cancers gave a negative result after twenty-four hours’ incubation, though there was every indication of a strong reaction in the first hour; there was evidence of cell poisoning arresting the migration, and it was found that the ether in which the glass parts of the apparatus were stored had become aontaminated with xylol. Of the remaining errors, 6 represented sn inadequate response to an established csnoer, possibly owing to cell poisoning or a non-viable tumor fragment. It is also likely that some human tumors would have no antigenic factor in oommon with the mouse sarcoma. The author believes that further experience may raise the chance of diagnostic success to at leaat 2 to 1, but according to the antigenic hypothesis there would always be some errors. Three illustrations are given. F. CAVERS

Roffo’sTest ia Tumors of the Ear,Noee and Throat, E. BOWHESAN.Sul valore dens reazione di Roffo in otorinoleringoiatria, Valsalva 9: 684-692, 1933. The author has used Roffo’s neutral red serologic test in 46 cams of histologically proved cancer of the ear, nose, and throat, obtaining 18 positive (39 per cent), 20 negative, and 8 doubtful reactions. I n 22 cases of benign tumor there was only one positive reaction, with 13 negative and 3 doubtful results. In 60 cases of non-neoplastic diseases the reaction was positive in 20 per oent, negative in 70 per cent, doubtful in 10 per cent. In two cases of fractured skull the reaction was positive, The author, though ooncluding that the reaction is far from being specific for malignancy, thinks it may be useful in inducing more careful examination of cases giving positive reaotions. F. CAVERS

Tumor Type of Reaction with the Berlin Blue Test of the Cerebrospinal nuid, V. M. BUSCAINO.Curve a tipo blsetomatoso nel liquor aJla prova oolloidale del bleu di Berlino, Riv. di pat. nerv. 42: 596-601, 1933. The Berlin blue oolloid flocculation test is based on the finding that in diseases of the central nervous system there is considerable increase in the protein oontent of the cerebrospinal fluid without. a proportionate increase in the number of leukooytes. This “ cytolytic protein dissociation ” is not specific for neoplasms, but occur8 also in various types of radiculitis, postdiphtheritic paralyses, msleria, eta. The two types of curve obtained in this test, with which the author deals, have been regarded by some Italian

DIAGNOSIS AND TREATMENT

143

neurologists as assisting in the differential diagnosis of tumors, though both may also occur in lues, echinococcal cysts, chronic arachnoiditis, and cerebral abscess. The author gives a table showing the findings with this test in 44 cases, with the operative or neeropsy diagnoses, and a series of curves plotted from the flocculation findings. The first three curve types are the strongly luetic, weakly luetic, and meningeal (tuberculous and diplococcal); the fourth and fifth types of curve included the cases of neoplasm. It is noted that there is considerable resemblance between the third, fourth, and fifth types, and that comparatively little value can be claimed for this reaction F. CAVERS in the diagnosis of tumors of the central nervous system, New Discoveries in Carcinoma, BRUNOM. KLEINAND A. MISSRIEGLER.Neue Befunde am Carcinom, Xtschr. f. Krebsforsch. 41 : 87-102, 1934. By means of a silver method the authors have discovered a dissociation and hypertrophy of the intercellular fibrillae which are said to be characteristic for carcinoma when well advanced. Benign epithelial new growths show similar but less pronounced changes. WM. H. WOOLOM Oxydo-reduction Phenomena, N. WATERMAN.Sur quelques phhomhnes d’oxydoreduction, Acta Cancrologica 1: 5-12, 1934. Determination of the oxidation-reduction potential may be helpful for several reasons. Thus, in the case of a reversible chemical system, such as a buffered solution of methylene blue, it affords a measure of x-ray dosage; in the case of the blood serum, it will yield information that may be of diagnostic and prognostic value; and in the case of tissues, it may give some insight into the altered metabolism of the cancer cell. WM. H. WOGLOM Surgical Ethics in Malignant Disease, URBANMAESAND E. M. MCFETRIDGE.New Orleans M. & S. J. 86: 525-529, 1934.

The authors emphasize the importance of considering each cancer patient individually in contemplation of any surgicd procedure. The need of a biopsy is stressed W. S. MACCOMB and the use of radium urged as a supplement to surgery. Modern X-ray Development, A. BOUWERS.Brit. J. Radiol. 7: 21-32, 1934. The modern development of x-ray apparatus aims a t improvement in quality and simplification of method. In the field of radiography a definite advance is the improved rotating anode. The author demonstrated a small x-ray apparatus weighing only 10 lbs. Here the transformer is placed around the tube and the anode is in air, so that its energy does not heat the insulating material. The tube may be held in the hands during exposure. A shoulder may be radiographed or a lateral view of the skull taken in three seconds. In therapy the advances have been in the direction of simplicity, reproducibility of dose, and protection. Higher tensions are now demanded. Brasch and Lange have obtained 1 million volts or more. The author, however, finds their system disappointing. Other systems are those of van de Graaf, of Breit and Tuve, and Lauritson. Bouwers describes his own small generator which develops 900 kv. A difficulty in producing these high voltages lies in the secondary electrons which cause heat and ionisation. In conclusion, the author discusses briefly the problem of atom splitting. Whether the neutrons produced are of therapeutic value must be determined. CHARLES PACKARD

X-ray and Radium Therapy in the Future, N. S. FINZI. Brit. J. Radiol. 7: 9-20, 1934. Finzi believes that the value of radiotherapy in the treatment of malignant disease will be greatly enhanced by the use of very high-voltage x-rays and large amounts of radium. Already the clinical results following exposures to 300-700 kv. are encouraging, even in unfavorable cases. Voltages of one million and more should be sought for. Massive radiation with several grams of radium is preferred to interstitial treat-

144

ABBTUbTB

ment, for the skin distanoe can be inoreased and the uniformity of dosage ensured. The radiotherapist must be experienoed in both x-ray and radium technios, for in certain oases one produoes better results than the other. Possibly a oombination of both may prove more efficient than either one acting alone. The urn of radiation in the treatment of microbial diseases has resulted in many failures, probably because too high doses have been given. The problem of proper dosage, the time factor, and the way in whioh radiations sot on the oell oall for much more investigation.

Conference on Radium: Value of Massive Radiation, Lanaet 1 The decision of the Radium Commission to aubdivide the 4 use a t the Westminster Hospital into 4 units of 1 gm. each, led a into the advantages and disadvantages of m w radistion, and with that of radium needles and seeds. The Committee points ou tios has a greater selective power than the longer x-rap, and that it oan oonvey a larger proportion of energy to the deeper tissues. Very essential to proper treatment is a uniform distribution of the radiation, This oan be obtained with large amounts of radium. But needles, placques, and seeds have the advantage of being Sasw to use, It is doubtful whether they produoe better results than massive radhtion. The ComCHARLWPACKARD mittee reaommends the aonstruation of a 6 gm. unit.

Present Popition of Radium Therapy, 8.3,WIOODER.Bristol Med.-Chir. J. SO: 233-

a a , 1933.

The author reviews briefly some results of rsdium treatment of malignant tumors in various sites, used alone or in conjunction JKith surgery or x-rays or both. She considers that on the whole radium is not a t present a substitute for surgery. F. CAVBRS Report on Treatment by Radium st Guy%Hospital lo the Years 1930, 1931 and 1932, P. READING.Guy’s Hosp. Reports 8.1.: 160-170, 1934. This paper aonsists mainly in tables of oarefully compiled statistics, from which a valuable report of end-results wiil doubtless emerge with further lapse of time. F. CAVERR

Reactlone to Radiation in Lymph Nodes Containing Carcinoma Meta~tases Squamouu-cell Type, L. MCGBEGOR.Acts Radiologice 15: 129-162, 1934, This is an histological study of cervioal and inguinal lymph nodes removed after irradiation in 41 cases of metastases of squamous-cell carcinoma, The ment consisted of moderate d w e of 170 kv. x-rays or of gamma rays pack, each given by the fraational method. For oomparison the au unirradiated lymph nodes taken from the same regions. In 11 oases the radiations caused a complete destruotion of the oanaer cells, their plme being filled with a mass of necrotio material often surrounded by giant cells. In 23 oases there were large areas of canoer necrosis lined by oanoer epithelium. The same aondition is found also in non-irradiated nodes, but in the letter, mitosea are more frequent. The presence of giant cells is a favorable sign, for they wall off the necrotic areas. Where oanoer tissue is growing they are soaroe or absent. An acute or subacute inflammatory prooess oacurred in a few oases, but here there was no oomplete neorosis of the tumor. Changes in the blood vessels are oommon and appear to depend on the preesnae of cancer ceUs, sinae they are not found i diated non-cancerous nodes. The author concludes radiations sot direatly on cancer aeUs, but the ahanges are not speoifio since the also in non-irradiated tissue. Lymphatia tissue seems to be uninjured by radiations. Data on the 41 caws, methodr of treatment, and oommenta are given. CHARLBB PACKARD

DIAGNOSIS AND TBEATMENT

145

Treatment of Pain and Malignant Tumors, C. TAQUET.La cure des algies et des tumews malignes, Bull. et mem. SOC.m6d. de Paris 137: 310-311, 1933. A brief article on the use of snake venom in cancer, supplementing that appearing in Bull. de 1’Acad. med. 109: 27, 1933 (Abst. in Am. J. Cancer 19: 889, 1933). The author claims alleviation of pain and postponement of a fatal outcome but not as yet a cure. Indications for the Use of Cobra Venom in the Treatment of Pain in Cancer, LAIQNELAND N. T. KOREBSIOS. Indications de l’emploi du venin de cobra dans LAVASTINE le traitement des algies canc6reuses. Bull. et m6m. SOC.m6d. d. h6p. de Paris 50: 487-494, 1934.

Physiologic Mechanism of the Hypotensive Action of Cobra Venom, LAIQNEL-LAVASTINE, L. WURMSER AND N. T. KORESSIOS.Le m6canisme physiologique de l’action hypotensive du venin de cobra, Bull. et m6m. Soc. mbd. d. hop. de Paris 50: 494498, 1934.

Sixty cancer patients were treated with 0.1 mg. of cobra venom every eight to ten days. Pain was markedly relieved in the majority of cases. The venom was also useful in diminishing edema, which may account for much of the analgesic action. In a second paper the authors report that in rabbits the hypotensive action of cobra venom was due to a direct effect on the peripheral vessels, and was independent of the vagus. [A good many clinicians have not found cobra venom of any value in the production of analgesia.] H. Q. WOODARD

Two Cases of Cancer Treated by Cancer Extracts Combined with Cobra Venom, GUEYTAT.Sur deux cas de cancer treit6s par les m6thodes combinbes des extraits de cancer et du venin de cobra, Lyon m6d. 153: 166-171, 1934. In the case8 reported treatment with cancer extracts combined with cobra venom seemed to cause some amelioration of symptoms, but nothing more. WM.H. WOQLOM Experimental Nerve Block for Relief of Pain in Inoperable Carcinoma, H. 5. RUTH. Hahneman. Monthly 68: 1-9, 1933. Also in Anesth. & Analg. 12: 108-112, 1933. There are undoubtedly many instances in which nerve block for the relief of pain in inoperable carcinoma should be used. As the author points out, it should certainly be tried before such procedures as intracranial neurectomy or posterior rhizotomy following cervical laminectomy, for few patients with advanced carcinoma are able to withstand these operations. In the author’s series the least amount of relief experienaed by any one patient has been 75 per cent. He states that 5 C.C. of 85 per cent alaohol produces a zone of necrosis 2 cm. in diameter. Therefore, great care should be exercised in the injection. W. S. MACCOMB Selenide Treatment of Cancer, A. T. TODD.British J. Surg. 21: 619-631, 1934. The author states that patients are treated in his clinic only after having been given up by the surgeon and the radiologist. Many of them have already been treated by surgery and irradiation, all are in an advanced stage, and about one-fifth practically moribund. Patients are not admitted unless they can attend regularly once a week. Each patient receives injections of a double colloid of sulphur and selenium (SSe), x-ray treatment, and drugs (thyroid extract, radiostoleum, calcium thiosulphate, sodium iodide). Two tables are given showing the results of this treatment (cases dating from 1931 and those from 1932 to the time of reporting), in which the cases are classed as failures, still under treatment, dropped out, inadequately treated, dead from other causes, and apparently cured. The earlier series includes 93 cases, with 15 apparent cures (with follow-up of six to twenty months). The later series includes 62 cases, but the follow-up periods are too short for assessment of results. F. CAVERS

146

ABSTRAUTS

THE SKIN

Common Growths of the Skin and Their Treatment, J. H. T. DAVIES. Med. Forum 1: 435-460, 1933.

The author discusses the treatment of such skin conditions as corns, calluses, warts, moles, and nevi. He believes that xeroderma pigmentosa is the only true precancerous skin lesion. W. 8.MACCOMB

Precancerous Dermatosis, JAMES K. HOWLES. New Orleans M. & S. J. 86: 624-626, 1934.

For many skin cancers a very definite predisposing etiological factor associated with cellular hyperplasia has bgen observed, as in roentgen-ray cancer or cancer due to excessive exposure to the sun’s rays. Some believe that skin cancers mre more frequently the cause of death than is indicated by autopsy because a large number of these patients die a t home. In England and Wales, from 1921 to 1925, 7.8 per cent of males and 5.7 per cent of females who died of cancer had cancer of the skin. The author gives a rBsumB of the known irritants and of skin diseases which seem to plsy a part in the etiology of cutaneous cancer. W. 8. MACCOMB

Classiflcation of Nevi, EUQENIU F. TRAUB.Arch. Pediat. 51: 45-48, 1934. Nevi have been claseified by Traub as vascular, pigmentary, verrucous, hairy, glandular, and systematised or localized. Each group is further subdivided. W. 5, MACCOMB Radiologist’s Cancer, R. DE NUNNO. Neoplasie da raggi X, Riforma med. 49: 728, 1933.

After mentioning a recent fatal case in an Italian radiologist, the author briefly discusses the etiology of x-ray cancer. He agrees with the views recently expressed by BBclhre and Regaud (Absts. in Am. J. Cancer 21: 872, 1934). In the case referred to, there were no signs of inflammation or ulceration, and the author believes that the chief change occurring in occupational x-ray cancer is metaplasia of the cells of the malpighian layer and the outer layers of the underlying derma, which would account for the rapid lymphatic dissemination which occurs in these cases. The victim was a surgeon as well as a radiologist, and the author suggests that repeated immersion of the hands in antiseptic solutions had lowered the resistance of the skin and hastened the development of the carcinoma. F. CAVERS

Trauma and EpitheUoma, H. M. MORAN. M. J. Australia 2: 647-551, 1933. The author reports 6 cases, from the study of which he believes the following conclusions to be justifiable. There seems to be no evidence that an epithelioma can be produced in previously healthy skin by a single trauma, though when applied to a precancerous lesion a single injury may be the determining factor in causing epithelioma, or msy increase the rate of growth and the rapidity of metastasis of an already existing epithelioma. Violence to a skin area in a patient with generdiaed epitheliomatosis may determine local metastasis. Although the factor of coincidence may be important, we are not at present justified in denying the possibility of a causal relationship between trauma and epithelioma, provided that in the circumstantial evidenee put forward certain postulates are satisfied. The latter are, for practical purposes, three in number: (1) the previous integrity of the injflred tissue should be established; (2) the tumor should appear on the exact site of the injury; (3) there should be histologic confirmation of the diagnosis of malignant disesee. Concerning two further criteria which have been put forward, that the trauma should be adequate *’and that there should be continuous bridging ” symptoms, the author remarks that there is much divergence of opinion on the first point, and that little or no value can be placed on the second. He is skeptical about reported cases in which a tumor has been alleged to appear a few months or weeks after an injury. A fairly extensive bibliography is given. F. CAVERS

THE SKIN

147

Squamous-celled Carcinoma Developing in Chronic Ulcer of the Leg, L. LINDON. M. J. Australia 2: 805-806, 1933. A man of sixty-eight had suffered from chronic recurring ulceration of both shins for about thirty-five years. His occupation had for many years included the shoeing of horses, and the frequent knocks he had received had repeatedly opened healing or healed ulcers. An indolent ulcer of the left shin had a thickened nodular margin, biopsy of which showed squamous-cell carcinoma, and the limb was amputated above the knee. Some time later the patient returned to hospital asking for amputation of the right leg, which he had not been able to put to the ground for several years. Biopsy of the edge F. CAVERS of this ulcer also showed squamous-cell cancer. Cure of Squamous-Cell Skin Cancer Developing on Site of Preceding Luetic Eruption and Psoriasis, L. TROSSARELLI. Sopra un caso di epitelioma spinocellulare insorto su sede di precedenti lesioni psoriasiche e luetiche, Osp. maggiore 21: 553-558, 1933. About twenty-four years before attending the author’s clinic, a man of unstated age had contracted syphilis. Soon afterward he had a red rash (“ luetic roseola ”) all over the body, and a little later an ulcer appeared on the site of a patch of long-standing psoriasis on the left upper arm. He had been given repeated antiluetic treatment, and the Wassermann and Kahn reactions were now negative. The ulcer had several times healed, become scabbed, and broken again. Recently it had become larger and deeper, and was now an ugly, infected sore, bleeding readily. Pieces taken from its edge ehowed typical squamous-cell cancer. X-ray treatment was given to the margin and radium to the deeper parts, and a t the time of reporting good healing had occurred; biopsy F. CAVERS showed no remaining carcinomatouB tissue. There are no illustrations. uber einen Fall Squamous-cell Carcinoma Associated with Psoriasis, K. ISHITANI. von Karzinom bei einem Psoriasis vulgaris-kranken, Acts dermat. 22: 59-60, 1933. Brief report of a case of multiple epitheliomas developing in a patch of long-standing psoriasis in an elderly man. There was no evidence of his having been treated by arsenical or other medication, and the skin showed neither dark pigmentation nor keratoses. [A good review of similar oases, with reports of five personally observed, has been given by Wright and Friedman (Arch. Dermat. & Syph. 27: 70, 1933. Abst. in Am. J. Cancer 18:427, 1933).1 Case of Multiple Primary Squamoua-celled Carcinomata of the Skin in a Young Man, with Spontaneous Healing, J. F. SMITH. Brit. J. Dermat. 46:267-272, 1934. A man of twenty-three had seven years previously qoticed spots on his legs and face. They began as reddish maaulea, became papular, enlarged, ulcerated, and finally healed, leaving pitted scam. The individual lesions lasted for several months, but new ones appeared. Biopsy of lesions in various stages of development showed that even the youngest were typical squamous-cell cancers. There was no history or evidence of antecedent ‘(precancerous,’’ atrophic, or other lesions. A large tumor on the leg was not visibly affected by two erythema doses of x-rays at 150 kilovolts, but smaller ones disappeared after radium treatment. Other early papules were excised and have not recurred. There are eight illustrations. F. CAVERS Visceral Metastases in a Case of Skin Carcinoma, M. JTJON.Des m6tastases viscdrales des 6pithdliomes cutan6s mdtatypiques, Acts dermat.-venereol. 14:287-298, 1933. A woman of seventy-five had five years previously noticed a wart on the dorsum of the left hand, which had grown slowly and was now a foul ulcer with raised, thickened edges. It was treated with x-rays and showed considerable regression, but there remained an ulcerating surface that did not heal. Four months later this was treated by curettage, but the ulcerated area continued to spread and a second tumor appeared on the palm of the same hand. Both tumors were of the metatypic or intermediate type (see below). Both tumors were given x-ray treatment, but in less than two months after the appearance of the second tumor the lymph nodes in the left axilla became enlarged

148

ABBTRAUTS

and hard, The patient showed rapidly developing cachexia and died with bronchopneumonia Necropsy revealed metastases in the lungs, liver, kidneys, and small intestine, all agreeing in histologic nature with the skin tumors. From the clear and well illustrated histologio amount given, what Juon terms a metatypic epithelioma is evidently a mixed or transitional cancer showing some of the characters of both squamous-cell and basal-cell tumors. The tumor cells are grouped in compact masses in the stroma, and have a large clear nucleus with reticular chromatin. No horny pearl nests are present, but in places there are dyskeratoses and multinuoleate cells like those seen in Bowen’s carcinoma. Juon considers that the latter is a precancerous condition, though most writers now regard it as definitely m a l i p n t . He says the metatypic form is usually benign, though sometimes, as in the case reported, it may be as malignant as the squamous-cell cancers, He further asserts that pure squamous and basal-cell types are somewhat rare in the skin, and that in almost any skin epithelioma there may be found areas of tissue representing or foreshadowing atypical cell proliferation. It is obvious that the metatypic tumors of Juon approach most closely to the basal-cell type, including Bowen’s cancer, neither of which is as a rule more than locally malignant, though both have been reported as producing distant metastases. There are five illustrations. F. CAVERB Rasal-Cell Epithelioma Developing in an Atheroma of the Scalp, K. STRAUSS.Ent. wicklung eines Basalrellencarcinoms auf dem Boden eines Atheroms der Kopfschwarte, Deutsche Ztschr. f. Chir, 242: 814-816, 1934. A basal-cell epithelioma growing inside an epidermoid cyst of the *calp of a seventyfive-year-old man was discovered on hietologic examination of the specimen. The tumor had been shelled out surgioally and there was no recurrence a t the end of three months. This growth was considered unusual, for the epitheliomas which have been reported in epidermoid cysts have mostly been of the squamous type. The article is without illustratign. BENJAMINR. SHORE Mtrathg Carcinoma of the Scalp, A. M. H, GRAY. Proc, Roy. 800. Med. 27: 1581, 1934.

A woman of fifty-seven had the left breast removed for carcinoma in 1923. Some years later nodules appeared in the operation soar, and in 1932 two courses of x-ray treatment were given. About eight months before the patient was seen she felt burning pain on the top of the head and noticed that the hair was falling. The bald area showed great infiltration and attachment to the bone, and several similar nodules were present in other parts of the scalp, also a mass of hard upper cervical nodes and hard nodules in the breast scar and surrounding skin. At the time of reporting no biopsy had been msde of the scalp nodules; clinically the case was obviously one of recurrence and late distant metastasis. F. CAVERS

So-called Intraepidemal Carcinoma, KENJI KOOA. tfber einen Fall von sag. intraepidermalem Karrinom, Fukuoka-Ikwadaigaku-Zasshi (Fukuoka Acts Med.) 26:

.

1514-1626, 1933.

A case is reported of a woman, sixty-seven, with eruptions on the medial side of the right upper thigh near the labium major, the inter-scapular space, the right side of the neck, and the right hand. These eruptions were partly warty, ecrematous, and uloerous. There were no other somatic symptoms and no enlargement of regional lymph nodes. Histologically the warty growth resembled senile keratosis, the ecrematous part Darier’s epithelioma, and the ulcerated part basal-cell osroinorna. .K.S U ~ I U R A Lpmphocytoma, W. N. GOLDBMITH.Proc. Roy. Soc. Med. 27: 1468,1934. A woman of forty-six had two brownish red tumors of the faoe, clinically resembling sarcoids but found histologioally to consist of immature lymphocytes. The intradermal reaction with old tuberculin was strongly positive, and x-ray showed clear areas in the bones of the foot. The author believes the assooiation of lymphocytoma and tubercultosis was merely coincidental. F. CAVERR

THE EYE AND EAR

149

Subaxillary Lymphangioma Cysticum Congeaitum, K ~ ~ C K E NLymphangioma S. cysticum congenitum subaxillare, Schweiz. med. Wchnschr. 63: 816-817, 1933. Report of a cystic lymphangioma in a newborn child with death from secondary infection. Multiple Haemangiomata Associated with Changes in the Central Nervous System, Case for Diagnosis, J. E. M. WIGLEYAND G. C. PETHER.Proc. Roy. SOC.Med. 27: 1574-1575, 1934. A man of forty had for about fourteen years noticed purplish spots on the skin, which persisted and gradually increased in number. These were found to be hemangiomas, mostly flush with the adjacent healthy skin, though one on the penis was raised; their olinical appearance had suggested purpura. Neurologic examination showed unequal pupils with sluggish light reaction, tremor of hands and tongue, weakness of abdominal reflexes, spasticity of the lower extremities, and bilateral extensor plantar responses. The blood and cerebrospinal fluid showed nothing abnormal. Dr. F. P. Weber, in the discussion of this paper, said that some cases like this had been diagnosed as hemangiomatosis miliaris, but he preferred the term miliary telangiectasia because these minute lesions were not true angiomas. He thought the condition of the nervous system in this F. CAVERS case was independent of the skin condition. Syringocystadenoma, Report of a Case, H. FEITAND E. F. KELLEY. Urol. & Cutan. Rev. 37: 302-304, 1933. The disease now called syringocystadenoma was first termed ‘‘ lymphangioma tuberosum multiplex.” Torok (Monatsh. f. prakt. Dermat. 14:169, 1892), who called it syringocyatadenoma, was the first to note the absence or rare occurrence of sweat glands in the tumors and suggested that they represented a transformation of sweat tubules. A case is reported in which the eruption had been present for two years over the lower half of the torso and the thighs. A lesion was removed for histologic study. The section showed a slight keratosis and relatively little acanthosis. The deep corium was dense with coarse bundles. Situated a t about the junction of the two types of collagen were cysts and masses of epithelial cells. The cysts had low and high cuboids1 epithelial cell linings, some being lined with two layers of cells. Some of the cysts showed epithelial projections. I n some there was a granular eosinophilic content. Therapy is not discussed. W. S. MACCOMB Boeck’s Disease (Sarcoid), R. KLABER. Proc. Roy. SOC.Med. 27: 1576-1577, 1934. A woman of fifty-two had for over twenty years had increasingly severe pain in the left ring finger, with diffuse swelling of the finger. Ten years ago there appeared on the left cheek a small red patch, and several skin nodules were now present in the affected finger and in various other regions. X-ray examination showed several rarefied bone areas in the left digits. There was bilateral enlargement of the cervical, axillary, and inguinal nodes. X-ray plates of the chest showed signs of healed tuberculous foci a t both apices, infiltration and increased opacity a t the left base, and enlargement of the hilar nodes. Biopsy of several nodules showed practically normal epidermis, but in the ctonum there were scattered well defined masses of epithelioid cells, several containing many giant cells indistinguishable from those seen in tuberculoma., In the discussion, Dr. I. Muende, who had examined the sections, agreed that one of the nodules (in the nostril) showed the typical histology of sarcoid, while one from the F. CAVERS arm was lupus vulgaris. T H E EYE AND EAR

Effects of Irradiation of the Eye by Radium, PHILIPPA MARTIN. Tr. Ophth. SOC.United Kingdom 53: 246-270, 1933. This report is based on 34 cases of malignant tumors in the neighborhood of the orbit, treated with interstitial radium. The needles varied in radium element content from 0.6 to 3 mg., and the screen from 0.5 to 0.8 mm. platinum. The needles were

150

ABSTRAUTS

usually kept in position for ten days. The author is concerned chiefly with the injurious effects of radium on the ocular tissues, and her chief findings are as follows. The commonest effect is a conjunctival reaction, which may be followed by scarring. Pain during the initial reaction indicates iritis and points to the probable development of serious ill effects. Cataract may develop as a part of the initial reaction or as a delayed effectduring the seoond or third year. Radium necrosis of the cornea is the most serious side result of radium treatment, its effects ranging from scarring with diminution of vision to complete disintegration of the eye. Repeated small radium doses are more likely to cause necrosis than a single large exposure. With improved technic, these side F. CAVERS effectsare becoming less frequent. There are ten illustrations.

Preliminary Report on Orbital Tumors, G . HARDYAND W. F. HARDY.Am. J. Ophth. 17: 18-21, 1934. After a general survey of orbital tumors, the authors report 7 cases, 5 of which were operated upon. Of these 5, 3 were mixed tumors of the lacrimal gland, one a pseudotumor of the orbit, and one of the optic nerve. The two latter cases, with one of the mixed tumors of the lacrimal gland, are reported in detail. W. S. MACCOMB Diagnosis and Treatment of Orbital Tumors, E. JESSEL.Contribution B. 1’6tude du diagnostic et pronostic des tumeurs intra-orbitaires, Arch. d’opht. 51: 232-238, 1934. This is a French translation of an article appearing in Ztschr. f. Augenh. 82: 31-63, 1933 (Abst. in Am. J. Cancer 22: 160, 1934). Neurinoma of the Orbit, R. RODRIGUEZ VILLEQAS AND C. S. DAMEL. Neurinoma de la &bite, Bol. y trab. Sac. d. cir. d. Buenos Aires 18: 531-540, 1934. A man of thirty-six had been infected with lues fourteen years previously, and soon afterwards had an erysipelatoid eruption on the left cheek extending to the orbit. During the past three years he had noticed increasing exophthalmos of the left eye, but the visual acuity and field were normal. As the Wassermann reaction was strongly positive, energetic treatment was given for three months, but the eye condition showed no change. On deep palpation a tumor was felt in the upper inner angle of the orbit, and this finding was confirmed by radiography, which showed absence of bone erosion. The tumor was encapsulated and was the size of a hen’s egg. It showed the typical structure of peurinoma, containing nests of fatty tissue, considerable hyalinization, and few mitoses. It had apparently arisen from one of the ciliary nerves. The patient recovered well, retaining normal vision of both eyes. The authors urge the advisability of discarding such terms as fibrillar neuroma, neurofibroma, schwannoma, and peripheral glioma, and of adopting for these tumors the term neurinoma suggested by Verocay, because the latter is convenient, noncommittal, and includes tumors derived from F. CAVERS the peripheral nerves and their sheaths. There are eleven illustrations Neuro-epithelioma of the Orbit; a Case Report, J. V. CLOTHIER. Eye, Ear, Nose & Throat Mo. 12: 471473,1933. A girl three years of age had rapidly increasing exophthalmos of the left eye with inflammation, occasional pain, and complete loss of vision; the right eye was normal. The left eye was enucleated, and showed a neuro-epithelioma of the optic nerve. The child died of meningitis complicating mumps. Four illustrations show the gross appearance. Voluminous Orbit-cranial Osteoma; Consecutive Cerebral Abscess of Nasal Origin, J. N. ROY. Brit. J. Ophth. 18: 159-166, 1934, Also in Union m6d. du Canada 63: 141-148, 1934; Canadian M, A. J. 30: 259-262, 1934; Am. J. Ophth. 17: 515-519, 1934. I n 1931 the author reported successful removal in 1925 of a large osteoma of the right orbit in a girl (Abst. in Am. J. Cancer 15: 1710, 1931). The patient, now aged twenty-four, recently returned to the hospital stating that six years after operation she had a sensation of fullness in the orbit and slight ptosis. The orbital roof was painful on

THE EYE AND EAR

151

pressure, and a tumor was felt on displacing the globe downwards. Frontal x-ray plates showed complete orbital opacity, but a lateral picture revealed a bony tumor occupying the back of the orbit and extending into the cranial cavity. After this nodulated osteoma had been removed, about.20 C.C. of pus escaped from the cranial cavity. The patient died twenty-eight hours after operation, and necropsy showed abscess of the frontal lobe, also diffuse leptomeningitis and destruction of the olfactory tract by the osteoma. There are two illustrations. F. CAVERS

Extensive Oculo-palpebral Neoplasm; Excision of the Lids and Enucleation of the Eyeball, Followed by Occlusion of the Orbit, K. PUSCARIU.Brit. J. Ophth. 18: 101-108, 1934. The author reports two cases of malignant bulbar and lid tumors involving the orbit, one a carcinoma, the other not histologically diagnosed. For such tumors, whether originating in the epibulbar or, more frequently, the palpebral region, she does an operation of which the main stages are extirpation of both lids, enucleation of the globe, and occlusion of the orbit by means of two skin flaps. In the reported cases only a few F. CAVERS months had elapsed since operation. There are seven illustrations.

Melonosarcoma of Iris and Ciliary Body, Report of a Case, B. I. BRINDLEY.Wisconsin M. J. 33: 359, 1934. A melanosarcoma of the iris and ciliary body was found in a sixty-six-year-old white woman who had had symptoms of pain and loss of vision for three weeks only. The eye was enucleated and the pigmented tumor was found to be limited to the iris and the ciliary body, not having penetrated the other ocular tissues. It was believed that the tumor had arisen primarily in the iris. The author states that melanoma occurs less W. s. MACCOMB frequently in the iris than in any other part of the uvesl tract. Metastatic Hypernephroma of the Iris, A. C. HUDSON AND W. LISTER. Proc. Roy. SOC. Med. 27: 1613-1615, 1934. A man of fifty-five had had one kidney removed two years previously, containing an encapsulated tumor which had ulcerated into the renal pelvis. No information was available regarding the structure of this renal tumor. A few days before he was seen by the authors, the patient had noticed a yellowish swelling on the right iris. This consisted of three small nodules in the substance of the iris and the free border, encroaching slightly on the pupillary area. Enucleation was done, and the tumor was found to have the structure of a cortical hypernephroma. Two years afterwards the patient died with a cerebral tumor. There are three illustrations. F. CAVERB Epithelial Cyst in the Posterior Chamber, C. W. TOOKER.Am. J. Ophth. 17: 41-17, 1934. A boy at the age of seven years suffered a laceration of the right lower eyelid which involved the ciliary body and the choroid. Two months after the injury, vision of the eye equalled 20/80. Fifteen months later on examination there was seen a small dark @potjust internal to the healed wound at the iris root. It resembled an iridodialysis, but the fundua oould not be seen through it, Vision still equalled 20/80. One month later the dark spot had become slightly larger and the overlying iris was grayish. In another two months there had been some lacrimation and vision had failed. The tumor seemed to involve the lower thiid of the iris. The eye was removed arid there was found an epithelial cyst of the posterior chamber. It is supposed that at,the time of the injury epithelial cells were implanted at the’root of the iris or in the ciliary body and that they proliferated, forming a cyst which extended into the posterior chamber. W. S. MACCOMB

152

ABSTRAOTS

Congenital Cymt of the Eyebrow, Diagnosed by Contrast Radiography, F. DI BELLA. Studio radiologico di una ciste dells coda del sopracciglio, Riforma med. 49:801-802, 1933. In a girl of fifteen years the parents had noticed slight ptosis of the right eye for some time. There was also internal squint, and a small swelling had recently appeared in the tail of the eyebrow. X-ray after lipiodol injection through a small aperture in this swelling showed considerable invasion of the orbit, with erosion of the bony wall. The author removed part of the cyst, leaving a fistula which discharged for a few weeks and then healed. He could not determine whether the cyst was a dermoid, or had arisen in the second branchial arch; he gives no histologic description. There are four good F. CAVERS x-ray pictures. Traumatic Origin of Cholesteatomas, GEORGE KELEMEN. Traumatische cholesteatomgenese, Acta oto-laryng. 20: 211-230, 1934. Traumatic hemorrhage into the tympanum is believed to be a predisposing cause for the subsequent development of cholesteatomas. Serial sections of the tympanum of persons dying after fractures of the base of the skull have demonstrated slit, epitheliallined, almost cystic areas which could easily be considered as forerunners of oholesteatomas. Injury followed by secondary infection is believed to be at least one etiologic factor in the development of these lesions. The article is well illustrated by several photomicrographs. BENJAMINR. SHORE THE BREAST Carcinoma of the Breast, Study in Etiology and Prognosis, H. H. TROUT.Am. J. Surg. 24:268-279, 1934. The histories of 412 patients with carcinoma of the breast admitted to the Jefferson Hospital in Roanoke, Virginia, during the past twenty-four years were studied in order to discover possible etiological factors. It is striking that none of these cases reveals any definite association between chronic cystic .mastitis and carcinoma. I n no patient did carcinoma develop after removal of a wide section of breast tissue histologicallf proved to be the seat of chronic cystic mastitis. Of 300 owes available for study, 264 or 88 per cent gave a history of some dysfunction of the affected breast; in 123 or 48 per cent the normal breast function had never been established; in 111 or 38 per cent there were distinct irregularities of lactation; in 30 or 10 per cent there were histories of abscesses, definite trauma and infected nipples; in 36 or 12 per cent nothing abnormal could be found in the histories. While the histologic grading of tumors is of value, it is not nearly as important and accurate as a well considered clinical index. For several years Trout has been observing the difference as regards the prolongation of life in those cases having one large, single, involved lymph node in the axilla and those cases showing numerous small nodes. The outlook for those owes having one large node is very much the better. In no case in which an involved lymph node was found under the falciform fascia of the pectoralis minor muscle has the patient lived as long as one year. In the entire series there have R. SHORE been seven such cases. BB~NJAMIN Modern Diagnosis of Carcinoma of the Breast, D. C. L. FITZWILLIAMS. Practitioner 131: 676-684, 1933. The author emphasises that the signs relied upon for the diagnosis of the moderately early palpable carcinoma of the breast-attachment to skin, retraction of nipple, axillsry sdenopathy, nipple discharge-are not found in the really early cases. Roughly speaking, for each of these signs that is found, the chance of permanent cure is diminished by about 26 per cent. In the really early case, transillumination of the breast is important. The author once examined a woman who said she could feel a small knot in the breast. He could not honestly say there was anything to justify operation, but six months later the patient returned with a well established carcinoma attached to the skin; radical operation was done, but death occurred from metastases two years later. The

THH BREAST

153

author believes that a patient may a t times be conscious of a mass which is not easily felt by her doctor, and he pays much attention to what a woman says she can feel in her own breast, believing she is sometimes better able to notice slight changes than a stranger, however skilful. F. CAVERS Modern Treatment of Carcinoma of the Breast, D. C. L. FITZWILLIAMS. Practitioner 132: 596-607, 1934.

Following up his discussion of this subject of a year ago (see Abst. in Am. J. Cancer 19: 159, 1933), the author embodies in this paper the results of his further experience in the treatment of breast cancer. He emphasiaes that cases in which the carcinoma has become intrathoracic are hopeless from the first, since at present the deep-lying malignant tissue can only be influenced, and but feebly, by x-rays. Local recurrences and metastases in the superficial lymph nodes can be treated by radium and the patient kept alive for several years. The author cites cases to illustrate the beneficial action of radium in inoperable cases, as well as in those which are advanced but still operable. For cases falling into the moderately early class, the treatment of choice has not yet been definitely agreed upon, though probably it will be a combination of surgery and radium. In early cases the author has obtained good results with partial operation followed by radium. F. CAVERS

A Technical Point in the Radical Operationfor Breast Cancer, P. DUVAL AND H. REDON. Un point de technique dans l’amputation du sein cancbreux, J. de chir. 42: 497-500, 1933.

The authors urge that in the radical procedure for mammary cancer the subclavicular muscle be resected in order to permit complete extirpation of the subclavicular lymph nodes and of the lymph vessels which sometimes proceed directly from the breast to the supraclavicular nodes. There are three illustrations. F. CAVERS Radium Treatment of Primary Carcinoma of the Breast, G. KEYNES. Canadian M. A.

J. 30: 24-30,

1934.

Until about ten years ago it was generally conaidered unjustifiable to treat with radium any case of breast cancer which was amenable-to surgery, and a start was made with obviously inoperable cases. The author has used radium needles in preference to radon tubes and seeds, The lymphatic areas require a practically constant amount of radium in all cases, whereas the amount required for the breast tumor is very variable. For instance, two or three times as much radium may be needed for a large breast in a stout patient as for a small, contracted growth in the breast of a thin patient. The only rough guide is the empiric observation that the best results seem to be obtained by using needles of 3 mg. in an active length of 4.8 cm., with filter of 0.6 to 0.8 mm. platinum, placed about 1.5 cm. apart. During the follow-up of several hundred cases treated by surgery or radium in the past eleven years, the author has never seen an intercostal recurrence traceable to invasion of one of the internal mammary lymph nodes. The end-results of radium treatment approximate to those for surgery, and it has been clearly established that when circumstances allow there is a very definite place for radium, either alone or combined with conservative operation. [For a full abstract of Keynes’ method, see Am. J. Cancer 16: Abst. p. 1102, 1932.1 F. CAVERS

New Method for the Treatment of 6‘ Bleeding Nipple ” by Radium Implantation, M. CUTLER. Am. J. Roentgenol. 31: 819-822, 1934. The clinical problem of bleeding nipple may be divided into two categories as follows: (1) the treatment of breasts exhibiting a serous or a serosanguineous discharge from the nipple, in which there is no palpable tumor; (2) the treatment of breasts in whlch a serous or serohemorrhagic discharge from the nipple is accompanied by a palpable tumor. The lesion underlying the syndrome of bleeding nipple is either a duct papilloma or a duct carcinoma. I n the presence of a palpable tumor the diagnosis of carcinoma is justified unless the tumor is an’ unrelated lesion such as a fibro-adenoma. I n the absence of

154

ABSTRAUTS

carcinoma interstitial irradiation in cases of bleeding nipple seems to offer an intermediate method between two extremes; the one, over-conservatism, consisting in no treatment, which is dangerous, and the other, complete removal of the breast, which although safe may be considered radical for small benign lesions. The use of platinum radium needles inserted into the tissue around the nipple and left so 88 to give 1600 milligram hours of irradiation is suggested for these cases. Abetracted histories of two illustrative BENJAMINR. SHORE cases are included.

Some Clinical, Pathological and Therapeutic Aspects of Cancer of the Breast, M. CUTLER. Wisconsin M. J. 33: 406-411, 1934. This is a general article concerning the clinical, pathological, and therapeutic wpects BENJAMINR. SHORE of cancer of the breast. No new material is added.

