ALVEOLAR GIANT-CELLED SARCOMA.
Mrs. Josefa F., 42 years old; had had several children and nursed them. She consulted me first in November, 1876, on account of a tumor as large as the fist which had existed a few months in the right breast. This tumor had large nodules, was lobulated, felt tolerably firm, completely encapsulated, and was easily movable in the gland; the axillary glands were not swollen. I did not get from it the impression of a carcinoma, but rather that of a lobular hypertrophy, and for that reason I used com pression with a bandage for a week. The tumor did not become smaller, but was much more turgescent and painful. I extirpated it December 9, 1876, and on account of the complete encapsulation I did not doubt that I had removed the whole diseased mass. It also appeared lobulated ou section, was grayish red, and a fine granular jelly-like substance could be pressed from it; I therefore took it for carcinoma. My assistants, who made the microscopical examination, reported that the tumor contained strikingly large cells, and that it had the character of an alveolar carci noma with some cystoid, muco-fatty foci of softening. The wound healed quickly by first intention. The operation was attended by an unusual amount of hemorrhage. In February, 1877, the patient returned with a tumor of the axillary glands, which was easily removed. In April a small recurrence near the cicatrix on the breast was removed. Soon there was a new recurrence in the axilla, which was extirpated on June 28; the patient was attacked by erysipelas after this operation and died July 9. The autopsy showed double pleurisy, fibrino-purulent periton itis, purulent cystitis, endometritis, salpingitis and bilateral oophoritis; no emboli anywhere and no metastatic tumors.
I have again and again examined different portions of the tumor re moved. Especially striking was, the formation of the partially smooth walled cystoid spots of softening in the axillary glands. If anyone could
still think that these cysts, in tumors of the breast, arose perhaps by dil station of the acini or excretory ducts, to which microscopic examination certainly gives no support, such ideas must surely be discarded in regard to the axillary glands. This cyst-growth, as is not unusual in giant-celled sarcoma of the bone, and also leads to the formation of hollow spaces with a perfectly smooth wall, similar to a serous membrane, certainly indicates sarcoma. Nevertheless some parts of the extirpated tumor appeared so markedly carcinomatous that I was constantly impressed with the idea that it was a carcinoma or a combination of sarcoma and carcinoma. Unfortunately I cannot so certainly decide the question in this case as in the former, because I myself did not make the microscopic examination in the first case, and because normal gland parenchyma, in which transi tion forms could have been sought, was wanting in the preparation.
The preparation, from which Fig. 19 is taken, is from the recurrent nodule of the mammary cicatrix. The lymphatic glands have a similar appearance. In order to form an idea of the size of those cells and their nuclei, one may compare this illustration (Fig. 19) with Figs. 16 and 17, as well as with the later illustrations of carcinoma, which are of the same enlargement.
Pure spindle-celled sarcoma, myxo-sarcoma (myxoma) and plexiform sarcoma I have thus far never seen in the mammary gland. But in pro liferating cysto sarcoma, which will be described later, there are not in frequently parts which consist entirely of spindle cells, and not infre quently also large portions which consist entirely of myxomatous tissue. Volkmann briefly mentions having observed an " intercanalicular spindle celled sarcoma as large as a walnut " in a woman 22 years old.