SOFT SA RCOMA. RY SARCOMA.
Soft sarcoma seldom occurs in the breast, though I have seen the fol lowing cases of this group of tumors.
A medullary granulation (round-celled) sarcoma, perhaps only acciden tally combined with the development of striated muscular fibres, I have seen only once (Arch. f. Path. Anat., Bd. XVIII., p. 69) and that in a very young girl.
D. B., 16 years old, somewhat chlorotic though otherwise strong, below medium size; has menstruated regularly for two years; came to B. von Langenbeck's clinic on March 14, 1859. Both breasts were well devel oped for her age. Nine months before a swelling had appeared deep down in the left breast; it was but slightly sensitive to touch, not painful otherwise, began slowly, but in the last few months had grown rapidly. Local blood-letting, iodine, iron, did not check the growth of the tumor. It soon attained the size of a child's head, was freely movable under the skin and in the gland, though the skin over it was tense, and was red dened at the summit of the tumor. The consistency of the tumor was very different at different places, partly soft and elastic, partly hard and nodular, and in other parts distinctly fluctuating. The axillary glands were not swollen. From all the symptoms a cysto-sarcoma was diagnosti cated. After the tumor was extirpated, however, it was seen that it con tained no large hollow spaces, but consisted partly of adenoid (externally), and partly of medullary substance, in which here and there small fissure cysts could be recognized. The tumor, completely encapsulated, was thoroughly removed, and at the same time some of the surrounding healthy tissue and the greater part of the skin. The wound was closed with sutures, healed completely by first intention, and the patient left the hospital 14 days after the operation, cured.
On July 22 the patient returned, because three weeks before a new and very rapidly growing tumor had developed in the cicatrix. The patient
had been rid of her chlorosis by the use of chalybeate waters, and looked blooming. Under the cicatrix in the left mamma, lay a more or less clearly fluctuating tumor as large as the fist, which was entirely painless; the axillary glands were not swollen. The extirpated tumor had the ex act appearance of brain substance, and was sharply circumscribed. Heal ing followed the extirpation of the tumor and remainder of the gland very quickly, and on August 7 the patient left with a small healthy gran ulating wound. But there is scarcely any doubt there was soon another recurrence, and that the girl finally died from the disease.
It is seen from the illustration (Fig. 16) that the original gland-ele ments are surrounded by the tumor, which contains besides small round cells, some fatty tissue also, which is not newly formed, but has not yet changed to sarcomatous tissue.
More often I have seen broad band-like fibre-filaments in sarcoma and cysto-sarcoma of the mamma, though on isolation I could not draw the conclusion that they were organized muscular fibres. That such may occasionally develop from the layer of muscular fibres of the larger ex cretory ducts there is no doubt. There was no connection of the tumor to the pectoralis major muscle. Since no one will believe that striated muscular fibres are formed from the sarcoma cells originating from the connective tissue, there remains scarcely anything else, from our pres ent histogenetic ideas, than the hypothesis that muscle-germs from the pectoralis major had wandered into the mammary substance in the first formation or during the development to puberty of this girl, and had taken on a supplementary growth by the development of the sarcoma.