Spheroidabcell Carcinoma of Breast; Extension of Growth Within the Peifmpium, R. J. V. PULVERTABT. Brit. J. Burg. 21: 701-703, 1934. A woman of fifty-four had had a radical right breast operation for carcinoma in 1929. Nearly four years later two metaetases in the scalp were removed. When the patient was seen by the author, there were two small lumps on the chest, one over the sternum near the apparently healthy left breast, the other at the level of the ninth left rib in the midaxillary line. These were removed and found to be deposits of carcinoma, of the same spheroidal-cell type ae the growths removed previously from the right breast and the scalp. In places the carcinomatous cells lay in the center of the muscle fiber, with lateral extension leading to columns of growth in cylinders composed of perimysium. Since there was nothing to suggest that the lymphatics of muscle travel ineide the perimysium, it is concluded that in this case surviving cancer cells had invaded the musculature by direct permeation within the perimysium. After operation radium was applied to the front and back of the left hemithorax from the supreclavicular region to the spine, the total dosage being over 20,000 mg. hours. There are two illustrations. F. CAVERS

Two Cases of Intracanalicular Carcinoma of the Breait Associated with Nipple Bleeding,

T. GRECO. Contributo all0 studio dells cosidetta ‘‘ mammella sanguinante,” Osp. maggiore 21: 426-429, 1933. (1) A woman of thirty-five stated that her infant son struck his head against her right breast, causing pain and shortly afterwards oozing of blood from the nipple. Latterly this bleeding had corresponded with the menses. No tumor could be felt in the breast, but bleeding was elicited by compressing the base of the nipple. A vertical incision from the nipple downwards revealed a thick cord of dilated milk ducts, containing brown fluid in which fat cells and erythrocytes were detected. This strand was resected, and the cystic dilatations were found to be lined by cubical epithelium which also covered papillomatous projections into the cyst cavity. In places abnormal epithelial proliferations and numerous atypic mitoses were found. (2) A woman of fifty-two had at the age of eighteen been operated upon for a tumor of the right breast, diagnosed as Abro-adenoma. Four years before consulting the author she had bleeding from the left nipple, and noticed a tumor in the superficial portion of the breast itself. This was promptly treated by local excision of tumor and nipple. There was now a large, irregular tumor under the operative scar, and numerous large hard axillary nodes were palpalable. Radical operation was done. The tumor showed the same histologic features as in the first case. The author regards intracanalicular epithelial proliferation as a form of carcinoma, not merely a precancerous state. In every case of bleeding nipple exploratory incision should be made, and if a tumor is found radical operation should be done, irrespective of the apparent siee and extent of the tumor. There are four illustrations, F. CAVERS

Bowen’s Disease, G. BAMBER. Proc. Roy. Boo. Med. 27: 1468-1469, 1934. A woman of thirty-one, with psoriasis since childhood, had ten years previously noticed a pimple below the left breast, which spread and became scabbed over. On the

THE BREABT

155

left of the epigastrium there was a scaly area containing papules, some of them crusted. Biopsy showed thickening of the horny layer and proliferation and down growth of the epidermis. Some of the cells had vacuolated cytoplasm and clumped nuclei. Other featusas characteristic of Bowen’s disease were edema of the epidermis and corium and lymphocytic infiltration of the derma. F. CAVERS Carcinoma in Aberrant Breast Lobes; Three Cases, MASSABUAU, A. GUIBALAND H. GUIBERT. Cancers aberrants du sein, Bull. SOC.d’obst. et de gyn6c. 22: 765-769, 1933. The authors report three cases, in which the tumors were respectivkly axillary, subclavicular, and juxtasternal in site. In each case the left side was affected. In two cases the tumor measured about 1.5 cm. in diameter; in the third about 6.0 cm. All showed axillary adenopathy, but the nodes contained no cancer tissue. The authors suggest that these paramammary tumors are fairly frequent, but are not often seen by the aurgeon, because by the time a breast cancer patient reaches him the tumor that had arisen in an aberrant lobe has become incorporated with the normal breast tissue. From the available literature it would seem that cancers are more frequent than benign tumors in these aberrant breast lobes. F. CAVERS

i

nous from Peritoneal Metastases Twenty-Three Years After a Radical Breast Operation for Carcinoma, s. HINDBE-NIELSEN.Brustkrebsmetastasen im PeritoneumIleus-23 Jahre nsch Radikaloperation, Zentralbl. f. Chir. 61 : 1646-1648, 1934. The author reports the case of a sixty-five-year-old woman in whom acute intestinal obstruction occurred from metastatic peritoneal carcinoma twenty-three years after radical amputation of the right breast for cancer. Besides the abdominal tumor there were metastases in the chest and a local recurrence a t the site of the mastectomy. BENJAMINR. SHORE There are no illustrations. Sarcoma of the Breast; Two Cases, HAMANT AND CHALNOT.Sarcome du sein, Bull. SOC. d’obst. et de gyn6c. 22: 800-801, 1933. In both the cases reported here the diagnosis of sa.rcoma was made histologically after removal of the breast. (1) A woman of forty had about a year previously noticed a swelling of the right breast, which during the fortnight before hospital admission had grown very rapidly, undergone ulceration, and bled freely. The breast was amputated; the patient died a t home six months later. The histologio diagnosis was polymorphic sarcoma, with numerous atypic mitoses and a highly vascular stroma. (2) A few months before attending hospital a woman of twenty-eight first noticed a swelling of the left breast, on which a small ulcer later appeared. There was a large mass in the axilla, which was removed when the breast was amputated. As in the first case, the tumor was diagnosed as polymorphic sarcoma; the axillary nodes showed inflammatory but no sarcomatous tissue. The authors state that the tumors in these cases may have been anaplastic carcinomaa, and point out that many tumors of similar histologio appearance have been reported a8 occurring in the breast. This type of tumor may attain large proportions and show histologic signs of high malignancy, despite the localized growth and absence of lymph node invasion. F. CAVERB

Influence of Pregnancy on Benign Breast Tumors, J. J. Vos. Invloed der graviditeit op benigne mammatumoren, Geneesk. Tijdschr. v. NederLIndig *73: 1497-1520, 1933. This is a study of 216 breast tumors seen in the Nederlandsch Indisch Kanker Instituut from 1927 to 1933, including 139 cases of cancer. Malignant breast tumors in native women were observed 2.2 times as frequently as benign tumors, whereas for Europeans the ratio is 1 : 1. These findings are in agreement with previous ones by Franssen (Geneesh. Tijdschr. v. NederLIndiii 70: 1077, 1930), who in Soerabaja found that in native women malignant breast tumors were about 2.8 times more frequent than

186

ABSTRAUTS

benign tumors, but that the two were of equal frequency in Europeans. The material of the Institute shows, however, that among European women adenofibroma and chronic cystic mastitis occur about equally often, whereas in the natives benign tumors are practically all adenofibromas. The rarity of chronic cystic mastitis among native women may be explained by a difference in the manner of living and possible constitutional differences between the two groups. The influence of pregnancy, lactation, and menstruation on adenofibromas is much more important in native women than in Europeans. This must be ascribed to the fact that the natives are slow to seek medical advice and the tumors may be enormous in size when thky are first seen, weighing 8 or 9 kilograms and even more. The clinical observations confirm the opinion that the enormous intracanalicular cystadenofibromyxomas develop from small adenofibromas. The writer believes that, although it is arbitrary to call only those tumors which have ulcerated, sarcoma phyllodes, it is useful to continue using this name for malignantappearing, ulcerating new growths. It seems probable that sarcoma phyllodes is much more frequent in the Dutch Indies than in Europe or America, since in six years the Institute received 16 cases, while Lee and Pack (Am. J. Cancer 15: 2583, 1931) for the period 1827-1931 could gather only 111 from the world literature. Sarcoma phyllodes may develop into a real oarcinoma or sarcoma or both. Three cases of sarcoma mammae seen in the Institute appeared to have developed from an intracanalicular cystadenofibroma. In an extensive table a short record is given of 60 cases of adenofibroma, both intra- . csnalicular and pericanalicular, cystadenofibromyxoma, sarcoma phyllodes, and sarcoma. Nine pictures accompany the text. JOHANNFIS P. M. VOQFILAAR THE THYROID GLAND

Question of Struma maligna, H. W. WULFINQ. Beitrag zur Frage der Struma msligna, Ztschr. f. Krebsforsch. 41:74-86, 1934. Experience has proved that struma maligns, used here to include all malignant growths of the thyroid, is closely connected with the problem of goiter. Renewed interest in this relationship led the author to review the autopsy records of the past fifteen years at the Pathological Institute of the University of Freiburg i. Br., which lies in a pronouncedly goitrous district. Among 1801 strumas encountered in 7196 autopsies, 38 were found to be malignant; 25 of these were of epithelial and 13 of connective-tissue.origin. Malignant tumors of the thyroid are notoriously prone to metastasize, and among these 38 patients only 5 had been spared. Lymph nodes, lungs, and bones were the organs most often aompromised. Adenomatous nodules in a goitrous thyroid are particularly predisposed to malignant change; according to Kocber, 8.8 per cent of malignant neoplasms arise in such lesions, as compared 'with the 1.2 per cent developing in diffuse strumas, and 0.6 per cent from the normal gland. These observations emphasize the importance of bearing always in mind the possibility that a struma may be malignant, and of examining all goiters removed by operation for early malignant changes. WM. H. WOGLOM Extensive Resection of the Great Neck Vessels, and Vagus and Sympathetic Nerves for Malignant b o r e of the Thyroid Gland, EMILJUST. Uber ausgedehnte Resektionen der grossen NalsegefLsse, des Nervus vague und sympathicus bei basartigen Geschwtilaten der SohilddrlZse, Zentralbl. f. Chir. 61: 1044-1047, 1934. The author reports two cases, one a spindle-cell sarcoma and the other an adenocarcinoma of the thyroid gland, in which the common carotid artery, internal jugular vein, and vagus and sympathetic nerves on one side of the neck were resected with the ' tumor. Both of these patients showed the clinical signs associated with division of the vagus and sympathetic nerves but neither showed any symptoms relative to vascular

BUCCAL CAVITY, PAROTID ULAND, UPPER RESPIRATORY TRACT

157

disturbances in the brain. In spite of this radical type of operation and postoperative radiation, there was a local recurrence in the wound of the patient with the sarcoma and he died of pneumonia eighteen months after his original operation. The patient with the carcinoma is now well two months after operation. There are no illustrations. BENJAMINR. SHORE THE BUCCAL CAVITY, PAROTID GLAND, AND UPPER RESPIRATORY TRACT R6le of Surgery in Carcinoma of the Buccal Cavity, H. 5. STACY. M. J. Australia 1: 712-717, 1934. The author discusses the theory of lymph stasis as applied to buccal cancer and describes the lymph drainage of the tongue and the buccal cavity generally from the lip to the tonsil. For buccal cancer he has used surgery alone or combined with radium and electrocoagulation, preferring surgery for invaded lymph nodes. He illustrates his points by references to cases of carcinoma in different oral regions, but no statistics of treated cases are given. F. CAVERS Epithelioma of the Lip; Analysis of Cases, E. M. FISHER.M. J. Australia 1 : 720-721 , 1934. The author reports a series of 358 cases, of which 25 were in women. Twenty-six of the patients were less than thirty years old, the youngest male seventeen and the youngest female twenty-five. The upper lip was the site in 3 cases. The author does not think that histologic grading is of much help in prognosis, since one type seems as likely as another to recur, invade the nodes, or prove radioresistant. Most lip cancers, however, are radiosensitive. Buried radium needling was used in 219 of the cases reported; surgical excision was done in 56 cases, in many of which the lesion was early and small and was excised completely for biopsy; 24 were treated by x-rays, and 2 by diathermy; 30 were considered hopeless and given no treatment, and 27 patients failed to return for treatment after the condition was diagnosed. In discussing the question of lymph node excision, the author, though hesitating to advise excision in all cases as a routine measure, states that the difficulty is to decide when not to excise, rather than when to do so. Excision should be done in all cases with a long history, especially when there has been previous treatment; in all large cancers; when any lymph nodes are palpable, even when soft; in young patients; when the growth has invaded the buccal mucosa; when the tumor occurs at the corners of the mouth, and when the lip is deeply infiltrated. If excision is decided on, the nodes of the submental group and both submandibular triangles should be removed; it is not sufficient to operate on one side only. The carotid pocket below the digastric muscle should be F. CAVERS palpated and any enlarged nodes removed. Epithelioma of the Lip and Associated Glands, I. B. JOSEAND H. A. McCoy. M. J. Australia 1 : 721-723, 1934. During the past four years an attempt has been made at the Adelaide Hospital to standardi~ethe treatment of epithelioma of the lip. After preliminary examination, including a Wassermann test, treatment or extraction of septic teeth, and biopsy, the routine has been to bury radium needles in the substance of the lip and chin. The dosage has been 1.5 millicuries destroyed per C.C. of tissue treated. For lesions not larger than a om. in diameter, two 2-mg. needles are embedded parallel in the lip, a t a distance of 1 cm., one in the mucous aspect and the other below the mucocutaneous margin, and two 1-mg. needles in the chin tissue. When the lesion is larger, the block of tissue treated is extended and longer needles are inserted. In cases of recurrence after previous treatment, whether by surgery or radium, combined surgery and surface radium is given. In nearly all cases the submandibular nodes are excised three to six weeks after radium treatment of the primary lesion; if not removed, the node areas are treated with a surface radium mold, the latter being also used as a supplement to excision when biopsy of the

158

ABSTRAOTS

nodes reveals metastasis. Of 141 cases, 120 are classed as operable and borderline, 21 as inoperable and very advanced. Of the former number, 85 (71 per cent) were alive and F. CAVERS well at the time of reporting, and of the latter 4 (19 per cent).

Treatment of Cancer of the Lip by X-Rays, E. H. MOLBSWORTH.M. J. Australia 1: 752-753, 1934.

The author briefly describes a method by which he has treated 50 cases of lip cancer during the past five years. The method is applicable only when not more than half the depth of the lip from the edge to the mucosal reflection to the alveolus is involved. The lip is everted and fixed with strapping. A dose of 700 r (120 kv.; 1 mm. aluminium filter) is delivered to the inner surface of the lip over a semicircle, 1 om. of apparently healthy mucosa being allowed to come into the beam, The lip is then unstrapped and a similar dose delivered to the skin surface, bringing the total at each surface to 1200 r , with approximately equal distribution throughout the lip. In every case the tumor disappeared, but in two cases there was recurrence, attributed to failure to irradiate a wide F. CAVERS enough margin of apparently normal tissue.

Cancer of the Lip, L. M. MCKILLOP. M. J. Australia 1: 717-720, 1934. In twenty centers which furnished statistics to the Australian Health Department for the five-year period 1928-1933 there were 1400 cases of lip cancer (not inoluding patients receiving private or ordinary public hospital treatment). In the mortality statistics for all of Australia during this period there were 381 deaths (20 in women) attributed to cancer of the lip. Just how many deaths registered as due to cancer of the glands of the neck should be added to this figure is difficult to estimate, as canoer of the lip is perhaps the commonest cause of seoondary malignancy in the cervical nodes. In the Brisbane cancer center 52 patients were treated between 1929 and 1933,22 by surgery alone. The latter, with which the author is mainly concerned, included 13 cases with palpable lymph nodes. The youngest patient was a boy of fifteen years, with extensive node involvement. F. CAVERS Epithelioma of the Lip, R. G . BROWN. M. J. Australia 1: 34, 1934. This is a brief report of 162 cases treated at the Brisbane Cancer Clinic up to the middle of 1932. Of the 162 patients, 125 were alive and well at the time of reporting, after periods varying from eighteen. months to four and a half years; 14 could not be traoed; 9 died from intercurrent disease and 9 from recurrence and metastasis; 8 were alive with recurrence. On the whole, the data point to better results from radium implantation than from surface radium application or surgery. The author’s experience leads him to conclude that nearly every early case (grade I of Broders) can be cured by any reasonable line of treatment, and that in such cases there is no need to interfere with the lymphatic area. No localized growth need be excised except for histologic examination at the time of radium implantation. F. CAVERS Hemangio-endothelioma of the Tongue, Probably of Thyroid Origin, V. MESOLELLA. Emoangiomesotelioma tubulare saroomatoso della base della lingua di probabile origine tiroidea, Arch. ital. di otol. 44: 477-488, 1933. A girl of eighteen years had for about seven months suffered increasing difficulty in swallowing. In the region of the foramen caecum was a firm, elastic, yellowish-red tumor, the size of a haselnut, covered by small, tortuous blood vessels and bleeding slightly on being handled. It was removed with the galvanic loop and its base electroooagulated. One part of the tumor showed colloid-containing tubules resembling those of the thyroid gland, while in other places the appearances suggested a diagnosis of hemangioma and endothelioma. The author uses the term “ mesothelioma ” as a synonym for endothelioma, and discusses the somewhat confusing olassification, mainly of Italian origin, of tumors supposed to be derived from various tissues in the walls of blood vessels. Apparently the tumor here described waa a lingual goiter, the connective-tissue stroma of which had

BUCCAL CAVITY, PAROTID GLAND, UPPER RESPIRATORY TRACT

159

undergone proliferation of its fibers, while the vessels and some portion of their walls proliferated so as to present the features of angioma and endothelioma. The eight illustrations include six fairly good photomicrographs. F. CAVERS

Ewing’s Tumor (Endothelid Myeloma) of the Mandible; or DSuse Myelosarcoma, G. T. HANKEY.Proc. Roy. SOC.Med. 27: 100P1610, 1934. A girl of seventeen visited a dentist after four days of pain in the lower right molars, with swelling of the gum. The crown of the decayed first molar had previously been filled, and extraction of this tooth was followed by considerable bleeding. The dentist found no sign of suppuration or inflammation. Three weeks later the patient consulted the author because of a granular mass which was creeping forward along the buccal gum margin. Biopsy elicited a histologic report of chronic inflammation of the gum. X-ray examination showed rarefaction of the alveolar border and around the socket of the extracted tooth. The patient was now operated upon for appendicitis, and on examination in the hospital ward, fourteen days after the first oral examination, it was found that the tumor had extended onto the opposite side of the mouth and was adherent to the cheek; in addition, firm swellings had appeared in the submental and submaxillary regions. Biopsy now elicited the diagnosis medullary carcinoma of the jaw. The tumor had at this time been present for four months. Radium needles were inserted in the mass, which rapidly subsided. Six weeks later the patient was readmitted with a hard, tender swelling in the middle of the left tibia. She said that about three weeks before noticing the mouth symptoms she had sustained a severe blow from a hockey stick on the left shin, but though the area remained tender she had not drawn attention to it. This swelling was diagnosed . clinically as chronic osteomyelitis, but one radiologist suggested periostitis and another detected changeg in the subcortical portion of the bone with rarefaction. The swelling was incised and a considerable amount of granular tissue removed and diagnosed histologically as Ewing’s tumor. The slides of the jaw tumor were again examined and showed the same structure. Deep x-ray therapy was given, but the patient rapidly lost weight and became feverish and anemic; the jaw tumor extended to the cheek, parotid, and buccal floor, and a tumor appeared in the head of the left fibula. Death occurred less than eleven months from the appearance of the first symptoms. The author considers that the trauma to the left tibia was the cause of the neoplasm, the tibia1 tumor being primary and that of the mandible metastatic. There are four illustrations . F. CAVERS Dentigerous Cyst of the Lower Jaw, J. A. CAEIRO AND J. M. FIORINI.Quiste dentffero del maxilar inferior, Bol. y trab. Soc. cir. de Buenos Aires 18: 815-822, 1934. A woman of twenty-one had a large, hard, painless swelling of the angle and ascending ramus of the left mandible, diagnosed on radiography as a cyst, in which the crown of the third molar tooth was embedded. The tumor had eroded this region of the mandible, reducing the bone to a thin shell, which showed spontaneous fracture. The cyst was widely exposed, its purulent contents were removed, and the cavity was packed and drained. The wall consisted of squamous epithelium. The operation was followed by F. CAVERS rapid bone regeneration. Three x-ray illustrations are given. Artiflcid Replacement of the Lower Jaw Following Resection for Adamantinoma, A. E. VAN HUTTEN. Prothetische vervanging der wegens adamantinoom gereseceerde onderkaak, Geneesk. Tijdschr. v. Nederl. Indie 73: 1545-1548, 1933. The author reports from Dutch East India two cases of adamantinoma in native women of fifteen and thirty-eight years. The treatment in each case consisted of an extensive resection of the lower jaw,which was replaced with a prosthesis. v. Hutten prefers this procedure to an autoplastic operation, since a dental prosthesis is required in any event, for restoration of deglutition, and its fixation is difficult in implanted bone tissue which has no alveolar process. The results of these operations were very satisfactory. Eleven pictures show the patients before and after operation and the macroJOHANNES P. M. VOQELAAR scopic aspects of the tumors.

160

ABSTRILOTS

Parabuccal Mixed Tumors, Especially Cyllndromas of the Maxillary Antnun, H. H. N O O ~ T AND E ~ NJ. J. TH.Vos. Over parabuccale menggezwellen, in het bijronder over cylindromen der bovenkaaksholte, Cieneesk. Tijdschr. v. NederLIndilj 73: 1453-1476, 1933.

.

Among the so-called mixed tumors of the salivary glands and the parabuccal mixed tumors, the cylindromas occupy a special position. They are generally of a benign character, but clinically are frequently diagnosed as malignant. Mixed tumors are of common occurrence in Dutch India. The Cancer Institute has about 50 cases on record, of which 16 are parabuccal. The writers discuss in detail 4 cases of cylindroma of the antrum of Highmore. The clinical diagnoses in these cases had been carcinoma, sarcoma, sarcoma, and malignant tumor or chronic inflammation. The cylindromas should not be grouped with the malignant tumors of the upper jaw. They resemble exactly some of the mixed tumors which occur in the salivary glands and in the hard and soft palate. The confusion existing in the literature is shown by a list of 19 different names which have been given to these tumors by various authors. Opinions as to their genesis also vary. A discussion of 11 cases of parabuccal mixed tumors gives the writers the opportunity to mention the varied localizations in the region of head and neck. Two schematic drawings give possible sites. From this it is evident that it can no longer be assumed that all parabuccal mixed tumors arise from displaced salivary gland tissue. The writers assume that they may arise from any of the groups of mucous glands, lacrimal glands, and salivary glands occurring in the head and neck. The 11 patients cited were adult natives from twenty-eight to fifty years of age. The clinical diagnosis was incorrect in every case. The operative treatment of a cylindroma of the antrum of Highmore should be more conservative than for a carcinoma. Probably electrocoagulation ie the treatment of choice, in combination with the surgical knife. This article is followed by a list of 29 references which are not mentioned in LangJs extensive bibliography on this subject in the textbook of Henke-Lubarsch (Volume V, Part 2). Twelve of the nineteen pictures added to the text show the microscopic aspect of the tumors and their common resemblance. JOHANNB0 P. M. VOQBLAAR

Treatment of Parotid Tumors with Roentgen Rays and Radium, B. P. WIDMANN. J. M. SOC.New Jersey 31: 95-98, 1934. The prognosis in rapidly growing parotid tumors of short duration, where surgical means are employed, is poor, for these tumors are apt to recur in a short time and metastasire early. They tend to be highly cellular and sometimes are radiosensitive. Surgery *combinedwith irradiation offers the best results, The author has reported a series of 54 parotid tumors, of which 35 were malignant. Of these 35 patients, 31 died, 3 could not be traced, and one was living after three years. In each instance death resulted from extension of the tumor. Twenty-seven were treated by intensive irradiation. W. S. MACCOMB Malignant Tumors of the Larynx and Pharynx, R.STI~IWART HALRRIOON.Uber maligne Erkrankungen des Kehlkopfes und des Rachens, Strahlentherapie SO: 91-126, 1934. During the three-year period from 1929 to 1931inclusive, 144 patients with malignant tumors of the larynx and pharynx were treated in the Roentgen Institute of the University of Ziirich. Because of certain contraindicstions to further treatment, a complete series of x-ray therapy was possible in only 116 or 80 per cent of this group. Such contraindications depended upon the general condition of the patient and not upon the local extent of the tumor or upon the presence of metastases. Of the 144 patients, 10 now have no local signs of tumor but show evidence of distant metastases, 13 have recurrences locally or in the regional lymph nodes, 14 have died of intercurrent diseases without evidences of recurrent tumor, and 40 have remained well for from nine months to three and a half years after radiation therapy. Comprising the entire group were 4 tumors of the epipharynx, 55 of the mesopharynx, 70 of the hypopharynx, and 15 of the larynx.

BUCCAL CAVITY, PAROTID GLAND, UPPER RESPIRATORY TRACT

161

The author concludes that protracted fractional roentgen radiation is the preferred method of treatment for malignant tumors of the epipharynx, mesopharynx, and hypopharynx. For tumors of the larynx the choice between surgery and radiation must depend upon the experience and skill of the physician. The article is illustrated with several photomicrographs. BENJAMINR. SHORE Radiosensitivity in Cancer of the Pharynx, G. HALLORAN.M. J. Australia 1: 280-281, 1934. The author briefly reports 30 cases of pharyngeal cancer, recently treated with radium. The majority of these tumors were radiosensitive, though varying in degree rather widely. The most undifferentiated types of tumor are apt to occur a t the base and, to some extent, at the sides of the tongue in its posterior third, and such tumors are often radiosensitive. The gauging of sensitivity depends so greatly on the histology of the tumor that biopsy is essential. A radio-epithelitis appears on the twelfth to fourteenth day after radium application, and is sometimes still present six to eight weeks later. F. CAVERS Carcinomas of the Rhinopharynx in Young Patients, C. BRUZZONE.Carcinomi del rinofaringe nell’eth infantile e giovanile, Cancro 4: 198-202, 1933. The author reports two cases of carcinoma of the nasopharynx. (1) A boy of five had suffered from difficult nasal breathing for three months and had a palpable node in the neck. A mass was found in the right nostril occupying the entire choanal region and extending to the lateral and posterior walls of the nasopharynx. Biopsy showed squamous-cell carcinoma with metastasis to the cervical nodes. There was a rapid recurrence following x-ray treatment. (2) A boy of eighteen had difficulty in nasal breathing and in hearing; both sides of the neck were swollen. Examination revealed a large choanal mass infiltrating the nasopharyngeal mucosa, and adherent cervical masses. Biopsy showed carcinoma heavily infiltrated with lymphocytes and eosinophils. Both of these cases showed many mitoses. The author believes that such examples of carcinoma in youth are probably due to embryonal rests. He stresses the diagnostic MUNRO difficulty and the necessity for biopsy in these exceptional cases. JEANNETTE AND D. BRACHETTO-BRIAN. RabdomiRetropharyngeal Rhabdomyoma, J. M. JORQE oma retrofaringeo, Bol. y trab. SOC.d. cir. d. Buenos Aires 18: 522-530, 1934. A man of thirty-seven had for several years had some difficulty in swallowing and breathing. The dyspnea was intensified during an attack of influenla, ending in asphyxia, demanding tracheotomy. At the time of hospital admission, a year later, the tracheotomy tube was still in place, and its withdrawal was followed by immediate asphyxia1 symptoms. Externally there was a firm elastic swelling, the size of a mandarin, in the right upper cervical region; endoscopiqally this appeared as a rounded tumor projecting from the posterior wall of the pharynx just above the epiglottis. Lateral radiography during ingestion of barium demonstrated the retropharyngeal position of the tumor, which extended downwards nearly to the site of the low tracheotomy. At operation it was found to be deeply bilobed and to be in contact with the right thyroid lobe and the esophagus, but not densely adherent to these or to the neighboring structures. It was well encapsulated and enucleable. It consisted of fibrous tissue and of striated muscle of adult type, and had probably arisen from the pharyngeal constrictors. Taking as a starting point the review of rhabdomyomas by Montpellier (Bull. ASSOC. franp. p. 1’6tude du cancer 18: 538, 1929), the authors cite most of the few recent reports of such tumors in the upper air and food passages. Except in the tongue and the esophagus, these tumors are apparently of very rare occurrence in such sites, and no previous case of retropharyngeal rhabdomyoma could be found, though it is suggested that some retropharyngeal tumors diagnosed as fibromas might we11 prove to be muscular tumors if they were examined histologically after impregnation with iron or silver. . There‘ are F. CAVERS seven illustrations.

162

ABBTRAOTS

Early Diagnosis of Cancer of the Larynx, G. E. TREMBLE. Canadian M, A. J. 30: 280-283, 1934.

An admirable feature of this clear discussion is the presentation of two tables setting forth the main points in the differential diagnosis between tuberculosis, syphilis, and carcinoma of the larynx, and between benign and malignant laryngeal tumors. F. CAVERS Intrinsic Cancer of the Larynx; Report of Three Caeee Apparently Cured by Operation, R. REYNOLDS.Military Burg, 74: 182-186, 1934. Three cases of intrinsic laryngeal cancer are reported, occurring in men aged fiftytwo, fifty-eight, and forty-one. The first was treated by total Iaryngectomy, with no recurrence when seen two years later; the second and third by laryngofissure with the electric knife, without recurrence after ten and fifteen months. There is one illustration. F. CAVERS Large Hemangioma of the Larynx,I. KAWAI. Uber einen Fall von Hllmangioma hypertrophicum an der Eingangsstelle des Kehlkopfes, Okayama-Igakkai-Zaashi 45 : 1015-1020, 1933,

A report of a single case of malignant tumor of the larynx in a man thirty-three years of age. On histologic examination it was thought first to be a sarcoma, but a more careful study led to a diagnosis of hemangioma. Following radium therapy (1530 mg. hrs.) the patient improved in general health, but died shortly afterward. K, SUGIURA Tracheal Fibra-angioma Extending into the Larynx, E. DI LAURO. Fibroangioma tracheale ad evolurione laringea, Valsalva 9: 702-708, 1933. A man of thirty-five had complained for about two years of hoarseness and slight laryngeal obstruction, and more recently of spasmodic attacks of dyspnea with coughing up of blood-tinged mucus. On examination a small red tumor was seen, apparently attached by a stalk to 'the subepiglottic region. This was found at operation to arise from the back of the trachea at the level of the second cartilage, whence it was easily removed. In the text of the paper the author calls it an angiofibroma. There are three illustrations, F. CAVERS A Lipoma of the Larynx, E. D. D. DAVIS. J. Laryng. & Otol. 48: 824-825, 1933. In a woman of twenty-nine complaining of hoarseness for three years, there was slight stridor on deep inspiration, but no real laryngeal obstruction, pain, or dysphagia, and no * enlarged nodes. There was a smooth pink rounded swelling on the right aryepiglottic fold, bulging into the piriform fossa. External enucleation wa8 done, and the tumor diagnosed histologically as a fibrolipoma. There are two illustrations F. CAVERS Subglottic Granuloma (Scleroma) Simulating a neoplasm, A. ORLANDINI.Scleroma sottoglottico, Sperimentale, Arch. di biol. 87: clxi-clxv, 1933. A woman of sixty complaining of nasal and laryngeal obstruction showed neoplasmlike masses in the right nasal cavity and in the glottis, which on removal showed the structure of scleroma. There are four illustrations. F. CAVERS Reticuloma of Tonsil Treated with Radium, B. Lo VULLO. Retiouloma tonsillare trattato con radiumterapia, Sperimentale, Arch. di biol. 87: clxxviii-olxxxi, 1933. A man of forty-five had for two months notiaed increasing swelling of the left tonsil, and recently this had become ulcerated. The tumor was hard and on biopsy was diagnosed as a retiouloma [no histologic description given]. Radium was given, first by surface application and then by puncture, and the tumor rapidly regreseed, disappearing sixteen days after the beginning of treatment. There are two illustrations of the gross spedimen. F. CAVERS

INTRATHORACIC TUMORS

163

Five Caeea of Tumor of the Upper Respiratory Passages, A. PEYSER. , Epikritisches liu 5 Fallen von Geschwlllsten der oberen Luftwege, Folia oto-laryngol. 36: 293-299, 1933. The author reports 5 cases of tumor of the upper respiratory passages in which there was a discrepancy between the clinical course and the histological diagnosis. (1) The first case was an alveolar carcinoma of the left antrum without enlargement of the nodes or other clinical signs of malignancy. Radical resection was done, but symptoms of lung tumor developed, and death ensued in nine months, without local recurrence in the antrum. The author thinks the pulmonary tumor was the primary neoplasm. (2) A laryngeal tumor was removed with a margin of healthy tissue. Microscopically the growth was an early squamous-cell epithelioma. Postoperative x-ray therapy was given and the patient was well a year and two months after operation. The author doubta if there was any true malignancy in this case. [Why?] (3) A nasopharyngeal tumor in a young man of seventeen was diagnosed as a fibroma and rayed. The tumor disappeared, but a recurrence a few months later was found to be a round-cell saraoma. Several subsequent recurrences were treated surgically and with radium, but improvement was only temporary and the patient died. (4) A tumor of the velum palatinum ww reported as a chondroma. The speoimens showed cartilage as the only foreign element, and the author believes this to have been an embryonal remnant, and not a neoplasm. (5) A tumor of the larynx was removed. Histologically it consisted of inflamed granulation tissue with some thickening of the pavement epithelium. Tuberculosis could be definitely excluded, and there was no clinical or serological evidence of syphilis. No definite diagnosis was made. Histologic Study of the Behavior of an Arytenoid Cartilage toward an Epithelioma of the Vocal Cord, J. TERRACOL AND H. L. GUIBERT. Etude histologique sur le comportement du cartilage arythnoide via il vis d’un Bpithhlioma de la corde vocale, Bull. de 1’Assoc. franc;. p. 1’6tude du cancer 23: 358-374, 1934. This is a detailed histologic study of the reaction taking place in cartilage as it is approached by squamous epithelioma. A series of ten photomicrographs illustrate the procese. C. D. HAAGENSEN

INTRATHORACIC TUMORS Contribution to the Knowledge of Teratomas and Dennoids in the Anterior MediasActa radiol. 15: 210-224, 1934. tinum, B. HAMMARSKJ~LD. The anterior mediastinurn is the common site for both dermoid cysts and teratomari. Radiographically there are, as a rule, no pulsations, at lea& of the expansive type, nor any shifting with the movements of respiration. A change in position during swallowing L seen only in those rare cases where there is fixation to the trachea. Dermoid cysts are characterized by even, rounded, distinctly outlined area8 of density which often fuse with the heart shadow, The diagnosis is sometimes made easy radiographically by the demonstration of teeth or fragments of bone within the tumor shadow. Of the conditions which should be excluded when making a diagnosis of intrathoracic dermoid, are aortic aneurysm, echinococcus cyst, intrathoracic goiter, a persistent thymus, and tuberculous abscess. Teratomaa are to be distinguished from the benign dermoid cysts by their more solid structure. The typical thin-walled dermoid cyst, uniformly distended by its contents, has little in common with’the irreguIar structure of the teratoma. The sharply rounded contour of a dermoid cyst is replaced in a teratoma by a partially rounded but at the same time lobulated outline which shows up distinctly against the surrounding tissues. The lobulation is due to the different types of tissue in the wall. As malignant degeneration only affects a limited area within the mass, it has no noticeable effect on the siae of the tumor. This is the explanation of the fact that, even while the tumor is metastasizing, there is no increase in the sire of the teratoma.

164

ABSTUOTS

To illustrate this paper the author reports the histories of two patients with mediastinal teratomas. The first was a twenty-two-year-old man who died of cerebral metastases from the primary growth in the chest. Autopsy showed a cystic teratoma containing chorionepithelioma in the anterior mediastinum, which had metastasilred to the lungs and brain. Up to the present time only three cases of chorionepithelioma tissue in patients with mediastinal teratomas have been repsrted in the literature. The second patient was a twenty-eight-year-old man in whom the diagnosis of intrathoracic teratoma was made on the radiologic evidence of the location of the tumor, its homogeneous charaoteristics, its sharp, wavy contours, and the absence of displacement of the trachea or of bronchial compression in spite of the considerable size of the tumor. The article is illustrated by a photograph and diagrammatic drawings. B ~ N J A M IR. N SHORIO

Lymphosarcoma of the Mediastinum, LEONI. Lymphosarcome du mediastin. Tunisie m6d. 27: 459-461, 1933. A man forty-one years of age had an attack of hemoptysis followed by dyspnea and precordial pain. Examination showed evidence of mediastinal pressure and enlargement of the subclavicular and axillary nodes, The symptoms grew rapidly worse and the patient died in four months. Autopsy showed a large mediastinal lymphosarcoma.

Primary Cancer of the Lung, Its Incidence and Pathology, R. M. HILL.Edinburgh M. J. 41: 320-333, 1934. The author has collected statistics from the available literature, which he has arranged in a series of tables, regarding the incidence and the clinical and pathologic features of lung cancer. Cancer of the lung occurs in about 1 per cent of necropsies and in about 8 per cent of cases of malignant disease. The etiology is not clearly established. The two lungs are affected with about equal frequency, and there is no marked predilection for individual lobes. Tumors composed largely of cells having a lesser degree of differentiation are rather more common than the clearly squamous, cubical or cylindercell carcinomas. The distribution of metastases is characterized by their frequency in the suprarenals (15 per cent), kidneys (14 per cent), and brain (over 10 per cent). The presence of the lung tumor is often masked by bronchiectasis or pleural effusion. Extreme emaciation is rare. 1n.about 16 per cent of the cases there are no symptoms referable to the respiratory system. The average period of survival after the disease has been diagnosed is about six months, but its entire course may extend over several years. The author remarks that he has consulted several hundreds of publications in preparing this analysis, but has limited his own bibliography to those (sbout thirty in number) which seemed to be the most useful. F. CAVBRS Pathological Anatomy and Histology of Primary Pulmonary Carcinoma, I. A. KRAIT. Pathologische Anatomie und Histologie des primaren Lungenkrebses, Etschr. f. Krebsforsch. 41: 51-73, 1934. The author encountered 150 primary carcinomas of the lung in 9316 autopsies performed at the Metschnikoff Hospital, in Leningrad, during the period 1925-1932. The lung in one year (1929)was the most common site for internal cancer next to the stomach. The high rate for males observed by other investigators was particularly striking in this material, where the proportion was 11.5: 1; a greater preponderance of males over females occurred only in the case of laryngeal cancer (20 : 1). The disproportion is probably due to greater industrial hazard among men in respeot to agents that irritate the respiratory tract. The ages of the patients that died of cancer of the lung ran from thirty to seventy-five years. The largest number were in the fifth decade, the next largest in the fourth, and the third largeat in the sixth. No difference was found between men and women in regard to the period of life when the neoplasm arose. The right lung, said by many investigators to be the more frequently affected, was less often the seat of the neoplasm in this material. As for the lobes, all were about equally attaoked, with the possible exception of the right middle lobe.

lNTRATHORAOI0 TUMORS

165

There is still no Batisfactory classification for pulmonary cancer. The author suggests the following for gross purposes: (1) carcinoma of the large bronchi; (2) carcinoma of the small bronchi, as in his experience all develop from the bronchial tree. Microscopically, he distinguishes (1) slightly differentiated small-cell carcinoma; (2) polymorphoua-cell carcinoma; (3) flat-cell carcinoma; (4) cylindrical-cell adenocarcinoma. Among the first three there are found many transitional forms, and in some cases polymorphism is more outspoken than in the case of any other organ. It is this, perhaps, which has prompted the statement that some of these tumors are carcinosarcomas. Widespread metastasis is the rule even when the primary growth is still small, the preferred organs being the regional lymph nodes, the liver, and the suprarenals. The last-named seem to be characteristically involved, since they are rarely the seat of secondary growths (1-3 per cent) in the case of other tumors. Though it is widely held that cancer of the lung often arises from alveolar epithelium, the author has found no convincing evidence for this belief either in the literature or in his own material. The large clear epithelial cells said by some to be characteristic af cancers developing from the alveoli he has found in those that were indisputably of bronchial origin. The relationship between pulmonary carcinoma and pulmonary tuberculosis is still a debatable question; on the basis of his own material Kraft is inclined to regard fibrous WM. H. WOOLOM phthieis as a possible predisposing cause.

Stenosing Tumors of the Trachea and Bronchi, Four Cases, F. BRUNETTI. Stenosi neoplastiche tracheo-bronchiali, Valsalva 9: 661-679, 1933. The author reports four carefully investigated cases, in all of which the tumor was so situated that bronchoscopic biopsy was possible. The patients were men aged fortysix, forty, fifty-two, and thirty-four years; the tumors were diagnosed as mucigenic cylinder-cell carcinoma of the trachea , squamous-cell carcinoma of the main bronchus (two cases), and round-cell sarcoma of the main bronchus. The first patient died a year after operation; the tracheal tumor had invaded the thyroid gland. The second died shortly after hospital admission; necropsy showed bronchiectasis and pulmonary abscess. The third died a few days after operation, and necropsy revealed a large mediastinal sarcoma involving the lungs and bronchi. In the fourth case the visible tumor was removed, but x-rays showed a dense shadow in the lower part of the right hemithorax. F. CAVERS There are five illustrations. Papillomatosis of the Trachea and Bronchi, A. BEUTEL. Die Papillomatose der Trachea und der Hauptbronchien, Rontgenpraxis 6: 287-290, 1934. Beutel reports the case of a twenty-one-year-old patient in whom the diagnosis of multiple papillomatosis of the trachea was made from study of bronchograms. When viewed in relief the tumors appeared as large filling defects of various sizes and shapes. The diagnosis in this case was confirmed by bronchoscopy and histologic study of a biopsy specimen. The article is illustrated with one roentgenogram. BENJAMINR. SHORE Roentgen Treatment of Mcdiastinal and Lung Tumors, R.DU MESNILDE ROCHEMONT. uber die Rtintgenbehandlung der Mediastinal- und Lungentumoren, Strahlentherapie 50: 290-296, 1934. Tumors of the mediastinum and lungs can be divided into three groups according to their radiosensitivity : (1) those which are completely radioresistant; (2) those which can be influenced somewhat by radiation; (3) those which respond to radiation although a cure is not to be expected. The tumors belonging to the first group are the lipomas, fibromas, chondromas, teratomas, cysts, and all lesions of the heart, pericardium, and aorta. Tumors which can be somewhat benefited by x-ray are the bronchial carcinomas and rnetsstatic carcinomas and sarcomas from other organs. In the third group, in which symptomatic relief is to be expected, are the lymphogranulomas, lymphosarcomas, BENJAMIN R. SHORE and lymphomas of leukemia. There are no illustrations,

166

ABSTRAUTB

Successful Excision of a Bronchial Carcinoma, F. SAUERBRUCH. Erfolgreiche Exstirpation eines Bronchialkarsinoms, Zentralbl. f. Chir. 61 : 1672-1676, 1934. Radical excision of lung tumors must usually be confined to those situated near the cortex of the lung. Bronchial carcinomas involving the hilum of the lung and neighboring structures offer a much more difficult surgical problem. Sauerbruoh reports the successful surgical removal in two stages of a bronchial carcinoma involving the lower lobe of the left lung of a forty-two-year-old patient. The patient has remained well and has gained fifteen pounds in the six months since operation, Histologic study of the specimen removed showed it to be a squamous-cell epithelioma without marked keratinisation. The article is illustrated with a roentgenogram and a photograph of the surgiBENJAMIN R. SHORE cally removed specimen. Treatment of the Surface of the Lung after Excision of Tumors. Death Following Emphysema of the Larynx and Pharynx, P. CLAIRMONT.Zur Vereorgung der LungenwundflBchenach Geschwulstentfernung. Tadlicher Ausgang durch Schleimhautemphysem des Larynx und Pharynx, Zentralbl. f . Chir. 61: 821-825, 1934. Clairmont reports the case of a fifty-two-year-old man who died of subcutaneous emphysema and emphysema of the larynx and pharynx following radical excision of a tumor of the right lung. After extirpation of the pulmonary growth the raw surface of the lung was sutured to the chest wall. Death oocurred from asphyxia seven hours after operation. Autopsy showed the cause of death to be complete obstruction of the larynx from submucous emphysema which had undoubtedly arisen from the cut surface of the lung. Clairmont suggests that it would be better in such cases t o suture the lung very loosely to the chest wall and to change frequently the dressings and paoking. The article is illustrated with a roentgenogram and a photograph of the larynx removed a t autopsy. BENJAMINR. SHORE Tumours of the Heart; Histological and Clinical Study, R. M. LYMBURNER.Canadian M. A. J. 30: 368-373, 1934. From 1916 to 1931 inclusive, 62 cases of secondary and 4 of primary tumor of the heart were found in 8660 necropsiee at the Mayo Clinic. Of the primary tumors, two were myxomas of the left auricle, one a lymphangioma of the right auricle, and the fourth a rhabdomyoma of the left ventricle. One of the cases had already been reported fully; the author gives a detailed account of the three remaining cases. Of the metastatic tumors, 36 were carcinomas, 10 sarcomas, and 6 malignant melanomas. Their sites are given in a table. The majority of these were considered to have metastasised by the blood stream. In many cases tumor cells were found within the coronary arteries, in a few cases within the lymphatic channels of the heart; in one case of primary carcinoma of the bronchus the superficial lymph nodes the heart were dilated with active malignant cells, The author gives in a series of tables the findings in the metastatic oases, including sex and age incidence, site and histologic diagnosis of the primary tumor, site of cardiac tumor, sites of other metastases found, duration of symptoms, etc. In only 6 cases were there definite cardiac symptoms suggestive of secondary involvement of the heart by tumor growth. There are six illustrations. F. CAVERS Sudden Death due to a Fibrinous Polyp of the Aortic Valve, M. CAMPBELL AND W. R. CARLIHQ. Guy's Hosp. Reports 84: 41-42, 1934. A woman of forty-aeven was said by an eye-witness to have been seised with sudden dyspnea and ayenosis, and died in a few minutes. There was no history of previoua illness. At necropsy no lesion was found until the heart, whioh was'not enlarged, was opened. The left posterior cusp of the aortic valve bore a round mass attached by a slender stalk, which was twisted and blocked the opening of the left coronary artery. The tumor looked like a flbroma, but histologic examination showed that it consisted of fibrin which had been gradually deposited on a slight tear on the edge of the valve. There is one illustration. F. CAVERS

THE DIGESTIVE TRACT

167

THE DIGESTIVE TRACT Clinical Observations on Carcinoma of the Elophagus, V. SANQIOVANNI.Rilievi clinici sul carcinoma dell’esofago, Arch. ital. di otol. 45: 1-27, 1934. Necropsy records of 30 cases of esophageal cancer, representing 4 per cent of all malignant tumors diagnosed during this period were reviewed. Brief notes on 18 cases, with the clinical findings and diagnosis and the radiographic and histologio reports, are given. In about half of the cases (some radiologically examined and others not) a correct diagnosis was made during life. No reference is made to publications in the English language, and there are no illustrations. F. CAVERS Oesophageal Obstruction, R. M. GLYNN. M. J. Australia 1: 329-334, 1934. I n the portion of this paper dealing with malignant stricture the author refers to 51 cases of esophageal oancer occurring during the years 1926 to 1931 at the Adelaide General Hospital. Six of the patients were women. The site and age incidence were about the same as in larger series. The apparent duration of symptoms was given as three weeks to twelve months, with an average of four and a half months. In his own praotice the author has had 17 cases, all treated by intubation before resort was made to gastrostomy. H. A. McCoy, in a discussion (p. 354) of this paper, said that in favorable cases the tumor was accessible to radium, and that it was worth while to use this (dosage 1.5 m.c.d. per cm. of length of tumor, filter a t least 1.5 cm. platinum) when the total extent of the lesion could be determined. F. CAVERS Irish J. M. Sc. pp. 28-31, January 1934. Malignant Stricture of the Gullet, R. WOODS. The author advises the uae of the Y-shaped Symonds tube for stenosing esophageal cancers located not less than one inch below the cricoid cartilage. I n the tube is fitted a radium carrier about 7 cm. long, coneisting of a platinum tube 0.3 mm. thick and triangular in cross section. To the outer surface of this tube are attached three slender 0.6 mm. platinum tubes, and into each of these there are inserted two radon capillaries in tandem. This arrangement ensures that in whatever direction the radiation from the six radon tubes proceeds it will neceesarily pass through 0.6 mm. platinum. A case history is given. The patient had gained considerable weight, and showed amelioration of symptoms three months after the first radium application (1164 m.c.d. in four days). There are two illustrations. F. CAVERS

An Unusual Oesophageal Neoplasm, G. BLACKBURN.St. Bartholomew’s Hosp. J. 41 : 138-139, 1934.

A woman of fifty-three had six weeks previously noticed in the left side of the neck a swelling which rapidly increased in size and caused dysphagia. The tumor seemed to occupy the position of the left thyroid lobe, but filling radiography showed that it involved the esophagus. At operation the tumor mass was found to be an annular esophageal tumor lying behind the thyroid, fixed to the prevertebral musculature, and extending downwards into the superior mediastinum. With a view to possible lateral oervical esophagectomy, the mediastinum was plugged with gauze, a portion of the tumor removed, and gastrostomy done, but the patient died eight days later with mediastinitis and pneumonia. The tumor showed in places the typical histologic pioture of spindle-cell sarcoma, but in some areas it had the appearance of anaplastic carcinoma. There are two illustrations F. CAVERS Carcinoma of the Stomach, R. R. GRAHAM.Canadian M. A. J. 30: 393-399, 1934. The author’s observations are based on 227 cases of gastric cancer out of 1724 hospital admissions for chronic gastro-intestinal disease, and 162 out of his own total of 1869 cases. Probably a t least 3 per cent of persons complaining of stomach trouble have gastric cancer; the incidenoe was higher both in the Toronto General Hospital series (13.1 per cent) and in the author’s cases (9 per cent). He emphasizes that every individual over forty years of age who complains of indigestion occurring for the first

168

ABSTRAUTS

time must be suspected of having cancer, and is entitled to a thorough investigation. If there is achlorhydria, and pernicious anemia and gallbladder disease can be excluded, the patient should have radiologic examination, but a negative x-ray finding in such a patient is no justification for assuming the absence of gastric cancer, and laparotomy F. CAVERS should be advised.

Problem of Gastric Carcinoma, A. G. OQILVIE. M. J. Australia 1: 144-145, 1934. The aufhor believes that rather too much is made of dietetic precautions prior to examining the stool for occult blood by means of the bemidine tests. There are two possible sources of confusion of dietetic origin, neither of them of much practical importance. When large amounts of green vegetables are taken a pseudo-positive reaction may be obtained, dirty green coloration appearing, usually late, and very BlOWlY deepening; blood gives a blue or bluish-green color which appears suddenly. If doubt exists, boiling the stool will remove it, as the pseudopositive reaction is apparently due to ensymes. Tests are not reliable during diarrhea, when partially digested food reaches the lower bowel, but diarrhea is not common in gastric carcinoma. F. CAVERB Problem of Gastric Carcinoma, A. E. TAYLOR.M. J. Australia 2: 608-609, 1933. The author says that he has used the bensidine test for blood in the stool and finds‘it F. CAVERS absolutely reliable. He uses it in about ten cases annually. Cancer Arising on Gastric Ulcer, S. IMPERIO. L’ulcera-cancro, Morgagni 76: 113-114, 1934.

