SYMPTOMS AND COURSE OF SOFT SARCOMA OF THE BREAST.
The four cases reported show already how little infectious soft sarcoma of the mamma depends upon age: the cases were in the 14th, 31st, 42d and 65th years. As regards the course of these tumors, the reported cases in literature are not to be trusted. The differentiation of soft sar coma from soft carcinoma and of the different forms of soft sarcoma from one another, is principally, and in part exclusively based on exact micro scopic examination, and is the result of the progress made in the last ten years. By Velpeau, Erichsen, Paget, Gross, Birkett and other authors, these tumors are doubtless placed in the category of " encephaloid" ; though to completely identify them with these is impossible, or else Velpeau could not possibly say that the encephaloids are more frequent in the mamma than in any other portion of the body. He would also probably indicate the. soft medullary appearing carcinoma as encephaloid; he considers it as identical with what Burns (1800) calls spongoid inflam mation, Hey (1803) and Wardrop (1809), fungus Inematodes, Abernethy (1804) pulpy medullary sarcoma. In a more singular way, he identifies it with carcinoma fasciculatum and carcinoma villosum (Rokitansky). Later there has arisen a class of "cancers fibro-plastiques" (Lubert), under which again napiform cancers, chondroids and colloid cancer have been placed as subdivisions. It is not to our purpose to discuss what we shall understand by these notations; the first incomplete beginnings of pathological histology brought a great deal of confusion into the former classification of tumors based on outward similarity.
Since melanotic sarcoma is so clearly characterized by its color, the older surgeons of course described it when they found it in the mamma.
But most of those who speak of it among the mammary tumors, say that they have not seen it. Velpeau only reports two cases, but lie particu larly says that the black nodules occurred in the skin near others of the same sort, and not in the substance of the gland. It therefore appears that the above-described case is the only one that has been observed in recent times. Birkett mentions older preparations. In the museum of Guy's Hospital is a preparation of melanoma in the mamma, connected with melanoma in other parts. But it is not said of either case whether the melanoma in the mamma was the primary tumor.
To present a clinical picture of soft sarcoma of the breast and its course is impossible on account of the small number of descriptions hitherto given. We can only say that the tumor is usually movable in the glandular tissue, is encapsulated, has solitary nodules on one side, and is seldom diffused in both breasts; that no age from the beginning of puberty up to the middle of the sixth decennium, is exempt, that it feels firm at first and grows slowly, then after perhaps one year it grows rapidly, is usually painless, and then. becomes larger and softer in differ ent places. The differential diagnosis of cysto-sarcoma is not always to be made with certainty; the axillary glands are sometimes swollen, some times not, recurrence appears quickly after operation, and death most frequently follows from internal metastases, especially of the lungs and liver. The duration of the disease is often very short, though sometimes as long as four years.