CARCINOMA AND SARCOMA- ADDISON'S DISEASE AND OTHER Carcinoma may be primary in the adrenal bodies, but is more com monly secondary to such growth in neighboring structures. In 123 cases of new growths (102 carcinoma, 21 sarcoma), Dr. Norman Moore found secondary growths in the supra-renal capsules iu only 8. Of these, 2 occurred primarily in the lungs (sarcoma), 2 in the heart (endothelioma), 1 in the brain (sarcoma), 1 in the kidney (carcinoma), 1 in the stomach (carcinoma), 1 in the cesophagus (carci noma). Microscopic examinations were made in each case." In these cases it is usual to find new growths widely disseminated over the viscera. Round-celled sarcoma appears to be the commonest form met with. Dr. Pye-Smith has recorded a case in which primary sar coma occurred in each adrenal body in a child. Direct extension of malignant growths may be met with where the disease has spread from the kidney, lumbar glands, vertebrae, or pancreas.
Addison, in his memoir, included four cases of cancer of the ad renals, and he believed at first that any disease which entirely de stroyed these bodies could produce the characteristic symptoms of the disorder he described. Dr. AVilks proved that this was not the case, and that cancer of the adrenals was incapable of producing true Addison's disease. There may be a tumor of the capsules so large as to be palpable during life, but this is an extremely rare event. ].t is very noteworthy that disease so completely destructive of these or gazes should fail to induce the characteristic symptoms of Addison's disease. An explanation of this fact is suggested by analogy with
cancerous growths in the liver, which often fail to set up jaundice and other symptoms, all of which might naturally be looked for in such cases. The process is often so rapid and acute, and so frequently fails to strangle the nervous structures adjacent to those organs, that there is hardly time for the induction of many of the leading symptoms of Addison's disease.
The fact remains that in the majority of cases of malignant dis ease of the adrenal 'bodies, the condition of these organs is not clini cally recognized and is only discovered at the necropsy. Other fea tures of the case are more prominent and obvious. Nine cases of cancer have, however, been recorded in which brdnzing of the skin occurred without other specific symptoms of Addison's disease.
The duration of these cases is generally not more than a year. In one instance, an adult was treated for dyspepsia for two years, and subsequently developed symptoms like those of phthisis. He was deeply jaundiced and delirious during the last two weeks of his life. There was found cancer of the head of the pancreas, the lungs and kidneys were full of cancerous masses, and the right adrenal body was infiltrated with carcinoma. In not a few of these cases, the age of the patient is more advanced than that at which Addison's disease is most apt to occur.