The author discusses briefly the question of gastric cancer arising on an ulcer base, with references to three papers in the French language [all dealing with small numbers of cases], but adds nothing new. He suggests that when clinical investigation indicates the probability or even the possibility of cancer, immediate laparotomy should be done. F. CAVERS

Bacterial Infection of the Omentum in Cases of Ulcer and Cancer of the Stomach, M EINAUDI. Contributo allo studio dells flora microbica dell’omento nell’ulcera e nel cancro dello stomaca, Gior. di batteriol. e immunol. 11: 289-320, 1933. I n specimens that were placed in fixing fluids immediately after operative removal for ulcer and for cancer of the stomach, the author found inflammation associated with bacteria in 2 out of 12 ulcer cases and in 5 out of 20 cancer cases. He points out that the presence in the omentum of these microbes, mostly B. coli, may set up inflammatory complications following operation, and that the latter may be prevented by systematic resection of the omentum and by accurate peritonealisation. There are three photomicrographs. F. CAVERS Anemias Associated with Gastric Tumors, G. MANEELLA.Contributo allo studio delle anemie nei tumori dello stomaco, Morgagni 75: 1267-1277, 1933. The author reports four cases in which patients who were anemic but did not complain of gastric symptoms were found on roentgen examination to have appearances suggestive of carcinoma of the stomach. There is no mention of examination of the gastric contents, and nothing is said as to what happened to these patients. The remainder of the paper is taken up with a discussion, in which various writers are cited by name only, of the possible relation between various forms of anemia and various gastric lesions, neoplastic and otherwise. The author advises that in every case of anemia the patient should undergo full gastric. investigation. There are four x-ray illustraF. CAVERS tions. Thrombopenic Purpura Associated with Carcinoma of the Stomach with Extensive Metastases, J. S. LAWRENCE AND E. B. MAHONEY.Am. J. Path. 10: 383-390,1934. Whereas it has been stated that carcinoma is practically always associated with a normal or increased numher of platelets in the peripheral blood stream, the authors report in detail a case of carcinoma of the stomach accompanied by thrombopenia.

THE DIGEBTIVE TRACT

169

This condition has usually been found associated with extensive metastasis in the bone marrow, as was true in the present instance. This patient had had gastric symptoms for approximately six years. For two weeks prior to admission he had had constant severe pain in the lumbar region, radiating to the chest and thighs. Coffee-ground vomitus had been present for several days. The patient had noticed pallor for several months and also that he bled easily after shaving. On the day following admission to the hospital, many petechise were visible on the lower extremities. The platelets were markedly diminished, averaging about 1 to 2 per oil immersion field. The coagulation time (test tube method) was twelve to sixteen minutes. The clot retraction was good and the clot itself showed normal elasticity on one occasion and on two other occasions it was friable. The bleeding time varied between ten and a half and twenty-nine minutes. The icteric index was 6. Roentgenograms of the dorsal and lumbar vertebrae showed no metastatic lesions. A gastro-intestinal series revealed findings that were interpreted as carcinoma of the pyloric region of the stomach with obstruction. On the twenty-fifth day after admittance the patient suddenly became dyspneic and cyanotic and died a few hours later. At autopsy, besides the primary carcinoma of the stomach, tumor cells were found on microscopic examination in the lymphatics about the bronchi and vessels, the capillaries of the alveolar walls, and the smaller lymphatics and vessels of the pleura. Although the spleen was congested, no tumor cells were found. In the liver, however, there were clusters of tumor cells which had stimulated a marked growth of connective tissue, almost completely obliterating the normal architecture. Although the medulls of the adrenals were invaded with tumor cells, there was not the extensive connective-tissue formation seen in the liver. The mesenteric nodes were almost entirely replaced by tumor cells. The femoral marrow cavity showed a large amount of fibrosis. The connective tissue was quite dense and cellular, and spicules of bone were prominent. They were dense and showed no evidence of destruction by osteoclasts. Throughout the marrow cavity were clusters of tumor cells, similar to those seen in the stomach. These cells lay between the bony spicules and had not eroded the bone. A section through the shaft of the femur showed dense bone formation with clusters of eosinophilic and neutrophilic myelocytes, as well as the mature polymorphonuclear type. Erythroblasts and mature red cells were conspicuous. Normal appbring megakaryocytes were present but were probably diminished in total numbers. Section of the vertebra showed an extensive infiltration of tumor cells without erosion of bone. The authors believe that there is probably a close association between the hemorrhagic diathesis and the thrombopenia, although it would be impossible to say that the bleeding phenomena were not dependent, a t least in part, on changes that may have occurred in the permeability of the capillary walls, as is thought by many to be the case in idiopathic purpura. The presence of large numbers of early cells of,the myeloid series and of numerous nucleated red blood cells is not usual in the case of idiopathic thrombopenic purpura, although they may be found after a recent massive hemorrhage. A photomicrograph of a typical section from the vertebral marrow is included, and W. S. MACCOMB a bibliography is appended.

Gastric Carcinoma with Invasion of the Thoracic Duct, T. DE SANCTIS-MONALDI. Carcinomatosi secondaria del dotto. toracico, Riforma med. 49: 1284-1285, 1933. Four months before his death in the hospital, a man of forty-two began to have dyspeptic symptoms, in the form of loss of appetite and slight pain in the left upper quadrant. A month after this he had a sensation of fullness after meals, and began to vomit three or four hours after each meal. No gastric tumor could be palpated. There were two enlarged hard supraclavicular nodes. Radiography revealed a stenosing tumor of the pyloric antrum, encroaching on the lesser curvature. At operation the gastric tumor was found to be firmly fixed; there were numerous metastases in the lymph nodes and peritoneum, with tumorous infiltration of the entire mesocolon. Anterior gastro-enterostomy was done. After operation the patient showed rapidly increasing cachexim, increasing involvement of cervical lymph nodes, and ascites, and died two months later.

170

ABSTRAUTS

At necropsy the peritoneum contained abundant milk-like fluid, in which were masses of tumor cells; the entire peritoneum was studded by metastases, and a hard tumor mass surrounded the duodenum, several loops of ileum, and part of the transverse colon. There were metastases in the liver, but not in the spleen, kidneys, and suprarends. On opening the thorax, the thoracic duct was found to be enormously distended and tortuous, and was packed solid with metastatic cancer tissue; there were also metastases in the lungs and the heart. The tumor was an alveolar adenocarcinoma with papillary formations and numerous foci of necrosis. There are three illustrations. F. CAVBRS Present Day Outlook for Diagnosie and Cure of Gastro-intestinal Cancer, M. DONATI. Criteri di diagnosi e cura dei carrcinomi gastro-intestinali, Osp. maggiore 21: 468-460, 1933.

The author is concerned mainly, in this review, with the statistical aspect of diagnosis and operative results in carcinoma of the stomach and bowel. From the literature of various countries he infers that thare is reason for considerable pessimism as regards diagnosis and for a fair amount of optimism concerning the results of surgical intervention. That is, surgery of these tumors has shown remarkable progress as indicated by diminishing operative mortality and increasingly good end-results, but diagnosis has lagged behind sadly, mainly because few patients seek medical advice at an early stage in the malady, and unfortunately many physicians continue palliative treatment without suspecting the possible presence of a tumor and giving the patient the benefit of the doubt by referring him to a surgeon. Unlike some writers, Donati does not believe that radiographic examination alone can establish a diagnosis of gastric cancer. In his experience careful clinical and chemical study is equally necessary, with early resort to F. CAVERS laparotomy in doubtful cases.

Surgical Treatment of GrBtric Cancer, G. CAVINA.Stato attuale della terapia chirurgica del cancro dello stomaco, Riforma med. 49: 1606-1610, 1933. It has been estimated that in Italy, out of a total of about 26,000 cancer deaths in a year, about 10,000 are due to gastric cancer. The author discusses some of the larger series of operated cases, beginning with Mayo's 1897-1919 series of 2094 cases, and arranges these in a clear table, indicating the treatment given and the mortality rate. He has himself operated in 171 cases during six years (1827-1932). About two-thirds of the patients (111) were women. The distribution in the different life decades was as follows: 21-30 years, 4 cases; 31-40 years, 20 cases; 41-60 years, 40 cases; 61-80 years, 49 cases; 61-70 years, 60 cases; over 70 years, 3 cases. Other writers have reported casea in the second and even in the first decade of life. The author believes that palliative operations are worth while, especially as the operative mortality for these, as well aa for exploratory laparotomy, has shown an appreciable fsll during the past quarter of a century, It does not appear that during this period there has been a marked increase in the proportion of patients in whom resection can be done with hope of considerable prolongation of life. In more than one third (64)of his cases the author was able to do resection, with 13 operative deaths (20 per cent). He adds that owing to lack of follow-up arrangements, the small number of cases dealt with, and the short period since operation in his series, he can make no useful statement as to resulfs. He cites with approval the suggestion of a recent American writer that every person over the age of forty years should have a gastric examination once or twice a year. F. CAVERS

On the Treatment of Cancer of the Stomrch by Resection, V. TUOMIKOSKI. Acta chir. Boandinav, 74: 466-467, 1934. From 1916 to 1930 resections of the stomach for carcinoma were performed in 203 ca8es in the First and Becond Surgical Clinics in Helsingfors. The operative mortality for the entire series was 30 per cent. Tbe Billroth I type of resection and its modifications were used in 89 cases, with an operative mortality of 17 per cent, and the Billroth 11 operation and its modifications were used in 111 cases, with an operative mortality of 39

THE DIGESTFIE TRAUT

171

per cent. In 21 cases death was caused by peritonitis, in 17 by heart failure, in 16 by pneumonia, in 3 by a gastro-intestinal fistula, and in one case each by empyema, pulmonary embolism, and intra-abdominal hemorrhage. Of the 128 patients who survived the radical operation, 79 or 62 per cent died within three years, while 49 or 38 per cent have lived for three years or more, and 20 or 15 per cent have lived more than five years. Histologic study of the 163 surgically removed specimens of stomach and adjoining lymph nodes demonstrated that resection in cases of carcinoma in the pyloric end of the stomach should be extended for about 3 cm. beyond the pylorus and about 7 cm. proximal to the palpated border of the tumor. The lesser omentum should be removed as completely as possible together with the pericardial lymph nodes. The entire greater omentum should be removed in all cases. BENJAMIN R. SHORB Results of Subtotal Gastrectomy for Carcinoma, CHAS. W. FLYNNAND JOHN W. DUCKWTT.Am. J. Burg. 24: 746-758, 1934. Postoperative studies and autopsy findings offer conclusive proof that gastric cancer, even in advanced stages, is amenable to treatment by resection, with a low primary mortality, a good chance of prolonging life with freedom from pain, and a fair chance of cure. The case of a forty-year-old man who was subjected to resection of more than four-fifths of the stomach for carcinoma is reported. Physiologic and chemical studies over an unspecified period of time have shown that leaving a small portion of the pyloric end of the stomach and a small cuff of cardia, as was done in this case, not only adds to the safety of the operation but provides an intrinsic factor which probably prevents the development of a serious and fatal anemia in gastric cancer cases following resection. The article is illustrated with roentgenograms, a photograph of the resected portion of BENJAMIN R. SHORE the stomach and photomicrographs. Cancer of ths Stomach in Natives of Dutch East India, R. S. TJOKROHADIDJOJO. Maagcarcinoom bij Inheemschen, Geneesk. tijdschr. v. NederLIndii! 73: 1435-1439, 1933. The writer stresses the fact that in contrast to the great frequency of primary cancer of the liver in natives, gastric cancer seems to be very rare. No essential differences exist between cancer of the stomach in natives of the Dutch East Indies and in Europeans and Chinese. A case history is given of a thirty-two-year-old man. The article contains alist of observations on cancer of the stomach in Dutch East India as they appeared from 1852 to 1926 in the Geneesk. Tijdschr, v. NederLIndi6, hitherto unpublished statistics on tumors observed over a period of five years in various laboratories, and a short survey of 19 tumor cases seen in Bandoeng. Five photographs and a drawing accompany the text. JOHANNES P. M. VOGELAAR Cure of a Lymphosarcoma of the Stomach by Roentgen Therapy, R. KAISER. Ein Lymphosarkom des Magens und seine Heilung durch RLlntgenbestrahlung, Rlintgenpraxis 6:233-234,,1934. The author reports the case of a fifty-one-year-old woman with a large tumor involving the greater portion of the stomach. Exploratory laparotomy was performed and the growth was found to be inoperable. A small portion removed for histologic study showed the tumor to be a lymphosarcoma. Several series of deep x-ray therapy were given, and the patient has remained well without evidence of recurrence for eight yeare. There are no illustrations. [There is a similar case on record in the literature which proved ultimately to be Hodgkin’s disease. The differential diagnosis from a small fragment of material is not BENJAMIN R. SHORE always possible.] Fibromas and Lipomas of the Stomach, H. DANNEEL.uber Magenfibrome und Magenlipome, Frankfurt. Ztschr. f. Path. 46:477-485, 1934. The author presents abstracted histories of two patients with fibromas, one with a lipoma, and one with multiple myomas of the stomach. In the fibromas bleeding was the characteristic symptom. In a series of 500 autopsies 15 benign tumors of mesen-

172

ABSTRAUTS

chymal origin in the gastro-intestinal tract were found. There were 9 myomas, 4 lipomas, a fibroma, and a neuroma. However, in 50 stomachs which were fixed in formalin and studied, 6 benign mesenchymal tumors were found. The article is illustrated by a photograph and two photomicrographs. BENJAMIN R. SHORE

Lipoma and Ulcer of the Stomach, E. MELCRIOR.Magenlipom und Ulcus pepticum, Zentralbl. f. Chir. 61: 1701-1702, 1934. Melchior reports the case of a fifty-seven-year-old man who was operated on for a possible carcinoma of the prepyloric region. At operation a soft mass was found just proximal to the pylorus, and this portion of the stomach was excised. Examination of the specimen showed it to contain a typical submucous lipoma with ulceration of the overlying mucosa. A photograph of the gross specimen accompanies the report. BENJAMIN R. SHORE Adenomyoma of the Stomach with Adjacent Subserosal Abscess, M. PBTROWJTCH AND S. DAVIDOVI&Adbnomyome de l’estomac avec abc&s,Bull. et m6m. SOC.nat. de chir. 59: 1330-1335, 1933. Aman of twenty-one had had severe abdominal pain with vomiting and diarrhea two days before hospital admission. On account of the rigidity of the right half of the abdomen appendicitis was suspected, At operation the peritoneal cavity contained seropurulent fluid; the stomach was dilated and the thickened pyloric antrum was covered by a hyperemic fibrinous deposit. This part of the stomach was resected, and on section showed a small abscess containing staphylococcic pus. Adjoining the abscess was a small, hard tumor embedded in the musculature and infiltrating the submucosa but covered by normal-looking mucosa. The mass consisted of acini lined by a single layer of cylindric epithelium, embedded in scanty connective tissue and hyalinized muscle fibers. There were no signs of malignancy. The histologic features suggested that the tumor had arisen from ectopic intestinal (Brunner’s) glandular tissue, while the adjacent abscess might have been produced by the contraction of the gastric wall, due to the tumor, favoring the enclosure of a local infection. There are three illustrations. F. CAVERS Pernicious Anemia Associated with Gastric Adenoma; Recovery after Removal of Tumor, N. R. CHRISTOFFERSEN. Ansmia perniciosa svundet efter fjernelse af ventrikeladenom, Ugesk. f. lsger 95: 1331-1334, 1933. A man of thirty-seven had been treated medically for several years for hematemesis attributed to gastric ulcer. Latterly he had become weak and anemic, the anemia being apparently of pernicious type. Liver extract had failed to cause clinical or hematologic improvement. Chemical study revealed achylia and low acidity. Radiography showed an extensive filling defect in the lesser curvature, and a t operation a large tumor was removed. This had a polypoid surface, with some areas af ulceration. Histologically it was a highly vascular adenoma. The anemia rapidly cleared up after operation. The author found in the literature a few similar cases of severe and sometimes pernicious anemia associated with achylia and gastric polyposis. A case of this kind was reported by Pendergrass (J.A.M.A. 94: 317, 1930). From such cases it is clear that the anemias occurring in association with gastric tumors do not depend on the nature of the tumor, as to malignancy or benignancy, but simply on the extent to which its presence interferes with the normal functioning of the gastric mucosa, particularly when the tumor is extensive or causes loss of blood owing to ulceration. There are three F. CAVERS illustrations. Gastric Newinoma; Case Report with Review of Benign Gastric Tumors, M. RONZINI. I neurinomi nel quadro dei tumori gastrici benigni, Arch. ital. de chir. 36: 1-88, 1934. The author reports a case of gastric neurinoma (Schwannoma). This was an exogastric tumor occurring in a woman of forty-two. The remainder of this long paper is

THP DIGESTTW TRAOT

173

devoted to a review of the literature of benign gastric tumors in general and of neurinomas occurring in the stomach and elsewhere. Fifty-six reported cases of gastric neurinoma are analyaed and the data presented in tabular form. The author believes that careful histologic investigation of benign gastric tumors will show that many of the so-called fibromatous tumors are neurinomas, and that tumors of the latter type have also frequently been reported as leiomyomas and even atypical carcinomas. There are twenty illustrations, and an extensive bibliography on benign gastric tumors. F. CAVERS

Single Gastric Polyp, M. G . VORHAUS AND A. E. T. ROQERS. Am. J. Digest Dis. & Nutrition 1 : 169-170, 1934. This is a case report of a single gastric polyp occurring in a woman fifty years of age. Pain occurring five t o ten minutes after meals, radiating to the back and right shoulder, was the chief symptom. It was relieved by the taking of alkalies. The patient complained, also, of distention, heart-burn, belching, anorexia, severe constipation, and loss of fourteen pounds in weight in three months. A cholecystectomy had been performed two years before at another institution for the symptoms described, but no relief had been obtained. Roentgen-ray examination revealed a regular, constant, punched-out filling defect on the greater curvature of the pyloric antrum and a fairly constant incisura on the opposite curvature. There was considerable gastric residue seen in both the three-hour and sixhour films. The roentgen diagnosis was single gastric polyp. The mass was removed surgically, and all symptoms disappeared. Pathological examination showed an inflammatory polyp of the gastric mucosa. W. S. MACCOMB Roentgen Diagnosis of Lesions of the Small Intestines, S. J. GOLDFARB.New York State J. Med. 34: 500-505, 1934. This is a general discussion of the radiographic diagnosis of inflammatory, mechanical, and neoplastic lesions of the small intestines. No new material is added. BENJAMINR. SHORE Hemorrhagic Newinoma of the Duodenum, LEMONNIER AND PEYCELON. Tumeur hernorragique de l’intestin grele (schwannome), Bull. et m6m. SOC.nat. de chir. 59: 1318-1322, 1933. A man of forty-six was admitted to hospital with a recent history of anal hemorrhage of increasing severity. As the bleeding continued despite repeated blood transfusions, and the patient was beconling weaker and more anemic, laparotomy was done. A small ulcerated tumor was found in the prepyloric region, which was resected. Neither the stomach nor the upper part of the duodenum contained blood, but large clots were felt in the transverse colon. The duodenum was therefore incised just beyond the anastomosis which had been made, and as a small ulcerated bleeding submucous tumor was found in its wall the operation was completed by resecting 10 cm. of the small bowel. Histologically the tumor showed the structure of a neurinoma (schwannoma). There are F. CAVERS three illustrations. Radical Excision of a Mpoma of the Duodenum, S. KONDO. uber einen Exstirpationsfall von einem Myom des Duodenums, Zentralbl. f. Chir. 61: 1732-1736, 1934. I n a review of the literature the author has been able to collect 64 cases of benign tumor of the duodenum. There were 23 leiomyomas, 23 adenomas, 13 lipomas, 2 papillomas, 2 hemangiomas, and 1 enterocystoma. The case reported is that of a thirty-six-year-old woman with a history of digestive disturbances, loss of weight, and bleeding from the gastro-intestinal tract. Radiologic examination showed a large filling defect in the descending portion of the duodenum. At operation a well encapsulated growth about 5 cm. in diameter was found and excised. The patient made an uneventful recovery. Histologic study of the specimen showed it to be a typical leiomyoma composed of bundles of muscle cells. The article is illustrated by a roentgenogram and a photograph of the gross specimen. BENJAMINR. SHORE

174

ABSTRAUTS

Primary Lymphoearcoma of the Ileum with Perforation and Death from Acute PeriAND J. H. FISHER.Canadian M. A. J. 30: 420-421, 1934. tonitis, L. WHITAKRIR A man of fifty-five was brought to the hospital in an unconscious state and died three hours later. A blood count showed 6150 leukocytes, with 76 per cent polymorphonuclears, 19 per cent lymphocytes, and 6 per cent myelocytes. The peritoneal cavity contained about two liters of turbid fluid, and in the ileum, near the jejuno-ileal junction, was an ulcerated tumor with a hole in its center. The tumor was diagnosed as lymphosarcoma, and similar tissue was found in the enlarged neighboring lymph nodes and in renal nodules. The attending physician stated that the patient had complained of abdominal pain fifteen days previously, but had not sought advice until the day before F. CAVERS he was sent to the hospital. Ileocecal Invagination due to Fibroma of the Small Intestine, 0. AMOROSI. Invagina~ i o n eileo-cecale da fibroma dell’ intestino tenue, Clin. chir. 36: 938-946, 1933. The author reports clinical and histopathological details of a case of intestinal obstruction resulting from ileocecal invagination caused by the presence of a small intracavitary fibroma in the terminal ileum. I n reviewing the literature he found fibromas of the small intestine to be very rarely reported. Such as are reported seem to be of clinical interest chiefly in connection with invagination due to their. presence. The JEANNETTE MUNRO article is illustrated by photomicrographs. Intuesusception in Cases of Growths of the Caecum, ERNSTEHNMARK.Aota ahir. Scandinav. 74: 470-474, 1934. Twelve instances of cecal tumors, 7 with intussusception, all demonstrated roentgenographically, are discussed. All but one of the patients gave a history of attacks of abdominal pain. In three out of five cases without intussusception the cecum was adherent to the lateral abdominal wall. BENJAMINR. SHORE Cancer of the Cecum, G. VINCENT. Cancer du caecum. RBsection en un temps. GuBrison, J. d. sci. mBd. d. Lille 51: 475-476, 1933. A forty-two-year-old woman complained of cramp-like pain in the right lower abdominal quadrant, the presence of a steadily enlarging tumor in this area, increasing constipation, and loss of weight. Examination showed moderate abdominal distention. A barium enema failed to fill out the cecum, the shadow of the opaque mixture being abruptly terminated in the lower portion of the ascending colon. At operation a large tumor of the cecum was found, The procedure consisted of a one-stage resection of the cecum, ascending colon, and terminal 50 centimeters of the ileum, followed by a side-toWILLIAMJ. HOFFMAN side anastorno& of the ileum and transverse colon Lymphosarcoma of the Cecum in a Five-year-old Boy, E. PALUMBO. Un caso di linfosarcoma del cieco, Riforma med. 49: 1727-1731, 1933. A child of five years was brought to hospital because the lower abdomen had become progressively swollen. For about two years he had had attacks of vomiting and diarrhea, the feces being slimy and.blood-streaked. In the right lower quadrant was a freely mobile hard mass about the siae of a fetal head. The enlarged cecum was removed with the adjment portions of the colon and ileum. The boy made a good recovery, but when the stitches had been removed on the eighth day and the abdominal binder was about to be applied, he made a sudden movement which tore open the wound, causing exenteration of loops of bowel. General anesthesia was at once given, the prolapsed bowel hastily’ replaced, and the abdominal wall resutured, but death from shock occurred six hours later. The tumor, which measured 16 x 12 x 12 om., showed the structure of lymphosarcoma. The adjacent mesenteric lymph nodes were infiltrated by tumor cells. While growth is usually slow, and operated patients may survive for some years, death from metastasis is the general rule, evidently owing to the early invasion of mesenteric and retroperitoneal lymph nodes. There are three illustrations. F. CAVERS

THE DIGESTIVE TRACT

175

Multiple Carcinoma of Colon, with Four Original Cases, A. J. COKKINIB. British J. Surg. 21: 570-576, 1934. Following a review of the available literature of multiple cancer, with two tables of collected series showing respectively low and high incidence of such cases in necropsy material, the author expresses agreement with Warren and Gates (Am. J. Cancer 16: 1358, 1932) that under the term multiple primary malignancy should be included all multiple tumors except those with a probably metastatic origin and those which are commonly pluricentric, as multiple skin cancers, bilateral ovarian tumors, and multiple myelomatosis. The careful study of Warren and Gates seems to have established beyond dispute the cardinal fact that one primary cancer does not inhibit the development of a second. Among 54 cases of colonic carcinoma attended a t St. Mary’s Hospital, London, there were 4 multiple cases. (1) An annular malignant stricture a t the lower end of the pelvic colon was associated with carcinoma of the descending colon. The condition was inoperable owing to mesenteric metastases. Since the lower growth was obviously older, implantation seemed excluded. (2) Four separate tumors were present in the left colon, the largest being in the pelvic colon and the others higher up. This was interpreted as an instance of pluricentric malignant change in multiple adenomatosis, but implantation wad apparently excluded. (3) Cancers were present in the pelvic colon and right colon, the lower tumor being more advanced. There was no evidence of adenomatosis. (4)Two cancers of the large bowel were present, also, in the fourth case, one in the ascending colon and the second a t the pelvirectal junction. Here again the distal tumor was the more advanced of the two growths. There is one illustration. F. CAVERS Carcinoma of the Sigmoid Colon, Sir Cases, CH. LEFEBVRE,Six observations de cancer de l’anse sigmofde, Bull. et m6m. SOC.nat. de chir. 59: 1441-1442, 1933. Five of six patients operated upon for carcinoma of the sigmoid colon-two men of fifty-one and three women between forty-five and fifty-were reported well five to nine years after operation. The sixth, a sixty-nine-year-old woman, remained well for five F. CAVERS years and then died of recurrence in the liver. Colectomy in Three Stages for Cancer of the Right Colon, VIANNAY. Un cas da c8lectomie en trois temps pour cancer du c8lon droit, Loire m6d. 47: 235-239, 1933. In a man of fifty an x-ray diagnosis of tumor in the right colon was made. Operation was done in three stages: (1) the colon waa mobilized, and, since the tumor was adherent to the duodenum but did not invade it, an artificial anus was formed, and a side-to-side anastornosis made between the ileum and the medium portion of the tranaverse colon; (2) the transverse colon, including the tumor was resected; (3) a new anastomosis (end-to-end) between the ileum and the lower portion of the colon was formed. The artificial anus persisted as a fistula, and through it some mucus and other matter secreted by the excluded portion of the intestine passes occasionally. Because of the duration of symptoms before operation and the adhesion between the tumor and the duodenum, the author considers that there is some danger of recurrence in this case, but as cancer of the large intestine (except in the left colon) is usually of a low degree of malignancy, the prognosis may be considered relatively favorable.

.

Operative Complications in Right Hemicolectomy for Carcinoma, G . M. ANTONIOLI. Sulle complicanee operatorie d e b emicolectomia destra per carcinoma, Riforma med. 49: 949-955, 1933. In a man of forty-eight with subacute intestinal obstruction and intense anemia, clinical and x-ray examination revealed a large tumor occupying the right angle and the upper third of the ascending colon. The blood count showed considerable improvement after transfusion. At operation the tumor was found to be a large vegetating mass, and enlarged mesocolic nodes were present. The right colonic angle was firmly fixed to the anterior wall of the duodenum, and in attempting to free it a part of the duodenal wall was torn off. The oval rent (5 x 3 cm.) in the friable duodenum was repaired by freeing

176

ABSTRAOTS

the second part of the duodenum and the adjacent peritoneum and stitching these over the hole. Hemicolectomy was followed by ileotransversostomy, and a large drain was inserted. During the first few days there was a copious discharge of bile-stained fluid which caused maceration of the skin, but this ceased after ten days, and five daya later the abdominal wound was closed. In a discussion of the treatment of carcinoma of the right colon, the author cites European Statistics indicating a high operative mortality in complicated cases. He believes this may be greatly reduced by preoperative blood transfusion, repeated transfusions of 150-200 C.C. being considered preferable to a single large one. Spinal anedthesis should be used, and during the operation gentleness in handling the tissues is as important as accurate and firm suturing. Carcinoma in this site is not usually highly malignant, remaining for a long time localized in the bowel or invading only the immediately adjacent lymph nodes of the mesentery. There are no illustrations. F, CAVERS

Carcinoma of the Large Bowel as the Direct Cause of Acute Appendicitis and SimulAND D. B. ROSENTHAL.Lancet taneous Acute Intestinal Obstruction, G.E. PARKER 2: 1089-1090, 1933. The authors report two cases. In the first a slow growing symptomless carcinoma of the cecum had invaded and obstructed the appendix. The condition was masked by the fact that the patient did not come for treatment until the eighth day of the illnesa. Several weeks after removal of the gangrenous appendix and drainage of a retrocecal abscess, a tumor was palpated which was removed by ileocecal resection and proved to be a carcinoma of the cecum. I n the second case, operated upon on a diagnosis of acute appendicitis with obstruction, there was empyema of the appendix, the fecal fistula closed fourteen days later, but the patient was readmitted on account of obstruction, found a t a second operation to be due to an annular carcinoma of the transverse colon about ten inches from the hepatic flexure. F. CAVERS Diagnostic Criteria of Rectal Cancer, C. ROSSER. Am, J. Digest Dis. & Nutrition 1: 141-143, 1934. The author considers continued irritation to be a contributing cause of anal cancer. He states that on his service one fissure, four hemorrhoids, and nine fistulae are known to have undergone malignant degeneration after periods of from two to twenty years. I n an analysis of 100 consecutive cases of benign stricture, it was found that 67 per cent were of the type called “ proctitis obliterans,” commonly seen in the negro female. Twelve per cent of this series were obstructions following the injection of oil-containing solutions used in the treatment of hemorrhoids. Abstracts of six case histories aacompany this article as examples of errors in diagnosis W. 8. MACCOMB which are easily and no doubt not infrequently made. RoentgenologicFindings in Tumors of the Rectum and Colon, R. P. STURR. Clin, Med. & Surg. 41 :272-274, 1934. The author gives a detailed account of the various procedures in the roentgenological examination of the rectum and colon and discusses in some detail the various findings. W. S. MACCOMB Carcinoma of the Rectum, CLAUDE^ F. DIXON. Southwest. Med. 17: 370-374, 1933. General discussion containing nothing new. Progress in Rectal Surgery, C. GORDON-WATSON. St. Bartholomew’s Hosp. J. 41: 104110, 1934. The author recalls some extremely pessimistic opinions expressed by eminent surgeons during the second half of the nineteenth century concerning the prognosis of cancer of the rectum. To illustrate the progress made during the past quarter century in the effort to cure rectal cancer, he refers to the evolution of the technic of excision, the

THE DIGESTIVE TRACT

177

improvements in radiologic technic applied to diagnosis, the increase in knowledge regarding the hyperplasia-adenoma-cancer sequence, and the anatomo-histologic classification of these tumors. The technical difficulties in the radium treatment of rectal cancer are great, and the results, despite some brilliant successes, uncertain owing to the fact that adenocarcinomas vary considerably in radiosensitivity. In his own practice he limits the use of radium to borderline cases, with a view to rendering them operable, to early cases of anal carcinoma, and to operable rectal growths when radical surgery is contraindicated on general grounds. F. CAVERS Surgical Treatment of Carcinoma of the Rectum, CLAUDE F. DIXON. Proc. Staff Meet. Mayo Clinic 8: 333-334, 1933. In a brief review of surgery in cancer of the rectum the author emphasizes the importance of grading in determining the type of operative procedure and the prognosis. Malignancies of low grade Iend themselves well to simple posterior resection with its lower morbidity and mortality, while tumors of higher malignancy should be removed by the combined abdominosacrsl method to insure complete eradication of the lesion. At the Mayo Clinic the mortality of the former procedure dropped from 10 per cent in 1928 to 4 per cent in 1933. The importance of irradiation either as an adjunct to resection or for palliative reasons alone cannot be overemphasized. Dixon urges rectal examination as a routine part of every physical examination. THEODORE S. RAIFORD Choice of Operations for Cancer of the Rectosigmoid and Rectum, FREDW. RANKIN. Am. J. Surg. 24: 759-775, 1934. Rankin describes in detail his technic in the two-stage radical excision of cancer of the rectosigmoid and rectum. No routine measure, however, is adaptable to all cases. That there should not be a marked lowering in the operability curve seems most essential. The very fact that 46 per cent of the removed specimens show node involvement seems adequate reason for applying a technic which will extend the operative field beyond the local growth and the group of lymph nodes in immediate juxtaposition to it. The article is illustrated by several drawings of the operative technic. BENJAMINR. SHORE Indications for the Multiple-Stage Radical and Palliative Extirpation of Rectal Cancers, 0. GOETZE. Die Indikationen zur mehrzeitigen radikalen und palliativen Exstirpation des Mastdarmkrebses, Zentralbl. f. Chir. 61 : 1537-1543, 1934. In about one-third of the patients with cancer of the rectum, one-stage radical excision of the growth is possible; in one-third operations for relief of symptoms in the presence of inoperable growths are indicated; and in the remaining one-third radical excision of the tumors in multiple stages can be done. I n all cases careful preoperative preparation is necessary. This consists in blood transfusion, relief of obstruction by oolostomy, electrocoagulation of infected growths, and careful cleansing of the portion BENJAMINR. SHORE of the bowel to be resected. Two-Stage Operation for Cancer of the Rectum, 0. GOETZE. Zweizeitige Operationen beim Mastdarmkrebs, Zentralbl. f. Chir. 61 :.796-805, 1934. Goetze discusses the technic of the two-stage abdominosacral operation for cancer of the rectum in individuals in whom the one-stage operation is contraindicated. Among the more common contraindications to one-stage resection are partial or complete ileus, general debility, anemia, autointoxication from ulceration of the tumor, senility, and obesity. The srticle is illustrated by several drawings of the operative procedure. BENJAMINR. SHORE Synchronous Abdominal and Sacral Technic for the Radical Excision of Rectal Cancers. synchrone Verfahren der abdominosacralen Radikaloperation dea K. N ~ M E C Das . Mastdarmkrebses, Chirurg 6: 415-416, 1934. In discussing a paper by Kirschner (Chirurg 6: 233, 1934. Abst. in Am. J. Cancer 22: 447, 1934), Ngmec questions the priority of Kirschner’s claim to the technic there described. Bake; used the combined method for the resection of rectal cancers in BENJAMINR. SHOEIE Brtinn as early as 1925.

178

ABBTRAOTB

Cancer of the Rectum in a Patient Operated upon Three Years Previously for Breast . du rectum ches une malade oper4e trois ans auparavant Cancer, D. F ~ E Y Cancer d’un cancer du sein. Ablation du rectum. Excellent resultat maintenu depuis plus de trois ans, Bull, et mbm. SOC.nat, de chir. 59: 1430-1431, 1933. In 1927 a woman of forty-six was radically operated upon for cancer of the left breast with axillary node metastasia. Three years later she was operated upon for cancer of the anal canal. At the time of reporting, more than three years after the second operation, there was no sign of recurrence. Although the rectal tumor was not histologically examined, the author believes that it was a metastasis from the breast tumor. In ~ more probable that the rectal tumor had discussing the case, Hartmann said it w a much arisen independently. F. CAVERS Unusual Post-rectal Tumow, H. 8.MEADHI.Irish J. M. So. pp. 84-85, February 1934. A man of sixty had for about a year noticed pain starting in the left sacral region and extending down the back of the leg. Rectal examination revealed a smooth mass which pushed the rectum and bladder forwards. At laparotomy the pelvis WBB occupied by a rounded semi-cystic mass, which was ruptured during an attempt to remove it, creamlike msterial escaping. The tumor hsd passed through the sacrosciatic notch and part of it lay behind the hip joint. It was enucleated with difficulty. Histologically it consisted of fat-filled oells with a fibrous stroma; no tissue suggestive of mrcoma was F. CAVERE found.

Invagination and Prolapse of Huge Villous Tumor of Upper Rectum, E. M ~ R I E L . Volumineuse tumeur villeuse du haut rectum avec invagination et prolapsus, Toulouse med. 34: 673-678, 1933, This is a report of 8 large polypoid tumor of the upper rectum which became invaginated and prolapsed through the anus. Although the mass was successfullyreduced by steady manual pressure, the patient died six days later. Histologic study disclosed an extensive, benign, villous tumor of the rectum. WILLIAMJ. HOFFMAN Primary Carcinoma of the Vsrmiform Appendix, CHAS.A. VANCE. Am. J. Surg. 24: 854-862, 1934.

The author reviews some of the literature concerning primary carcinomas of the appendix and reports three cases of his own. There are no illustrations. BENJAMIN R. SHORE Carcinoma of the Appendix, R. RUTHERFORD. Brit. M. J. 1: 1119,1934. At laparotomy on a woman of thirty-five, on account of abdominal pain and vomiting, with resistance but not rigidity in the right iliac fossa, nothing abnormal was observed, but the appendix was removed. On slitting the latter open, a small apical thickening waa found, which was histologioally a carcinoma, not a carcinoid, consisting mainly of columnar cells. There were no extensions of the growth noticed, and the patient was well eight months later. There is one illustration. In a note commenting on this paper, R. C. Howard (Ibid. 1 : 1189, 1934) emphasiaes the importance of histologio examination of every organ removed from the abdominal cavit y . F. CAVH~RS

Newomas and Cardnoids of the Appendix, H. HELLNBIR.Neurome und Karsinoide des Wurmfortsatees, ZentraIbl. f, Chir. 60:2293-2302, 1933. Hellner reports 8 cases of true neuromas and 3 of carcinoids of the appendix. The latter are considered to be neuro-entodermal blastomas and are usually relatively benign, The owe histories and photomiarographs of the tumors are included. BENJAMINR . SRORE

THE BILIARY TRACT

179

THE BILIARY TRACT

h h a r y Carcinoma of the Liver, with Report of Case Successfully Treated by Partial Hepatectomy, A. L. ABEL. British J. Surg. 21: 684-700, 1934. This case report is preceded by a good discussion of the incidence, etiology, symptomatology, and diagnosis of primary liver cancer. A man of fifty-one had, a few days before examination, noticed a central abdominal swelling. Contrast radiography of the gastro-intestinal tract indicated the presence of a large tumor which displaced the body of the stomach to the left, the pylorus and first part of the duodenum upwards, the descending duodenum to the right, and the transverse colon and small intestine downwards. Laparotomy revealed a large tumor arising from the left lobe of the liver. Practically the whole of this lobe was removed, and the patient made a favorable recovery. He was in good health when seen seyen months after operation, but later he had a febrile attaok with slight jaundice. After recovery from this, examination showed marked liver enlargement with ascites. The tumor was an adenocarcinoma, probably of intrahepatic bile duct origin. There are four illustrations, and a good bibliography is appended. F. CAVEBS Acute Febrile Form of Carcinoma of the Liver, G. MOLINARI. La forma acuta febbrile del cancro del fegato, Riforma med. 49: 716-718, 1933. Without contributing anything new, the author reviews some reports by French and Italian writers of cases of primary and secondary cancer of the liver which had run a febrile and rapidly fatal course. The outstanding features of these cases are acute fever, rapid liver enlargement, and death within a few weeks. In some such cases there have been severe pain in the hepatic region, vomiting, and jaundice, while in others none of these symptoms has been noted. The severe pain may be attributed to the rapid stretching of the liver capsule. Fever, which occurs occasionally in cancer of almost any organ, has been attributed to infection or ulceration but neither of these complications has been found in the tumor in most of the cases coming to necropsy. In some cases the rapid onset of high fever in the apparently complete absence of other signs, apart from hepatic enlargement, has led to difficulty in diagnosis. The author suggests that in such oases exploratory laparotomy should be done, especially as this enables the surgeon to deal with hepatic abscess, which is the lesion most likely to be confused with this acute F. CAVERS febrile form of liver cancer. Melanosarcoma of the Liver, K. OSHIMA. Uber einen Fall vom Melanosarkom der Leber, J. Chosen M. A. 23: 710-716, 1933. Oshima reports a case of melanosarcoma in which the primary site of the tumor could not be determined in spite of careful examination. A woman of forty-one gave birth to a normal child and died a few hours later. Autopsy revealed many large tumor nodules in the liver, Some of the mediaatinal lymph nodes showed metastatic growth. As a result of the rupture of one of the metastatic deposits just under the capsule of the liver, hemorrhage into the abdominal cavity occurred. The recent labor probably had much to do with this fatal accident. HistoK. SUQIURA logically the tumor was a melanosarcoma. Lymphosarcoma of the Liver, C. STERNBERQ.uber Lymphosarkomatose der Leber, Wien. med. Wchnschr. 84:417-419, 1934. Sternberg reports the case of a thirty-two-year-old man who died seven weeks after the beginning of his illnesa of lymphosarcoma involving the liver, spleen, and kidneys. The lymph nodes were only slightly involved. Sternberg believes that in this case the original lesions were lymphadenomas and that the characteristics associated with lymphosarcoma represented malignant degeneration of the benign lesions. The article BENJAMINR. SHORE is illustrated with photomicrographs.

180

ABSTRAUTS

A Modlfied Mercuric Chlorid Reaction (Takata-Ara) in Cirrhosis and in Neoplasms of the Liver, MARTINP. CRANE. Am. J. M. Sc. 187: 705-710, 1934. The author discusses the mercuric chloride test on the blood serum as an aid in the differential diagnosis between cirrhosis and tumors of the liver. I n 21 cases of advanced portal cirrhosis there were 20 positive reactions in both blood serum and ascitic fluid. In one case of hemochromatosis the reaction was strongly positive. In 6 cases of secondary liver tumors the reaction was negative. As the test is positive only in advanced cirrhosis, it is therefore of little value from the standpoint of early diagnosis. BENJAMINR. SHORE A description of the technic is included. Primary Carcinoma of the Gall-bladder, V. NATH. Indian M. Gas. 69:7-9, 1934. A tall, emaciated Sikh was admitted to the Mayo Hospital, Lahore, with jaundice, ascites, and edema of the hands and feet. ,He was feverish and complained of pain in the right hypochondrium. The blood showed nopsrasites. Death occurred four days after admission. The fundus of the gallbladder contained a hard, infiltrating tumor, II squamous-cell carcinoma. No metastases were found, even in the bile-duct or adjacent lymph nodes. In a series of 129 gallbladder operations at Lahore, 92 showed gallstones; 11 carcinomas were found, but in only 2 of the latter were gallstones present. Of the 11 cancer cases, 7 showed metastases in the liver and one metastasis to the stomach. There F. CAVERS are three illustrations. Case of Carcinoma of the Gall-bladder Simulating Subacute Hepatic Necrosis, R. A. RATCLIFF. Guy’s Hosp. Reports 84:84-87, 1934. A woman of twenty-eight, with a history of syphilis treated ten years previously with novarsenobenzol, was admitted to the hospital on account of jaundice. There were slight enlargement and tenderness of the liver and spleen. During observation she had bruising of the right arm, nosebleeds, and increasing enlargement of the liver. The diagnosis considered most probable was subacute hepatic necrosis. Death occurred ten weeke after admission. Necropsy revealed carcinoma of the gallbladder with metastases in the liver, regional lymph nodes, the pouch of Douglas, and both lungs. F. CAVERS Rare Tumour of the GallBladder, F. W. WIOLESWORTH. Canadian M. A. J. 29:410-412, 1933. A woman of seventy-nine had noticed, about ten years ago, a hard, painless lump, the size of a walnut, in the right upper abdomen. About six months before hospital sdmission this had begun to increase rapidly in size and to be painful. Palpation revealed a large, irregular, roughly spherical mass extending from the epigastrium to the midaxillary line. The overlying skin was thinned, shiny, and blue, with evidence of beginning ulceration. The superficial part of the mass was aspirated and yellow sterile fluid withdrawn. At operation a polycystic mass was excised. A depressed thickened area was then observed in the peritoneum, having in its center a small ragged hole from which sticky fluid exuded, evidently from the gallbladder, which was closely adherent at this point. Cholecystectomy was done, but the patient died two days later. The wall of the gallbladder was found to consist chiefly of fibrous tissue, the mucosa being reduced to a few scattered patches of cubical epithelium. Scattered in the wall were numerous epithelium-lined spaces, as well as areas showing alveolar structure, the whole appearance of the wall suggesting compression and atrophy of the glandular and muscular elements. No mitotic figures or signs of invasion of the basement membrane were found, and the author considers the condition to be a form of proliferating glandular oholecystitis, producing a striking resemblance to a true neoplasm. There are four F. CAVP~RS illustrations.

Primary Myosarcoma of the Common Bile-duct, V. SCHUPPLER.Ein primtires Myosarkom des Ductus choledochus, Wien. klin. Wchnschr. 47:395-396, 1934. Schuppler reports the clinical characteristics and autopsy findings of a forty-threeyear-old patient with a large obstructing myosarcoma Originating in the wall of the

THE PANCREAS

181

common bile-duct. Death followed exploratory laparotomy. Histologic study of the growth showed it to be composed of bundles of spindle cells supported by a framework of connective tissue. The nuclei varied considerably in size and shape. The diagnosis of myosarcoma was made from these histologic characteristics. Only two other cases of primary sarcoma of the common bile-duct can be found in the literature [references not given], and in both instances the tumors were melanosarcomas. There are no illustrations. BENJAMINR. SHORE

Papilloma of Vater’s Ampulla, A. F. LANDfvAR. Papiloma de la ampolla de Vater. Operaci6n. Curaci6n. Con presentacibn de enfermo, Bol. y trab. SOC. de cir. Buenos Aires 18: 880-886, 1934. In his recent report of a case of adenoma of the ampulla of Vater, Christopher (Surg., Gynec. & Obst. 56: 202,1933. Abst. in Am. J. Cancer 19: 733,1933)collected from the literature 5 cases of benign tumors a t this site: 3 papillomas and 2 adenomas. The author reports a case of papilloma. Aman of forty-nine had for seven months suffered increasingly severe epigastric pain, with progressive jaundice, and had noticed that the urine was dark and the stool almost colorless. During this period he had lost about 14 kilos. The urine contained a considerable amount of bile pigment, with traces of urobilin; the stool was whitish and contained blood; and the liquid obtained by duodenal sound under radiographic control contained blood, but no bile constituents. The tumor was resected, and from its site and the columnar epithelium covering of the papillae appeared to have arisen by proliferation of the mucosa of the common bile-duct and Wirsung’s duct. There are five illusF. CAVERS trations.

