ALVEOLAR MELANO-SARCOMA.
Mrs. M. M., 68 years old, first seen July 12. 1869; noticed the begin ing of a tumor in the right breast three years previously; a nodule had formed externally to and below the nipple; she had borne ten children, but had nursed none of them. Menstruation was regular from her four teenth to her fifty-third. year. She had under the right eye a dark blue nodule about the size of a flax-seed, which she said she had had from her birth; her brother had a similar one in the same place. She had a similar one on the back in the region of the fossa supra-spinata, which had also existed from birth.
The woman was pale and emaciated. The right mamma was larger than a child's head, hard, nodular, with the skin adherent to the tumor; a group of axillary glands could be felt. The whole tumor, which was freely movable on the thorax, together with the mamma and the axillary glands, was removed July 15, 1869. The operation was an extended one. When the patient left the hospital October 12, with the wound healed, a bluish nodule, which infiltrated the skin, was observed on the right side of the back. This subsequently developed into a black tumor, with sim ilar nodules near it. The region near the sear and the axilla remained free. She died June 30, 1870. No autopsy was made. Duration of the disease, 4 years When I first reported this case in my Klinische Berichte (Vienna, 1869-1870, p. 177) I had some hesitation about the classification of this tumor, and I wrote as follows. " On examination of this mammary tumor, which throughout its course has acted like a carcinoma, I was for a long time in doubt in what category to place it. The brownish-black pig mentation and the arrangement of the large cell elements in somewhat small meshes, which here and there gave great security to the cell in the alveoli, made it appear for a long time probable that I had to deal with a sarcoma. Other situations of the tumor, as well as the method of spread ing, the early involvement of the lymphatic glands, exquisite gland-like forms of the large-celled cellular cylinders and bulbs, left also little doubt that it was a true, rapidly growing carcinoma of the mammary gland. I
must finally conclude that it was a very intimate combination of carcinoma with sarcoma: a rapidly spreading epithelial growth and metamorphoses of the stroma into the tissue of an alveolar sarcoma very rich in pigment." It will be seen from the above citation that I very unwillingly reached the compromise of §arcoma and carcinoma. On 'pore recent grounds, from repeated examination of the subject and wider experiences with alveolar sarcoma and melanoma, I do not hesitate to call the tumor under con sideration simply a " sarcoma." I am especially prompted to do this be cause I found the roundish alveoli in part filled with pigmented cells, and which I took for dilated gland-acini, also in the axillary glands, where they certainly could not have originated from the gland-clusters. Further, the continuous and detailed examination of rapidly growing melanoma has shown me that they are always sarcoma. Thus far there has been no observation which furnishes proof that epithelial cells, for example, arising from the cutis, become pigmented in carcinoma; nor is there anything known as pigmented epithelial carcinoma. Now, since the epithelium of the mammary gland is derived from the epithelium of the cutis, it is in the highest degree improbable that it gives rise to true melanotic mammary carcinoma. It has been further especially proved as to large-celled alveolar sarcoma that it infects the lymphatic glands; that is, cell elements are prolonged into the lymphatic glands and there find a favorable soil for development, which is otherwise not frequent in Parcoma. So it was in the following case (see Fig. 19), which for a long time I took to be carcinoma, until repeated examinations of different portions of the tumor showed it to be a sarcoma.