THE PANCREAS Sarcoma of the Pancreas, M. BORTOLOZZI.Contributo allo studio del sarcoma primitivo del pancreas, Gior. med. d. Alto Adige 5: 868-875, 1933. A man of fifty-one fainted in the streetand was taken to a hospital, where he died a few hours later. He regained consciousness long enough to state that soon after serving in the war he had repeated attacks of hemoptysis, but had never had symptoms referable to the digestive system. At necropsy a large, diffuse tumor was found in the head of the pancreas, with nodules in the liver and the adjacent lymph nodes, also in the pleura on both sides. The histologic diagnosis of the pancreatic tumor and the metastases was short spindle-cell sarcoma, with a highly vascular stroma. There are two F. CAVERS photomicrographs. Case of Primary Lymphosarcoma of the Pancreas, H. Z. SALIH. Ein Fall von primarem Lymphosarkom in Pankreas, Zentralbl. f. Chir. 61: 990-992, 1934. Salih reports the case of a twenty-year-old patient who was admitted to the hospital because of increasing weakness and marked jaundice. Examination of the abdomen showed a firm, well circumscribed, fixed mass in the upper portion of the abdomen. Laparotomy disclosed a large tumor involving the entire pancreas, and a cholecystogastrostomy was done to relieve the jaundice. The patient died two weeks later because of insufficiency of the pancreas. Autopsy showed a tumor primary in the pancreas and without metastases to the liver, spleen, or other organs. Histologic study of the neoplasm showed it to be a typical lymphosarcoma. One roentgenogram of the abdomen BENJAMINR. SHORE following the administration of a barium meal is included. Purulent Cyst of the Pancreas, J. CUNY. Kyste du pancr6as B contenu purulent; marsupialisation, gu6risonJ Bull. et m6m. SOC.nat. de chir. 59: 1404-1405, 1933. A woman of forty-one had about ten years previously noticed a painless swelling centered around the umbilicus. After a recent attack of influenza the swelling had become larger and for the first time painful. At operation a large cyst of the pancreas was found, displacing the transverse colon downwards and causing compression and deformation of the duodenum. To facilitate resection, the cyst was punctured and a

182

ABSTRAUTS

large amount of pus issued. The ayst was marsupialiaed, and drainage tubes were kept in place for ten weeks owing to the ooeing of pus. Eventually the patient made a good F. CAVERS recovery. Large Cyst of the Pancreas, VIANNAY.Un cas de grand kyste du pancr6ss trait6 par l’excision partielle de la poche et la marsupialisation de la portion restante, Loire m6d. 47: 296-299, 1933.

A thirty-nine-year-old man experienced severe pain in the right hypochondrium, unaccompanied by any functional disturbance. Soon afterward a smooth, cystic tumor appeared in this region and steadily enlarged. The mass wa8 dull to percussion and was diagnosed as either a cyst of the pancreas or hydatid cyst of the liver. At operation a large, thick-walled pancreatic cyst was found, adherent to many neighboring structures. Most of the ayst was carefully dissected free from the surrounding organs and removed. The remaining portion was treated by marsupialiaation. WILLIAMJ. HOFFMAN RETROPERITONEAL AND MEBENTERIC TUMORS Retroperitoneal Cystic Tumors Arising In ResG of the Wolf3an Bodies, E. JUST. Zur Frage der aus Resten des Wolff nchen Kbrpers stammenden, retroperitoneaIen cystiachen Geschwulstbildungen, Deutsche Ztschr. f. Chir. 242 : 786-791, 1934. Just reports the case of a sixty-year-old woman with a large retroperitoneal cyst which measured 27 x 21 x 16 cm. There was a second cystic tumor lying on the upper pole of the flattened left kidney. These two growths, together with the kidney, were removed, and the patient made a satisfactory recovery. Histologic study showed the tumors to be cystadenomas, oomposed of sinucres lined with a dingle layer of cuboidal epithelium and supported on a framework of connective tissue. These tumors were considered to have been derived from remnants of the wolffian bodies. The article is R. SRORE illustrated by two photbgraphs and two photomiarographs. BENJAMIN Spindle-celled MesentericTumows,with Remarks on Similar Retroperitoneal Tumouh H, A. PHILLIPB.British J. Burg, 21: 637-649, 1934. The author points out that a term such as paramesenteric is required to include both retroperitoneal and mesenteric tumors. As these have a common anatomic relation to the peritoneum, all being subperitoneal, the ssme theories of developmental origin are applicable to them, and the actual pathology of the solid tumors is similar. Six tumors are reported, one located in the gastrohepatic ligament, one in the great omentum, and the remainder retroperitoneally. All showed spindle-cell structure. The two mesenteric tumors were diagnosed as fibromyxoma and fibromyomyxoma, the retroperitoneal growths as fibromyxoma, leiomyosarcoma (two oases) and fibrosarcoma. All these tumors are regarded as originating from unipotent mesenchymal rests. There are eight F. C A V E R ~ illustrations. Mesenteric Cysts, with the Report of a Case, D. Ross AND C. I. MEAD, Canadian M. A. J. 30: 262-264, 1934. I n a boy of eight years, with constipation and abdominal pain, a large tumor was found in the lower abdomen. At operatian a thick-walled cyst was delivered after puncture and aspiration of 800 0.0. of yellow liquid. This brought to view another smaller cyst in the left upper quadrant, which also had to be punctured. Enucleation of the cysts being impossible, owing to extensive adhesions, they were reseated with fourteen inchtw of small bowel and mesentery. The cyst wall contained muscle as well as fibrous tissue. In a small cyst situsted near the bowel there were circular and longitudinal muscle layers arranged as in the intestinal wall, while another cyst was intramural and was lined with intestinal mucosa, absent from the other oysts. The mesenteric cysts are believed to have arisen from remnants of intestinal diverticula present in embryonal life. There are five illustrations, F. CAVERS

THE FEMALE GENITAL TRACT

183

Dermoid Cysts of the Mesentery; TWOCases, L. UQELI. Due casi di cisti dermoidi del mesentere, Policlinico (sez. prat.) 40: 1534-1538, 1933. Two cases are reported in which the presence of a mesenteric tumor had caused very slight symptoms, the patients seeking advice mainly because of abdominal swelling. I n the first case the clinical diagnosis was calculous cholangitis. The cyst lay in the ileal mesentery and contained fat, sebaceous glands, and hairs. In the second case retroperitoneal echinococcus cyst was suspected: the tumor occupied the mesocecum and contained degenerated epithelium and a large amount of cholesterol. There are two illustrations. F. CAVERS T H E SUPRARENAL GLANDS

Multiple Neuroma of the Suprarenal Medulla, MASUMINISHINOIRI. Ein Fall vom multiplen Neurinom des Nebennierenmarkes, J. Chosen M. A. 23: 995-996, 1933. In a man of forty-one years, who died from pulmonary tuberculosis, there was accidentally discovered multiple neuroma in the medullary tissue of the left suprarenal gland. Altogether there were ten small nodules, composed of irregular bundles of nerve fibers. No neuromas, neurofibromas, nor any similar structures were found elsewhere in the body. K. SUQIURA T H E FEMALE GENITAL TRACT

Present Position of Surgery, Radium and X-rays in Gynaecology, H. H. SCHLINK. M. J. Australia 1 : 425-430, 1934. In the section of this paper dealing with tumors the author maintains that, except in selected cases of uterine fibromyoma, hysterectomy, unless contraindicated by the general condition of the patient or refused by her, is preferable to irradiation. Among other reasons, he mentions that he has removed three fibroid uteri which had been treated by radium and in which cancer subsequently developed. ‘ I Anyone who fully appreciates the number of degenerations to which fibromyomas are heirs will be very cautious in advising irradiation in place of the unequivocal curative method of surgery, which has the added advantage that the ovaries need not be sacrificed.” For cervical cancer the relative cure rate is about the same for surgery and radium. The author uses radium for all first, second and third stage cases, and in three to five weeks does radical hysterectomy. His histologic study of irradiated cancers has shown that radium action on malignant cells is very variable; sometimes local growth has been almost entirely eradicated, in other cases very little destruction of the cancer cells has taken place, while radium has had no effect whatever on cancer in the lymph nodes. In corporeal cancer, also, he uses preliminary radium and radical hysterectomy, except in old, feeble patients unable to stand the operation. F. CAVERS Use of Radium in Gynaecology, R. McG. SAUNDERS.Med. Press & Circ. 188:307-310, 1934. The chief indications for radium therapy in gynecology are for malignancy in the uterus, vagina, and vulva, and for simple lesions, such as angioma and pruritus, of the vulva. The author is Radium Officer a t King’s College Hospital, London, and his views on the treatment of cervical cancer in each of the four generally recognized stages are a8 follows. In Stage 1 hysterectomy following radium treatment gives a better chance of non-recurrence. Stage 2 cases may become operable following radium therapy, though if a patient survives for two years with radium alone recurrence is unlikely. In Stage 3 radium a t least spares the patient the toxic ill effects of the primary tumor and prolongs life. Stage 4 cases are perhaps better left untreated, since radium tends to hasten fistula formation. There are three illustrations. F. CAVERB

184

ABSTRAOTS

ProtractedRadfationof Gynecologic Carcinoma,HANS REICHENMILLER. Beobaohtungen bei Langzeitbestrahlungen gynibkologischer Karainome, Zentralbl. f . Gynlik. 57 : 105-108, 1933.

Following radium therapy by the Stockholm or Paris technic , Reichenmiller’s patients received protracted x-ray treatment according to the plan of Coutard. With alternating doses of 250 r units to the abdominal and 200 T units to the posterior field, therapy was continued until 3350 t units per field had been delivered. Aside from the skin reaction, the patients in good condition bore the treatment much better than those who were caohectic. The former suffered no gastro-intestinal or cardiovascular symptoms and even gained weight during the time of treatment. A moderate leukopenia appeared, which lasted about three months. The cachectic patients, on the other hand, showed a marked systemic reaction, and the tumor appeared refractory to radiation. Thirty cases have been treated by the method desoribed with the oonclusion that this method is of great value for the moderately advanced oases, but is to be rigidly avoided in those in poor general condition. The possibility of late radiation damage has not yet HOWARD C. TAYLOR, JR. been excluded.

Pelvic Roentgenography, Its Value as an Aid in Gynecological Diagnosis, JOHN HUBERMAN AND D. R. MISHELL. Am. J. Surg. 23: 243-247, 1934. The authors report 7 cases in which the correct diagnosis of various pelvic lesions was aided by roentgenograms of the pelvic organs taken after injection of COa into the peritoneal cavity and iodized oil into the uterus. This is not recommended as a routine procedure in all cases and does not supplant a good physical examination. Contraindications to this method of roentgenography are acute pelvic infections, a raw cervical surface with a purulent discharge, uterine bleeding, pregnancy, cardiovascular disease, and active tuberculosis. The article is illustrated with several roentgenograms and a photograph of a surgically removed specimen. BENJAMINR. SHORE Histopathologyof Epithelial Hyperplasia and Neoplasia of the Cervix Uteri, H.SCHMITZ, F. A, MCJUNXIN AND M. A, MACALUSO.Am. J. Obst. & Gynec. 27: 336-341, 1934. Serial sectioning of all amputated uterine cervices has demonstrated three significant changes whioh are present in advanced cervical cancer and sometimes in the absence of malignant changes. These concern the position and arrangement of the epithelial cells and the character of the stroma. In varying degrees these changes were present in 15 of 75 cervices removed for chronic cervicitis. Cystoplasmic changes consist of loss of differential characters, especially intercellular bridges, and lessened keratiniaation associated with a diminished reaotion to iodine. Irregularity in she and shape of the nuclei is seen in hyperplasia but is more pronounced in neoplasia. In the first stage of cervical neoplasia the typical mitoses assooiated with excess chromosomes are infrequent. By the method of serial sectioning the penetration of the stratified epithelium into abnormal locations may be accurately determined. Glandular epidermiaation was seen in 14 cervices, but was present in only 2 of those showing pronounced blastomatoid changes. In non-glandular areas the penetration of the squamous epithelium to an abnormal depth may be considered as an heterotopia. In this way epithelial pearls may form in both canoer and inflammation. Changes in the stroma surrounding cancer cells have frequently been studied in their relation to the grading of tumors and should be considered more often in connection with early neoplasms. I n 6 cervices showing other blastomatoid changes cells of the lymphocytic series had appeared in the stroma next to the proliferating epithelium. When, besides the anaplasia and hyperplasia of the epithelium, there is a stroma reaction like that of true epithelioma and in addition a penetration of the epithelium into abnormal locations, the authors are of the opinion that the epithelium has undergone malignant changes. The treatment should then consist of radical hysterectomy or radical radiation treatment. Two photomiorographs illustrate the article. BENJAMINR. SHORE

THE FEMALE GENITAL TRACT

185

Histologic Structure and Radiosensitivity of Cancers of the Uterine Cervix, H. O. KLEINE. Histologiseher Aufbau und Strahlenempfindlichkeit der Collumkrebse, Arch. f. Gyniik. 155: 96-99, 1933. From 1925 to 1928, 162 patients with cancer of the cervix were treated with radium in the Woman's University Clinic at Heidelberg.. In only a few cases were the radium treatments followed by a course of roentgen irradiation. Of 7 patients with adenocarcinomas, 2 have remained well for five years. Of 155 squamous-cell epitheliomas, 18 were well differentiated, 96 partially differentiated, and 41 completely undifferentiated. Of these 155 growths, 101 were early enough to be considered operable. Thirty-nine of the entire group of patients have remained well for five years. It is interesting that no patient with a completely differentiated growth is among those surviving five years. BENJAMIN R. SHORE Leucoplakia Cervicis Uteri and Early Carcinoma, J. HOFBAUER. Am. J. Obst. & Gynec. 27: 633-646, 1934. Hyperplasia of the squamous epithelium covering the vaginal portion of the uterus can be initiated either by repeated intraperitoneal administration of hypophyseal extracts or by intramuscular transplantation of bits of the anterior pituitary of beef. The best results in this direction were obtained in mature guinea-pigs by the repeated transplantation of the peripheral parts of the anterior pituitary gland. The proliferation of the squamous epithelium on the outer surface of the cervix manifests itself in these experiments by the remarkable development of epithelial prolongations which, in places, extend deeply into the connective tissue and glandular ducts. They bear a distinct resemblance to the phenomena occurring in leukoplakia. Attempts to produce cancerlike lesionsof the cervix by superimposing local inflammation, as by repeated local applications of from 5 to 20 per cent silver nitrate solution or of tincture of iodine upon the cervical lesions of guinea-pigs treated with hormones, yielded only negative results. It must be remembered, however, that the occurrence of spontaneous cancer development in this .ipeeies of animals is unknown. Pregnancy is associated in the human being. with hyperplastic and hypertrophic cha.nges in the anterior lobe of the hypophysis as a response to chorionic stimuli. The acquired constitutional predisposition of the multiparous woman to the development of cervical cancer during the early menopausal period may be defined as the result of a disturbance of balance between hypophyseal and ovarian activity, associated with altered conditions of their final receptor; the latter factor embracing both diseased cervical tissue which has been rendered vulnerable to cancer production by previous epithelial events, and reduction at this period of the natural resistance of the fibrous cervical tissue. In other words, it is the concurrence of 8. systemic factor intimately associated with the mechanism of cellular growth and metabolism, and of a local factor bound up with previous tissue changes, which apparently plays a predominant part in determining the liability of the uterine cervix to develop malignancy. Restoration of anatomically normal cervical epithelium represents the most valuable weapon for attack in the problem of prevention of cancer of the uterine cervix. BENJAMIN R. SHORE Advanced Carcinoma of the Cervix, with a Report of 166 Necropsies, C. A.BEHNEY. Am. J. Obst, & Gynee, 26: 608-614, 1933. Upon the basis of 166 autopsies performed upon patients dying with advanced carcinoma of the cervix Behney reviews the pathological details exhibited by the disease in its terminal stages. His discussion deals psimarily with the cause of death, the extent ofdisease,and the effects of irradiation. All but 4 per cent of the patients died of causes directly traceable to the malignant growth. In older patients the immediate cause of death was most frequently infection, while in the younger group, mechanical causes such as hemorrhage or ureteral obstruction were the lethal factors. The most common sites for metastases were the lungs and liver, and the frequency of secondary growth depended upon the anaplastic character of the tumor. Involvement of the pelvic sympsthetio nerves was demonstrated as a cause of pain, although it is believed that the interruption of impulses through these nerves may occasionally account for the spontaneous

186

ABSTRACTS

disappearance of pain. That extensive irradiation of advanced malignancy may be a source of danger was demonstrated by the presence of marked necrosis in three cases so THEODORE S. R4IFORD treated. There are three diagrammatic illustrations. The Symptom-Free Period in Cancers of the Uterus, F. STAHLER. Die symptomfreie Zeit des Gebarmucterkrebaes, Arch. f. Gyniik. 153: 561-570, 1933. A latent, relatively symptom-free period, averaging 2.7 months, before the disease became manifest was found in a study of 200 cases of carcinoma of the uterus. In this series 12.5 per cent of the patients had inoperable growths at the time of their first examination. The abstracted histories of 7 patients in whom carcinomas of the uterus were discovered accidentally are included. In all of these cases the extent of the disease led to the conclusion that the growths had been present for at least 4.75 months. There BENJAMIN R. SHORE are no illustrations. Uterine Carcinoma and the Skeletal System, E. PHILIPP. Uteruskarzinom und Knoch. ensystem, Deutsche med. Wchnschr. 60: 710-713, 1934. Skeletal metastases from uterine cancers by way of the blood stream are extremely rare .. In the course of a rather large experience the author has seen only five or six tumors in the long bones metastatic from uterine cancer. Involvement of the bony system from these growths is not rare, however, and may be of two types; (1) local erosion of the pelvis by direct extension of the tumor; (2) erosion of the sacrum or vertebral column by extension of metastatic tumor involving the retroperitoneal lymph nodes. Such local involvement of the pelvic bones occurs in about 15 per cent of patients with uterine cancers. The prognosis in these cases is unusually bad, and a fatal termination is to be expected fairly early, in spite of all forms of treatment. The article is illustrated by roentgenograms and a photograph of a gross specimen. BENJAMIN R. SHORE Carcinoma of the Cervix Uteri with Complete Procidentia, W. J. BOUKALIK. Am. J. Obst, & Gynec. 27: 620-621, 1934. Boukalik's patient was a thirty-three-year-old white woman with a squamous-cell carcinoma of the cervix uteri and procidentia. A biopsy specimen was taken and the growth was treated by inserting radium needles directly into it and by placing in the cervical canal a 50 mg. pack screened with 0.5 mm. of silver, 1.0 mm, of brass, and 1.5 mm. of rubber. The radium was allowed to remain nineteen hours, giving a total radiation of 1900 milligram hours. The patient has remained completely well for eleven and one-half years after treatment. The rarity of the association of carcinoma of the cervix and procidentia is probably dependent upon one or more of the following reasons. (1) Carcinoma occurs usually before that time of life when pelvic relaxation permits the development of procidentia. (2) By fixation of the uterus, carcinoma prevents relaxation and subsequent procidentia. (3) Free drainage and the lessened vaginal secretion that is present with procidentia diminish the chronic irritation that predisposes to carcinoma. (4) The cornification of .the cervical epithelium that is present in procidentia is believed by some to offer a barrier to the development of carcinoma. BENJAMIN R. SHORE Paracarcinomatous Changes in Cervical Carcinoma, A. BABES. Uber einige paraearsinomatose Veriinderungen bei Portiocarzinom, Acta Cancrologica 1: 13-21, 1934. The histological diagnosis of cervical cancer from material obtained at biopsy is often difficult or even impossible for the pathologist because the fragment of tissue removed does not include the actual carcinoma. In such cases the author relies on the presence of large collections of spindle-shaped epithelial cells in the basal layer of the epithelium. These have been described, though in very small number only, in normal epithelium also, under the term II pin cells" (Stijtzellen), and ascribed to degeneration. Their cytoplasm, which is reduced to a thin layer, stains intensely with eosin, the nucleus is spindle-shaped, very long and thin, and the cell boundaries are indistinct; neighboring cells are often connected by cell bridges.

THE FEMALE GENITAL TRACT

187

Babes regards these as vigorously growing young cells, rather than degenerated ones, since they penetrate both epithelium and underlying stroma, and calls the change which they have undergone a parasancerous alteration. For a more detailed description he refers to a previous article (Bull. Assoc. franp. p. 1’6tude du cancer 18: 280, 1929). Similar cells, except that their cytoplasm stains deeply with hematoxylin, have been described in cervical carcinoma itself by Lahm (Die klinische Bedeutung des mikroskopischen Vor- und Nachuntersuchung des bestrahlten Uteruscarzinom, Handbuch der gesamten Strahlenheilkunde, Biologie, Pathologie und Therapie, Vol. ii: Section 2. Edited by Paul Lazarus), who considers them of good omen, and Babes himself inquires cautiously whether they may not represent some sort of protective reaction. WM. H. WOGLOM

Cancer of the Body of the Uterus Complicating Pregnancy, A. J. WALLINGFORD.Am. J. Obat. & Gynec. 27: 224-231, 1934. In the ten-year period between 1921 and 1931 there were seen in the Gynecological Department of the Albany Hospital 477 cases of cancer of the uterus. One hundred and eighty-three, or 38.4 per cent, were in the body of the uterus, while 294, or 61.6 per cent, originated in the cervix. There were only 3 patients with corpus carcinoma below the age of forty years, while 19.7 per cent of the cancers of the cervix occurred under that age; 79.2 per cent of all cancers of the body of the uterus occurred after fifty years of age, while 50 per cent of the cervical cancers were found in patients under fifty. In spite of the frequency of cancer of the body of the uterus, only a small percentage of cases occur in the child-bearing age, which would account in a large degree for the infrequent association of pregnancy and carcinoma of the body of the uterus. During the last twenty-year period of the Gynecological Department of the Albany Hospital there have been four cases of cancer of the cervix and one of cancer of the body of the uterus complicating pregnancy. The latter case was in a thirty-five-year-old Italian woman with a diffuse adenocarcinoma of the body of the uterus which caused a spontaneous miscarriage during the fourth month of pregnancy. A panhysterectomy was done following the histologic study of the uterine curettings, and the patient has remained well for eighteen months after operation. The article is illustrated by a photograph of the uterus and photomicrographs. BENJAMINR. SHORE Carcinoma of the Cervix Uteri in Pregnancy and Labour, I. Wertheim’s Operation at Term, without Caesarean Section, C. OLDFIELD. J. Obst. & Gynec. British Empire 41 : 400-401 , 1934. 11. Wertheim’s Operation at Term, Preceded by Lower Segment Caesarean Section and Followed by Radium Treatment, A. M. CLAYE. Ibid. pp. 401-402. III. Wertheim’s Operation at Term, Following the Classical Caesarean Section Preceded by Radium Treatment During Pregnancy, C. BERKELEY.Ibid pp. 402-404. W.Normal Delivery at Term, Preceded by Radium Treatment During Pregnancy, A. W. W. VAN ROOY. Ibid. pp. 404-405. Each of these authors reports a case successfully treated by the method mentioned F. CAVERS in the title of his contribution to this symposium. Early Diagnosis and Treatment of Uterine Cancer, H. H. SCHLINKAND C. L. CHAPMAN. M. J. Australia 2: 476-482, 1933. Surgical and radiotherapeutic technics have now attained such a high standard of efficiency that it seems useless to expect much further improvement in the treatment of cervical cancer so long as patients continue to present themselves in an advanced stage of the disease. The authors advise radical prophylactic treatment of all suspicious cervical lesions, many of which justify endocervical enucleation. Out of nearly 1000 subtotal hysterectomies done by them, with such enucleation, for various diseases, they met with only one in which the residual cervical shell was the site of subsequent cancer. From the study of 970 cases of uterine cancer treated in their hospital, the authors draw the following conclusions. Although the five-year results of radium and operative treatment are much the same, the fact that the average cervical cancer takes about four

188

ABBTRACTS

years t o kill the patient shows that relative cure should be based on ten years of freedom from recurrence, and this is most likely to be achieved by operation preceded and followed by radium treatment. Preoperative radium usually reduces the size of the tumor and causes the disappearance of adventitious inflammatory induration, thereby making movable a tumor that was originally fixed. Radium can also eradicate sepsis, and is the best of all surgical antiseptics. Most of the postoperative deaths in the authors’ series, apart from those due to injury of the ureters and bladder, were caused by septic peritonitis, probably due in the majority of cases to previous latent infection from a necrotic tumor. Radium as used by the authors seemed to have no influence on cancer deposits in the lymph nodes, which were invaded in all their cases. In recent years the best results have been obtained with a dosage of 4000-5000 mg. hours. Histologic examination of uteri removed after irradiation showed that a dosage of 2000 mg. houra is not sufficient to kill all the cancer cells in even a relatively early and localized tumor. There are twenty-one excellent photomicrographs showing the features of precancerous ” lesions and early cancer of the cervix, and of the tissue changes following radium application. F. CAVERS ((

Early Clinical and Microscopic Diagnosis of Cervical Cancers, H. HINSELMANN.Frtihdiagnose und elektive Therapie des Collumcarcinoms. Die klinische und mikroskopische Frtihdiagnose, Arch. f. GynZik. 156: 239-244, 1933. Earlier diagnosis of cervical cancer has been made possible by the use of the colposcope. Close inspection of suspicious areas will often show whether the area is ulcerated or not and whether a productive epithelial lesion is present. Careful histologic study of portions of cervical tissue removed because of suspected carcinoma may eventually lead to the recognition of the changes present in that period of the disease between simple ulceration and the development of a true neoplasm. BENJAMINR. SHORE Hysterography in the Diagnosis of Uterine Lesions, C. B ~ C L ~ R L’hystBrographie E. dans le diagnostic des lesions intrauterine8 et des m6trorragies fonctionnelles, Bull. SOC.obst. et gyn6c. 22: 815-822, 1933. The author reviews his experience with hysterography, which he has employed in 125 caseB during the past nine years. He uses it only when no lesion is clinically observable apart from uterine hemorrhage. His series included 13 cases of carcinoma of the uterine body, 37 of surgical lesions of the uterus and adnexa, and 58 of ovarian dysfunction. He discusses the objections which some writers have urged against this method of examination, the chief being (1) risk of causing or lighting up infection, since the uterine body is generally infected in cases of cancer; (2) risk of pushing malignant cells through the fallopian tubes into the peritoneum; (3) risk of embolism due to penetration of the lipiodol through the vessels of the bleeding uterine mucosa. In the course of about 500 lipiodol examinations he has seen only two cases of infection; in both there was preexistent salpingitis. The risk of cancer call dissemination is largely theoretical, and would apply equally in cases of ulcerated gastric or intestinal cancer examined by contrast radiography. In 8 of the 13 cases with corporeal cancer there was occlusion of the tubal ostia (bilateral in 6 cases). In no case were signs of embolism observed. Hysterography enables division of cases of uterine hemorrhage into those with objective surgical lesions revealed by an abnormal uterine or tubal roentgenogram, and those with functional disorders and a normal uterine and tubal picture. In the former it indicates the site of an intra-uterine lesion, and facilitates diagnostic curettage. The author emphasizes the need for the latter, since the x-ray appearances alone can rarely justify a diagnosis of malignancy. After describing the appearances seen in verified oases of corporeal cancer, submucous fibroids, polypi, benign hyperplasia of the endometrium, placental retention, and oystic salpingitis, he discusses some points in the technic of hysterography, and advises that at least three pictures be taken, one frontal and two lateral. There are no illustrations. F. CAVERS

THE FEMALE GENITAL TRACT

.

189

Investigation on the Excretion of the Ovarian Follicular Hormone in Human Urine. II. Estimation of Hormone in Urine from Uterine Cancer, J. KOSAKAE, T. OHGA,AND S. OKAMOTO.Untersuchungen uber die Ausscheidung des Ovarialfollikelhormons im Harn beim Menschen. 11. Mitteilung. Hormonbestimmung im Harn von Gebfirmutterkrebskranken, Jap. J. Obst. & Gynec. 16: 299-310, 1933. This paper is based upon 10 cases of uterine cancer. In every case it was found that the Allen-Doisy test for the ovarian follicular hormone in the urine was positive, even in women who had passed the menopause. In cancer patients the excretion was irregular in amount but in general the quantity was not much more than that of normal females. After extirpation of the uterus the amount of the hormone in the urine was usually increased. These observations, especially in women who have passed the menopause, raise the question as to whether the excretion of the follicular hormone is dependent upon the presence of carcinoma or upon age of the patient. K. SUGIURA Treatment of Carcinoma of the Uterus, JOHNTASCHE, JR. Wisconsin M. J. 33 : 420-426, 1934. This is a general article concerning the treatment of carcinoma of the uterus as practiced in Weibel’s clinic in Prague. The standard operative procedures and irradiation technic are described in detail. No new material is added. BENJAMIN R. SHORE Considerationof the Radical Operation as the Preferred Treatment of Uterine Cancer, F. v. MIKULICZ-RADECKI. Die Radikaloperation im Rahmen der elektiven Therapie beim Collumcarcinom, Arch. f. Gynak. 156: 244-268, 1933. The author has studied 5,455 cases of carcinoma of the uterine cervix treated in eleven clinics from 1912 to 1926. Surgical and irradiation therapy was used as indicated in this group, with a five-year survival of 24.5 per cent. The author believes that surgical excision remains the method of choice for all operable carcinomas of tha cervix. Metastatic tumor cells, even in early case8, may be present in the parametrium and they are most easily removed by surgical excision. Abdominal and vaginal hysterectomies have been shown to give identical end-results when used in cases of the same type. However, since vaginal hysterectomy for carcinoma of the cervix carries with it a mortality of only 7.5 per cent and abdominal hysterectomy carries a mortality of 15 per cent, the former method is to be preferred. I n a small percentage of cases preliminary radiation will render inoperable growths operable. Some of the worst failures of treatment are seen following radium therapy of operable but radio-insensitive tumors; this leads the author to the conclusion that all operable cervical cancers should be removed surgically, leaving for irradiation only those which cannot be mechanically removed. The article is illustrated by several photomicrographs. Analyses of the cases studied by the author are given in tabular form. BENJAMINR. SHORE Does the Possibility of the Appearance of a Carcinoma of the Stump Justify the Giving up of the Supravaginal Hysterectomy, K. HEROLD. Berechtigt die Maglichkeit des Auftretens eines Stumpfkarzinoms zur Ablehnung der supravaginalen Uterusamputation? Zentralbl. f. Gynfik. 57: 108-113, 1933. , Various theories for the prevention of a carcinoma of the cervical stump after hysterectomy have been contradictory and not always successful in practice. Thaler believed, for example, that the development of a carcinoma was favored by removal of the ovaries, but Laborde maintained that extirpation of the ovaries tended to prevent such a carcinoma. In view of the known high incidence of carcinoma in parous women, complete hysterectomy has been advocated following any previous delivery. Others have recommended excision or cauterization of the cervix or examination by the colposcope and complete hysterectomy in suspicious cases. In Herold’s own series there were 3 cases of carcinoma of the cervical stump among 473 cases of supravaginal hysterectomy, an incidence of 0.6 per cent. Collected statistics indicate that among 12,273 cases of supravaginal amputation there were 80 cases of carcinoma of the stump, a frequency of 0.65 per cent. Study of the time of appearance

190

ABSTRACTS

of the cancer showed that 39 per cent appeared within the first three years, 11 per cent from three to five years, and 50 per cent after five years. This apparently indicates a special predisposition immediately after the operation. The incidence of 0.6 per cent of carcinoma of the cervical stump in Herold’s opinion does not counterbalance the increased mortality of the complete over the supravaginal operation. In addition, it must be remembered that a certain percentage of the cases of cancer of the cervical stump will be cured. Finally, there are certain other advantages in the preservation of the cervix, particularly in its creation of a more favorable biological setting for the vagina and for the prevention of vaginitis, which is common after the HOWARD C. TAYLOR, JR. complete operation.

Three Cases of ChemicalExtirpationof the Uterus, VAN VUGT. Een drietal gevallen van chemische uterusexstirpatie, Nederl. tijdschr. v. verlosk. en gynaec. 36: 297-300, 1933. van Vugthas used the method of chemical extirpation of the uterus by zinc chloride in three patients with cancer. In all three it was seventeen days before the dead tissue had entirely sequestrated. The treatment is not without its dangers-vesical or intestinal fistula formation and peritonitis-and therefore should be applied only when operation is impossible. In the discussion Plate described the clinical results of this treatment in 10 patients suffering from cancer of the uterus. Three again showed carcinoma within two to ten months: six were free from cancer from six months to five years after the treatment; one succumbed when being treated, and autopsy revealed peritonitis and bronchopneumonia. van Rooy remarked that the action of rinc chloride can be controlled by mechanical removal of the sequestrum eight days after the beginning of the treatment. van Vugt warned against the possibility of bleeding in suah cases. Artificial removal seems not necessary to him, since the wall of necrotic tissue prevents too strong an action of the zinc chloride on the healthy tissue. JOHANNES P. M. VOGELAAR What Can be Expected from Irradiation in Uterine Cancer, A. TOMMASELLI. Cib che si pud chiedere alla radioterspia nel carcinoma dell’utero, Riforma med. 49: 12861287, 1933. The author deplores the recent reawakening of controversy between surgeons and radiologists concerning the treatment of cancer of the uterine cervix, and concludes that in the best hands there is practically nothing to choose between operation alone, irradiation alone, and combined treatment, with regard to survival results. Most writers agree that corporeal carcinoma should be treated surgically. From the standpoint of treatment the author finds that the most radiosensitive cervical cancers are those showing high proliferative activity and more or less numerous atypic, monstrous and degenerated nuclei, while the radioresistant growths show few atypic and monstrous cells and nuclei and a higher degree of differentiation. However, quite frequently cervical cancers that are highly radiosensitive, as judged both histologically and from their rapid shrinkage on being irradiated, later show rapid extension and metastasis. The author advises Iaparotomy in every case of uterine cancer that is not obviously inoperable. If the tumor is operable, it should be removed and postoperative irradiation should be given. In borderline or doubtfully operable cases, which form the majority of those seen, the author again prefers surgery in order to remove as much as is possible or advisable of the malignant tissue, postoperative irradiation being given. In some of these cases, a short courae of radiotherapy may improve the prospects of operation. Finally, in inoperable cases radiotherapy holds out the only hope of palliation, even of five-year cure. F. CAVERS ‘

THE FEMALE GENITAL TRACT

191

Influence of Syphilis and Diabetes on the Radiosensitivity of Patients with Cervical Cancers, H. 0. KLEINE. Zur Frage der Beeinflussbarkeit der Strahlensensibilitiit durch Lues und Diabetes bei Radiumbehandlung von Collumcarcinomen, Arch. f. Gyniik. 156: 285-287, 1933. The association of syphilis and carcinoma of the cervix has been observed in 20 patients. In the group of 12 operable cases, there were 5 deaths, while 7 patients remain well, 3 for more than five years. No difference between the end-results obtained in these patients with syphilis and in those with carcinoma of the cervix without syphilis could be demonstrated from the study of this series. However, luetic alterations of the connective tissue of the body were apparently responsible for numerous complications following the use of radium. In this small series there were two vesicovaginal and two rectovaginal fistulae, one ulcer of the bladder, and in two cases marked damage of the rectal mucosa, necessitating a colostomy. During the same period of time only one vesicovaginal fistula was observed in the patients without syphilis. All of the luetic patients receiving salvarsan shortly before and after radium irradiation have remained well. This indicates that better results in cancer therapy may be secured by the combined use of arsenic and irradiation. The author suggests that in luetic patients smaller doses of irradiation may be used than in non-luetic patients. Diabetes was a complication in fifteen patients irradiated for carcinoma of the uterus. In those with cervical cancers this association appeared to be unfavorable, especially if the urine could not be made sugar-free a t the time of irradiation. On the other hand, for some unknown reason, early cases of carcinoma of the body of the uterus associated with diabetes did unusually well after irradiation. BENJAMINR. SHORE Radiation Therapy in Carcinoma of the Corpus Uteri, W. P. HEALY. Am. J. Obst. & Gynec. 27: 1-11, 1934. In 134 cases of carcinoma of the body of the uterus there was no mortality associated with either radiation therapy or hysterectomy. One hundred per cent of 14 patients with Grade I carcinomas and 87.5 per cent of 58 patients with Grade I1 carcinomas have lived for an unstated length of time regardless of the plan of treatment followed. This would seem to indicate that in these histologic types the disease remains localized in the uterus for a long time, and if the risk of hysterectomy is not unduly great, a cure may be obtained by this procedure. On the other hand, when operation is contraindicated, radiation may be carried out to advantage. Sixty-three per cent of the patients with true adenocarcinomas have lived for an unstated period of time after treatment. Fourteen of these patients received radiation therapy before hysterectomy and 57 per cent of these have remained well for an average of five years. In a group of 9 patients in whom hysterectomy preceded radiation, only 33.3 per cent have lived for an average of three and one-half years. It is believed that intra-uterine applications of. radium and, if feasible, roentgen ray therapy should precede hysterectomy in all cases of adenocarcinoma of the body of the uterus. In order to permit the full effect of radiation the operation should be delayed from four to six weeks. Postoperative radiation with radium applied in capsules throughout the length of the vagina and a cycle of x-ray treatments should be utilized as an additional precautionary measure from eight to twelve weeks after hysterectomy. A routine method suggested for the treatment of adenocarcinomas of the body of the uterus consists of a diagnostic curettage, implantation of radium capsules in the body of the uterus so as to give a dosage of 3,000 to 4,000 millicurie hours over a period of twenty-four to thirty hours, administration of 700 r units of roentgen radiation to the pelvis beginning two or three days after the termination of the radium treatment, and hysterectomy about six weeks later. The article is illustrated with several photomicrographs. BENJAMINR. SHORE

A Method for Biopsy and for Facilitating Insertion of Radium in Carcinoma of the Cervix, H. STRAUSS.Am. J. Obst. & Gynec. 27: 451-452, 1934. Strauss recommends the use of a loop on a high-frequency current for the removal of biopsy specimens from cervical cancers. This loop cuts out a piece of tissue of any

192

ABSTRACTS

desired sire, and seals as it cuts. When the procedure is properly done, the specimen is not coagulated to the extent that its value for microscopic diagnosis is impaired. I n preparing the cervical canal for the application of radium the author objects to the use of dilatation, as cancer cells may be actually forced throughout the adjacent tissue, blood vessels, and lymphatics. If the cutting of tissue for a biopsy is bad, forcible dilatation is worse. An endothermic loop has been devised for the purpose of coning out the endocervix, enabling one to insert a radium tandem with ease. This loop dilates as it advances and seals as it cuts. A photograph of this instrument is included. BENJAMINR. SHORE

Prevention of Infectious Complications in Radium Treatment of Uterine Cancer, D. DEN HOED.MBthode pour Bviter des complications d’infection pendant le traitement radiologique du cancer de l’utBrus, Bull. Assoc. franp. p. 1’6tude du cancer 22: 701-706, 1933. The author has investigated the bacterial flora in 194 cases of cervical cancer before and after preliminary weak radium dosage, as recommended by van Damme (Bull. d. 1’Assoc. franp. p. 1’6tude du cancer 20:4,117,1931. Abst. in Am. J. Cancer 15: 2990, 1931). These patients could be divided into four groups according to the presence or absence of hemolytic streptococci in fluid obtained from the ulcerated tumor, and the presence or absence of bactericidal bodies (((bactericide ”) in the patient’s blood as indicated by mixed cultures of the cancer fluid and the blood. The rzsults obtained are shown in a table:

Hemolytic streptococci Bactericide No.of cases !

Group 1

Group 2

Group 3

Group 4

Absent Present

Absent Absent 17

Present Present 41

Present Absent

109

27

Radium Cure [of Cervical Cancer], G. DE B. TURTLE.Med. Press & Circ. 187:417-418, 1933. The author briefly reports a case diagnosed clinically in 1914 as cervical cancer, considered inoperable, and given two radium treatments [dosage not stated] with an interval of two months. Soon after the second application vaginal examination revealed only scar tissue, and bleeding had stopped. The patient remained well for nineteen years, then complained of slight intermittent abdominal pain. A hard nodule was felt just outside of the cecum; this grew rapidly, and in a few weeks death occurred from intestinal obstruction.

THE FEMALE GENITAL TRACT

193

Since the author makes no mention of radiographic examination, operation, or necropsy, the nature of the second tumor, the chief point in this history, remains undetermined. F. CAVERS

Pyometra Following Application of Radium for Carcinoma of the Cervix, with Late Development of Adenocarcinoma of the Body of the Uterus, A. HIRSCH. Am. J. Obst. & Gynec. 27: 750-752, 1934. The case reported by Hirsch is that of a sixty-year-old patient who had been treated eight years previously with radium for a squamous-cell carcinoma of the cervix. The patient had remained well until recently, when she began to have symptoms relative to an enlarged uterus which was thought to contain fibroids. A panhysterectomy was performed. Examination of the specimen showed a pyometra with chronic metritis and an adenocarcinoms of the body of the uterus. The pyometra in this case was considered to be a sequel of the radiation treatment of the cervical cancer rather than as a part of the adenocarcinoma of the fundus. Only two other cases of adenocarcinoma developing in the fundus after irradiation for carcinoma of the cervix could be found in the literature. There are no illustrations. BENJAMINR. SHORE Two Cases of Cervical Cancer Treated by Hysterectomy Following Radium Therapy, P. PICARD AND E. OLRY. A propos des suites Bloign6es du traitement du cancer du col utBrin, Bull. SOC.d.’obst. et de gyn6c. 22: 676-678, 1933. The authors report two cases, treated in 1923 and 1924, in which hysterectomy was done after radium had been applied for a few weeks. In both cases the tumor had in this brief space shown regression under the radium treatment. I n one case the uterus was histologically examined, and the sections showed fibrosis, no tumor cells being found. Both patients were seen in 1933 and were in good health. From more recent experience the authors are convinced that a short preliminary period of radium treatment is advisable when operation has been decided upon, and they have been giving radium postoperatively as well. They give no information a s to F. CAVERS end-results, apart from the two cases here reported. Report of a Series of Cases of Carcinoma of the Cervix Uteri Treated Between 1922 and 1929 with Surgery, Radium and X-rays, F. A. MAOUIRE. M. J. Australia 1 : 647-652, 1934. Of cases of carcinoma of the cervix treated between 1922 and 1929 the author considered 76 suitable for study. Of the remainder, 7 could not be traced and 11 were discarded because no pathologic report was available. Of the cured patients, 5 were treated by hysterectomy, 3 by radium following hysterectomy, one by radium followed F. CAVERS by hysterectomy and deep x-rays. Prevention of Uterine Cancer, H. H. SCHLINK. M. J. Australia 1 : 267-268, 1934. The author states that many practitioners are apparently unable to recognize cervical cancers in the second stage; patients with such tumors have been frequently sent to him with a diagnosis of cervical erosion. He has great hopes of the routine use of colposcopy, combined with biopsy of suspected lesions. Among the letter, which may either play a direct etiologic r81e in the determination of cervical malignancy or conceal an early cancer, he enumerates infected lacerations, endocervical infections, residual cervix, leukoplakia; desquamated patches, papules, and polyps. F. CAVERS Histologic Study of Hemorrhage in the Fibromatous Uterus, C. SCARPITTI. Sul determinismo patogenetico del contegno emorragico dei fibromiomi uterini studiato attraverso le modificazioni del connettivo della mucosa, Ann. di ostet. e ginec. 55: 1037-1073, 1933. The author has studied the endometrium histologically in 18 uteri removed on account of fibromyomas, with a view to determining the mechanism of hemorrhage in these cases. From the findings, given in considerable detail, he concludes that in submucous

194

ABSTRACTS

fibromas the menorrhagia is caused by mechanical pressure erosion of the regenerating mucosa. The bleeding associated with intramural tumors is attributable to insufficient regeneration of the precollagenous reticulo-endothelial connective tissue network of the endometrium. This insufficiency is probably related to endocrine dysfunctioning of the F. CAVERS ovary. There are six illustrations. Interstitial Bleeding in Uterine Myoma, Z. v. SZATHMARY.uber interstitielk Blutungen in Uterusmyomen. Zentralbl. f. Gynak. 57: 215-218, 1933. During a fourteen-year period there were admitted to the University clinic in Budapest 2,746 patients with myoma. A review of the laboratory data on these cases has shown that in 141, or 10.4 per cent, there were signs of tissue necrosis, in 9 cases suppuration, and in 14 cases extensive calcification. The case which stimulated this study was that of a fifty-two-year-old woman in whom interstitial bleeding was so extensive as to threaten life. A fibroid had been known to be present for the previous twenty years, but an increase in its sire associated with pain in the lower abdomen had been noticed for only a few weeks. Examination showed the presence of a large tumor, reaching to the xiphoid, of elastic consistence and suggesting an ovarian cyst. The red blood cells numbered 2,800,000, the hemoglobin was 54 per cent. At oueration 2.500 C.C. of fluid blood were drained from the tumor before it could be removed from the abdomen. Later examination of the specimen showed the presence of an immense fibroid in the anterior wall of the uterus in whose center was a cavity measuring 15 by 19 om., partly filled by blood clots. Histologic examination showed an edematous, cellular fibromyoma with regressive changes. Although there is an extensive list of case reports on the rupture of veins on the outside of fibroids, this is the first report of serious bleeding within the tumor itself. This complication is, however, one more reason for believing that the so-called I ‘ benign ” myomas are in a clinical sense not without danger. HOWARD C. TAYLOR, JR. Conservative Surgical Treatment of Uterine Myomas, HAUPT. Zur konservativen Myomoperation, Arch. f. Gynak. 156: 86-89, 1933. From 1912 to 1932 520 patients with uterine myomas were operated on a t the University Clinic in Bonn. I n 78 cases, or 15 per cent, simple myomectomies were done, while in 442, or 85 per cent, radical hysterectomies were performed. The majority of the patients treated conservatively were under forty years of age, and 16 of the patients went through normal pregnancies after operation. Five patients were operated on during pregnancy, with miscarriage in three instances. One hundred and twenty-nine myomas were removed from the 78 patients treated conservatively, without a single death. Recurrences were noted from three to ten years after myomectomy in 9 cases, or 11.5 per cent. In selected cases myomectomy appears to be a suitable method for treatment of uterine myomas and carries a much smaller mortality than does hysterectomy. BENJAMINR. SHORE AND Surgery versus Irradiation in the Treatment of Uterine Fibromas, J. BERNARDBEIQ P. L ~ C L ~ R4 C propos . du traitement des fibromes ut&ins, Bull. SOC.d’obst. et de gyn6c. 22: 731-733, 1933. The authors consider that the method of treatment of uterine fibromas still remains an open question. Some radiotherapiats go so far as to claim nearly 100 per cent cures, but surgeons frequently have occasion to operate in cases previously irradiated unsuccessfully. The authors have tried radium, but have recently abandoned itb use, on the grounds that it is no more effective than x-rays, often causes the patient more pain than an operation, is less certain in its results, and carries a greater risk of ill effects on adjacent healthy tissues. They favor operation in the majority of cases, giving x-ray treatment only to patients who refuse surgery. In a recent period of twelve months, the authors treated 38 patients, and in 24 of these they operated for one or other of the following reasons: large sire of tumor, hardnew of tumor, coexistent adnexitis. In two cases the patients demanded operation rather

THE FEMALE GENITAL TRACT

195

than irradiation. In 12 of the 14 cases treated by x-rays‘the immediate results were good, in the sense that bleeding was arrested. The authors advise lipiodol filling in order to verify the absence of adnexitis before giving x-ray treatment. If a bleeding fibroma if soft and small, and the tubes permeable, there is practically no risk of adnexal infection. F. CAVERS

Uterine Fibroid6 and Radium. A RBsum6 of 370 Cases in Private Practice, A. 0. OLMSTED. Wisconsin M. J. 33 : 340-345, 1934. The chief indications for intra-uterine irradiation with radium are as follows : benign uterine hemorrhage; fibroid enlargement of the uterus producing symptoms; polypoid endometritis due to circulatory disturbances from overgrowth of fibrous and muscular tissue of the uterus; tumors not over 7 inches in diameter; continued bleeding after myomectomy; as a second choice for young or old patients refusing surgery. Contraindications are tumors exceeding 7 inches in diameter; rapid increase in size; pressure symptoms requiring immediate relief; associated pelvic pain; pedunculated tumors; tumors in young women who desire later pregnancies, and in nervous women with a cancerphobia, where the diagnosis is not absolutely clear; extended calcareous or cystic degeneration; pregnancy; associated neoplasms such as fundal carcinoma or ovarian tumor; the presence of other intraperitoneal lesions than the myoma which require surgical attention. Usually 1800 milligram hours of radium irradiation in patients over thirty-five years of age applied inside the uterus is sufficient to cause a menopause. It is given in divided doses with a day’s rest between applications. Eighteen of 370 patients were re-treated for return of the bleeding from two to twenty-eight months following the first irradiation. Two of the patients in this series subsequently had hysterectomies. The only death was of a fifty-four-year-old woman who had a cerebral hemorrhage four days after irradiation. BENJAMIN R. SHORE A Series of Myopathic and Myomatous Uterine Conditions Treated with Radium, H. K. PORTER.M. J. Australia 2: 614-620, 1933. The author has treated with radium 16 of 110 cases of uterine fibromyoma and 30 of 171 patients with menorrhagia. He obtained the best results in the cases in which no organic lesion was found. He has generally used 40 mg. radium, varying the dosage by varying the period of application. It was observed that patients previously treated by x-rays or operation often complained of an unusual degree of hemorrhage, and that curetted specimens of endometrium in these cases showed thickening of the vascular walls and infiltration of the muscle coats by fibrous tissue. The author admits that the number of cases treated is too small and the period of follow-up too short to allow of F. CAVERS conclusions as to results. Postoperative Mishaps in a Case Previously Treated by X-rays for Uterine Fibroma, KULIKOWSKA. Accidents post-op6ratoires chez une femme irradihe pour fibrome, Bull. SOC.d’obst. et de gyn6c. 22: 697-698, 1933. A woman of forty-two had been radiosterilized a t another hospital on account of a uterine fibroma which had caused abortion. Two years later there was severe metrorrhagia, and the attending physician packed the vagina and sent the patient to the author’s clinic. The uterus was soft and enlarged, and a submucous tumor could be palpated. Despite the gentleness used in manual examination, free bleeding occurred. A blood transfusion was given, and the abdomen was opened next day. About 100 C.C. of fresh blood were found in the uterovesical pouch, caused by rupture of the thin uterine wall during examination. The tumor was very friable and was riddled with hemorrhagic and necrotic cysts. After subtotal hysterectomy scarring was poor, owing to the thinness and brittleness of the abdominal wall, and removal of the sutures thirteen days later was followed by eventration. After reclosure of the abdomen and further blood transfusions, a good recovery was made. The author attributes these mishaps to the devitalization of the tissues of the uterine and abdominal wall caused by the action of the x-rays, and believes that the dosage had been too heavy. F. CAVERS

196

ABSTRACTS

Myoma Malignum, E. D. MITCHELL, JR. J. Tennessee M, A. 27: 46-48, 1934. The incidenoe of myoma malignum is given as about one per cent of all cases of fibroid tumors of the uterus. Complete surgical removal followed by x-ray therapy is W. S. MACCOMB advised by the author. A case report accompanies the article. MalignantMyoma of the Uterus, E. MOURQUE-MOLINES AND H. GUIBERT. Leiomyome malin de l’ut6rus, Bull. SOC.d’obst. et de gyn6c. 22: 704-705, 1933. A woman of fifty-six had passed the menopause a t fifty-three. Two years later metrorrhagia occurred, being almost continuous and acoompanied by colicky pain. The uterus was enlarged, mostly soft, irregular and mobile, but several small firm nodules were palpated. The patient agreed to total hysterectomy, proposed on the ground that severe postclimacteric bleeding may be attributed to malignant tumor unless the contrary can be proved. In addition to numerous small subserous and interstitial nodules, there was a large submucous nodule a t the fundus. Histologically all the tumors were myomas with definite signs of malignancy, atypical cells and nuclei and abnormal mitoses being frequent, while the tumor cells were infiltrating the endometrium. F. CAVIDRS Malignant Leiomyoma of the Uterus, Case Report, R. CILENTO. Alcune osservazioni sopra i tumori maligni uterini di origine muscolare, Sperimentale, Aroh. de biol. 87: ccx-ccxvii, 1933. A woman of seventy had an attack of colicky uterine pain which lasted several days and ended in extrusion from the vagina of a large red tumor. Histologically this consisted of cells varying greatly in form and size, some being pear-shaped or polygonal with a lobed nucleus, while others were giant cells with a large single, very deeply lobed nucleus. The author regards the tumor as a malignant leiomyoma, not an outspoken myosarcoma, though neither his description nor the four illustrations given seem to support this interpretation, which led him to refrain from doing hysterectomy. F. CAVERS Case of ‘‘ Myoma Rosso ’y of the Uterus, A. TADDEI.Su di un caso di I ‘ mioma rosso ” dell’ utero, Clin. chir. 36: 903-912, 1933. A woman of thirty had suffered for a week from generalized stabbing abdominal pain, most marked in the right lower quadrant and accompanied by fever. Rectal examination disclosed a hard, movable, smooth pelvic tumor. At operation a large myoma, intensely red, with liquid degeneration in the center was found. The author considers the necrobiosis to have been of circulatory origin. The article is illustrated by photomicrographs. JEANNETTE MUNRO Uterine Fibroma, with Positive Aschheim-Zondek Reaction, KULIICOWSKA. Un cas de fibrome mou, Bull. SOC.d’obst. et de gyn6c. 22: 687-888, 1933. In a woman of fifty complaining of menorrhagia and leukorrhea for two years, with increasing anemia and weakness, examination showed the uterus to be soft and enlarged to the size of fifth-month pregnancy. Although the latter could apparently be excluded, a positive Aschheim-Zondek reaction was obtained. Intravenous injection of anterior pituitary extract caused immediate transient contraction and hardening of the uterus. This confirmed the clinical diagnosis of soft fibroma, and total hysterectomy was done. There was a single soft edematous submucous fibroid, with considerable hypertrophy of the adjacent uterine musculature, the latter fact explaining the reaction to pituitrin. F. CAVERS Case of Bicornate Uterus with Fibroma, DUJOLAND A. VANSTEENBERQEE. Un cas d’ut6rus bicorne unicervical avec fibrome, Loire m6d. 47: 70-71, 1933. A woman twenty-eight years of age complained of leukorrhea and attacks of pelvic pain especially severe at night. Examination sliowbd a uterine fibroma, for which a subtotal hysterectomy was done, leaving the right ovary intact. On examination the uterus proved to be bicornate, with a single cervix; the fibroma had developed in the septum between the two uterine cavities.

THE FEMALE GENITAL TRACT

197

Uterine Fibroma and Pregnancy at Term, ALBERTOSAAVEDRA.Fibrome ut6rin et grossesse A terme, Progres m6d. pp. 1657-1661, Sept. 30, 1933. A fuller account of a case previously abstracted in Am. J. Cancer 21: 203, 1934. Case of Chorion Epithelioma of the Uterus Confined Entirely to the Myometrium, Diagnosed by the Zondek-Aschheim Test, J. BEATTIE. Proc. Roy. SOC.Med. 27: 1500-1501, 1934. A woman of thirty-one, after seven months of amenorrhea followed by irregular hemorrhage for four months, spontaneously expelled a vesicular mole. Menstruation recommenced seven weeks later with a cycle of fourteen days. Irregular and continuous bleeding then set in. The uterus was not palpably enlarged, but the right ovary was large and cystic. Tissue obtained by uterine curettage was normal. The AschheimZondek test was done four times. The reactions were strongly positive, except the third, which was weakly positive with undiluted urine and negative with a dilution of 1 :20. Following panhysterectomy the reaction became negative and remained so to the time of reporting, six months after operation. The endometrium was smooth and normal in appearance, but in the myometrium of the left cornu there was a small area of chorionepithelioma one inch in diameter, unconnected with the endometrial lining of the cavity. The cyst of the right ovary was lined by granulosa lutein cells. Dr. Blair Bell remarked that the case was notable for the variations in the AschheimZondek reaction. If the growth was not disturbed by the curette there must surely have F. CAVERS been some technical error in the third test. Chorionepithelioma,Treated with Radium Followed by Hysterectomy, R. M. BEACH. Am. J. Obst. & Gynec. 27: 782-783, 1934. Histologic study of the uterine curettings led to the diagnosis of chorionepithelioma seven and one-half weeks after the uterus of a twenty-one-year-old patient had been emptied of an hydatid mole. The patient was given an intra-uterine application of 3600 milligram hours of radium screened by 2 millimeters of brass and enclosed in 1 millimeter of rubber. An unstated amount of roentgen irradiation followed this. Six weeks after the radium application a panhysterectomy and bilateral salpingo-oophorectomy was performed. Histologic study of the uterus showed a small amount of residual chorionepithelioma. At the time of reporting the patient was perfectly well, eighteen months after operation, and there were no evidences of recurrent or metastatic tumor in the BENJAMINR. SHORE pelvis or lungs. The article is without illustrations. Chorionic Carcinoma, W. SALISBURY.Brit. M. J. 2: 916-917, 1933. Chorionic Carcinoma, J. H. HANNAN.Ibid. 2: 1046-1047, 1933. Salisbury’s patient, a woman of twenty-eight, gave a history of amenorrhea which began fourteen weeks previously and was followed in seven weeks by slight uterine hemorrhage and more recently by two floodings. The uterus reached a little above the umbilicus. Digital examination led to a diagnosis of vesicular mole, which was evacuated, together with a fetus of about three months. All the vesicles of the mole were of minute siae. The author advised hysterectomy, but the patient refused. She returned four weeks later on account of continued hemorrhage. The red cell count was 1,970,000,and after blood transfusion the author removed the uterus but, on account of the patient’s age, left the apparently healthy tubes and ovaries. Section of the uterus showed chorioncarcinoma. Hannan, commenting on Salisbury’s paper, points out that in every case of persistent uterine hemorrhage following the expulsion or removal of a vesicular mole the urine should be examined a t fortnightly intervals by the Aschheim-Zondek test. If the reaction is positive a t the end of four weeks following evacuation of the uterus, and the curetted material is suspicious, total hysterectomy with removal of tubes and ovaries is necessary to save life. This should be followed by intensive deep x-ray therapy.

F. CAVERB

198

ABSTRACTS

Quantitative Study of Pregnancy Reaction in a Case of Malignant Chorionepithelioma, K. TAKETOMI. J. Orient. Med. 20:99-104, 1934. Since chorionepithelioma always shows anterior pituitary-like hormone in the urine, Taketomi attempted to estimate this quantitatively in the case he reports. The patient was a young nulliparous woman of twenty. Assay with female mice showed 250 mouse units per C.C. Twenty days after supravaginal hysterectomy the Aschheim-Zondek K. SUQIURA reaction was negative. Coexistent Uterine and Extrauterine Endometriosis, G. DELLE PIANE. Su di un caso di adenomioma interno dell’ utero associato ad adenomiofibrosi esterna, Osp. magg. di Novara 10:257-270, 1933. A woman [age not stated] with a history of dysmenorrhea since the menarche had during the past two weeks had pain in the lower abdomen, with exacerbations on menstruation. The uterus was enlarged, with two tumors attached to it, one on the left and the other behind and above. At laparotomy a large, irregular left ovarian cyst was found, as well as a solid tumor lying between the leaves of the broad ligament. Total hysterectomy was done and the cyst was removed. X-ray treatment was given, and a t the time of reporting, six months after operation, there was no recurrence. The uterus was lined by normal-looking endometrium, but nests of endometrial tissue were found in the uterine musculature and left ovary. None of the sections showed signs of inflammatory changes. Nothing is said about the condition of the tubes. The author discusses the various explanations of the origin of adenomyomatosis (endometriosis), but while otherwise maintaining a noncommittal attitude, he does not think it is necessary to invoke a mullerian or wolffian rest derivation for this condition, 3’. CAVERS whether intra- or extra-uterine. There are ten good illustrations. Question of Radical Operation or Irradiation for Endometriosis of the Uterus and Rectum, H. ALBRECHT.Zur Frage der Bosartigkeit der Endometriosis rectouterina. Radikaloperation oder Bestrahlung? Arch. f. Gynhk. 155: 74-95, 1933. Albrecht has reviewed and tabulated 359 cases of endometriosis involving the pouch of Douglas and the rectum. Surgical excision in these cases is rather radical and carries with it a relatively high operative mortality. Roentgen or radium irradiation of the ovaries so as to produce an artificial menopauRe appears to be a more simple and less dangerous method of treatment. In cases in which a partial or complete stenosis of the rectum is present, a temporary colostomy may be necessary. For patients with isolated, relatively symptomless endometriosis of the pouch of Douglas the expectant form of treatment is recommended. BENJAMINR. SHORE Fibroma of the Broad Ligament, N. C. LAPEYRE AND H. ESTOR. Fibrome du ligament large, Bull. SOC.d’obst. et de gyn6c. 22: 771-776, 1933. The authors distinguish between autochthonous fibromas of the broad ligsment and fibromas which arise in the uterus or ovary and later become included in theligament. They report a case of the former type, in which a large, hard tumor extending nearly to the umbilicus was preoperatively diagnosed as ovarian because bimanual examination showed it to be separate from the uterus. It was removed with difficulty, and weighed 5 kilos. The uterus and ovaries were normal. Histologically the tumor was a myoma showing edematous change and aseptic necrosis. Most of these solid intraligamentary tumors evidently arise from muscle fibers occurring on the posterior aspect of the anterior layer. Clinically they are distinguished from uterine fibromyomas by the abeence of hemorrhage, but they are frequently mistaken for solid ovarian tumors. They have generally reached a considerable size at the time of operation, since in the early stages they give rise to few or no symptoms, inasmuch as they mostly extend upwards. They may, however, become pedunculated and cause symptoms, the stalk consisting of an hypertrophied fallopian tube. Solid tumors arising in the lower portion of the ligament, which are less frequent, tend to become incarcerated in the pelvis and may produce severe symptoms by pressure on neighboring F. CAVERS structures.

THE FEMALE GENITAL TRACT

199

Rhabdomyoma of the Round Ligament; Case Report, G. FIQURELLI. Rabdomioma del ligament0 rotondo, Riforma med. 49: 1017-1019, 1933. The author reports a rhabdomyoma of the round ligament in a girl of nine years. The child’s mother had noticed a swelling, the size of a large pea, in the right labium majus. The lump was located in the upper third of the labium, and was movable only in the transverse direction. At operation it was found to be encapsulated and attached to the lower end of the round ligament. Sections stained by van Gieson and other methods showed a reticular stroma of connective tissue containing in its meshes groups of immature muscle cells with faint cross-striation. The author points out that tumors found in the middle and lower thirds of the labium majus are of purely labial origin. There are three illustrations. F. CAVERS Histogenetic Classification of Carcinomas of the Fallopian Tube, L. CORNIL,M. MoSINGER, R. IMBERT AND R. HARVEY. Sur une classification histog6n6tique des 6pith6liomas tubaires, Gyn6c. et obst. 28: 561-574, 1933. The authors found 400 cases of primary tubal carcinoma in the available literature. They believe that this disease may often be overlooked, and emphasize that tubes removed for pyosalpinx should always be examined by a pathologist. In examining a series of tubes removed for various lesions in one year, they found two unsuspected cases of carcinoma and one benign wolffian tumor. They propose to divide tubal carcinomas into two main groups, according to their origin in normal or in metaplastic tubal epithelium. They distinguish two types of metaplasia, epidermoid and sarcomatoid. The former occurs in the papillary carcinomas and in the wolffian tumors, the cells tending to become flattened and arranged in overlapping onion-like masses, though not showing keratosis. In the sarcomatoid type the cells become fusiform, giving the tumor a pseudosarcomatous appearance. Since tumors of similar histologic types occur in the ovary, it is sometimes difficult to determine whether a tubal tumor is in reality primary or metastatic from an ovarian tumor. There is no difficulty when there is coexistence of a tubal and uterine tumor: the former is metastatic if the ostium is invaded and the tubal tumor is not of papillary type, while it is primary if the uterine tumor shows the papillary structure characteristic of tubal carcinoma. There are six illustrations. F. CAVERS Coexistent Carcinoma and Sarcoma of the Fallopian Tubes, J. LEURET. Epith6lioma et sarcome de la trompe utbrine, Ann. d’anat. path. 10: 1220-1222, 1933. This is a necropsy report, without case history. The patient died a month after laparotomy, at which both tubes were found to be greatly enlarged and adherent to the sigmoid and rectum. The condition was inoperable, since hard nodules were present in the mesentery and bowel, and there was also a hard right ovarian tumor. The tumor in the left tube was a solid carcinoma. In the right tube there were two tumors, one a small solid carcinoma and the larger one a spindle-cell sarcoma. The right ovarian tumor was a solid carcinoma, which had apparently metastasized to both tubes; while the intestinal and mesenteric tumors were spindle-cell sarcomas, evidently metastatic from that in the F. CAVERS right tube. There is one illustration of the gross specimen. Chorionepithelioma of the Fallopian Tube, T. BUNNAG AND C. BACHMAN.Am. J. Obst. & Gynec. 27: 276-280, 1934. The authors report the cam of a thirty-year-old patient who was admitted to the hospital because of a swelling in the lower abdomen and irregular menstruation of thirteen months’ duration. She had been pregnant twice previously. Examination of the abdomen showed a tender, movable, cystic tumor the size of a six months’ pregnancy in the left lower quadrant. There was also evidence of a small amount of free fluid in the abdomen. At operation a tumor involving the outer end of the left fallopian tube was found and removed with the uterus and other adnexa. A moderate amount of serosanguineous fluid was found in the peritoneal cavity, but there was no evidence of metastatic tumor. Histologic study of the excised neoplasm showed it to be composed of irregular masses and cords of tumor tissue, indisputably chorionepitheliomatous in

200

ABSTRAUTS

character. The patient made an uneventful postoperative recovery and has shown no evidence of recurrence after a very short period of time. A specimen of urine, collected after operation and preserved with a glycerine-phenol mixture, was tested by the Aschheim-Zondek method and was found to have a concentration of anterior pituitary hormone in excess of 250,000mouse-units per liter. In spite of lack of considerable evidence, it is believed by the authors that the growth in this patient was a true primary tubal chorionepithelioma, apparently arising as an ‘‘ orthotopic ” tumor a t the site of a previous tubal pregnancy. The article is illustrated by photoR. SHORE micrographs. BENJAMIN

Cysts of the Infundibulum and Ostium of the Fallopian Tube: Three Cases, G. JEANNENEY AND S. MAGNANT.Les kystes du pavillon de la trompe, GynBc. et obst. 27: 536-539, 1933. The authors briefly report three cases in which cysts were removed from the distal portion of the fallopian tube. These cysts may remain latent and are discovered only at necropsy or during operations such as hysterectomy or appendicectomy ; or they are found on clinical examination and are then mistaken for adnexitis or ovarian oysts; or they give rise to pain, generally due to pedicle torsion in the case of large cysts. The author’s first case clinically simulated appendicitis; in the second and third the tumor was clinically diagnosed as an ovarian cyst. These “ trumpet cysts ” are apparently always of wolffian origin, and are benign, though sometimes causing severe symptoms when they grow large and the pedicle undergoes torsion. There is one illustration. F. CAVERR Endocrine Effects of Certain Ovarian Tumors, EMIL NOVAK. Am. J. M. Sc. 187: 599-606, 1934. Certain tumors of the ovary, like tumors of other endocrine glands, are capable of highly developed endocrine function. The two most clearly defined types are the granulosa-cell tumors and the so-called arrhenoblastomata, the latter belonging to the group of testicular adenomata, most often of a typical variety. The granulosa-cell tumors exert a feminizing effect, through the production of theelin by the tumor cells, so that in older women, perhaps far beyond the menopause, they produce most often a hyperplasia of the endometrium associated with periodic bleeding (pseudo-menstruation), together with increased sise of the uterus. In the few cases seen in very young children, they have produced the syndrome of precocious puberty, with precocious menstruation. The arrhenoblastomata, on the other hand, have a definitely masculinising tendency, as might be expected from the fact that they apparently have their origin from undifferentiated epithelium in the region of the rete ovarii. Under conditions which are not clear, these cells, capable of development along either male or female lines, may sssume definitely masculine tendencies, as in the group of tumors under discussion. The relation of this endocrine cause of partial sex reversal to the general problems of intersexuality, sex differentiation, and sex reversal is obvious, although our knowledge on these subjects is still far from complete, Patients suffering from arrhenoblastoma present in the extreme instances not only such manifestations of defeminisation as amenorrhea and breast atrophy, but also such evidences of masculinization as a masculine type of hair distribution, deepening of the voice, and hypertrophy of the clitoris. Removal of the tumor brings about a regression of these symptoms. BENJAMINR. SHORE Malignant !?eoplasms of the Ovary. An Analysis of One Hundred and Fifty Cases, A. W. JACOBS. Am. J. Obst. & Gynec. 27: 257-260, 1934. During the eight-year period from 1924to 1931 inclusive, 150 patients with malignant diseases of the ovaries were admitted to the clinic and hospital division of the New York City Cancer Institute. The majority of these patients had already been treated elsewhere and were in a more or less hopeless condition. The youngest patient was eleven and the oldest seventy-four years of age. The three patients under twenty were eleven,

THE FEMALE GENITAL TRACT

201

sixteen, and seventeen years old respectively. Ascites was present in about 50 per cent of the cases, and the presence of tumor cells in the fluid was recorded in 2 instances. The duration of symptoms from the onset until the diagnosis was made varied from a minimum of one month to as long as three years, the average being nine months. In a series of 71 patients operated on, 12, or 15 per cent, lived from three to six years after the onset of symptoms; 31, or 45 per cent, less than three years; 28, or 40 per cent, less than one year. The average duration of the disease in this group was nineteen months. I n a series of 35 patients receiving no treatment the average duration of life from the onset of symptoms was sixteen months. Sixty per cent of this group lived less than one year, 25 per cent from one to two years, and 15 per cent from three to six years after the onset of symptoms. As radiation therapy was used in only a small number of cases, no conclusions regarding this form of treatment can be drawn. It is suggested, however, that closer cooperation between surgeons and radiologists in the management of patients with ovarian tumors may give better end-results in the future.

BENJAMINR. SHORE Malignant Tumours of the Ovary, C. E. D’ARCYAND L. K. KEATINQE.M. J. Australia 1: 652-660, 1934. The authors report 46 cases of ovarian cancer treated by deep x-rays alone or combined with surgery. All except 7 were operated upon. I n 6 cases exploratory laparotomy was done (in 4 with and in 2 without biopsy); in 15 cases the tumor was completely and in 16 partially removed; in 2 cases the condition was diagnosed as benign, but its malignancy was proved by subsequent recurrence. In 20 cases metastases were found a t operation. The 37 histologically examined tumors included 32 cystic and 4 solid carcinomas, and one carcinoma in a pseudomucinous cystadenoma. The authors give 1600 T to two anterior and two posterior pelvo-abdominal fields in doses of 200 T daily, through 2 mm. copper, a t 50 cm. distance, with 15 ma. at 200 kv. This course is repeated in three or four months, even if there is no clinical abnormality. If recurrence or metastasis occurs during or after this period, doses up to 24,000 T are given, through 3 mm. copper, the other factors remaining the same. If considered necessary, a third dose similar to the second is given three or four months later. The 46 oaae histories are briefly given, but the cases are too recent for assessment of results. F. CAVERS Review of a Series of Thirty Cases of Malignant Disease of the Ovary, F. A. MAGUIRE. M. J. Australia 1: 660-662, 1934. In the author’s clinic 30 cases of ovarian cancer have been treated since 1923; 7 patients are alive and well, 20 dead, 3 untraced. Short notes are given on 17 of the cases in which death occurred. The majority of the patients were seen in a late stage, with large tumors and considerable ascites. Two patients are alive and free from recurrence eight years after operation; a third regained weight and lived for three years before fatal recurrence. During the past five years operation has been followed by deep x-ray therapy. F. CAVERS Pathologic and Clinical Characteristics of Ovarian and Tuba1 Carcinomas, E. W. WINTER. Beitrag zur Pathologie und Klinik des Ovarial- und Tubencarcinoms, Arch. f. Gynak. 154: 374-383, 1933. Winter reports the case of a sixty-year-old woman from whom a tumor involving the right fallopian tube and ovary was removed. Histologic study showed it to be a primary ovarian carcinoma which had involved the tube by direct extension. Following the operation a Coutard series of roentgen irradiations was given over the pelvis through four portals, but in spite of this, when the patient was last seen, six months after operaBENJAMINR. SHORE tion, she was in extremely poor condition.

202

ABSTRACTS

Clinical and Histologic Characteristics of Mnlignant PseudomucinousAdenocystomas of the Ovarp, E. LATZKE. Beitrag zur Kenntnis der Klinik und Histologie des Adenocystoma pseudomucinosum ovarii malignum, Arch. f. Gyniik. 154: 574-590, 1933. Of 174 patients with primary ovarian cancers, 132 were operated on from 1921 to 1932 inclusive in the First University Woman's Clinic in Vienna. Histologic study of the tumors showed that 22 or 16.6 per cent were pseudomucinous adenocystomas. Two of these latter were so advanced as to be considered inoperable. The patients ranged in age from thirty to eighty, the greatest incidence being between forty and fifty years. Hemorrhage occurred in 9 cases and symptoms associated with twisting of the ovarian pedicle were present in 3 cases. Eight, or 53 per cent, of 15 patients followed for more than five years have remained well. In 7 of these only one ovary was involved; in 4 implantations on the pelvic peritoneum, bladder, and uterus were found at operation. The article is illustrated by several photomicrograehs. BENJAMINR. SHORE Solid, Large, Round-cell Carcinomas of the Ovaries, Z. VON SZATKMARY. Uber das solide grosse Rundzellencarcinom sog. Disgerminom des Ovariums, Arch. f. Gyniik' 153: 333-349, 1933. The author reports 5 cases of solid round-cell carcinoma of the ovaries. In three cases the patients had normal generative systems except for the tumor in one ovary, while in the other two patients there was marked hypoplasia of the uterus associated with the unilateral ovarian tumor. All of the growths were solid, partially degenerated, but nowhere cystic. Late metastases were not observed. Histologically the growths were characterized by sheets of large epithelial cells supported by a framework of loose connective tissue. The article is illustrated by several photomicrographs. R. SHORE BENJAMIN Free Metastases in the Peritoneal Cavity from Ovarian Cancer, W. M. DE VRIES. Uber freie Metastasen in der Bauchhbhle bei Ovarialkrebs, Beitr. z. path. Anat. u. 5. allg. Path. 93: 198-208, 1934. Microscopic study of the ascitic fluid removed from patients with ovarian cancer showed it to contain numerous small globules, the surfaces of which were covered with a single layer of epithelial cells. The author concludes from this study that tumor cells derived from ovarian tumors are capable of division and growth in ascitic fluid. The article is illustrated with photomicrographs. R. SHORE BENJAMIN Roentgen and Radium Therapy in Inoperable Ovarian Carcinoma, E. VOGT. Uber die Rbntgen- und Radiumbestrahlung der inoperablen Ovarialkarrinome, Med. Klin. 29: 1464-1466, 1933. The author believes that while operable ovarian tumors should always be treated surgically, laparotomy should be done also in apparently inoperable cases. If the condition is found to be quite inoperable, the surgeon should, as a rule, be content with removing the ascitic fluid and excising part of the tumor for histologic examination. In other cases he may be able to remove part of the tumor mass, or all of the primary tumor, even when metastases are present. This procedure facilitates irradiation. Latterly the author has been trying a combination of surgery, radium, and x-rays in borderline and frankly inoperable cases. Three or four weeks after operation he applies radium within the uterus, the usual dosage being 1800 to 2200 mg. hours. A few days later a full dose of x-rays is given. These radium and x-ray treatments are repeated at intervals of six weeks. Four cases are briefly reported, and although it is too early to permit conclusions, the author believes that the results will be better than those obtained in his earlier cases treated by x-rays alone. F. CAVERS

THE FEMALE GENITAL TRACT

203

Is Combined Chemical and Radiation Treatment of Certain Carcinomas Possible, J. VOIQT. 1st eine kombinierte chemische und Strahlenbehandlung gewisser Karzinome moglich? Zentralbl. f. Gynak. 57: 113-114, 1933. Voigt reports the use of colloidal silver preparation injected directly into the tissue of two inoperable carcinomas of the ovary. The injections and subsequent x-ray therapy were accomplished without serious effects to the patient HOWARD C. TAYLOR. JR. Theca Cell Tumors of the Ovary, P. J. MELNICK AND A. E. KANTER. Am. J. Obst. & Gynec. 27: 41-51, 1934. According to their clinical activity in altering the sexual characteristics of the afflicted person, there are three general types of ovarian tumors. The first consists of those growths arising from the rete ovarii or medullary tubules (tubular adenoma; adenoma tubulare testiculare of Pick; arrhenoblastoma of Meyer) which masculinize the patients, causing excessive growth of hair on the face, chest, and abdomen; deepening of the voice; masculinization of the facial expression; increase of the skeletal muscles and shrinkage of the breasts. The second group of tumors are those which arise from the granulosa cells of the follicles. These granulosa-cell tumors in either their folliculoid or diffuse form usually have a feminizing action, producing a glandular hyperplasia of the endometrium, more or less periodic bleeding from the uterus in postmenopausal women, and amenorrhea in younger patients. The third group is composed of those tumors which arise from the cells of the theca interna. These growths are of the feminizing type and, like the granulosa-cell tumors, produce glandular hyperplasia of the endometrium together with more or less periodic bleeding in postmenopausal women and amenorrhea in younger persons. Two cases of these theca cell tumors are reported. I n both instances they produced hyperplasia of the myometrium and endometrium and postclimacteric bleeding. Both of the tumors were composed of cells having the histologic characteristics of those of the theca interna. Apparently these tumors secreted theelin, but unfortunately they were both fixed in formalin before implantation experiments or blood and urine tests were made. The authors offer the suggestion that if, in a woman past the menopause who is bleeding, nothing of an etiologic nature is found in the systemic or local examination, and curettage proves barren, one should perform a colpotomy and examine the ovaries, in order that ovarian tumors be not overlooked. The article is illustrated by a photograph of a gross specimen and photomicrographs. BENJAMINR. SHORE So-called Granulosa-cell Tumors of the Ovary, VIKTORLISSOWETZKY.Zur Frage der sogenannten Granulosazelltumoren der Ovarien, Acts Cancrologica 1 : 84-100, 1934. R. Meyer classifies neoplasms of the ovary in 3 groups: (1) those originating in the germinal epithelium; (2) embryonal-teratoid tumors such as dermoids or pseudomucinous cysts; (3) combinations of the first two. Growths developing from the germinal epithelium are of special interest to both clinician and pathologist, as they almost always exert an incretory function which may be powerful enough to bring about fundamental changes in the organism. This group Meyer subdivides as follows: (a) the arrhenoblastoma, which converts female into male characteristics; ( b ) the dysgerminoma, a large-cell carcinoma of functional activities still undetermined; ( c ) the large group of so-called granulosa-cell tumors, which almost always elicit changes in the female characteristics (e.g., precocious development, menorrhagia, metrorrhagia, amenorrhea, enlargement of the breasts, and changes in the secondary sexual characteristics). These alterations have been referred to an overproduction of follicular hormone in the absence of that provided by the corpus luteum, a n explanation which easily accounts for the enlargement of the uterus and the hyperplasia of its mucosa that are so often observed. It is almost universally agreed that the granulosa-cell tumor does not arise from mature follicles, but from embryonal granulosa cells. Three varieties of the neoplasm are recognized: folliculoid, cylindromatous, and a diffuse or mixed type. The growth last mentioned, which is the most common of the three, causes the most difficulty in

204

ABSTRAUTS

diagnosis, because of its varied forms, and until the past few years many of them have no doubt been called carcinoma, adenocarcinoma, or sarcoma. Though granulosa-cell tumors have the morphological appearance of malignancy, they are clinically benign. They may occur at any age, but are more common in later life. They do not alter the shape of the ovary, are generally unilateral, of a size running from that of a cherry to twice that of a man’s fist, never pass beyond the boundaries of the ovary, and never involve neighboring organs. In the gross these tumors are encapsulated, rather soft, light yellow in color, and contain cysts of various size filled with a turbid and more or less gelatinous fluid which, in the larger ones, is often mixed with blood. The microscopic appearance is bizarre in the extreme. Isolated or contiguous masses and strands of cells of all shapes and sizes present a puzzling picture, and the diagnosis often alternates in the mind of the pathologist, between carcinoma and sarcoma. The diffuse growth of the cells and their polymorphous or spindle shape suggest sarcoma, but a closer study of s,ections from different parts of the neoplasm will eventually disclose a resemblance to granulosa cells and recall the development of the follicle. In one tumor of the 6 described in this paper the stroma seemed to be a product of the epithelium, a possibility that has already been discussed by other investigators. R. Meyer separates the granulosa-cell tumor from that described by Brenner, and called by him oiiphoroma with the intention of emphasizing its organoid character, though previously the two had been included in one group. Clinically they resemble each other, but microscopically the Brenner tumor is distinguished by the presence of cavities resembling follicles; the stroma is poor in nuclei and inclined to hyaline ohanges, while the epithelium is chiefly cylindrical and contains glycogen. As the granulosa-cell tumor resembles thyroid hypertrophy in its incretory relationships, the author suggests that it be called “ strums ovarii,” with the warning that it must not then be confused with teratoid growths of the ovary containing thyroid tissue, now incorrectly known as strums ovarii. WM. H, WoaLoM Morphologic and Functional Characteristics of Granulosa-Cell Tumors, H. 0. KLEINE. Die morphologische und funktionelle Eigenart der Granulosablastome, Arch. f . Gynak. 155: 168-184, 1933. The author reports the histories of 12 patients with granulosa-cell tumors of the ovaries. All of these tumors were relatively small and all were unilateral. Five were solid and the remaining 7 were cystic. The ovarian pedicle was twisted in 3 cases. Recurrences or intraperitoneal metastases were observed after operation in 2 cases. The 7 living patients have been observed for from two to twenty-one years and have remained in good health. The article is illustrated with geveral photomicrographs. R. SHORE BENJAMIN Hormonal Function of Granulosa-cell Tumors, H. DWORZAK AND K. PODLEBCHKA. Zur hormonalen Funktion des Granulosazelltumors, Arch. f. Gynak. 154: 441-448, 1933. Thickened, almost cystic hyperplasia of the uterine mucosa is one of the characteristics associated with granulosa-cell tumors of the ovaries. This relationship between ovarian neoplasms and the endometrium is probably dependent upon the production of hormones in the tumors. The authors report the case of a fifty-year-old woman from whom a tumor of the left ovary of unknown histologic structure had been removed elsewhere one year previously. A laparotomy was performed by the authors and a recurrent granulosa-cell tumor of the left ovary was removed. The patient received postoperative roentgen irradiation and has remained well without evidence of recurrence for eight months after operation. Although the nature of the first tumor removed is not known, the second was considered to be a recurrence. It is suggested that quick-section study of ovarian tumors be made in the operating room and more radioal procedures be carried out in the case of granulosacell tumors. The article is illustrated with several photographs. BB~NJAMIN R. SHORE

T H E FEMALE GENITAL TRACT

205

Granulosa-cell Carcinoma of the Ovary as a Cause of Postmenopausal Bleeding, with Discussions of Pathologic Physiology of These Tumors, E. NOVAK. Am. J. Surg. 24: 595-610, 1934. A cause of postmenopausal hemorrhage not generally recognized by surgeons and pathologists is granulosa-cell carcinoma of the ovary. While rather rare, this tumor is of great biological interest, particularly because the tumor cells produce folliculin, and thereby, in the postmenopausal patient, bring about a certain degree of rejuvenation in the uterus. Menstruation, or a t any rate a periodic bleeding, is re-established, and the uterus often is as large as, or larger than, its premenopausal size. Hyperplasia of the endometrium, is observed in these patients. Three cases of this type are reported, including one in which the tumor was of very small size, so that it caused no ovarian enlargement. This tumor proved to be of especial interest, not only because of its unusual histological structure, but because of the pathologic physiological effects which it produced upon the endometrium. The possibility of lutein-like transformation of the granulosa cells of the tumor is discussed as a possible explanation of the secretory changes seen in some of the endometrial glands. The article is illustrated with a photograph and several photomicrographs. BENJAMIN R. SHORE A Rare Form of Granulosa-cell Tumor of the Ovary. The So-called “ Lipoid Folliculoma ” of Leche, W. P. PLATE. Eine seltene Form eines Granulosazelltumors des Ovariums, das sog. Folliculome lipidique ” (LecBne), Arch. f . Gynak. 153: 318332, 1933. Also. in French, in Gynbc. et obst. 28: 42-58, 1933, and, in Dutch, in Nederl. tijdschr. v. verlosk. en gynaec. 36: 233-252, 1933. The author reports the case of a twenty-three-year-old patient with a history of metrorrhagia followed by amenorrhea. After removal of a tumor of the left ovary about 6 cm. in diameter, normal menstruation was restored. Histologic study of the tumor showed it to be composed of strands of cylindrical epithelial cells containing large amounts of fat. The diagnosis of granulosa-cell tumor, identical with the lipoid folliculoma of LecBne, was made. The article is illustrated with photomicrographs. BENJAMINR. SHORE

Case of Granulosa-cell Tumour in Both Ovaries with Metastases in the Corpus and Cervix Uteri, A. J. M. HOLMER.J. Obst. & Gynaec. British Empire 40: 1207-1213, 1933. Also in Nederl. tijdschr. v. verlosk. en gynaec. 37: 8-20, 1934. A woman of forty-nine sought advice because the previously normal cycle had for about a year been accelerated, being a t first completed in three weeks, later in two weeks, and finally passing into almost continuous hemorrhage. She had a distinct growth of hair on the face and her voice was deep and hoarse. The uterus and both ovaries were enlarged, and both tubes thickened and kinked, but no enlarged lymph nodes were seen, nor knots on the peritoneum, and the stomach appeared normal. Total hysterectomy was done. The normal tissue of both ovaries was largely replaced by yellow tissue, and there were similar masses in the uterus; the tubes showed only signs of old inflammation. The yellow tissue showed the typical structure of granulosa-cell tumor, with a strong tendency to luteinization. That the tumor was malignant is emphasized by a note a t the end of the paper, stating that the author had recently examined the patient and found extensive infiltration on the right and left sides of the pelvis, and that she had lost considerable weight in the preceding few months. The illustrations include eight good photomicrographs. F. CAVERS Brenner Tumors, R. FREUND. Zur Kenntnis der Brenner-Tumoren, Arch. f. Gynak. 155: 67-73, 1933. The author reports the histories of two patients with ovarian tumors containing areas of tissue characteristic of Brenner tumors. In the first case, that of a sixty-six-year-old woman, cells of the Brenner type were found in the wall of a large pseudomucinous cyst, while in the second case, in a fifty-seven-year-old woman, a small tumor of the Brenner

206

ABSTRACTS

type was found in one ovary which had been removed routinely with the uterus for adenocarcinoma of the corpus. The article is illustrated with photomicrographs. R. SHORE BENJAMIN

Genesis of Brenner Tumors, E. G. ABRAHAM.Zur Genese der Brenner-Tumoren, Arch. f. Gynak. 154: 565-573, 1933. The author reports the case of a fifty-eight-year-old woman from whom a large pseudomucinous ovarian cyst measuring 25 cm. in diameter and weighing 2550 grams was removed. Histologic study of the wall showed islands of cells typical of the Brenner type of tumor. The article is illustrated with two photomicrographs. R. SHORE BENJAMIN Brenner Tumors in the Walls of Ovarian Cystomas, Z. VON SZATHM~RY. Uber Brennersche Tumoren in der Wand grosserer Ovarialcystome, Arch. f. Gynak. 154: 390-414, 1933. The author reports 5 cases of Brenner tumors observed during the last fifteen years. In four of these cases the Brenner type of epithelium was found in the walls of large pseudomucinous cysts and in one case in the wall of a simple serous cyst. The histories of the patients and photomicrographs of the tumors are given. Brenner tumors of the ovary have been observed only 5 times among 1114 ovarian tumors studied histologically by von SzathmAry. They may be cystic or solid and in R. SHORE BENJAMIN general must be considered as benign. Report of a Case of Bilateral Ovarian Tumors of the Brenner Type, J. M. MAURYAND H. C. SCHMEISSER.Am. J. Obst. & Gynec. 27: 290-293, 1934. The authors report the case of a seventy-year-old colored woman with bilateral ovarian tumors of the Brenner type. The tumor of the right ovary was firm, irregular, bluish-white in color, measured 9 x 6 x 3 cm., and weighed 100 grams. The left ovary was converted into a round, fluctuating mass measuring 20 am. in diameter and weighing 3000 grams. Histologic study of both tumors showed them to be of the Brenner type, the one of the right ovary coming under Meyer’s Group A, composed of ‘‘ solid tumors of Brenner’s type with or without cysts,” while the tumor of the left ovary was classified under Meyer’s Group B, composed of “ cystomas with nodules of Brenner’s tumor in the margins, with and without pseudomucinous epithelium.” Accordmg to the authors this is the first case of bilateral ovarian tumors of the Brenner type to be reported in the literature. The article is illustrated by a photograph and photomicrographs. R. SHORE BENJAMIN Brenner Tumor of the Ovary,S. A. WOLFEAND S. KAMINESTER.Am. J. Obst. & Gynec. 27: 600-603, 1934. The authors report the case of a forty-one-year-old woman in whom a small solid tumor of the Brenner type was accidentally discovered in the left ovary removed for chronic inflammation. The article is illustrated with three photomicrographs. R. SHORE BENJAMIN Cured Case of Arrhenoblastoma Followed by Pregnancy. Hormonal Active Tumors of the Gonads, E. SEDLACZEK.Geheiltes Arrhenoblastom mit nachfolgender Schwangerschaft; gleichaeitig ein Beitrag iur Lehre von den hormonal-aktiven Keimdrtisengewachsen, Arch. f. Gynak. 153 : 276-295, 1933. An arrhenoblastoma of the ovary was removed from a seventeen-year-old patient with a deep voice, male distribution of hair, and hypertrophy of the clitoris. After operation the patient began to menstruate and the masculine characteristics gradually disappeared. The patient was married four years later and went through a normal pregnancy. She is now living and well six years after operation. The author has been able to collect from the literature 27 ovarian tumors associated with masculiniaation; 11 of these were typical arrhenoblastomas, 6 atypical tubular testicular adenomas, and 2 typical tubular testicular adenomas of Pick. In the remain-

THE FEMALE GENITAL TRACT

207

ing 8 cases the exact nature of the tumors& not known. The return of feminine characteristics after surgical removal of these growths is as typical as the masculinization associated with them. Menstruation usually returns in about four weeks after operation and remains normal. In 5 of the cases studied normal pregnancy followed the removal of the growths. The article is illustrated by several photomicrographs. The important characteristics of the 27 cases collected from the literature are included in tabular form. BENJAMIN R. SHORE

A Defeminizing Tumor, G. W. PHELAN.Am. J. Obst. & Gynec. 27: 748-750, 1934. Phelan reports the case of a twenty-year-old woman with male distribution of hair, a coarse, distinctly masculine voice, male distribution of fat, but a distinctly feminine skeletal system. The hair on the face was of such an amount as to necessitate shaving three or four times a week. The patient had never menstruated and had been married for two years without becoming pregnant. A pelvic examination showed a well formed vagina, a markedly hypertrophied clitoris, and a solid tumor in the left ovary. The latter growth was removed surgically. The subsequent course of this patient was remarkable. Six weeks after being discharged from the hospital she began to menstruate and four months after operation she became pregnant. The hair on the body became much finer in texture and that on the face decreased markedly in amount. The voice gradually softened, though a t times it is still harsh. There has been no change in the clitoris. The excised ovarian tumor was firm in consistency and measured 2.5 x 1.5 inches. Histologic study led to the diagnosis of arrhenoblastoma. The article is illustrated with two photomicrographs. BENJAMINR. SHORE

Ovarian Teratomata: Report of Three Unusual Cases, E. B. 2. MASTERMAN.St. Bartholomew’s Hosp. J. 41: 157-159, 1933. A report of three teratomas of the ovaries. On histologic examination these tumors were diagnosed as (1) squamous-cell carcinoma developing in the wall of a dermoid cyst containing sebaceous material and hairs; (2) multilocular pseudomucinous cyst, in one area of which there was a partly solid and partly cystic mass containing hair, teeth, and bits of bone; (3) solid teratoma containing fragments of bone, cartilage and ectodermal tissue. The second and third tumors showed no histologic signs of malignancy. There are two illustrations. F. CAVERS Ovarian Fibroma Associated with Retroversion of the Uterus and Posterior Colpocele, FULCONIS AND XICLUNA.Fibrome de l’ovaire; r6troversion uterine; colpocble postbrieur, Bull. SOC. d’obst. et de gyn6c. 22: 666-667, 1933. A woman of forty-four had had menorrhagia for two years, with increasing pain and latterly the passage of clots. The uterus was retroflexed and slightly prolapsed, and the left ovary enlarged. After posterior colpoperineorrhaphy the author opened the abdomen, ventrifixed the uterus, and removed a hard fibroma from the ovary. F. CAVERS ,

Sarcoma Arising in an Ovarian Fibroma, C. G. JOHNSON AND S. H. WILLS. Am. J. Obst. & Gynec. 27: 918-919, 1934. An ovarian tumor measuring 18 x 12 x 6 cm. was removed from a twenty-four-yearold patient. Histologic study of the growth showed it to be composed of connective tissue which in some places had undergone degeneration. The diagnosis of sarcoma arising in an ovarian fibroma was made. No follow-up of this case is given. The article is without illustration. BENJAMINR. SHORE Krukenberg Tumors of the Ovary, JAMES C. MASSON. Am. J. Obst. & Gynec. 27: 825-830, 1934. Krukenberg tumors of the ovary are usually bilateral, retain the form of the ovary, and are probably always secondary. Of the patients seen a t the Mayo Clinic with tumors of this type, and whose subsequent history is known, all have died of the disease.

208

ABSTRACJTS

Abstracted histories of five illustrative cases, photographs of gross specimens, and BENJAMINR. SHORE photomicrographs are included.

Krukenberg Tumor of the Ovary, M. V. ARMSTRONQ AND 8. A. WOLFE. Am. J, Obst. & Gynec. 27:908-910, 1934. The authors report the case of a fifty-year-old patient with a primary carcinoma situated at the pyloric end of the stomach and metastatic Krukenberg tumors of both ovaries. Propagation from the primary tumor was considered to be by retrograde lymphatic metastasis. Palliation only was secured by supravaginal hysterectomy and bilateral salpingo-oophorectomy. The article is illustrated with photographs and 'photomicrographs, BENJAMINR. SHORE Origin of Columnar Epithelium in the Graaflan Follicle and Its Relation to the Histogenesis of Ovarian Cysts, D. H. MACLEOD.J. Obst. & Gynec. British Empire 41: 385-389, 1934. The author remarks that, apart from the simple retention cysts, the nature of cystic tumors of the ovary cannot yet be considered to have been satisfactorily explained by any one of the various histogenetic theories that have been propounded. He gives an illustrated account of sections taken from various parts of the wall of a graafian follicle found in an ovary removed for multiple chocolate cysts, showing that the follicle may develop a columnar epithelium which may eventually give rise to epithelium-lined cysts. This epithelium appears to develop from the deepest layer of the granulosa cells. This finding is believed to support the follicular theory of the origin of ovarian cysts. F. CAVERS Differentiation of Hormonal Substances by Means of the Reid Hunt, AschheimZondek and Oestrus Reactions, Especiallyin Ovarian Cyst Fluids, H. 0.KLEINEAND H. PAAL. Die Differenzierung hormonaler Substanzen mittels Reid Hunt-Reaktion, Aschheim-Zondek-Reaktion und Oestrus-Reaktion, insbesondere in Ovarialcystenflilssigkeiten, Arch. f. Gynllk. 154: 147-160, 1933. Positive Reid Hunt reactions are obtained with hypophysin, adrenalin, and folliculin. This test has been found positive in the fluid from follicular ovarian cysts, pseudomucinous cysts, and dermoid cysts of the ovary presumably due to the presence of folliculin in the fluid. Benign and malignant epithelial ovarian tumors give a positive Reid Hunt and Aschheim-Zondek reaction, presumably due to the presence of the anterior pituitary hormone. The cases on which these conclusions were based are described in detail. BENJAMINR. SHORE Polycystic Ovariesin the Newborn and Early Infancy and Their Relation to the Structure of the Endometrium, M. SPIVACK.Am. J. Obst. & Gynec. 27: 157-173, 1934. In a series of thirty-six fetuses, newborn babies, and infants, follicular cysts of the ovaries were found in 39 per cent. Five of the newborn infants showed hyperplastic endometrium, an incidence of 14 per cent for the whole group. Coexistence of polycystic ovaries and hyperplastic endometrium was observed twice in the newborn group while polycystic ovaries in infants of three weeks and older were not associated with hyperplastic and hypertrophic endometrium. From this study it is concluded that there is no causative relationship between cystic follicles of the ovaries and the structure of the endometrium in the newborn and in infants. The article is illustrated by a series of photomicrographs. BENJAMINR. SHORE Conservative Surgical Treatment of Benign Cystic Ovarian Tumors, B. KRISS. Konservative Operation benigner, cystischer Ovarialtumoren, Arch. f. Gyniik. 154: 415420, 1933. During the past ten years follicular, dermoid, corpus luteum, and chocolate ovarian cysts have received conservative surgical treatment in the Gynecologic Division of the Wieden Hospital in Vienna. The cysts are enuclested with conservation of as much as is

THE FEMALE GENITAL TRACT

209

possible of the ovarian stroma. In 106 cases so treated there were 70 follicular, 12 dermoid, 11 tubo-ovarian, 5 chocolate, and 8 bilateral pseudomucinous cysts. I n 59 of these cases one ovary was normal, in 28 the ovary which did not harbor the cyst was chronically diseased, most often by infection, and was removed, and in 28 cases cysts of both ovaries were enucleated. Macroscopic ovarian tissue was left in 63 of the 106 cases. Five of the patients, one with cysts in both ovaries, treated in this conservative manner became pregnant, and 60, or 70.5 per cent, menstruated after operation. In only 3 instances was laparotomy necessary a second time for recurrence. BENJAMINR. SHORE

Lateral Incision for Approach to Ovarian Cysts Coexistent with Pregnancy, LE LORIER. L’incision laterale comme voie d’accf)s sur certains kystes de l’ovaire pendant la gestation, GynBc. et obst. 28: 535-536, 1933. Since median laparotomy for removal of an ovarian cyst during pregnancy may result in injury or displacement of the uterus and fetus, the author has latterly been making a n oblique incision, starting from near the right or left iliac spine, so as to pass behind the uterus and reach the pouch of Douglas, if necessary, with a minimum of trauma and uterine displacement. He has operated in this way in seven cases, selected because the size and site of the ovarian cyst could be determined with fair accuracy. F. CAVERS Ovarian Cyst and Preeclamptic Toxemia Complicating the Same Pregnancy, W. T. STACY. Am. J. Obst. & Gynec. 27: 299-301, 1934. The author reports the case of a twenty-eight-year-old patient from whom a simple ovarian cyst measuring 18 x 16 x 10 cm. was removed during the third month of pregnancy. The patient made an uneventful recovery from this operation, and the pregnancy went to full term. During the last month of pregnancy preeclamptic toxemia was a complication. BENJAMINR. SHORE Ovarian Cyst with Coexistent Tuba1 Pregnancy, J. BERNOT. Kyste de I’ovaire droit et grossesse tubaire gauche coexistent, Bull. SOC.d’obst. et de gyn6c. 22: 804-805, 1933. At operation on a woman of twenty-five for ruptured left tuba1 pregnancy there was found also a cystic tumor of the right ovary. The author did not remove the left ovary, F. CAVERS and two years later the patient had a normal pregnancy. Ovarian Cyst with Coexistent Acute Appendicitis, C. STOIANAND P. COSTESCO.Kyste tordu de l’ovaire droit et appendicite aigue, Bull. SOC.d’obst. e t de gyn6c. 22: 805-806, 1933. In operating on a woman of thirty for acute purulent appendicitis, the author also removed a right ovarian cyst, the size of a fetal head, with a pedicle twisted clockwise F. CAVERS through 360”. Good recovery ensued. Folliculoma of the Ovary, GEORGES MULLER. Folliculome de I’ovaire, Bull. de ~’ASSOC. franp. p. I’htude du cancer 23: 350-357, 1934. Muller’s patient was a woman aged forty-nine who began to menstruate after seven years of amenorrhea. The abdomen was enlarged, and a t operation ascites and a large cystic ovarian tumor with twisted pedicle were found. The tumor proved to be a folliculoma. The patient died on the eighteenth day with a pulmonary embolus. Four good photomicrographs of the tumor and a short bibliography are included. C. D. HAAGENSEN Mild Symptoms from Rupture of Follicle Cyst or Corpus Luteum, JEANP. PRATT. Am. J. Obst. & Gynec. 27: 816-824, 1934. The onset of pain in the lower abdomen during the middle or latter half of the intermenstruum in patients in the active reproductive age, especially if accompanied by tenderness over the ovaries, slight elevation of temperature, and mild leukocytosis, should suggest a diagnosis of peritoneal irritation from fluid from a ruptured follicle or

210

ABSTRAUTS

corpus luteum. The serious problem presented by these cases is the difficulty of distinguishing them from acute appendicitis. Owing to the seriousness of neglected appendicitis, operation is to be advised in all doubtful cases. Abstracted histories of ten BENJAMIN R. SHORE illustrative cases are included.

Ovarian Cysts Associated with Intestinal Obstruction: Two Cases, v. RICHEAND E. MOURQUE-MOLJNES, Occlusion et kyste de l’ovaire, Bull. SOC.d’obst. et de gynBc. 22: 769-771, 1933. (1) A woman of sixty, in whom a large ovarian cyst had been diagnosed some years earlier, was suddenly seized with abdominal pain, vomiting, and complete intestinal obstruction. Operation showed that the cyst pedicle had undergone two clockwise twists, causing in turn volvulus of the sigmoid. The ovary was removed. The colon was healthy, and recovery ensued. (2) A woman of forty-five had several times passed blood in the stool. She then noticed a tumor in the right lower quadrant, and shortly before entering hospital had two attacks of colic with obetruction. She had lost considerable weight. Laparotomy revealed blood-tinged ascitic fluid and a cystic ovary, which was as large as an adult head, multilocular, and adherent to the anterior abdominal wall, causing difficulty in removal. Examination of the distended bowel revealed a tumor in the sigmoid, which was resected and found to be an annular carcinoma. The patient died a few hours later. F. CAVERS Ovarian Dermoid Cyst with Positive Aschheim-Zondek Reaction, A. TIERNY.RBaction de Brouha positive dans un cas de kyste dermoide de I’ovaire, Bull. SOC.d.obst. et de gyn6c. 22: 669-672, 1933. A girl of fourteen years complained during one of her early menstrual periods of pain in the right lower quadrant, suggesting to the family physician a diagnosis of appendicitis. The pain passed off, but returned a t the next period. A tumor was felt in the lower abdomen, and the physician suspected pregnancy and believed this diagnosis proved when a positive Aschheim-Zondek reaction (as modified by Brouha) was reported by a pathologist. The perturbed parents sent the girl on a visit to country relatives, whose physician diagnosed right ovarian or parovarian cyst and sent the young lady back to Paris to consult the author. The latter confirmed this finding, and x-ray showed that the tumor contained two pieces of bone. On removal of the cyst the wall of the latter was found to contain two fragments of cranial bone covered by hairy scalp. I n the ensuing discussion Gernez elicited from the author that the ages and weights of the mice used in the test had not been recorded, and emphasized that the mice should be four or five weeks old or, if their age was unknown, should weigh not less than ten grams, otherwise the reaction could not be relied upon as a diagnostic method. He added that the method, whether done by the original Aschheim-Zondek technic or one of its various modifications, required considerable experience and extreme care in order t o F. CAVERS furnish a reliable result. Ascites or Ovarian Cyst, R. REMMELTS.Ascites of Ovariaalcyste, Geneesk. tijdschr. v. Nederl. Indie 73: 1282-1288, 1933. This is a clinical lecture in which the writer gives a short case history of an eighteenyear-old patient who after delivery was suffering from what seemed to be ascites. Laparotomy showed the existence of an ovarian cyst which was removed successfully. JOHANNES P. M. VOQELAAR The diagnostic difficulties are discussed. Ascites or Cyst of the Ovary? W. J. BAIS. Ascites of Ovariaalcyste? Geneesk. tijdschr. v. NederLIndie 74: 120-122, 1934. Bais reports a single case of pseudomucinous cyst of the left ovary in a twentythree-year-old Malayan woman, which apparently had developed during pregnancy. Twenty-one liters of fluid were aspirated and the cyst was successfully removed a t operation. Pregnancy apparently acts as a stimulant to growth of a latent cystoma. JOHANNES P. M. VOQELAAR

T H E FEMALE GENITAL TRACT

211

Torsion of an Ovarian Cyst in a Child of Five, R. M. GLASSON.M. J. Australia 1: 411, 1934. A five-year-old child was brought to hospital because on the previous day she had had a sudden attack of pain in the right groin and back, with vomiting. The right side was occupied by a large ovarian cyst with twisted pedicle, which was removed with difficulty. The wall of the cyst was black and its contents blood-stained fluid. F. CAVERS Tumors of the Urethra, C. H. PHILLIPS AND M. D. DOUGLASS.Am. J. Obst. & Gynec. 27: 99-104, 1934. Among the benign tumors of the urethra, caruncles are perhaps the most common. They are usually of the vascular type and tend to recur if they are not adequately removed. Fibromas of the urethra and true sarcomas have been infrequently described. True carcinomas usually follow leukoplakia or caruncles. From a clinical standpoint there seem to be two distinct clinical types of carcinoma in the female urethra. The first originates in the mucosa of the floor of the urethra, while the second begins as a para-urethral tumor which surrounds and occludes the urethra. The first type is extremely malignant, while the second tends to be slow growing with considerable fibrosis and hyalinization. Radical surgical excision followed by adequate plastic repair offers the only desirable method of treatment for carcinomas of the urethra. Radium is difficult t o apply and is extremely likely to cause an incurable vesicovaginal fistula. Abstracted histories of four cases and several photomicrographs are included BENJAMINR. SHORE Three Cases of Primary Carcinoma of the Female Urethra Treated with Radium, L. A. POMEROY. Am. J. Obst. & Gynec. 27: 606-613, 1934. Abstracted histories of three patients with primary carcinomas of the female urethra are given. The growths were all treated by direct implantation of radium and, although there was marked improvement in the local condition of one patient and moderate improvement in the others, all died within one year after the treatment. The article is illustrated with photographs and photomicrographs. BENJAMINR. SHORE Carcinoma of the Urethra During Pregnancy, C. M ~ L L E R Urethralkarzinom . in der Schwangerschaft, Zentralbl. f. Gynak. 57: 2314-2315, 1933. Also in Ztschr. f. Geburtsh. u. Gynak. 105: 462-485, 1933. Muller cites the case of a forty-seven-year-old woman in whom an ulcerating squamous-cell carcinoma of the urethral opening was found incidentally in the seventh month of pregnancy. The difficulty of treatment is stressed. Radiotherapy would endanger the life of the child while a radical operation would endanger the lives of both the mother and child and in all probability be of little avail in effecting a permanent cure. Muller advocates waiting two or three weeks before attacking the problem, then terminating pregnancy and treating the malignant lesion by radiotherapy. Frommolt in discussing the case emphasizes the extremely rapid growth of the lesion. In view of this Sachs feels that one would not be justified in waiting to start treatment and advises immediate termination of pregnancy with radical therapy of the carcinoma. THEODORE S. RAIFORD Carcinoma of the Perineum, H. GOECKE. Karzinom am Damm, Zentralbl. f. Gynak. 57: 117-119, 1933. Primary carcinoma of the perineum has not to the author’s knowledge been previously reported. His case occurred in a twenty-eight-year-old nulliparous woman, who presented herself at the clinic on account of discharge and bleeding. Examination showed on the perineum an ulcer penetrating rather deeply into the musculature of the pelvic floor. The lymph nodes in both groins were moderately enlarged. Histologic examination of a biopsy specimen from the edge showed a typical squamous carcinoma with cornification. The operation consisted of excision of the local tumor and dissection of both inguinal regions. Following operation, the patient received deep x-ray treatment, but ti re-

212

ABSTRACTS

currence developed in the region of the left pubic bone within a few months. The patient died not quite nine months after the first appearance of the tumor. HOWARD C. TAYLOR, JR. Multiple Neurinomas of the Vulva and Perineum, L. DI NATALE. Contributo allo studio dei tumori dei nervi periferici. (Neurinomi multipli svillupati lungo il nervo perineo-labiale posteriore), Arch. ital. di chir. 35: 289-302, 1933. After a brief discussion of the nomenclature and pathogenesis of tumors arising in the peripheral nerves, the author reports an unusual case of multiple neurinomas occurring in the left labium majus and adjacent perineum in a woman of thirty-four. These were small, hard subcutaneous nodules, very painful t o the touch. The nine tumors were resected from the left posterior perineolabial nerve. Histologically they showed the typical structure of Verocay’s neurinoma, consisting of isolated and mostly parallel fibers with nuclei arranged in palisade form. There are nine illustrations of sections stained in various ways, and a fairly good bibliography. F. CAVERS Rhabdomyoma of the Hymen, with the Report of a Case in a Child, A. C. EDWARDE AND A. L. RICHARDSON.Am. J. Obst. & Gynec. 27: 896-900, 1934. The authors report the case of a three-year-old girl with a primary rhabdomyoma of the hymen. Histologic study of a portion of the tumor showed it to be composed of hyperplastic bundles of striated muscle supported by a framework of connective tissue. There were focal areas of lymphocytic infiltration throughout the tissues. The condition was progressive in character, metastases to the retroperitoneal lymph nodes occurred, and the patient died eighteen months after the disease became manifest. Neither the primary growth nor the secondary retroperitoneal tumor was materially affected by extensive roentgen and radium irradiation. The article is illustrated with several photomicrographs. BENJAMINR. SHORE Myoma of Anterior Wall of Vagina, P. PETRIDIS.Myome de la paroi antdrieure du vagin, Bull. SOC.d’obst. et de gyndc. 22: 740-742, 1933. A woman of forty-six had about a year previously noticed a small lump a t the front of the vaginal orifice, which had grown to the siie of a pigeon’s egg. This was easily enucleated and found to be a solid leiomyoma. Myomatous tumors in this rather F. CAVERS unusual site have been reported as undergoing malignant change.

THE GENITO-URINARY TRACT Electro-surgery, Its Application to Urinary Pathology, W. S. PUQH. Urol. & Cutan. Rev. 37: 679-685, 1933. Pugh discusses the application of cutting and coagulating high-frequency currents in the field of urology. I n the course of his paper he presents very briefly, among other cases, a solitary cyst of the kidney treated by heminephrectomy and three cases of carcinoma of the bladder in which the tumor was cut away with the electrosurgical scalpel and the base thoroughly coagulated. GRAYTWOMBLY Treatment of Carcinoma of the Bladder and Prostate by Radium Implantations, R. J. SILVERTON.M. J. Australia 1: 776-783, 1934. After giving a short review of radium therapy in vesical and prostatic carcinoma, the author states conclusions arrived a t from his own experience. He believes that in bladder cancer endoscopic methods of surface application or implantation of needles or seeds are to be deprecated as being liable to great error in obtaining uniformity of dosage. Suprapubic approach, with a good self-retaining retractor and brilliant illumination of the cavity, is the best method of implantation, The protuberant parts of the tumor are removed by electrocoagulation until the growth lies flush with the mucosa, and needles are implanted all round the growing margin. I n prostatic cancer, absence of advanaed fixity of the growth is the first essential for radium therapy, also absence of lsteral spread beyond reach of the finger, and, of course,

THE GENITO-URINARY TRACT

213

absence of demonstrable metastases. Only by the open perineal operation can free access for needling be obtained to the region of primary growth spreading over the seminal vesicles. The blind method of direct perineal puncture for insertion of small needles or seeds seems to be futile. An alternative method is extravesical suprapubic approach, the prevesical space being opened and the needles embedded in the prostate without opening the bladder; but with this method it is difficult to be sure of even radiation of the rectal and vesical areas of the tumor. The author has treated 13 patients with prostatic cancer by open perineal access and radium needling. Of these, 4 are alive, 2 fifteen and twenty-four months afterwards; the other 2 have been treated more F. CAVERS recently. There are eight illustrations.

Large Cysts of the Left Kidney, E. JEANBRAU AND E. TRUC. Grands kystes du rein gauche, Arch. SOC.d. sci m6d. et biol. de Montpellier 14: 443-447, 1933. A woman of fifty-three had a palpable painless mass in the left flank. A pyelogram showed enlargement of the left renal pelvis, while the ureter was so displaced that it extended almost horizontally to within a centimeter of the spinal column and then downward. A roentgenogram of the gastro-intestinal tract showed displacement of the lower part of the stomach, while the lower portion of the tumor was outlined by the gas in the intestines. At operation it was found that the entire left kidney was cystic except for its upper pole, and nephrectomy was done. The inner wall of the cyst consisted of renal parenchyma markedly atrophied and sclerotic. Diagnosis of Perinephritic Cysts by Pyelography, E. JEANBRAU AND E. TRUC. Le diagnostic des kystes p6rin6phr6tiques par la pyClographie, Arch. SOC.d. sci. m6d. e t biol. de Montpellier 14: 377-381, 1933. A case is reported to illustrate the value of pyelography in differentiating between perinephritic cyst and renal tumor. The presence of perinephritic cyst is indicated by displacement of the kidney and deviation of the ureter from its normal course due to pressure of the tumor; sometimes the tumor itself is demonstrable. The renal pelvis shows no lesion, and renal function tests reveal no abnormality. Hydronephrosis with Multiple Calculi and a Carcinoma of the Pelvis, K. WALKER. Brit. J. Urol. 6: 159-161, 1934. A man of fifty had had periodic attacks of painless hematuria for nearly thirty years. During the past three months he had had a persistent dull ache in the left loin and frequency of urination. X-rays showed multiple calculi, including small facetted stones, in the periphery of the left kidney, and a large one lying in the pelvis. Excretion urography showed an apparently normal right kidney. The left kidney was removed and found to be large and hydronephrotic, with large cavities containing 75 small calculi. A tumor, necrotic in places, extended inwards from the pelvis, invading the parenchyma; histologically it was a squamous-cell cancer with *many cell nests. Probably the sequence of events was developmentof hydronephrosis, depositionof calculi, and carcinoma resulting from chronic irritation by the large calculus in the renal pelvis. There are two illustrations. F. CAVERS

Primary Carcinoma of the Ureter, T. R. BARRY. J. Tennessee M. A. 26: 334-339,1933. Barry found 63 cases of primary ureteral neoplasms reported, including his own, in 11 of which the diagnosis was made clinically. His patient was a man of fifty-nine, whose only symptom was pain over the right hip, radiating to the thigh. A roentgenogram showed a small shadow in the lower portion of the right ureter. The bladder was found normal on cystoscopy except for slight congestion at the right ureteral orifice. A ureteral catheter was passed by careful manipulation, yet no urine was obtained, but when the catheter was withdrawn, a small piece of tissue was found to be adherent to it, suggesting the possibility of ureteral tumor. A ureterogram showed definite filling defects in the upper and middle portions, and a diagnosis of ureteral neoplasm was made. A nephro-ureterectomy was done, and pathological examination showed the tumor to be

214

ABSTRACTS

a papillary carcinomit originating in the ureter and extending into the pelvis of the kidney. The patient died a month after operation from streptococcus septicemia. Among the 63 cases of primary malignant tumor of the ureter collected by the author, only one patient was reported living two and a half years after operation. There are five illustrations, including two photomicrographs and a bibliography.

Primary Carcinoma of the Ureter, W. W. SCOTT. Burg., Gynec. & Obst. 58: 215-227, 1934. The author reports two cases of carcinoma of the ureter, the first in a man of fifty-five, complaining of pain in the right side of the back and hematuria. At operation a right hydronephrotic kidney filled with bloody urine was found and removed. Two months later the ureter was removed with a portion of the bladder. It contained a papillary carcinoma 6 x 2.5 cm. with an implant in the bladder mucosa near the ureteral orifice. The patient recovered and was discharged from the hospital four weeks after the second operation. The second patient was a man of thirty-six who complained of a pain in the right thigh and foot for two years and recurrent hematuria for a year. Two years after the onset of symptoms he began to have severe pain in the right kidney region radiating to the groin; the right kidney was enlarged and the right ureter completely obstructed. A right nephrectomy waa performed and a hydronephrotic kidney filled with blood clots removed. The pain in the thigh increased and symptoms of intestinal obstruction appeared. At operation a metastatic mass was found to involve the transverse colon. The patient died two days later. Autopsy showed extensive papillary carcinoma of the lower two thirds of the right ureter with metastases. Scott abstracts in tabular form 61 additional cases of ureteral carcinoma from the literature, 44 operative cases being given in some detail. The average age in these cases was 55.7 years. The right ureter was involved with a slightly greater frequency than the left. The lower third of the ureter was involved in 57 per cent of the cases. The postoperative mortality in the series was 27 per cent. Of the 32 patients for whom complete follow-up data were available, only two were reported well more than five years after the operation. GRAYTWOMBLY A fairly long bibliography is appended. Aniline Tumors of the Bladder, A. M ~ ~ L L E R Ueber . Anilintumoren der Blase, Schweiz. med. Wchnschr. 15: 241-244, 1934. From 1901 to 1910 in the city of Base1 18 men, 6 of whom were aniline workers, died of bladder tumors. The dye must reach the body through the lungs and be secreted through the kidneys into the urine. The area of predilection for the tumors is at the base of the bladder and low down on the lateral walls. Histologically all forms of carcinoma are seen, varying from the papillary to the purely squamous. In five instances where the tumor involved the lateral walls of the bladder radical excisions were possible, and these patients have remained well for peiods of from two to eight years. Autopsies were done in 17 cases. Death in these cases was found to be due to ascending infection of. the urinary tract with gradual failure of kidney function. The author makes a plea for the early diagnosis and treatment of bladder neoplasms. There are no illustrations. R. SHORE BENJAMIN Curability of Carcinoma of the Urinary Bladder, E. 8. JUDD AND J. R. PHILLIPS. Proc. Staff Meet. Mayo Clinic 8: 413-416, 1933. Although involvement of retroperitoneal nodes from primary carcinoma of the urinary bladder has been observed in a few instances as well as occasional metastasis to the liver, in the majority of cases the disease will remain confined to the bladder for a long time, For this reason the authors are in favor of utilizing any radical procedure to eliminate the lesion. Four case reports are given. All the patients were men, the youngest thirty-five years of age and the eldest fifty-four years. I n all partial excision of the bladder was done. In two patients it was necessary to transplant one of the ureters. In one of these

THE GENITO-URINARY TRACT

215

cases nine years after the first operation a nephrectomy and ureterectomy were done for hydronephrosis and hydro-ureter with stones. All the patients are reported as being well and free of symptoms when last seen or heard from, twenty to twenty-two years after operation. W. S. MACCOMB

Treatment of Bladder Growths, K. WALKER. Post-Grad. M. J. 9: 444-447, 1933. The author recalls that there is a complete gradation from the innocent vesical papilloma to the highly malignant infiltrating carcinoma. Between these extremes there are tumors difficult to class as benign or malignant, not only clinically but also histologically. Moreover, in elderly patients it is only too likely that the type of neoplasm will change in the course of years, the recurrences after operation for simple papilloma approximating nearer and nearer to the infiltrating carcinoma. The author finds electrocoagulation the treatment of choice for all benign bladder tumors. For malignant tumors excision is preferable, but this is often impossible when diagnosis has been delayed until a late stage. Probably the majority of surgeons hesitate to perform such a drastic operation as total cystectomy, though if enough bladder wall can be left to allow of implantation of the ureters, partial resection can be borne by a patient who is not too worn out or in whom the cancer has not infiltrated surrounding structures. When excision is considered impossible or inadvisable, the best hope lies in implantation F. CAVERS of metal radon seeds. Apparent Cures of Papillary Carcinomata of the Urinary Bladder, J. J. VALENTINE AND J. W. ROGERS. New York State J. Med. 33: 1249-1251, 1933. The authors limit their discussion of papillary carcinoma of the bladder to 42 cases classified by treatment. Nine patients were treated by fulguration alone, and of these five were cured. Eight were treated by cystotomy with fulguration; none was cured but three were improved. Fifteen were treated by cystoscopy, fulguration, and radium, and of these only one was cured. Eleven cases were too advanced for any form of treatment. The authors conclude that the most satisfactory form of treatment of papillary carcinoma, if the tumor is not too large, is fulguration alone. Resection, when feasible, is next to be preferred. They believe that radium is of little value; that in low-grade malignancy the results are not appreciably better than with fulguration alone, while in widespread cancer it does not affect a cure. I n the only case given in detail by the authors in which radium was used, bare glass seeds containing a total of only 6.30 mc. were employed. [The methods used in many other clinics, giving more satisfactory results, involve the use of much larger doses with sufficient filtration to eliminate beta radiation.] GRAYTWOMBLY Irradiation and Electrosurgeryin the Management of Carcinoma of the Urinary Bladder, J. THOMPSON STEVENB. Radiology 22 : 99-104, 1934. Preoperative and postoperative x-ray irradiation is recommended for carcinoma of the bladder, in combination with cystotomy, fulguration, and radium implantation. Nothing new is suggested. GRAYTWOMBLY Case af Atony of the Urinary Bladder with Transverse Myelitis from Metastatic Prostatic Urol. & Cutan. Rev. 37: 632-634, 1933. Carcinoma, JOHN D. MACPHERSON. This is a report of a carcinoma of the prostate in a fifty-four-year-old man whose chief complaints were an anal fissure and a stiff, painful hip. The only urinary complaint was thinning of the stream. The stiffness of the hip had appeared some months before, but later improved and was followed by frequency and nocturia. A course of x-ray therapy was given. Four months later the patient returned to the hospital with paralysis due to spinal metastases. X-ray films showed involvement of the second, third, fourth, and fifth lumbar vertebrae by an osteoblastic process. The bladder was found to be disW. S. MACCOMB tended half way to the umbilicus.

216

ABSTRACTS

Recurrent Malignant Obstruction of the Prostate, Unrelieved by Prostatectomy, AND G. A. HOPKINS, Med. Ann. Treated by TransurethralResection, W. C . STIRLING District of Columbia 2: 200-203, 1933. Five cases of cancer of the prostate are reported, in 2 of which a prostateotomy had previously been done for hypertrophy. When obstruction due t o the malignant growth developed, this was relieved by transurethral resection. I n one of these cases carcinomstousBissue was found in the prostate after removal; in the other no carcinoma was found in sections, and the patient was free from symptoms for five years. I n the remaining 3 cases transurethral resection was done for urinary obstruction. In one of these the growth had extended posteriorly involving the rectum, and partially occluding it. I n another case, the patient complained of pain in the rectum, and a t a suprapubic operation following transurethral resection a cancer nodule was found attached to the rectum. In the latter case prostatectomy had been attempted, but the authors believe that this operation should not have been done, as it opened the prostatic lymphatics, and the patient died of carcinomatosis. The authors are of the opinion that in cases of urinary obstruction due to malignant disease of the prostate, transurethral resection is the method of choice to relieve the obstruction. A preliminary course of deep x-ray therapy may prove useful. I n those rare early growths limited by the prostatic capsule, implantation of radium needles or gold seeds by means of a suprapubic cystotomy, followed by resection, is the preferable technic. [No list of cures by this method is appended, however.] Carcinoma of the Prostate, N. J. HECKEL.Urol. & Cutan. Rev. 37: 535-537, 1933. A case of carcinoma of the prostate is reported in a man of forty years. The symptoms, due to metastasis to the first lumbar vertebra, developed before those referable to the urinary tract. The patient died some six weeks after cystotomy and radium treatment. W. S. MACCOMB Cancer of the Prostate with Left Supraclavicular Adenopathy, A. VALLI~E, CHARLES VEZINAAND FRANCOIS ROY. Un cas de cancer de la prostate avec adthopathie sus-claviculaire gauche, Bull. SOC.m6d. d. hSp. Universitaires de Qu6bec, pp. 284-286, September 1933. The author reports a case of carcinoma of the prostate in a man of sixty-five with metastatic involvement of the supraclavicular nodes on the left side. The autopsy findings are described. This form of node metastasis in prostatic cancer has been reported by others. Malignant Adenoma of the Prostate with Secondary Growths in the Vertebral Column AND T. R. HILL. British J. Surg. 21 : Simulating Pott’s Disease, W. E. C. DICKSON 677-683, 1934. A man of thirty with mqlignant adenoms of the prostate died in the hospital before operation could be done. The case presented the frequent and often confusing picture that may result from remote metastases of an undiagnosed primary malignant tumor, while the youth of the patient added to the diagnostio difficulties, diverting suspicion from the prostate. Metastases were found in the pelvic, the prevertebral abdominal and thoracic, and the deep cervical lymph nodes, and in the spine, the latter involving the bodies of the last cervical and first dorsal vertebrae and adjacent regions of the spinal column and ribs. The resulting collapse of the vertebral bodies produced a syndrome simulating Pott’s angular curvature, with compression of the cord, Froin’s syndrome with xanthochromia, etc. The bone metastases were completely osteoclastic, with no evidenoe of the osteoplastic process which has by some writers been regarded as characteristic of skeletal metastases from prostatic carcinoma. There are six illustrations. F. CAVERS

THE OENITO-URINARY TRACT

217

Leiomyoma of the Prostate; Case Report, D. R. MITCHELL AND J. L. BLAISDELL.Brit. J. Urol. 5: 381-383, 1933. The author believes his case to be the sixth of leiomyoma of the prostate reported. A man of sixty-two had prostatic symptoms for a year. Rectal and cystoscopic examination showed left lateral enlargement of the prostate, apparently benign. On opening the bladder a soft tumor was found projecting from this lobe, and a distinct line of cleavage allowed it to be shelled out intact. The tumor was 4.5 cm. in diameter and weigned 35 grams. It consisted of bands and whorls of smooth muscle fibers. There are two illustrations. F. CAVERS

Primary Benign Tumors of the Urethra; Report of Three Cases, J. A. LAZARUS.Urol. & Cutan. Rev. 37: 604-607, 1934. Primary benign tumors of the urethra have been classified as of epithelial and connective-tissue origin. I n the first group are polypi, papillomata, adenomata, and cysts; in the latter group fibromas, myomas, fibromyomas, and angiomas. The author states that tbe best treatment for polypi,. pap!llomata, and cysts is fulguration, and for larger tumors extirpation. Three case histories are included. W. S. MACCOMB Carcinoma of the Penis and Circumcision, W. KOUWENAAR. Carcinoma penis en besnijdenis, Geneesk. tijdschr. v. Neder1.-Indie 73 : 1539-1545, 1933. Kouwenaar cites statistics to show the frequency of cancer of the penis in the Far East. I n Madras out of 746 cases of carcinoma in men, 200 involved the penis, all in Hindus. In Lahore, where the number of Hindus equals that of Mohammedans, Sutherland found that of a total of 270 cases of cancer in men, 72 were penile; all of these were in Hindus, not a single Mohammedan being included. Out of 7692 cases of cancer in men observed in British India, according to Wolbarst, there were 1200 cases of cancer of the penis, of which 1169 were in Hindus and only 24 in Mohammedans, although the latter represented 21 per cent of the population. Statistics from other countries in the Far East show the same frequency. Le Roy des Barres found in Annam that 57 per cent of all the cancers in males were carcinoma of the penis. Heine’s statistics for China were 27.1 per cent. These various data are not comparable, however, since some are based on autopsies, others on operations, and still others on both. Failure to include inoperable cancers, as of the liver and stomach, tends to cause an overestimate of the frequency of penile cancer, but even allowing for this, the incidence is undoubtedly much higher in the East than in Europe. The disease would appear to be especially common among those people by whom ritual circumcision is not practised. The writer is of the opinion that phimosis is an important factor. Cancer of the penis is not rare among the Javanese. Sitsen found 9 cases among 74 cancers in Javanese, and there were 33 cancers of the penis among 423 cancers in Javanese studied in the Dutch Indian Cancer Institute. A comparison between Javanese and Chinese living on plantations under the same conditions and treated by thesame physicians is of interest. Among 225 cases of cancer in Javanese there were 10 cancers of the penis, while among 233 cases of cancer in Chinese there were 21 involving the penis. Of 52 caxicers in male Bataks 10 were of the penis. The writer gives the following list on the frequency of cancer of the penis in various groups: (a) (b) (c) (d) (e)

In circumcised Jews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .none In Mohammedan Upper India: . . . . . . . . . . . . . . . . . . .O-1.5 per cent I n Christian Europeans. . . . . . . . . . . . . . . . . . . . . . . . . . . .0.5-2 per cent I n Mohammedan Javanese. . . . . . . . . . . . . . . . . . . . . . . . . .4.4-12 per cent In Chinese, Hindus and Anamnites. . . . . . . . . . . . . . . . . . . .19-53 per cent

Kouwenaar believes that race differences are not important. Uncircumcised Jews may have cancer of the penis. In the southern parts of British India (e.g. Madras) are Mohammedans and Hindus for the most part of the same race and yet showing great differences in the incidence of the disease. The time a t which circumcision is performed would seem, as Wolbarst points out, to be of great importance; the sooner after birth this is done the less chance for the develop-

218

ABSTRACTS

ment of cancer. Jews are circumcised a few days after birth; by Mohammedans in British India circumcision is done during the first year; by the Javanese between the tenth and fourteenth years, except in West Java, where i t is done between the third and sixth year. These great differences may account for the vaned frequency of penile cancer among these classes. If a Javanese with phimosis is not ciroumcised until the tenth year there has been a sufficiently prolonged period of chronic irritation of the glans to result in cancer after a latent period. A short bibliography is added. JOHANNES P. M. VOQELAAR Epithelioma of the Penis of Rapid Development, J. GAT&,P. G. CUILLERETAND A. CHAPUIS. Epitheliome de la verge B Bvolution aigu8, Bull. SOC.frang. de dermat. et de syph. 40: 1069-1072, 1933. A man of forty-five had a recent chancroid with marked phimosis and enlargement of the inguinal glands. As the lesion did not heal under the usual treatment, a biopsy of tissue a t the base of the lesion was done, showing typical squamous-cell epithelioma. It was learned that the patient had noticed a small whitish plaque at this site abouta year previously, but it had caused no discomfort until the chancroid infection was acquired, after which it developed rapidly. Carcinoma of the Penis, H. W. MEYER. Ann. Surg. 99: 368-370, 1934. A fifty-year-old man was operated on in January 1929 for a prickle-cell epithelioma of the penis. Radical amputation was done, with implantation of the urethra into the base of the scrotum and dissection of both inguinal regions. The patient has been well and free from symptoms for over four years. There are no illustrations BENJAMINR. SHORE Tumors of the Testicle, A. PETERSON AND W. E. COSTOLOW.Urol. & Cutan. Rev. 37: 720-723, 1933. Forty-one cases of testicular tumors are presented in tabular form. The ages varied from sixteen to fifty-nine. Twenty-three of the tumors were classified as eeminoma (single-cell type) and 18 as teratorne (mixed-cell tumors). Thirteen patients are living and apparently free of disease from ten months to ten years following treatment by orchidectomy and radiation, 5 of these for more than five years. Usually 3600 r were given, through four portaIs, 15 x 20 cm., over the lower abdomen front and back, 50 cm. distance, 200 kv., 0.6 mm. copper filter. Three patients who had metastases following orchidectomy are well one year, one year and three months, and ten years and three months with radiation therapy alone, the doses being about twice that in the first group. Twenty-five patients have died, the duration of l i e being one month to four and a half years. Thirteen died in a year or less. The Aschheim-Zondek reaction was not determined in these cases. GRAYTWOMBLY Testicular Adenocarcinoma in an Infant, G. DE POL. Adeno-carcinomh del testicolo in bimbo di sedici mesi, Policliniao (sez, chir.) 40:497-602, 1933. A sixteen-months-old baby was brought to the hospital becauae about three months previously the mother had noticed a swelling of the right hemiscrotum, which had steadily grownlarger. The left testis was of normal size. Orchidectomy was dope. The tumor consisted mostly of tubules lined by a single layer of large cylindric or cubiaal cells, with solid cords of similar cells in places. The diagnosis was adenooarcinoma, qrobably congenital and derived from the seminiferous tubules. The author emphames the unfavorable prognosis of testicular tumors in young children. There are two illustrations. F. C A V E R ~

THE NERVOUS SYSTEM

219

Peculiarities of the Prolan-like Substance in the Urine in a Case of Embryonal Carcinoma of the Testis, H. M. EVANS, M. E. SIMPSON, P. R. AUSTINAND R. 5. FERQUSON. Proc. SOC.Exper. Biol. & Med. 31: 21-23, 1933. The gonadotropic substance which occurs in the urine of pregnant women differs from the gonadotropic substance in the pituitary itself in that, though it causes marked luteinization of follicles, it fails to give continued increase in ovarian weight with increase in dosage. When injected together with Evans’ “ synergic principle,” an aqueous alcohol extract of pig’s anterior hypophysis (Evans et al.: J. Exper. Med. 57: 897, 1933), the anterior-pituitary-like substance of pregnancy urine shows continued augmentation of ovarian weight similar to that obtained with extracts of the anterior pituitary itself. The urine from a patient suffering from embryonal carcinoma of the testis with generalized metastases was shown to have an extremely high titre of gondadotropic hormone (50,000 mouse units per liter). This substance resembled the gondadotropic hormone from the pituitary in that its injection into infantile female rats caused continued increase in the weight of the ovaries. On the other hand, it resembled the gonadotropic hormone of pregnancy urine in showing an augmentation in weight when injected with Evan@’(‘ synergic principle.” When injected into male rats, the hormone caused a more marked development of the seminal vesicles than that shown by pregnancy gonadotropic substance. The hormone was effective also in causing development of the testes in doves, according to some observations made by Dr. Oscar Riddle. GRAYTWOMBLY Testicular Teratoma; Report of an Unusual Case, D. F. E. NASH. St. Bartholomew’s H‘OSP.J. 41: 159-161, 1934. A man of thirty-three with a swelling of the left testis said that both testes had remained in the groins until eight years previously, when the left descended. The right testis could not be displaced into the scrotum. Left orchidectomy was done. The tumor, which replaced nearly the whole of the normal tissue, consisted mainly of a stroma of fusiform cells, e,mbeddedin which were smooth muscle, hyaline cartilage, and epithelial pearls. There were also numerous cystic spaces lined by cubical and columnar epithelium. Both the ectodermal and mesodermal elements showed malignant proliferation. There was no sign of chorionepitheliomatous tissue, and the Aschheim-Zondek F. C A V E R ~ reaction was negative. There are two illustrations. Malignancy of the Undescended Testicle, R. H. CRAWFORD.Southern Med. & Surg. 96: 26-28, 1934. Among men drafted for military service in Austria undescended testicle was recorded in 2.2 per 1000, while among American recruits there were 3.1 cases per 1000. I n 1,371 cases of malignancy of the testicle the tumor arose in an undescended testicle in 136, or 9.9 per cent of the cases [authority for this statement not cited]. Tumor formation occurs in association With cryptorchidism 220 times as frequently as in normal men. Crawford’s patient, a man of thirty, had always had a hernia with cryptorchidism on the right side. Four weeks before admission to the hospital he began t o have pain in this region. At operation the testicle was found to be replaced by a tumor 6 om. in diameter, adherent to the parietal peritoneum. It was removed with difficulty and the hernia was repaired. After the wound had healed, a large dose of radium was given over the scar. A single month’s follow-up is recorded. GRAYTWOMBLY T H E NERVOUS SYSTEM

Practical Value of Radiology in Neuropathology, MEDEA. Considerazioni sul valore pratico della radiologia in neuropatologia, Riv. oto-neuro-oftal. 10: 200-202, 1933. Two cases are reported to emphasize the need for close collaboration between the neurologist and the radiologist in the diagnosis and localization of intracranial tumors. (1) A woman of twenty-six complained of frontal headache, morning vomiting, and progressive dimming of vision and physical and mental apathy. Lumbar puncture revealed hypertension, increased albumin, and xanthochromia. There were bilateral

220

ABSTRACTS

papillitis and reduction in visual acuity, also moderate bilateral temporal hemianopia. Shortly afterwardsthe right eye became totally blind. The clinical diagnosis was tumor of the right frontal lobe. X-ray of the pituitary region showed slight enlargement of the sella and decalcification of the quadrilateral lamina of the sphenoid. Death occurred from bronchopneumonia, and necropsy revealed a large tumor, diagnosed as endothelioma, of the right cerebellopontine angle. (2) A woman of twenty-eight complained of occipital headache, vomiting, epileptiform convulsions of the right extremities, and loss of memory. There was bilateral papillary stasis, with diminution of right vision. X-ray examination showed disappearance of the quadrilateral lamina and erosion of the floor of the sella. Pituitary adenoma was diagnosed; the patient died a few days after operation, and necropsy revealed a tumor, diagnosed as endothelioma, of the left frontal pole. The pituitary gland was somewhat large but showed normal structure. F. CAVERS

Ventriculography and Cerebral Arteriographp in the Diagnosis of Intracranial Tumors; Two Cases, T. LUCHERINI.I1 valore dell'encefalografia nella diagnosi dei tumori cerebrali, Policlinico (sez. med.) 40: 596-632, 1933. Two case reports are preceded by a long account of the technic and findings of ventriculography and cerebral arteriography. I n both cases the clinical findings had left considerable doubt as to the localization of the tumor. In the first case the ventriculographic diagnosis was tumor of the right parietal lobe, confirmed a t operation and subsequent necropsy ; histologic diagnosis, endothelioma. In the second case arteriography made possible the correct diagnosis of a tumor of the left pontocerebellar angle, diagnosed histologically as an acoustic neurofibroma. There are twenty-two 'good F. CAVERS illustrations. Clinical Study of the Past-pointing Test in Brain Tumor Cases, L. E. MOBERG. Eine klinische Studie uber den Zeigeversuch bei Hirngeschwulsten, Acta oto-laryng., S ~ p p 18, . 1933, pp. 1-120. This is a report and analysis of the results of clinical tests upon some 64 patients with intracranial tumors. The writer recognises a " frontal lobe type " of past-pointing which was very pronounced in 10 of 12 cases of large frontal tumors. The frontal lobe type of past-pointing is to be found in the arm contralateral to the side of the tumor. A type of past-pointing characteristic of cerebellar tumors has long been recognized, and i R diecussed by the writer. This type is generally displayed by the homolateral arm. The writer has noticed [as have many others] that a remarkably large amount of cerebellar tissue may be removed surgically with little clinical evidence of the loss. The pathological features of the series of cases presented are not given aside from a statement of location and histological type of tumor, inasmuch as the writer is concerned solely with clinical aspects. The group included tumors of all the glioma series, meningiomas, solitary tubercle, angioma, neurinoma, pinealoma, teratoma, and adenomas of the hypophysis. [This study is of special interest to those working with past-pointing tests in neurological conditions.] EDWINM. DEERY Unusually High Cellular Reaction in the Cerebrospinal Fluid in Brain Tumors, H. R. MERWARTH.Med. Times & Long Island M. J. 61: 227-229, 1933. Four cases of brain tumor are reported in which the spinal fluid showed a high cell count, in two cases as high as 2,000. Differential Diagnosis of Brain Tumors, B. SCHLESINGER.Zur Diff erentialdiagnose des Tumor cerebri, Ztschr. f. d. ges. Neurol. u. Psychiat. 148: 215-227, 1933. Three case hiatories are presented, together with observations and remarks which reflect the generally known facts in neurological localization. Case I was that of a man of forty-two years, who complained of headaches, vertigo, and failing vison. No visual field defect was found and the patient proved to have papilledema. At operation a pituitary adenoma was found. [Such patients generally have a bitemporal defect in the visual fields and primary optic atrophy rather than papilledema.] Case I1 was that of a

THE NERVOUS SYSTEM

221

woman of thirty-six, complaining of headaches and progressive failure of vision. Because of primary optic atrophy, hemianopsia and anosmia, an intracranial tumor was suspected. No growth having been disclosed a t operation, the presumptive diagnosis is an adhesive meningeal process along the base. Case I11 was that of a woman of fiftyseven with a gradually developing left hemiparesis. A preoperative diagnosis of intracranial tumor having been made, surgical exploration was carried out, but no tumor was found. A presumptive diagnosis of cerebral softening was then made. Autopsy disclosed an embolism of the right middle cerebral artery with extensive softening of the right hemisphere. EDWINM. DEERY Surgery of the Brain, H. COENEN. Zur Hirnchirurgie, Zentralbl. f. Chir. 61 : 1523-1534, 1934. This is a general discussion of the surgical treatment of brain tumors and is illustrated by reports of six cases. There were 3 meningiomas, a glioma, and a cerebellopontine angle tumor. The author believes that ventriculograms and arteriograms are the two main advances of recent years in the more accurate preoperative localization of brain tumors. The article is illustrated by roentgenograms, photographs, and photomicrographs. BENJAMINR. SHORE The Eye and Surgery of Cerebral Tumors, G. P. SOURDILLE.L’cEil et la chirurgie des tumeura cBrBbrales, Gal;. mBd. de Nantes 46: 398-415, 1933. Four examples of brain tumor are reported in which loss of vision and the ophthalmological findings-especially the character of the choked disk-led the author, an ophthalmologist, to refer the patients for neurological examination. Three of the patients were seen relatively early and the tumors were removed with complete or almost complete restoration of vision. In the fourth case the damage to the optic nerve was so far advanced that vision was permanently impaired, although the tumor was successfully removed. As it is often the loss of vision that brings a patient with brain tumor under observation, a careful ophthalmological examination is of importance in establishing the diagnosis early. I n the presence of brain tumor, the optic disk shows marked edema, with blurring of the edges, and a ring of blood vessels a t the periphery. Bitemporal hemianopsia is a characteristic finding. The most usual oculomotor symptom is diplopia, due to paralysis of the 6th cranial nerve; there may also be a paralysis of the third cranial nerve, and rarely a paralysis of the 4th. The surgeons to whom the author has referred many of his tumor patients had an operative mortality, in 1930, of 17.5 per cent. Brain Tumor with Hemianopsia; Death Following Lumbar Puncture, J. S. CHARAMIS. HBmianopsie par tumeur cBr6brale suivie de mort la suite de ponction lombaire, Rev. d’oto-neuro-opht. 11: 623-625, 1933. A man of forty-seven years previously in good health gradually showed mild mental and personality changes. During the ensuing five months these became more marked and he began to complain of generalized headaches. There followed attacks of nausea and vomiting, then failing vision. Neurological examination revealed no definite signs aside from those of increased intracranial pressure. A definite hemianopic field defect could be demonstrated, however, and x-rays of the skull revealed the shadow of a tumor in the appropriate occipital lobe (contralateral to the hemianopsia). A lumbar puncture w a performed, ~ which was promptly followed by marked neurological manifestations and death. There was no autopsy. [The withdrawal of fluid from the lumbar subarachnoid space is always dangerous in the presence of increased intracranial pressure. It is particularly dangerous with tumors in the posterior half of the cranium.] EDWINM. DEERY

222

ABSTRAUTS

Histological Changes in Gliomas at Repeated Operations, W. MULLER. Anderung des Gewebscharakters nicht radikal operierter Gliome, Ztschr. f. d. ges. Neurol. u. Psychiat. 148:469-477, 1933. Three case reports are given in some detail, together with histological descriptions and illustrations of the tumor tissue to show how the histopathological nature of the glioma seems to vary with subsequent operations. A man of thirty-eight years, previously in good health, suddenly showed signs of increased intracranial pressure and neurological evidence of a tumor of the left cerebral hemisphere. At the first operation a brain needle was inserted into the depth of the left temporal lobe and encountered soft, abnormal tissue. The small specimen aspirated proved to be a very hemorrhagic, moderately cellular glioma composed of fairly mature elements, chiefly astrocytes. A second operation, carried out a short time later, resulted in the removal of a larger amount of tumor tissue. This material proved, when studied microscopically, to be of similar nature. Some time later a third operation was done, with further removal of tissue. This time the growth proved to be quite different in appearance. The tumor showed many signs of immaturity and a diagnosis of spongioblastoms multiforme was made. A woman of fifty-three years gave signs and symptoms of a right temporal lobe tumor. A brain puncture was performed and tissue was aspirated. The pathological diagnosis made was oligodendrogliocytoma. The right temporal lobe was then exposed a t operation and further tissue removed. This proved to be of similar pathological nature. Four months later a third operation resulted in the removal of a large amount of tumor tissue. When this and subsequent autopsy material were studied, they showed a very cellular growth composed chiefly of young spongioblasts. A woman of thirty-four years showed signs of a right temporal lobe tumor. At operation a firm tumor of this lobe was found and partly removed. Microscopically the growth appeared to resemble a neurinoma and seemed in general to be composed of fairly mature elements. Autopsy, three months later, disclosed a large tumor within the lobe. Microscopically the growth was composed chiefly of young spongioblasts in a great variety of sizes and shapes. [This is a large subject and the writer wisely refrains from any very definite conclusions. There are several illustrations and a review of the literature. I n any attempt to explain the differences between samples of tissue removed a t two operations from a glioma, many factors must be considered. The more malignant gliomas may vary a good deal in their appearance from area to area. This is particularly true of the spongioblastoma multiforme, some parts of which, taken alone, can scarcely be distinguished from astrocytoma. Some believe that adult cells in gliOmas may assume more immature forms. Little as yet is known about the effect of operation with partial tumor removal upon the remainder of the growth.] EDWINM. DEERY Importance of the Mesenchyma in Gliomas, H. J. SCHERER.Die Bedeutung dea Mesenchyms in Gliomen, Virchow’s Arch. f. path. Anat. 291: 321-340, 1933. An interesting histopathological study of the r61e played in the gliomas by connectivetissue elements. I n general, connective tissue as found in these neuro-ectodermal tumors may be considered under three headings. (a) Most of the gliomas have a variable amount of fibrous stroma, derived from the blood vessels. (b) When regressive changes are advanced in any part of the tumor, there often occurs a replacement fibrosis, effected by mesenchymal elements. In some of the gliomas, in whioh necrosis is a characteristic . feature, there may occur quite massive areas of fibrosis. (c) At the periphery of certain of the gliomas there occurs an overgrowth of the vascular tissue elements of mesodermal nature. This same feature may be found in association with non-neoplastio reactive glioses. Connective-tissue activity within gliomas is often marked, but is characteristically very irregular in form. Examples of fibrosis within gliomas are illustrated and described. These include hypervascularity with hypertrophy of blood vessels in the vicinity of necrosis in various gliomas; fibrous scarring in the central portions of a ganglioglioma; fibrous proliferation in areas of softening resembling a n angioma: blood vessel over-

THE NEEVOUS SYSTEM

223

growth at the margins of a malignant glioma, and finally instances of endothelial hyperplasia and hypertrophy in gliomas. There are several illustrations and a review of the literature. EDWINM. DEERY General Review of the Pathogenesis and Classification of Cerebral Gliomas, A. MARI. Le moderne vedute sull’origine e sulla classificazione dei tumori cerebrali di tip0 glide, Riv. di pat. nerv. 42: 200-238, 1933. This is a general review of cerebral gliomas based mainly on the work of Bailey and Gushing, and illustrated by numerous photomicrographs copied from a recent monograph by these writers. The author discusses various modifications that have been suggested regarding the scheme of pathogenetic classification adopted by the American writers, but .F. CAVERS considers that most of theee are of little or no importance. Case of Mesoglioma [Oliogodendroglioma], W. K. BELEZKY.Ein Fall von Mesogliom [Oliogodendrogliom], Virchow’s Arch. f. path. Anat. 290: 450-459, 1933. A boy of seventeen years complained of numbness of the right side of the body, then loss of the sense of taste, and later motor weakness of the right extremities. Intention tremor in both arms appeared, followed by progressively severe headaches. Irregular respiration developed, and death occurred, apparently from respiratory paralysis. A large infiltrating tumor was found a t autopsy, deep in the left cerebral hemisphere and extending into the midbrain. Grossly and upon preliminary microscopic examination the growth was considered to be a “ gliosarcoma.” More detailed study of the tissue made it apparent that the majority of the cells were oligodendroglia. The tumor is classified as a mesoglioma. [A mesoglioma implies that the tumor is composed of mesodermal derivatives. Mesogliomas, i.e. tumors composed of microglia have not so far been described. According to the classifications in general use in this country, the present case would be considered a glioma composed of oligodendroglia, of neuro-ectodermal origin.] EDWINM. DEERY Importance of Kennedy’s Retrobulbar Neuritis in Diagnosis of Frontal Lobe Tumors, G. DE NIQRIS. Sulla neurite retrobulbare e la sua importanza nella diagnosi dei tumori frontali, Riv. oto-neuro-oftal. 10: 127-129, 1933. The author reports a case in which the occurrence of retrobulbar neuritis assisted in the localization of a frontal lobe tumor. I n addition to the general signs of cerebral tumor, the patient showed papillary pallor and edema in the right eye and papillary stasis in the left, without diminution of visual acuity in either. Radiography revealed extensive erosion of the upper margin of the lesser sphenoidal wing. The patient showed rapidly increasing signs of deterioration, and died soon after hospital admission. At necropsy there was found a large right frontal lobe tumor, compressing the optic nerves just in front of the chiasma. The histologic diagnosis was lymphangio-endothelioma. F. CAVERS Case of Pure Neuroblastoma of the Frontal Lobe, K. ORZECHOWSKI AND Z. W. KULIQOWBKI. Ein Fall von Neuroblastoma verum des Stirnlappens, Ztschr. f . d. ges. Neurol. u. Psychiat. 147: 696-712, 1933. A man thirty-one years of age, previously in good health, had generalized convulsive attacks, accompanied by loss of consciousness. No explanation for the attacks could be found, and they proved refractive to all medication. The general condition remained good for the following five years except for frequent convulsive seizures. Headache and vomiting then appeared, followed by failing vision and the convulsive attacks increased in frequency and severity. Neurological examination revealed right-sided hyperreflexia, papilledema, and other signs of a left frontal tumor. Because of the five-year history, a meningioma was suspected. A left frontal craniotomy was carried out, and an infiltrating tumor found. It was possible to remove the greater part of the growth. The patient made a satisfactory recovery and has received postoperative roentgen therapy. The tumor, studied by a variety of methods, proved to be composed of neuroblasts.

224

ABSTBACTS

Most of the reported nerve cell tumors are a mixture of neuroblasts itnd more mature neurocytes or nerve cells. There is a review of the literature, and several illustrations EDWINM. DEERY are included.

Hemorrhagic Pachymeningitis and Hematoma Simulating Frontal Lobe Tumor, C. ANTONIO. Pachimeningite emorragica simulante un tumore dei lobi frontali, Gazz. d. OSP. 54: 1052-1056, 1933. A woman of fifty-two presented a syndrome which had developed during the preceding six weeks: frontal headache, vomiting, vertigo, apathy, somnolence, vestibular disturbances. Frontal lobe tumor was suspected. The patient died in coma a few days after admission, and the partial necropsy permitted showed hemorrhagic meningitis with a large hematoma on the left side of the anterior pole of the left frontal lobe. F. CAVERS Astrocytoma of the Left Temporal Lobe, G. B. AUDO-GIANOTTI.Sulla diagnosi di tumore del lob0 temporale, Morgagni 75: 1141-1150, 1933. A woman of forty-two entered the hospital complaining of the following symptoms, noticed successively during the preceding seven months: occipital headache and pain in both arms, vomiting not preceded by nausea, dimmed vision, and loss of memory. Radiography revealed nothing more than evidence of hypertension, which was relieved by lumbar puncture. Other symptoms observed in the hospital were paresis of the right facial and oculomotor nerves, sluggishness of patellar and other tendon reflexes, diminution of taste and smell, right temporal hemianopia, terminating in blindness. Right decompressive craniotomy was done and the displaced lateral ventricle punctured, with a view to possible further intervention. The headache and vomiting were relieved, but these and other symptoms soon returned, and almost continuous epilepsy set in, the patient dying a week after decompression. The tumor, an astrocytoma, involved mainly the hippocampus. The author reviews the available literature of temporal lobe tumors, comparing the syndrome observed in this case with those reported by other writers as being more or less valuable in the accurate diagnosis of these tumors. There is one illustration. F, CAVERS Tumor of the Temporo-occipital Region with Attacks of a Dream-like State, C. I. URECRIAAND A. RETEZEANU.Tumeur de la region temporo-occipitale avec crises de I‘ dreamy state,” Paris m6d. 2: 229-232, 1933. A woman, previously in good health, suffered from. visual hallucinations. The symptom for the most part was that of a formed hallucination involving “ an old woman with white hair.” Headaches, anxiety states, and many less definite complaint&followed, a t times interpreted as hysterical. Known objects were occasionally seen ‘ I larger and brighter ” than usual, particularly when the object was on the patient’s right. At times she complained of rather vague auditory hallucinations and dream-like states. She died suddenly and autopsy revealed an extensive glioma, a spongioblastoma of the right cerebral hemisphere, involving the temporal and frontal lobes. The writers stress the diagnostic value of dreamy states and visual hallucinations for tumor involving a temporal lobe. EDWINM. DEERY Cerebral Tumor Localizedin Right Temporo-Parietal Region, S. CARON AND L.BERQER. Tumor c6r6brale h localisation temporo-parietale droite, Bull. SOC.m6d. d. h6p. Universitaires de Qubbec, pp. 241-245, August 1933. A man of fifty-four years complained of severe right occipital headache accompanied a t first by somnolence and fever. Later a left facial paralysis, loss of memory, optic aphasia, and other mental symptoms developed, with left hemiplegia, which alternately regressed and recurred. Death occurred three months after the onset. Autopsy showed a necrotic glioblastoma of the right temporal and parietal lobes. One illustration shows the gross appearance of the tumor.

THE NERVOUS SYSTEM

225

Early Amyotrophies with Parietal Lobe Tumors, L. VAN BOQAERT.L’amyotrophie pr6coce dans les tumeurs du lobe paribtal, Paris m6d. 2 : 261-264, 1933. A man of thirty years complained of gradually developing amyotrophies of the left hand and forearm. Pain in this extremity next appeared, followed by the appearance of rather rapidly progressive amyotrophies in the left leg and foot. Generalized epileptic convulsions developed, then choked discs, and eventually death during a convulsive seizure, some three years after the onset of symptoms. A tentative clinical diagnosis of tumor involving the right thalamus was proved incorrect a t autopsy. A large solid glioma was found in the right parietal lobe. Microscopic examination showed astrocytoma. [These are characteristically slow growing, rather indolent tumors, and may produce symptoms over a period of years.] A boy of eight years, previously in good health, suddenly showed a left [central type1 facial palsy. Later there appeared motor weakness of the left hand and arm followed by rapidly progressive amyotrophies of the left upper and lower extremities. Vomiting and a left hemiplegia next appeared, and the atrophies already mentioned became more marked. A preoperative diagnosis of right parietal lobe tumor was substantiated a t operation, a t which time a cystic “glioma” was found. EDWINM. DEERY Simulation of Vascular Disease of the Geniculo-calcarine Pathway by Cerebral Tumour, K. B. NOAD. M. J. Australia 2: 400-404, 1933. The author gives an anatomic account of the geniculocalcarine radiation and its blood supply, and reports two cases in which the findings pointed to a vascular lesion in this area. Necropsy revealed a tumor in both cases: in one case an astrocytoma of the right occipital lobe; the other tumor, also in the right lobe, was not histologically diagnosed. The author reports these cases in order to point out that in homonornous hemianopia occurring in the middle aged (the patients were men of fifty-two and fifty-six) a guarded prognosis should be given, as in many respects tumors of the occipital lobe may closely simulate vascular disease. These cases also illustrate the point that the absence of papilledema cannot be relied upon in excluding occipital lobe tumors, on the ground that it usually appears only in the terminal stages. There are two illustrations. F. CAVERS Two Cases of Cerebral Tumour, F. F. DU TOIT. So. African M. J. 8: 253-254, 1934. (1) I n a man of twenty-three there developed in less than a year a syndrome seeming to indicate tumor of the left side of the cerebrum, but x-ray examination showed irregular enlargement of the sella and erosion of the clinoid processes. (2) An intelligent man of forty had about five weeks previously noticed difficulty in recalling the names of familiar persons and objects, and also in writing and reading. This aphasia progressed rapidly, and when seen by the author the patient had difficulty in understanding spoken words. Further symptoms suggested a diagnosis of rapidly growing tumor involving the speech center and extending towards the pyramidal system. F. CAVERS Both patients were under observation a t the time of reporting. Olfactory Groove Meningioma, P. WERTHEIMER, J. DECHAUME, JAPIOT AND L. P A U FIQUE. MBningiome du sillon olfactif, Lyon m6d. 152: 261-264, 1933. A woman of fifty-four years showed mild mental changes and marked apathy. Some six months later she became aware of a loss of the sense of smell, and more recently of failing vision and generalized headaches. Neurological examination showed atrophy of the optic nerve heads and anosmia. Roentgenograms of the skull revealed changes in the olfactory groove considered characteristic of a meningioma. At operation a large meningioma of this region was found and partly removed. Histologic examination of the growth showed it to be composed of epithelial-like meningoblasts. The clinical history in this case is coneidered somewhat unusual. [Failing vision and anosmia usually precede mental symptoms with a tumor pushing from below upward in this region.] EDWINM. DEERY

226

ABSTRACTS

An Unusual Death in a Case of Brain Tumour, H. H. HEPBURN. Canadian M. A. J. 30: 297-299, 1934.

A male patient [of unstated age] had for about a month complained of headache. His mother said that his movements and mental faculties had become much disturbed, and that he had slept a great deal during this time. The symptoms pointed to a tumor in the posterior fossa causing acute internal hydrocephalus. On puncture of the left lateral ventricle, for the purpose of ventriculography, clear fluid spurted out, and the patient showed cyanosis and labored breathing. Various restoratives were applied, but death occurred in coma ten hours later, Necropsy revealed a soft, circumscribed hemorrhagic tumor, 7 x 5 x 2 om., in the white matter of the posterior portion of the left cerebrum, projecting into the posterior horn of the left lateral ventricle. It was adherent only in the region of the splenium of the corpus callosum. The entire pons and medulla were edematous. Evidently this edema, caused by the sudden release of pressure when the ventricle was punctured, had resulted in respiratory failure. The F. CAVERS tumor was of spongioblastoma type, Teratoid Cyst of the Centrum Ovale, A. MARI. Tumore teratoide cistico del centro ovale, Riv. di pat. nerv. 41': 531-545, 1933. A boy of eight years was brought to the hospital with a recent history of repeated epileptic attacks, vomiting, headache, and loss of power in the left extremities. He died six days later in coma following a series of epileptic fits. At necropsy the only intracranial lesion found was a large cyst, 11 x 7.5 x 7 cm., in the right frontal lobe, replacing the white eubstance of the rolandic region. The cyst wall consisted of cubical cells, with islands of calcified cartilage and bone. Of 24 cases of intracranial teratomas found in the available literature, all contained mesodermal tissues; in 22 there were also ectodermal tissues, but none included endodermal elements. There are two illustrations. F. CAVERS Diagnosis of Tumors of the Corpus Callosum, K. ERB. Beitrag zur Diagnose der Balkengeschwalste, Wien. klin. Wchnschr. 47: 876-877, 1934. Erb reports the case of a fifty-six-year-old patient with a tumor of the corpus callosum which extended into the right cerebral hemisphere. The interesting feature of this case was the fact that correct clinical diagnosis was made from the psychic symptoms and apraxia. The diagnosis was confirmed by autopsy. There are no illustrations. BENJAMIN R. SHORE Glioma of the Septum Pellucidum, S. MARRAS. Sui gliomi del setto pellucido, Riv. di pat. nerv. 42: 265-282, 1933. The author summarires in tabular form the features of eight previously reported cases of septum pellucidurn gliomas, and reports a new case. A man of twenty-seven had during the preceding two months noticed failing vision, with severe pain in the right half of the head. Roentgenograms showed considerable dilatation of the sella, and signs of erosion in almost all the cranial bones. While in hospital the patient had increasingly severe epileptiform attacks and died in coma eight months after admission. Necropsy revealed a tumor in the septum pellucidum, with extension into the right lateral ventricle and high grade internal hydrocephalus. The histologic features of the tumor suggested a transitional form between unipolar spongioblastoma and astrocytoma. The pituitary showed normal structure. There are five illustrations. F. CAVERS Subthalamic Glioma with Invasion of the Chiasmal Region and of the Third Ventricle, D. MANOLEBCO, D. PAULIANAND D. LAZARESCO.Tumeur sous-thalamique (gliome) avec invasion du chiasma et du troisibme ventricule, Rev. d'oto-neuro-opht. 11 : 684-686, 1933. A woman of twenty-five years, previously in good health, sustained moderately severe trauma to the head in falling. During the following four months, although up and about much of the time, she suffered from increasingly severe headaches, then failing vision. When examined neurologically she showed evidence of increased intracranial

THE NERVOUS SYSTEM

227

pressure and rather indefinite ocular signs suggestive of a chiasmal region tumor. She succumbed directly after a right subtemporal decompression. Autopsy disclosed an extensive glioma of the basal ganglia and third ventricle region, classified microscopically as a glioma. The case illustrates the fact that fairly extensive lesions of the vegetative nuclei can occur with few or no neurological signs of damage to this region.

EDWINM. DEERY Cystic Hemangioma of the Fourth Ventricle, G. GUILLAIN,M. AUBRY,I. BERTRAND A N D J. LEREBOULLET. Hemangiome kystique du quatrihme ventricule, Rev. neurol. 2: 126-133, 1933. Hemangiomas of the cerebellum are not particularly rare. The present case is reported chiefly because the patient presented a vestibulo-spinal syndrome and positional nystagmus, which are described in some detail. A woman of forty-two years, previously in good health, complained of severe generalized headaches, vertigo, and attacks of vomiting, present for some three months and becoming steadily worse. Upon neurological examination nothing definite could be found. There were no convincing signs of cerebellar pathology, no papilledema, and no cranial nerve palsies. During the ensuing six weeks the patient became worse and complained of failing vision. When re-examined she showed incoordination, a slight Romberg sign, no definite ataxia, slight inequality of the pupils, and papilledema. I n addition there were found a vestibulo-spinal syndrome and positional nystagmus. Upon the basis of these neurological findings, a clinical diagnosis of fourth ventricle tumor was made. The patient died suddenly in a cerebellar crisis while awaiting operation. Autopsy revealed an enlarged right cerebellar lobe which, when sectioned, showed a large, partly cystic tumor. A fairly discrete mural nodule of tumor tissue lay in the lower part of the cyst cavity. The ventricular system was moderately dilated. Microscopic examination of the tumor showed it to be a typical hemangioma. This case illustrates the characteristic rapidity of evolution of tumors of the fourth ventricle. Sudden death is not uncommon in the presence of these tumors, as in the present case. EDWINM. DEERY Cavernous Hemangioma of the Midbrain, M. LINDE. Ueber einen Fall von Haemangioma cavernosum des Zwischenhirns, Ztschr. f. d. ges. Neurol. u. Psychiat. 147: 230-236, 1933. A woman of twenty-seven years had displayed some mental symptoms during the past ten years, which had a t times been interpreted as hebephrenia. More recently the trend of mental symptomatology had changed and become more marked, and the patient had complained of headaches of increasing severity, attacks of vertigo, and somnolence. When examined neurologically she showed, in addition, various rather ill-defined paresthesias and exaggerated reflexes. Pyramidal tract signs developed, then multiple cranial nerve palsies. Autopsy disclosed 8 large, firm mass involving the base of the brain. It extended from the optic chiasm back as far as the pons. Microscopic examination revealed a tissue of quite uniform structure made up of large thin-walled spaces containing blood. There is a review of the literature and one illustration.

EDWINM. DEERY Cerebellar Tumor in a Pregnant Woman, MERCKEN.Un cas de grossesse compliqube de tumeur cbrbbelleuse, Scalpel 87: 318-321, 1934. A woman thirty-two years of age, in the first months of pregnancy, had uncontrollable vomiting and rapid pulse, convergent strabismus of the left eye, some incoordination of movement of the upper extremities, severe headache, and choked disc. Autopsy showed a tumor invading the left hemisphere of the cerebellum.

228 Multiple Meningiomas of the Base. Differential Diagnosis of Cerebellopontine Angle Tumors, C . F. LIST.Multiple Meningiome der Schadelbasis (Zugleich ein Beitrag zur Diff erentialdiagnose der Kleinhirnbruckenwinkeltumoren), Nervenarzt 6: 566-574, 1933. A single cape report to illustrate the presence of multiple meningiomas, as well as the difficulties in differential diagnosis presented by symptoms suggestive of an acoustic neurinoma. A woman of fifty-seven years complained of difficulty in swallowing, headaches, vertigo, and attacks of vomiting. There had been right-sided tinnitus as well as progresaive deafness on that side. Vision failed and headaches became increasingly severe. Neurological examination revealed the characteristic signs of a tumor of the right cerebellopontine angle, presumably an acoustic neurinoma, and evidence of increased intracranial pressure. Partial removal of a tumor of the cerebellopontine region was followed by death. At autopsy there was found, not an acoustic neurinoma, but a meningioma in this region. Other meningiomas were found above the tentorium, along the base, and over the convexities of the cerebral hemispheres. Still others were found in association with the superior longitudinal sinus. For the most part the tumors proved to be of the psamniomatous type. The writer believes that a meningioma in the cerebellopontine angle is a more serious problem than the acoustic neurinoma. The former is often quite large and cannot be entirely removed. Partial resection of such a meningioma means a recurrence. [These remarks are in general equally applicable to the acoustic neurinoma.] There are references to the literature and three illustrations. EDWINM. DEERY A Characteristic Deformation of the Sella Turcica from Tumor of the Cerebellopontine Angle, C. ENDERLE.Uber eine charakteristische Deformierung der Sella turcica bei tumoren des Kleinhirnbriickenwinkels, Psychiatrisch-neurol. Wchnschr. 35: 361-363, 1933. The writer presents what he believes to be a unique point in the differential diagnosis between neurinoma of the acoustic nerve and other tumors of the cerebellopontine angle. With acoustic neurinoma no special change occurs, roentgenographically, in the sella turcica. With other tumors in this location, however, the homolateral posterior clinoid process i s pushed forward, as compared with the other posterior clinoid. This finding in a case of cerebellopontine angle tumor is illustrated. [Tumors of the cerebellopontine angle other than acoustic neurinoma are rare. The characteristic aymptomatology of the eighth nerve tumor usually serves to make a correct diagnosis. The point brought forth by the writer requires, of course, corroboration in a large series of cases.] EDWINM. DEERY Meningiomas of the Sphenoid Region, A. STENDER.Uber das Meningiom des Keilbeinriickens, Ztschr. f. d. ges. Neurol. u. Psychiat. 147: 244-262, 1933. Three reports of patients who proved a t operation to have basal meningiomas, located in the region of the sphenoid ridge. The first was that of a male of thirty-one who proved to have a psammomatous type of meningioma. Removal of the growth was followed by a satisfactory recovery. The second patient, a woman of forty years, had an increasing unilateral exophthalmos. At operation there was found a large psammomatous type of meningioma arising from the meninges in the sphenoid region and extending forward to enter the orbit. A first operation permitted removal of the intracranial portion of the growth. The intraorbital lesion was removed twelve days later. The patient made a satisfactory recovery. A woman of fifty-five years had failing vision and headaches, followed by loss of the sense of smell, then a loss of the sense of taste. The clinical diagnosis rested between meningioma of the olfactory groove or of the sphenoid ridge. Operation revealed a meningioma of the sphenoid region and two more farther forward under the frontal lobe. Following removal of the tumors the patient made a good recovery. There are several illustrations and a short review of the literature. EDWINM. DEERY

THE NERVOUS SYSTEM

229

Serous Meningitis Simulating Meningioma of the Lesser Wing of the Sphenoid, J. DECHAUME, P. WERTHEIMER, JAPIOTAND GIRARD. MBningite sereuse simulant un meningiome de la petite aile du sphbnofde, Lyon m6d. 152: 480-482, 1933. The writers believe that serous meningitis may be of greater clinical importance in the production of neurological symptoms than is generally recognized. A man of fifty years had had occasional epileptic seizures throughout the past ten years. More recently there had developed marked personality changes, as well as mental symptoms, somewhat suggestive of general paresis. Upon the basis of the neurological examination a definite diagnosis did not seem possible. Roentgenograms of the skull revealed slight erosion of the lesser wing of the sphenoid bone. A clinical diagnosis of sphenoid ridge meningioma was made. At operation no tumor could be found but, instead, a cystic serous meningitis. EDWINM. DEERY Case of Nerve-cell Tumor of the Brain Stem, 0. FOERSTER, 0. GAGELAND A. MCLEAN. Ein Fall von Ganglienzellgeschwulst des Hirnstammes, Ztschr. f. d. ges. Neurol. u. Psychiat. 147: 713-745, 1933. A man thirty-five years of age showed slowly progressive signs of increased intracranial pressure. At first considered to have epidemic encephalitis, he was subsequently recognized as having an intracranial tumor. Some three attempts a t tumor removal failed. At autopsy a relatively large neoplasm of the brain stem was found. Microscopic examination revealed a moderately cellular growth composed of medulloblasts, neuroblasts, and nerve cells in various stages of immaturity. The tumor was pronounced a ripening gangliocytoma. [This case of nerve cell series tumor is the seventh reported by the writers. In their review of the literature they list 20 other reported cases.] EDWINM. DEERY

Pituitary Tumors, M. A. H. ATTIAH. Bull. Ophth. SOC. Egypt 26: 117-128, 1933. Five cases of pituitary tumor are reported, two of which were associated with pregnancy. An autopsy report of one case is included. The patient was a man of twentyfive who had had headaches and failing vision for six years; later fainting fits occurred, preceded by an aura of putrid smell, and finally convulsive attacks and impotence. Death was due to bronchopneumonia. Autopsy revealed a carcinoma of the pituitary, pressing upon the third, fourth, and sixth cranial nerves, although there had been no clinical evidence of involvement of these nerves until shortly before death. The aura of abnormal smell and the anosmia were probably due to pressure of the tumor on the temporal lobes and uncinate gyrus, and the involvement of the first cranial nerve. There are five illustrations, including one photomicrograph. Pituitary Adenomas, R. C. MOEHLIQ. Am, J. Roentgenol. 30: 765-767, 1933. The clinical features associated with chromophobe, eosinophil, and basophil adenomas of the pituitary gland are reviewed. The chromophobe variety leads to hypofunction of the pituitary and may be compared to the colloid goiter with myxedema. The eosinophilic adenomas produce acromegaly and represent hyperpituitarism. The basophilic adenomas produce the syndrome known as basophilism or Cushing’s syndrome. They also represent a type of hyperpituitarism. All three types produce amenorrhea. The article is illustrated by photographs and a roentgenogram. BENJAMINR. SHORE Multiglandular Disease, 0. LEYTON. Lancet 1 : 1221-1226, 1934. The author points out that, as the numerous and varied functions of the pituitary gland have been gradually elucidated, there has been a tendency to replace the term “ multiglandular disease ” by ‘‘ basophilism.” Cushing leaned toward this view, because he found many cases of the syndrome which had beeh associated with an excess of basophil cells in the anterior part of the pituitary gland. He has, however, modified his opinion since cases have been reported with a similar syndrome but with lesions situated in tissues other than the pituitary. The author compares, point by point, four pairs of

230

ABSTBAOTS

cases in which necropsy was done. In four of these in which the “ basophil syndrome ” was more or less completely presented, the only lesion found was a carcinoma of the thymus in three, and 5 carcinoma (oat cell type) of the lung in the fourth. A table is given showing that in 8 cases of “ basophilism ” the only lesions found were in the suprarenal cortex, and the author suggests further investigation of the cortical tissue with new stains which may show that it consists of cells of differing morphologic character, secreting different substances. Hyperplasia of the suprarenal cortex often causes virilism or precocious development of the reproductive organs. In three of the author’s cases there was marked hypertrichosis without virilism. Since Collip (Proc. SOC. Exper. Biol. & Med. 30: 544,1933) has succeeded in isolating an adrenotropic substance from the pituitary gland, it would seem possible that an excess of basophil cells produces an excess of this hormone. Whether other tissues can produce an adrenotropic hormone, or whether the neoplasms of the thymus and lung here reported stimulate the basophil cells of the pituitary gland to excessive secretion without causing hyperplasia, is F. CAVERS not yet known. There are seven illustrations. Zondek-Aschheim Test after Partial Hypophysectomy, D. M. STERN. Proc. Roy, SOC. Med. 27: 1501-1503, 1934. A woman of twanty-one had noticed progressive enlargement of the hands and feet nearly two years before hospital admission. During the past month she had suffered disturbance of vision. The findings included bitemporal scotomatous hemianopia and enlargement of the sella turcica. Beginning about nine months before the acromegalio symptoms were noticed, there had been amenorrhea, except for one period, four months before hospital admission. A cystic tumor removed from the anterior pituitary lobe showed the characters of a solid, polygonal-celled and predominantly alpha-granuled adenoma. The hemianopia disappeared and the acromegalic appearances became less pronounced. Six months after operation the patient married. She never menstruated again, but a year later she was found to be five months pregnant. The AschheimZondek reaction was positive a t the 25th week, though below normal value, and six weeks after normal childbirth i t had become negative. In other words, normal pregnancy and labor occurred in a non-menstruating woman in whom there could have been very little anterior pituitary gland substance. Presumably there was sufficient to stimulate the ovary to normal ripening of folIicles with production of corpora lutes. A case like this raised the question whether the hormone found in the urine had some source other than the pituitary gland, such as embryonic trophoblasts. Dr. Blair Bell, discussing this case, said that the removal of the pars anterior had obviously been only partial, otherwise ovulation could not have taken place. Mr. Green-Armytage referred to a case of twice occurring acute pregnancy acromegaly in a woman who had oomplete amenorrhea during the eighteen months’ interval between the two pregnancies. During the second pregnancy and puerperium there was no mammary secretion, the breasts being small and dry. In replying to the points raised in the discussion, the author said that in the reported case there had been no glycosuria, the fasting blood sugar before operation being 0.08 per cent, and that the milk supply was normal, 11 ounces of milk being secreted in twenty-four hours. F. CAVERB

Recovery of Sight and Health in a Cam of Gigantism, E. A. SEALE. So. African M. J. 8:371-372, 1934. The author reports a case of pituitary tumor in a ten-year-old boy with a history of headache, vomiting, and almost complete loss of vision. He was over five feet high, and weighed 104 pounds. X-ray showed marked enlargement of the frontal and maxillary sinuses, and of the sella. Lumbar puncture was done; ‘ I next morning his apathy had changed to a bright and smiling welcome, and he told me his sight was there on waking.” The author attributes this rapid change to rupture of a pituitary cyst resulting in sudden release of pressure. At the time of reporting, however, the patient had Eevere headache, a tendency to somnolence, and reduction of visual acuity. F. CAVERS

THE NERVOUS SYSTEM

231

Calcified Suprasellar Cyst of Rathke’s Pouch, A. BTJSACCA.Sui tumori della tasca del Rathke (Studio clinic0 ed istologico), Riv. oto-neuro-oftal. 10: 326-344. 1933. A girl of seventeen who complained of almost continuous headache for two months, with considerable loss of strength, showed underdevelopment in height, weight, and chest measurement. She had never menstruated, and the external genitals were hypoplastic. She was somnolent and had noticed dimming of vision. Ocular examination showed bilateral paresis of the sixth nerves, with pupillary dilatation, bilateral papillary stasis, papillary and retinal hemorrhages, reduced right vision, right exophthalmos, and loss of right temporal field. Radiography and ventriculography revealed signs of increased pressure, with separation of the bone sutures and poor filling of the ventricles. The sella was of normal size and appearance. There was a small focus of calcification above the left posterior clinoid process. Operation was attempted, but given up owing to a rapid fall in blood pressure from 130 t o 80 mm. Hg, and the patient died during a second intervention two days later. At necropsy two cysts were found, one of which encroached on the lower wall of the left lateral ventricle while the other was in contact with the left optic thalamus and tract. Histologically the cysts had a connective-tissue stroma composed of edematous fibers and containing dilated blood vessels, while the parenchyma consisted of large cylindric cells arranged in tubes and alveoli. [The author’s description suggests that the tumor was of the adamantinomatous type.] The tumor had clearly arisen in Rathke’s pouch, and had no connection with the pituitary, which showed normal structure. There are F. CAVERS five good illustrations. Surgical Treatment of Tumor8 of the Auditory Nerve, M. BALADOAND R. MOREA. Traitement chirurgical des tumeurs du nerf auditif , Oto-rhino-laryng. internat. 17: 721-735, 1933. General remarks upon the diagnosis, differential diagnosis, and technic of operation in acoustic neurinomas. The paper reflects the generally known facts. Two cases in point are described in full detail. I n both instances the tumors were histologically verified. Much of the paper actually consists of the presentation of six other cases of posterior fossa lesions, other eighth nerve tumors (cerebellar tuberculoma, gliomae, EDWINM. DEERY mgiomas and arachnoiditis of the posterior fossa). ~

Bilateral Palsy of the Sixth Cranial Nerves Caused by Intracranial Extension of an Intranasal Epithelioma, H. ROGER, M. B R ~ ~ M O N AND D J. ALLIEZ. Paralysie bilatbrale du VI par propagation intracranienne d’un Bpithblioma du cavum, Rev. d’oto-neuro-opht. 11 : 530-532, 1933. A woman of sixty-nine years, previously in good health, complained of a chronic discharge from the nose, with pain high in the nasal cavity. A rhinologic examination revealed a tumor high up and well back in the left nasal cavity. A biopsy was taken, and the tissue, upon microscopic examination, was considered to be typical basocellular epithelioma. Mitotic figures were numerous in the material studied. Further examination of the lesion made it apparent that it extended up and backwards, probably penetrating the baee of the skull. It was considered inoperable and x-ray therapy was advised, but refused. Complete anosmia soon developed, then double vision and increasingly severe headaches, followed by diminution of hearing on the left side and spasticity of the legs. When examined again, about one year later, the patient showed a paralysis of both sixth nerves [abducens] and considerable loss of normal pupillary reactions. Roentgenograms of the skull revealed much destruction of the bone a t the base, in the region of the sella turcica. There was slight evidence of meningeal irritation EDWINM. DEERY and the spinal fluid showed an increased cell count. Diffuse Endotheliomatosis of Brain and Spinal Cord, Simulating Tuberculous Meningitis and Tabes Dorsalis, G. BORROMBO. Pseudotabe e pseudomeningite basilare di origine neoplasica, Policlinico (sez. med.) 40: 707-720, 1933. A man of forty with a history of treated syphilis and a feebly positive blood Wassermann reaotion presented symptoms of pseudotabes (cerebrospinal fluid Wassermann

232

ABSTRACTS

negative, no spastic phenomena present), associated with basal meningitis of probable tuberculous origin. A few days after hospital admission he died in coma following epileptiform convulsions. At necropsy tumor nodules were found scattered throughout the base of the brain and the spinal cord. The histologic diagnosis was endothelioma. There was no evidence of luetic or tuberculous lesions anywhere in the brain or cord. F. CAVERE There are ten illustrations. Spinal Tumours, Their Diagnosis and Localisation, A. G. BIGGAM. J. Roy. Army M. Corps 62: 337-351, 1934. After a general account of spinal cord tumors, the author reports three cases, in which the diagnoses were fibromyxoma, endothelioma, and upper dorsal neurofibroma. In the first case the patient died the day after operation, from which it was evident that mere removal of the vertebral arches does not relieve compression if the dura is left intact. The dura should be opened in a two-stage operation prior to closure of the wound; such a procedure would probably have saved the patient’s life. In the second case difficulty was experienced in cisternal puncture, emphasizing the importance of not using too much local anesthesia before making the puncture. Diarrhea followed the operation, but proved to be due to amebic infection. In the third caae the patient gave a positive Wassermann reaction, and the author emphasizes that this may be present and have nothing to do with the symptoms due to tumor. There are three illustrations. F. CAVERS Classiflcation of Primary Neuro-ectodennic Tumors of the Spinal Cord, Spinal Nerve Roots and Nerve Sheaths, L, CORNIL.Essai de classification des tumeurs neuroectodermiques primitives de la moelle epinihre, des racines et de leurs enveloppes, Bull. Acad. de med., Paris 110: 307-310, 1933. A paper presenting the essentials of the neuropathological problem involved in dealing with tumors of the spinal cord. The writer believes we should aspire to foretell the pathological nature of a growth within the spinal canal as well as to localize it [much as can now be done with intracranial tumors]. Because many of the intramedullary spinal cord tumors have in the past remained histologically unverified [surgeons were unwilling to incise into the spinal cord], there are few histological data available compared with material obtained at brain operations. Before much progress can be expected in correlating clinical course and symptoms with the histological nature of the growth, it will be necessary to collect and classify histologically such tumors with greater accuracy than has been possible in the past. Cornil has studied a group of 80 primary spinal cord tumors. These he divides into three main groups : (1) neuro-ectodermic tumors; (2) mesenchymatous tumors, (3) dysembryoplasias. In the present report he is concerned only with the 61 neuroectodermal tumors. In general these tumors display various degrees of differentiation which may be interpreted in terms of normal histogenesis much as in the case of intracranial tumors. The neuro-ectodermic tumors found are subdivided into three groups: (1) The first of these consists of intramedullary tumom, of which there were 20 in the entire group of 80. These tumors may be composed of ependymal or glial elements, either pure or combined. The individual tumors varied in the degree of maturity displayed by the constituent cells. The group was subdivided as follows: 9 ependymomas and 11 gliomas, the latter including macrocellular astrocytomas, microcellular astrocytomas, oligodendrocytomas, and glioblastomas. (2) There were 19 tumors of the spinal nerve roots& These were classified as neurinomas or true peripheral gliomas. Such tumors arise from and are composed of Schwann sheath elements. A subclassification of nodular, reticular, and fascicular types was made. (3) The third major group of neuro-ectodermal tumors consists of the araahnoid tumors or meningoblastomas, of which there were 22 examples. Three histological types may be recognized: a type showing globular cells, s type with lobular structure, and a fascicular type with fusiform cells. Occasionally a tumor is found which merits

THE NERVOUS SYSTEM

233

the term lacunar meningoblastoma. Psammoma bodies may be numerous in any of these tumors. [From the standpoint of neuropathology in America, this valuable contribution to the data on spinal cord tumors is somewhat confusing. The tumors making up Cornil’s first group are the intramedullary gliomas. Groups 2 and 3, the neurinomas and the meningiomas, are considered neuro-ectodermal tumors because their cells of origin, the schwann cell and the meningoblast, are believed to arise from the neural tube. That both cells can be of neuro-ectodermal origin and yet elaborate collagen is not considered impossible by the French pathologists. Groups 2 and 3 are generally considered in this country to be mesodermal tumors.] EDWINM. DEERY

Sudden Flaccid Paraplegia. Spinal Meningioma with Hemorrhages into and about the JUSTIN-BEZAN~ON, CUEL AND LEBLANC.Paraplbgie Tumor, J. L~vY-VALENSI, flasque foudroyante. Mhingiome spinal avec hkmorragies intra et p&itumorales, Rev. neurol. 2: 89-91, 1933. A man of sixty-four years entered the hospital because of a complete flaccid paraplegia with urinary retention occurring suddenly forty-eight hours previously. Upon examination he showed complete loss of voluntary motor power in both legs and absence of deep reflexes. The arms were unaffected. The sign of Babinski was positive on both sides. The abdominal and cremasteric reflexes were absent, and there was found a sensory level near the nipple line, with anesthesia below. The bladder was distended and catheterization was necessary. The patient died a few days later, and an autopsy was performed. On the posterior and left lateral surface of the cervical spinal cord was found a small oval tumor, showing upon its surface evidence of recent hemorrhage. Microscopic study of the growth revealed a meningioma of neuro-epithelial type having a fairly abundant collagenous stroma. Centrally there were many small foci of necrosis and considerable hypervascularisation. More peripherally were found focal areas of recent hemorrhage. The spinal cord itself showed little gross or microscopic evidence of injury, the long fiber tracts being in good condition. The past history of the patient revealed impairment of motor power in the right leg some four years previously, which had subsequently cleared up. The writers point out the discrepancy between the sudden apd massive neurological disorder and the lesion found. They report the case for its interest, but refrain from an explanation of the clinical course. EDWINM. DEERY Clinical Aspects of Angioma Racemosum (Arteriovenous) of the Spinal Meninges, H. ROSENHAOEN. Zur Klinik des Angioma racemosum arterio-venosum der Ruckenmarkshaute, Ztschr. f. d. ges. Neurol. u. Psychiat. 147: 216-229, 1933. A man of thirty-one years, when examined neurologically, displayed a paraplegia and vesical sphincter disturbances, together with sensory changes indicating a lesion of the cauda equina. He had been in good health up until six years previously. At that time he had what appeared clinically to be meningitis, soon followed by the onset of the above mentioned neurological signs. A clinical diagnosis of spinal cord tumor having been made, a laminectomy was performed. At the level of the third lumbar vertebra there was found an intradural, extramedullary blood vessel anomaly, considered to be a racemose angioma. At the time of the report the patient had shown a slow but steady improvement in the neurological condition since operation. He was able to walk again and the sphincteric disorder was less. A short review of similar reported cases from the literature is included. EDWINM. DEERY Extramedullary Spinal Dermoid Associated with Rachischisis, PAOLOOTTONELLO. Contributo alla conoscenza delle sindromi rare da tumori embriogenetici, Riv. di pat. nerv. 41: 512-531, 1933. In a woman of twenty, previously in good health, there developed within two weeks a syndrome of total paraplegia. There was pain on pressure over the third dorsal vertebra, and a t this point there was a very small nipple-like elevation of the skin, with a

234

ABSTRACTS

pinhole aperture into which a probe passed easily. Radiography showed rachischisis in the regions of the second and third thoracic segments. Descending lipiodol was arrested at the upper end of the body of the second thoracic vertebra. At operation there was found a tumor extending from the first to the Gfth thoracic segment, which on removal proved to be a cyst connected with the small skin projection by a stalk inserted in its upper third. The cyst wall contained sweat glands and hair follicles, with an inner lining of squamous epithelium. There are six illustrations. F. CAVERS

Tumour of the Spinal Cord, PENINOTON.M. J. Australia 2: 639-640, 1933. In the case here reported, in a man of forty-nine, three stages were recognized: (If insidious onset with pain shooting from the sacral region to the abdomen, right loin, and left thigh, lasting about three months; (2) diminution in pain for three months; (3) increasingly severe pains, during the past three months, with difficulty in urination and defecation. The patient had lost 24 pounds weight during the twelve months. Neurologic findings included impaired sensitiveness to touch and pin prick in the fourth and fifth lumbar dermatomes. Descending lipiodol was arrested at the upper margin of the twelfth dorsal vertebra, ascending lipiodol a t the Gfth lumbar. At operation an F. CAVERS intradural meningioma was removed. Surgical Removal of Extramedullary Tumors Lying Anterior to the Cervical Portion of the Spinal Cord, W. T ~ N N I SZur . Operation ventral vom Halsmark gelegener extramedulllirer Riickenmarkstumoren, Zentralbl. f. Chir. 61: 930-933, 1934. The author reports the successful surgical removal of an extramedullary neuroma of the sixth cervical nerve in a forty-six-year-old patient. Marked improvement of all of the neurological signs followed operation. The article is illustrated by one drawing of BENJAMINR. SHORE the tumor in situ. Generalized Neuroflbromatosis, TIXIER.Neuro-fibromatose g6n6ralis6e, Lyon chir. 30: 709-711, 1933. A woman of forty-eight years displayed the multiple lesions of cutaneous neurofibromatosis. A pes valgus had been present since birth, which had in recent years required astragalectomy. The deformity has been considered by the writer an evidence of bone involvement, sometimes found in generalized neurofibromatosis. Near the head of the left fibula the patient had had a small tumor nodule, as long as she could recall. Because of a sudden and progressive increase in the size of this lesion it was removed. Histologically the growth was considered to be a characteristic peripheral glioma [neurinoma]. EDWINM. DEERY

Sarcoma of the Sciatic Nerve and Heuroflbromatosis, J. L. ORR. Glasgow M. J. (Trans. Roy. Med. Chir. SOC.Glasgow) 2: 212-216, 1933. A man of thirty-eight had severe pain in the left lower extremity and a large swelling on the posterior aspect of the thigh just below the gluteal fold. He had had neurofibromato& since infancy, with skin pigmentation and nodules all over the body, The pain being so severe as to require almost constant administration of morphia, it was decided to remove the tumor, but at operation the latter was found to be impossible of enucleation, and hip disarticulation was done. The patient was making good progress, when pleurisy developed, from which he died ten weeks after operation, The tumor had in some places a definite though thin oapsule, and had evidently arisen in the central portion of the sciatic nerve, fibers of which coursed over the tumor. Histologically it was a spindle-cell sarcoma, actively invading the adjacent nerve tissue. There are three illustrations. F. CAVERS

Bone Changes in a Case of Generalized Neuroflbromatosis,0. PELLEQRINI. Particolari altera~ionios8ee in un caso di neurofibromatosi diffusa, Arch. di ortop. 49:1021-1055, 1933. The author reports in great detail a case of neurofibromatosis in a boy of fourteen years. The disease had become manifest five years previously, when brown spots and

,

THE BONES

235

enlarging hard nodules appeared in the skin of the trunk and limbs. I n the latter the nodules followed the course of the nerve trunks. Skeletal radiography revealed a large number of deformities, including kyphoscoliosis, genu valgum, flatfoot, and absence of the 12th dorsal vertebra and 12th rib. There are eleven good illustrations, and a useful bibliography is given. F. CAVERS

von Recklinghausen’s Disease, NAONORICHOJA. Uber die Recklinghausen’sche Krankheit, Mitt. a. d. med. Akad. zu Kioto 10: 72-84, 1934. A man fifty-one years of age had multiple tumors, the size of a finger tip, on the head, face, and body, with no evidence of sarcomatous transformation. It was suspected that the tumors arose for the most part from the perineurium, endoneurium, and Schwann’s sheath and partly from the connective tissue of the hair follicle, hair follicle glands, and sweat glands. Although it might be better to consider this case as one of Herxheimer’s neurofibromatosis, it seemed fitting to term it an incomplete form of von Recklinghausen’s disease because of the presence of an inflammatory complication, namely K. SUGIURA chronic syphilis and tuberculosis.

The Medullary Sheath in Ganglioneuromata, B. KARITZKY.Die Markscheiden in Ganglioneuromen, Virchow’s Arch. f. path. Anat. 290: 161-166, 1933. A group of 18 tumors, classified as ganglioneuromata, have been collected [at Dortmund] during the past twenty years. Of these, the writer has chosen 3 immature tumors and 4 fairly mature tumors for special study with reference to medullary sheaths of the neoplastic elements. I n all of the tumors studied, medullary sheaths were readily found. It became apparent that such sheaths were more numerous and more completely developed ih the more mature tumors. The writer concludes that the sheaths are actually formed within the tumor upon the neoplastic nerve cells. I n surveying any given tumor it could be shown that medullary sheath substance was forming in the more mature parts of the tumor, and its appearance is observed first upon those neoplastic cells nearest t o EDWINM. DEERY blood vessels. Some Activities of a Mental Hospital Laboratory During Thirty Years, 0.LATHAM. M. J. Australia 1: 739-748, 1934. In the portion of this paper dealing with intracranial neoplasms the author describes examples of various types investigated in the pathologic department of the New South Wales mental hospitals. He gives a table showing the classification of 172 histologically F. CAVERS examined tumors, and 14 good illustrations. THE BONES

Indications for Radiation Therapy of Sarcomas and Tumors of Bone, W. BAENSCH. Uber die, Anzeigestellung der Strahlenbehandlung der Sarkome und Knochengeschwiilste, Strahlentherapie 50: 278-289, 1934. The difficulty of early clinical diagnosis and the unusually rapid metastasis of many sarcomas makes the treatment of these tumors, either by surgery or radiation, most unsatisfactory. The more undifferentiated the cells, the more radiosensitive the tumors are apt to be, and a t the same time, the earlier they are likely to metastasize. Osteogenic sarcomas, with the exception of Ewing’s tumors and epulides, chondromas, and fascia1 sarcomas, should be removed by radical surgery as soon as possible. Radical electrosurgical excision followed by radium irradiation is recommended for melanosarcomas, while lymphosarcomas should be treated by radiation alone. The article is without illustrations. BENJAMINR. SHORE Wisconsin M. J. 33: 411-415, Roentgen Therapy in Giant Cell Tumors, B. W. JOHNSON. 1934. The author reports two cases of giant-cell tumors in bone which appeared to be benefited by x-ray therapy. One was 9 tumor of the clavicle in a twenty-year-old girl,

236

ABSTRACTS

while the other, in a thirteen-year-old girl, involved the tibia In the first case the diagnosis was confirmed by histologic study of a biopsy specimen, but in the second case the diagnosis of giant-cell tumor was made solely from roentgenographic study. The article is illustrated with several roentgenograms. BENJAMIN R. SHORE Rapidly Developing Sarcoma of Femur, Following Injury, L. DE GAETANO.Disarticolazione dell’anca per sarcoma moelle del femore a rapido decorso, Morgagni 75: 1235-1239, 1933. A boy of seven years fell on his right knee, and a few days later complained of pain in the middle of the thigh. His mother applied hot fomentations, and noticed that the boy’s temperature rose to 39” C. each evening and that swellings appeared in the right groin. She then sought advice. X-ray examination showed a tumor arising from the back of the femur and extending nearly the full length of the bone. Although the tumor lacked the characteristic x-ray appearances of Ewing’s sarcoma, the author decided to do hip disarticulation. The growth was found to arise from the periosteum and was diagnosed histologically as a small round-cell sarcoma. The author adds a discussion of the classification of bone tumors. There are three illustrations. F. CAVER8 Osteogenic Sarcoma of the Humerus in a Child, CH. LASSERREAND MOUONEAU. Sarcome ost6og6nique de l’hum6rus chez un enfant de six ans et demi, Gal;. hebd. sci. m6d. d. Bordeaux 54: 286, 1933. A six-year-old boy was brought to the hospital with a swelling of the right shoulder which had been noticed about six weeks previously. Since then he had complained of pain in the shoulder, especially at night. The skin over the swelling was traversed by numerous small veins and was warm to the touch. X-ray examination showed a zone of destruction in the great tuberosity of the humzrus, and in the upper half of the diaphysis zones of alternating rarefaction and condensation. On biopsy the tumor tiseue consisted of elongated and polyhedral cells of varied size; no osteoclasts were found; some of the tumor cells were multinucleate, and the stroma contained abundant blood vessels. Although the authors diagnosed highly malignant osteogenic sarcoma, they advised x-ray therapy. During treatment the child became very feveridh, the tumor grew rapidly in size, the forearm and hand showed increasing edema and cyanosis, and he was removed from the hospital in a dying condition. There are no illustrations. F. CAVERS Osteoclastoma of Femur; Excision; Reconstruction Operation, ST. J. D. BUXTON Brit. J. Surg. 21: 703-705, 1934. This case is reported chiefly to demonstrate a reconstruction operation after removal of an osteoclastoma (giant-cell myeloma) of the lower end of the left femur in a woman of thirty-four, admitted to hospital with a pathologic fracture involving the knee-joint. X-ray examination showed a tumor affecting both condyles. The lower end of the femur was excised, a round hole made in the upper surface of the tibia, and two bone pegs inserted to hold the femoral shaft in place, and the patella fixed on the front after removing the articular cartilage. The patient was soon able to walk freely, wearing a high boot on account of shortening (less than three inches) of the limb. There are four F. CAVER8 illustrationa. Carcinoma in Chronic Osteomyelitis, J. J. COLLINS.Am. J. Roentgenol. 31 : 787-791, 1934. The histories of two patients in whom carcinomas developed a t the site of old oeteomyelitis are given. In one the tumor became apparent thirty-nine years and in the other one year after the development of the osteomyelitis. The article is illustrated with photographs and roentgenograms. BENJAMINR. SHORE

THE BONES

237

Chondromata of the Long Bones, J. P. Ross. St. Bartholomew's Hosp. J. 41: 69-72, 1934. This is a report of a lecture which was illustrated by gross and histologic preparations. The author distinguishes primarily between multiple and solitary chondromas. The former, which may be regarded as manifestations of a growth disorder of cartilage closely related to diaphysial aclasis (multiple exoatosis), apparently originate, not from ectopic fragments of epiphysial cartilage, but from embryonal remnants of the primitive cartilaginous rods which form the bones of the hands and feet. They are congenital, and if not present a t birth become manifest in early childhood and grow slowly until the bones are reduced to mere shells. The benign solitary chondroma of adult life apparently grows from a displaced fragment of the epiphysial cartilage, and occurs a t the end of a long bone. Its evolution depends upon whether it continues to grow as a mass of cartilage or fulfils its proper functions and develops into bone. If the ectopic cartilage becomes ossified, the familiar cancellous osteoma is formed, which always behaves as a benign tumor, not recurring after operation provided the whole of its cartilaginous covering is removed. Solitary parosteal chondromas, appearing in adult life and not arising a t the ends of long bones from displaced epiphyseal cartilage, are malignant, probably from the first. The tumor breaks through the cortex, and continues to grow outside. Usually it grows slowly for several years, recurrence being invariable after attempts to remove it from the surface of the bone, and whereas the original tumor may be indistinguishable from normal hyaline cartilage the recurrent tumors will show definitely sarcomatous features, and metastasis may occur. The epiphysial chondroma starting inside the bone is also essentially a tumor of adult life, though it may occur in childhood. It grows rapidly, as compared with the parosteal variety, the duration of symptoms is commonly a few months instead of a few years, and its malignancy is graater, though the appearance of metastases may be delayed for F. CAVERS several years after radical operation. There are two illustrat'ions. Ossi5ed Chondroma of the Ribs in an Infant, A. FOLLIASSON AND P. BLANCHARD. Chondrome costal chez un nourrisson de trois mois et demi, Bull. et m6m. SOC.nat. de chir. 59: 654-657, 1933. In a male baby of fourteen weeks there had been noticed four weeks previously a hard lump located between the right scapula and the vertebral column. This had grown rapidly, doubling in size since it was first noticed. X-ray plates showed a dense shadow attached to the neck of the sixth rib by a stalk; the upper pole of this apparently ossified tumor was rounded, but the lower pole was irregular in outline and had caused erosion of the seventh rib. The latter feature, with the rapid growth of the tumor, aroused suspicion of a malignant bone tumor. The portions of the two ribs affected were resected; the lower part of the tumor was difficult to remove owing to its close proximity to the pleura. Histologically the mass was a largely ossified chondroma, showing no signs of malignancy. The authors conclude that the tumor must have arisen from an F. CAVERS embryonic remnant.

A Parostaal Chondroma of a Phalanx, L. HEASMAN.St. Bartholomew's Hosp. J. 41: 72-74, 1934. A woman of twenty-nine had ten years previously noticed a small painless swelling on the palmar aspect of the middle phalanx of the left ring finger. This was now spindleshaped and about 2.5 cm. long. X-ray examination showed an area of bone erosion and over this an opacity showing faint calcification. The patient refused operation, but returned three months later because the lump had grown considerably and was interfering with movement of the hand. The area of erosion was greater and the tumor more extensively ossified. The tumor was excised and the bone surface curetted. Nearly six years later there was local recurrence of the tumor, and the finger was amputated. The tumor had no capsule, and consisted of cartilage cells lying in a hyaline matrix; in places the cells showed myxomatous change, and many blood vessels were present. It was infiltrating the bone, which showed islands of bone lamellae completely surrounded

238

ABSTRACTB

by tumor cells. The tumor had the appearance of a parosteal chondrosarcoma which had originated from the epiphysial oartilage. There are three illustrations. F. CAVERS

Case of Chondromatosis of a Metacarpo-phalangeal Joint, OSKARLINDEN. Acta Chir. Scandinav. 75:181-184, 1934. The author reports the case of a twenty-five-year-old man with chondromatosis of the metaqarpo-phalangeal joint of the middle finger of the left hand. Recurrences followed primary excision of the tumors, but after the second operation no recurrences had been noted over a period of three years. Only one other case of chondromatosis of a metacarpo-phalanges1 joint has been reported in the literature, and this was before the roentgenologic era. The article is illustrated with roentgenograms. BBNJAMIN R. SHORE Chondromyxoma of the Calcaneus, E. CORNEJO SARAVIO.Condromixoma del calc&neo, Bol. y trab. SOC.de cir. Buenos Aires 18:684-696, 1934. A man of forty-seven had about seven years previously noticed a swelling of the back of his left heel, the steady growth of which had necessitated the use of larger and larger shoes to accomodate the increasing length of the foot. X-ray examination showed a honeycomb appearance of the greater part of the enormously enlarged calcaneus. The author advised operation, but the patient refused this because a physician suggested antiluetic treatment on the ground of a history of infection twenty-five years previously. Five years later the patient was again seen, with the swelling about twice as large as 6efore. On a diagnosis of cystic osteitis fibrosa, the bone was curetted and two tibia1 grafts were inserted. The tissue showed the characters of chondromyxoma, without . signs of histologic malignancy. Nearly three years later the bone was of normal size and there was no radiographic sign of recurrence of the lesion. The speakers who took part in the subsequent discussion agreed with the author that tumors of this type cannot be regarded as essentially benign, since they are apt to assume malignancy and to recur sooner or later unless dealt with more radically than by curettage. There are eight good illustrations, including four x-ray pictures and four photomicrographs, F. CAVERS Familial Chondrodystrophy with Rheostosis Treated by X-Ray Therapy, G . HILTON. Lancet 1 : 122-124, 1934. A girl of ten years, complaining of pain in the lower third of the left thigh, was found to have a large swelling of the femur extending from the inner condyle upwards for three inches. The right femur had a similar but smaller swelling in the same site. Both elbows showed dislocation of the head of the radius forward and outward on the humerus. None of the joints showed signs of fluid. Radiographs of the femora showed linear hyprostosis with new bone formation. Similar bone changes were seen in the patient’s mother and two maternal aunts. X-ray treatment was followed by continuous decrease in the swellings. The term rheostosis was suggested by LBri and Joanny in 1922 for a hyperostosis which runa along the axis of a long bone. The condition is probably attributable to an abnormality in the cartilage stage of development of the bone. There are six illustrationa. F. CAVERB

Bone Metastasis in the Cervical Vertebrae from M Unsuspected Renal Tumor, LE BERRE,J. PERVES AND DUPAS. MBtastase osseuse cervicale d’un cancer rBnal mbconnu, Ann. d’anat. path. 10:964-906, 1933. A man fifty years of age had a swelling on the back of the neck following an injury. Roentgenograms showed a healing fracture of the spinous processes of the second and third cervical vertebrae, with diffuse osteitis. Though the patient was syphilitic, the x-ray appearance was not characteristic of syphilitic epondylitis, and tuberculosis could be definitely excluded. Fifteen months later paralysis of all four extremities had developed, as well as laryngeal paralysis and diffiaulty of respiration. X-ray examination showed a destructive lesion involving the upper cervioal vertebrae, the second I

THE BONES

239

cervical being almost completely destroyed. Autopsy revealed a renal carcinoma with some areas of a papillomatous character; the vertebral tumor was a metastasis, and there was also a metastasis in one of the ribs. There had been no symptoms suggesting a renal lesion.

Spontaneous Fracture of Femur at Site of Hypernephromatous Metastasis, with Subsequent Consolidation, L. GOBBI.Sulla possibilith di consolidazione delle fratture spontanee da metastasi neoplastica, Policlinico (ser. chir.) 40: 680-696, 1933. A woman of fifty-eight was admitted to the hospital with a fracture of the lower third of the left femur. Eighteen months previously she had had burning pain on urination and noticed blood in the urine, but these symptoms had soon disappeared. About a month before admission she had pain in the right thigh, radiating to the knee. The x-ray appearance suggested spontaneous fracture due to metastasis from a malignant tumor. Biopsy aonfirmed this; the tumor tissue a t the site of fracture had the structure of hypernephroma. The limb was immobilized, and successive x-ray examinations showed gradual healing of the fracture, finally complete but with slight bony deformity owing to excess callus formation. The author considers that the formation of the callus and the consolidation of the fracture were due simply to a response of the bone-forming tissue and had nothing to do with the presence of the metastatic tumor tissue. Repeated examinations failed to reveal the presence of blood cells in the urine, and during the patient’s stay in hospital there were no symptoms of renal trouble. Radiography failed to reveal the presence of metastases elsewhere in the skeleton. There are eight illustraF. CAVERS tions. Difierential Diagnosis Between Osteitis Fibrosa and Osteitis Deformans, M. L A B B ~ AND M. PETRBSCO. Btude d’un cas d’ost6odystrophie deformante de Paget, Ann. d’anat. path. 10: 1145-1154, 1933. In reporting a case of Paget’s osteitis deformans occurring in a woman of sixty-eight, the authors disbuss the radiographic and blood chemistry findings whereby this disease F. CAVERS may be differentiated from osteitis fibrosa. There are two illustrations. Case of Generalized Osteitis Fibrosa Associated with Renal Lesions, C. SCHWENSEN AND T. EIKEN. E t tilfdde af ostitis fibrosa generalisata (forme rbnale), Ugesk. f. Lsger 95: 1259-1264, 1933. A woman of thirty-six complained of dysuria and polyuria, and stated that recently she had passed a stone during an attack of renal colic. The urine showed B . coli infection, and the condition was diagnosed as pyelonephritis. Shortly afterwards the patient was again seen with apparently spontaneous fracture of the left forearm a t the site of a tumor, which had meanwhile appeared. X-ray investigation showed generalized cystic osteitis fibrosa, and blood examination revealed marked hypercalcemia. No tumor could be felt in the thyroid region, but a t exploratory operation a flattened tumor was removed from below the right lobe, and proved histologically to be a parathyroid adenoma, measuring 5 x 3.5 x 2 cm. and weighing 37 grams. Its removal was followed by diminution of the blood and urine calcium, while repeated x-ray examinations showed fairly rapid disappearance of the bone lesions. [It is interesting to recall that Mandl and Uebelhor (Zentralbl. f . Chir. 60: 68, 1933. Abst. in Am. J. Cancer 20: 645, 1934) recently found calcium deposits in the renal parenchyma and pelvis in guinea-pigs after injection of parathormone.] F. CAVERS Recurrent Cyst of the Femur with Spontaneous Fracture, L. COSTA. Su di un caso di cisti delle ossa lunghe, Policlinico (sez. chir.) 40:709-721, 1933. The author’s patient had a t the age of thirteen years had a slight fall, followed a few days later by fracture of the upper third of the right femur. With simple immobilization treatment this apparently healed completely. Three years later spontaneous fracture occurred in the same site, and x-ray plates showed a cyst of the bone, but the patient refused operation. Three years after this, fracture again occurred and this time the cyst was curetted. [The author omits mention of histologic examination of the curetted

240

ABSTRACTS

material , despite his lengthy description and discussion of the clinical, radiographic} and etiologic aspects of the case and of bone cysts in general.] Three x-ray illustrations are given. F. CAVERS

SolitaryTraumatic Blood Cyst of the Ulna, A. CIOFFI. Cisti ossea in seda m a , Riforma med. 49: 756-761, 1933. A housemaid of twenty-one received a blow on her left elbow, and a few weeks later noticed pain and difficulty in %exionand extension of the forearm. X-ray showed a cyst just below the upper epiphysis of the ulna, found on incision to contain blood and curetted out with good results. The author used the opportunity of reporting this case to discuss a t considerable length the differential diagnosis of bone cysts. There is one illustration. U F. CAVERS THE LEUKEMIAS AND HODGKIN’S DISEASE

Erythraemia, the Leukaemias and Hodgkin’s Disease, as ‘‘ Neoplastic Mutations ” of Somatic Cells, F. P. WEBER. Med. Press & Circ. 188: 286-288, 1934. The author once more repeats his belief that erythremia, leukemia, and Hodgkin’s disease arise by somatic mutation. F. CAVERS Treatment of Leukemia and Malignant Lymphogranulomas, 0.DAVID. Riohtlinien fiir die Behandlung der LeukLmien und des malignen Lymphogranuloms, Schweiz,med. Wchnschr. 15: 351-352, 1934. This is a general article concerning the radiologic treatment of patients with leukemias and malignant lymphogranulomas. No new material is added. BENJAMINR. SHORE The Leukaemias, T. THOMPSON. Med. Press & Circ. 188: 165-168, 1934. The author gives a good general account of the leukemias, under the headings of symptoms, diagnosis, pathology, prognosis, and treatment, but reports nothing new. F. CAVERS Specific Dynamic Action of Food in Anemia and Leukemia, SABURO KIMURA. Spezifisch-dynamische Wirkung der Nahrungsstoffk bei Anlmien und Leukiimien, Tohoku J. Exper. Med. 21 : 613-828, 1933;22: 18-28,29-40, 41-52, 1933-34. In four papers the author discusses the specific dynamic action of protein, carbohydrate, amino-acids, and liver substance in anemia and leukemia. (1) In chronic anemia the basal metabolism is either slightly above normal or at the upper normal limit; in chronic myelogenous leukemia it is definitely increased. I n contrast to thie, the specific dynamic action of protein is decreased in both anemia and leukemia. The mechanism of these changes ia discussed. I n ohlorosis both basal metabolism and specific dynamic action of protein are normal. (2)In chronic anemia and leukemia the basal metabolism is slightly increased after glucose administration; in chlorosis it remains within normal range. Generally spsaking the specific dynamic action of carbohydrate is decreased in chronic anemia and leukemia; in chlorosis it is normal. (3) In post-hemorrhagic anemia, as well as in phenylhydrazin anemia, the specific dynamic action of amino-acid is definitely decreased. This diminution in both experimental anemia and post-hemorrhagic anemia ia brought about through the same mechanism. (4)The specific dynamic action of liver substance in both post-hemorrhagic anemia and phenylhydrazin anemia is decreased as compared with the normal. The specific dynamic action of the liver substance must be released mainly by the interaction of proteins and carbohydrates. K, SUGIURA

THE LEUKEMIAS AND HODOKIN ’S DISEASE

24 1

Leukemia and Pregnancy, P. Hiissy. Leukamie und Schwangerschdt, Schweiz. med. Wchnschr. 15: 629-630, 1934. The author reports two cased in which the diagnosis of leukemia was made during pregnancy. I n each instance the disease remained rather stationary until the termination of pregnancy, when it showed unusually malignant qualities leading rapidly to death. The infants in each case were perfectly normal and have remained so. I n considering the correct method of procedure in such cases the author auggests that the saving of the child’s life is of prime importance, and that there should be no fear that the offspring will be affected with the leukemia of the mother. BENJAMINR. SHORE Roentgen Therapy of Leukemias With and Without Preliminary Impregnation with Thorotrast, C. GUARINI. Circa il comportamento dei leucimici alla roentgenterapia dopo impregnazione con il thorotrast e senza, Riforma med. 49: 1388-1394, 1933. Referring t o Izar and Castronuovo’s paper (Riforma med. 49: 703, 1933. Abst. in Am. J. Cancer 22: 977, 1934), the author says that he has been treating leukemia with x-rays, usually preceded by thorotrast injection, for several years. He gives notes on 8 patients who received the double treatment. Four of these have been followed less than a year and a half. Three of the other patients who were treated earlier have been lost sight of (one after being traced for six years), but one has been followed for twelve years. The history of the last-mentioned patient is given in detail, with successive blood counts, and appears to be typical. In most cases the spleen underwent rapid and considerable reduction in size after the thorotrast injection, and the blood picture showed a more or less marked approach to normal. I n some cases, however, there was practically no change in the spleen, or in the blood condition, or in either. As compared with patients who were given x-rays alone, the author believes that the patients receiving the preliminary thorotrast injection made better progress, showing longer periods of remission and shorter and less marked periods of exacerbation. With thorotrast injection a very small x-ray dosage is ueed, usually one tenth of a skin erythema dose, repeated monthly. F. CAVERS Treatment of Chronic Myeloid and Lymphatic Leukaemias by X-rays, R. J. REYNOLDS. Med. Press & Circ. 188: 171-173, 1934. The author reports two cases, one of lymphatic and the other of myeloid leukemia, treated by x-rays to the spleen. I n each case the condition failed after a time to respond to weak dosage, but improved considerably with stronger doses. The myeloid case showed within three years a drop in the total leukocyte count from 428,100 to 5,100, and the myeloid elements fell from 33 to 16 per cent. In the lymphatic case, treated for two years and four months, the leukocytes had fallen from 140,000 to 18,000, but the lymphocyte percentage (98) remained unchanged. F. CAVERS Case of Lymphatic Leukemia with Fatal Rupture of Infiltrated Descending Aorta, A. COSTA. Una lesione non nota dell’aorta :infiltratio leucemica aortae, Sperimentale, Arch. di biol. 87: vii-xiii, 1933. A man of thirty was found in the street in a state of collapse, and died a few hours after removal to hospital. The signs observed seemed to point to intestinal obstruction and peritonitis. All the external lymph node regions showed adenopathy. Necropay revealed a small quantity of blood in the peritoneal cavity and a large retroperitoneal collection of blood infiltrating the mesentery of the small bowel and descending colon. The descending aorta was greatly thickened and ragged, and showed a rent a few inchea above the iliac bifurcation. The liver was slightly and the spleen enormously enlarged, and infiltrative masses were found in the lymph node regions, kidneys, and lungs. The aorta was involved in a mass of hypertrophic lymph node tissue which had caused extensive destruction of its wall. All these infiltrations showed the structure of lymphatic leukemia. There are five illustrations. F. CAVERS

242

ABSTRAOTS

Case of Acute Lymphatic Leuchasmla with Leuchlamia Cutis and Leucimides, T. J. F. FRANK, M. J. Australia 1: 128-128, 1934. A man of fifty-nine had been in good health until five weeks before hospital admission, when he became feverish and complained of backache, with the result that he was sent to bed and treated for influenaa. A week after this there appeared a brownish rash over the front of the chest and abdomen, and a few days before entering the hospital pink spots were seen over the same area, and the throat became sore. The axillary and inguinal nodes were enlarged, and firmly attached to the right tonsil was a tough whitish membrane. Between the brown skin nbdules there were numerous small petechiae and purpuric spots. Application of a tourniquet to the arm, with just enough force to obliterate the venous pressure, caused the appearance of many petechiae distal to the site of bandaging. Blood examination showed 3,800,000 erythrocytes, 59 per cent hemoglobin, 26,700 leukocytes (immature lymphocytes 83.5 per cent, small lymphocytes 12.5, lymphoblasts 1.5, myelocytes 1.75, polymorphs 0.75). The prevailing cells were pale staining and non-granuIar with basophil cytoplasm; only 6 per cent of these cells were positive to peroxidase tests. The patient became rapidly weaker and died six days after admission, six weeks after the onset of symptoms. Necropsy showed extensive infiltration of immature lymphocytes in various organs and lymph nodes, and also in the skin nodules. There are three illustrations. F. CAVERS Trial of Malarial Infection Therapy in Two Cases of Myeloid Leukemia, B. DB LUCA. Tentavi di malariraaaione terapeutica nella leucemia acuta e cronica, Riforma med. 49: 1207-1210, 1933.

The author cites reports of cases in which temporary arrest of leukemic diseases has followed intercurrent infections such as erysipelas, typhoid, scarlatina, influenaa and malaria. Apparently Schupfer (1905) was the first to treat a case (chronic myeloid leukemia) by injection of blood from a malarial patient, but without noticeable influence on the course of the disease. Since then, several writers have reported temporary improvement in leukemic cases treated in this way. The author has used this method in two cases, one of acute and the other of chronic myeloid leukemia, injecting the mdarial blood intramuscularly. In the acute case there was considerable reduction in the siae of the spleen and in the myelocyte count, but these signs of improvement lasted only a few weeks after the fever had subsided, though x-ray treatment was also given. In the chronic case the period of amelioration was somewhat longer. The author gives only the blood count made on hospital admission in each case, but his impression is that, apart from the temporary regression of splenic enlargement, the improvement was mainly subjective, the patients experiencing a feeling of well-being until the spleen again became enlarged. F. CAVERS

Chronlc Myeloid Leukemia in a Very Young Child, J. C. ScHrmERs. Een geval van chronische myeloide leucaemie bij een leer jong kind, Maandschr. v. Kindergeneesk. 2 : 490-496, 1933.

Schippers describes a case of myeloid leukemia in a nine-months-old boy who had suffered shortly before from acute bronchitis, bilateral otitis media, bilateral conjunctivitis, and whooping cough. The patient died at the age of eighteen months. JOHANNEB P. M. VOQELAAR

Case of Myelogenous Leukaemia, C. D. BRINK. So. African M. J. 8: 375, 1934. A woman of twenty-eight complained of a feeling of dragging in the abdomen and of loss of weight and strength. The liver and spleen were much enlarged, and there was cervical, axillary, and inguinal adenopathy. The total leukocyte count was 246,000, including 11 per cent myeloblasts and 10 per cent myelocytes. Sixteen days after deep x-ray therapy the spleeen and liver had become smaller; the total leukocytes fell to 37,000,and the percentage of myeloid elements to 5. The patient has been lost sight of. There are two illustrations. F. CAVERS

THE LEUKEMIAS AND HODGKIN’S DISEASE

243

Case of Chronic Myelocytic Leukaemia in Which Splenectomy Had Been Performed, P. R. WREATLY.Guy’s Hosp. Reports 84: 77-79, 1934. A woman of fifty-seven had undergone splenectomy in 1922 in another hospital; the spleen weighed 19 ounces; the blood count was normal. In 1928 there was considerable bleeding from the gums for about six months. From 1932 onwards slight nosebleeds occurred, and during the six months preceding the patient’s admission to Guy’s Hospital in 1933, she had noticed increasing frequency of urination, weakness, and dyspnea. There were no petechial hemorrhages. Examination revealed great tenderness over the sternum and the long bones; the teeth were carious and the gums red and in places purulent; the liver was considerably enlarged. A blood count showed 6,200,000 erythrocytes and 125,000 leukocytes (neutrophils 67 per cent, eosinophils 8, basophils 6, myelocytes 13, lymphocytes 4, hyaline cells 2). A caruncle a t the urethral orifice was removed, and the uterus curetted to exclude any local cause of uterine hemorrhage, of which the patient complained. This cured the urinary symptoms, but bleeding continued. On passage of a catheter considerable blood was obtained from the bladder. A week later bleeding had ceased, and the hemoglobin percentage had fallen from 110 to 90, and the total leukocyte count to 85,000. The latter showed a further fall to 42,000 after a small dose of x-rays over the liver. The differential count remained almost unchanged, except that the myelocyte percentage rose to 17 per cent. The author says there are apparently three possible explanations of the findings in this case. (1) When splenectomy was done and there were no myelocytes in the circulating blood, the condition may have been a leukemia in the early stage, in which nothing more than an unexplained excess of normal leukocytes occurs. (2) The original lesion causing the splenic enlargement may have been thrombosis of the hilar veins (found in the removed spleen); this might well have caused the leukocytosis found in 1922. (3) The high figures for hemoglobin and erythrocytes suggest that the case may represent the occasionally observed transition from polycythemia to leukemia. F. CAVERS Alaulremic Lymphadenosis with Infiltration of the Skin of the Face, H. HAXTHAUSEN. Aleukaemisk Lymfadenose med specifeke infiltrater i Ansigtets Hud, Hospitalstidende (Danske Dem. Selsk. Forhandl.) 76: 38-39, 1933. A man of seventy-six had noticed, six months before hospital admission, several raised patches on the face, especially about the nose, eyes, and cheeks, showing a striking resemblance to butterfly lupus. There was bilateral cervical and axillary sdenopathy, and the liver and spleen were moderately enlarged. Blood examination showed 4,300,000 erythrocytes, 72 per cent hemoglobin, and 12,720 leukocytes (lymphocytes 67 per cent, polymorphonuclears 26, eosinophils 3, transitional forms 4). Biopsy F. CAVERS of the facial lesions confirmed the diagnosis of aleukemic lymphadenosis. Hodgkin’s Disease: A Treatise, L. UTZAND L. KEATINOE.M. J. Australia2: 412-421, 1931; 1! 521-537, 1932. These two papers complete a series of three on Hodgkin’s disease (for the first see M. J. Australia 1: 397-408, 1931. Abst. in Am. J. Cancer 16: 265,1932). In the earlier one (the second of the series) the literature on the morbid anatomy and histology ia reviewed, with liberal quotations; the signs and symptoms are enumerated, and the diagnosis is discussed. The final paper deals chiefly with the treatment of the disease. The authors have used a serum obtained from chickens injected twelve days previously with an emulsion prepared from a gland or a group of glands of the patient to be treated. The serum was administered subcutaneously. A first dose of 0.25 C.C.was given, and if no severe reaction resulted, 1.0 C.C. or thereabouts was given on the succeeding day; if a severe reaction occurred, the first dose was repeated. This procedure was repeated (fresh serum being obtained from the hen) after seven days, and so on for four series of injections, after which injections were given fortnightly (0.75 C.C. and 1.0 c.c.) on successive days. In most cases deep x-ray therapy accompanied the serum treatment. Twenty-six cases are reported in detail. Two patients are said to be cured, 11 showed marked improvement, 5 showed improvement, and there were 6 deaths.

244

ARSTRACTS

Hodgkin’s Disease, JOHN MCCRATH. Irish J. M. Sc., pp. 643-666, December 1933. The author reviews the subject of Hodgkin’s disease, quoting numerous authorities, and includes reports of four cases treated by the method of Utz and Keatinge (see above) without effect. A bibliography is appended, and photographs and photomicrographs are included. Transverse Myelitis Syndrome as an Early Sign of Lymphogranulomatosis, L. MANN AND E. MATHIAB. Ueber spinale Querschnittsllision als Anfangserscheinung bei Lymphogranulomatose, Ztschr. f. d. ges. Neurol. u. Psychiat. 147: 237-243, 1933. A woman of thirty-five years, apparently in good general health, complained of pain in the lower back and sacral region. Over a period of some ten months signs of spinal cord compression appeared, which ultimately became those of a complete interruption of spinal cord function. A laminectomy disclosed multiple extradural lymphogranulomatous tumor masses, compressing the cord. Microscopic examination of specimens from the various lesions showed a similar 1ymphogranulomaZous nature. Temporary improvement occurred following the operation, but the patient later failed rapidly and died eight months after the operation. Autopsy revealed extensive lymphogranulomatosis throughout the body. There is, a short review of the literature. EDWINM. DEERY Differential Diagnosis of Lymphograndomatosis, R. H. JAFFB. Zur Differentialdiagnose der Lymphogranulomatose, Wien. med. Wchnschr. 84:388-392, 1934. Jsff6 reports the case of a fifty-three-year-old woman with a rapidly fatal disease characterized by marked anemia, leukopenia, enlargement of the lymph nodes and spleen, and subcutaneous hemorrhages. Autopsy showed the typical lesions of lymphogranulomatosis in the liver, spleen, lymph nodes, and bone marrow. The article is illustrated BENJAMINR. SHORE with photomicrographs and clinical records. Hodgkin’s Disease Mistaken for Thyroid Tumor,L. M. GOLDMAN AND JULES NEWMAN. Am. J. M. So. 187:744-746, 1934. The authors report two cases of Hodgkin’s disease of the lymph nodes of the neck mistaken for primary tumors of the thyroid gland. In one case the correct preoperative diagnosis was made, but a t operation the lymph nodes were found so closely adherent to the thyroid gland that the diagnosis was altered in favor of a primary thyroid growth. One photomicrograph is included. BENJAMIN R. SHORE Severe Relapsing Anaemia in a Case Apparently of Hodgkin’s Disease, F. P. WEBER. Lancet 1 : 680-682, 1934. An anemic youth of nineteen had bilateral cervical adenopathy. Apparently the disease began at the age of seven years with enlargement of the left cervical nodes. These were excised, but four months later the adenopathy recurred. Radium treqtment was followed by disappearance of the nodes and improvement in general health. Two years later the patient was readmitted to the hospital because of extreme weakness and anemia. A blood count showed 1,222,000 erythrocytes, 25 per cent hemoglobin, and 11,800 leukocytes with a normal differential count. Following several blood transfusions and administration of liver preparations, the erythrocyte count rose considerably, then fell again. Transfusions and other measures a t last proved to be of no avail in raising the erythrocyte count. Throughout the patient’s stay in the hospital there had been remittent fever, and the temperature reached 106’ F. shortly before his death, which occurred four years after admission. At necropsy infiltrations were discovered in various organs. Although no Sternberg cells were found, there were fibrosis and infiltration with mononuclear lymphosarcoma-like cells. The case was apparently one of Hodgkin’s diaease modified by radium treatment, with severe anemia of largely hemolytic nature. There is one illustration. F. CAVERS

EDUCATION

245

STATISTICAL STUDIES

Race and Cancer, SIQISMUND PELLER.Rasse und Krebs, Acta Cancrologica 1 : 29-47, 1934. Comparison of the mortality rates for various races is subject to so many sources of error that the author has restricted his investigation to three Semitic folk-Jews, Egyptians, and the Arabians of Palestine. The proportion of sarcoma to carcinoma was found higher among adult Jews than among other races of Europe and America, though a part of this excess is referable t o differences in age constitution. The sarcoma rate was equally high among Arabians in Palestine. It was high, also, among the Egyptians; lower than that for Jews and Arabians, it was still much higher than that for Christian peoples. Among Christians in Palestine the sarcoma rate was lower than that for Mohammedan Arabs, but higher than in Europe. The sarcoma rate was much higher in men than in women. Peculiarities in the organ attacked, observed among Jews in many European countries (e.g., a high rate for ovarian cancer), were found in Palestine also. WM. H. WOGLOM Tumors in the Tropics, P. MUHLENS. Uber Tumoren in den Warmen Zonen, Tung-Chi Med. Monatsschr. 9: 65-75, 1933; 121-127, 1934. In this general review, a lecture to Chinese physicians, the author gives an account of the most important tumors and new growths seen in tropical regions. The problem of tumor distribution in the. tropics involves the following factors: (1) the relative incidence of various types; (2) internal and external factors which may be present and play a r61e in tumor genesis; (3) possible association between neoplasms and diseases peculiar to the tropics, as, for instance, certain parasitic infections. On none of these points are reliable statistics available. The importance of tumor research in K. SUQIURA tropical countries is stressed. Cancer in Malta, FREDERICK L. HOFFMAN.Acta Cancrologica 1 : 52-55, 1934. The recorded death rate for cancer in Malta is not much over 60 per 100,000, or less than half the rate for England and Wales. Comparison of the frequency by organs and parts with that recorded for Massachusetts shows a lower frequency for each site; thus for the stomach the rate is 22.4 per 100,000 for Malta as against 40.0 for Massachusetts; for the female genital organs 8.8 as against 16.9, etc. [No mention is made of age distribution or of the possibility of obtaining highly skilled medical advice in Malta.] WM. H. WOQLOM Observations on the Incidence of Malignant Disease in South African Natives, A. S. STRACHAN.J. Path. & Bact. 39: 209-211, 1934. The author analyzes the casss of malignant disease coming to necropsy at the General Hospital, Johannesburg, during the ten years 1924 to 1933. Among 1622 Europeans there were 190 cases of carcinoma (12.5 per cent), 12 of sarcoma, and 30 cerebral tumors. In Bantu natives there were 1910 necropsies, with 73 carcinomas, 10 sarcomas, and 8 cerebral tumors. The lower incidence of carcinoma in Bantus may largely be accounted for by the absence of children in the European group and the small number of native patienta over forty years of age. The maximum incidence of cancer in Europeans occurred in the sixth decade, while for natives it was in the fourth decade. The liver was the commonest site of primary carcinoma in the Bantus (37 of the 73 cases). F. CAVERS EDUCATION

Popular Discussions of the Cancer Problem, ALBERTSOILAND. Die offentliche Besprechung der Krebsfrage, Schweiz. med. Wchnschr. 15: 698-699, 1934. One of the opening addresses at the Zurich Radiological Congress, calling attention to the improvements in surgery and radiology which have considerably increased the cure

rate of cancer in the past thirty years. But it must be remembered that cancer education is of' no value unless the reoipient of the instruction acts with promptness and intelligence in obtaining the best form of treatment and avoiding quackery.

One Hundred and Fifty Years of Cancer Research, HANBR. SUHINZ.Hundertftinfcig Jahre Krebsforschung, Deutsche med. Wchnschr. 60:1075-1080,1934. I n this paper, read at the IV International Congress of Radiologists (Zurich, July 24-29,1934), the author traces the history of cancer research and comas t o the conolusion that primitive ideas have been replaced by much more scientific conceptions, though the goal is not yet in sight. WM. H. WOQLOM

K. NARAT. Am. J, Surg. 23:4346,1934. Recent Progress in Cancer Research, JOSEPH The author reviews some of the recent progress made in cancer research but adds no material of his own. BBINJAMIN R. SHORE Short Introduction to Practical Cancer Control, OTTOHAHN. Einige Worte iur Einleitung praktischer Krebsbekiimpfung, Tung-Chi med. Monatsschr. 9:78-81, 1933. This is a lecture given by the suthor to Chinese physicians, voicing the fundamental principles for the coxitrol of cancer by early recognition and correct treatment. K. STJQITJBA