S.1 t fl a Of the choroid starts as a (1.-1,1,w( ment of the retina, whi,11 1- not wavy like an ordinary 1,11.11111cm: and through which large ves Si Ma1" tql.-11.
Ca,o of reditary sarcoma of the eye ball in three gtnerations. The left eye f the mother and daugliter were affected inelanotic sarcoma, and it was stated that a sister of the mother had died of multii le tumors, and had lost an eye, and that the father and a twin-sister of the first patient had also lost an eye. The nature of the affection was unknown in the last three instances. Silcock Brit. :Med. Jour., :May 21, '92).
Instance of leueosarcoma of the choroid that had apparently developed from the lamina fusca. It y-as composed of two distinct lobes of unequal size. 'Microscopically, it was remarkable on ac count of the huge vascular spaces that permeated it in all directions. Atropine, which was dropped into the eye the bet ter to examine that organ, probably gave ris.e to an increase in the arterial spaces of the tumor, rupturing and precipi tating an attack of acute glaucoma, which had necessitated enueleation of the eye. Fromaget (Gaz. Ilebdom. des Sci. M6d. de Bordeaux, Aug,. 20, '93).
Microscopical examination of sarcoma of the ehoroid, arising from injury, made early in its prog,ress, shows that the groy th is almost wholly confined to the choroid. Buller (Trans. Amer. Ophthal. Soc., '95).
Front observations based upon the mi croscopical examination of nine cases of sarcoma of the claoroid it is thought that these tumors beg,in in the vessel-walls and cause an obstruction to the venous ein-ulation, which becomes greater as the vertex veins become involved. As a re sult of the involvement of the sclera by the tumor the lymph-channels also be come blocked. In those cases in which there is greatly-increased tension the ar terial lumen is concentrically narrowed.
The venous congestion and increases in capillary area produced by the venous obstruction canse 1111 augmented tran sudation and (edema, especially in the ciliary body, and this is the cause of in creased tension. Schlennit's canal re mains nearly normal ill all instances, but, in cases in which the tension remains low, the surrounding veins become enlarged. lit cases of markedly-increased tension the root of the iris is forced against the posterior layer of the cornea, the choroid pressing against the sclera. The tension of the eyes is not dependent upon the size of the growth, but upon its position. Travis (Ophthalmic 'Record, Apr., '96).
Case of sarcoma of the choroid situated in the macular re,gion. with propagation along the sheath of the nerve to the or bital tissue, the sclera not being perfo rated. rile intra-ocular portion of the growth was smooth and flat, and had not produced detachment of the retina, nor had it extended farther into the globe after four years of observation. Histo logically, it was composed of fusiform cells, relatively poor in vessels, but con taininr, an abundance of pigment. The intra-orbital portion was much larger and wa.s lobulated and incapsulated. Histologically, it was an endothelioma (or angiosarcoma), presenting- cavities filled with large round cells. surrounded by a stroma of connective-tissue bundles. Many of these cells had undergone hya line degeneration and gave the chemical reaction of glycogen. Pallas (Archives d'Opbtal., Aug., '96).
Case of metastatic sarcoma of the choroid. which occurred in a man 26 years Of ap•e. In this ease bath the eyes were affected. Examination of one eye
showed sarcomatous patches, varying in size. color. etc., the larg,est and most prominent one lying just below the op tic-nerve entrance and apparently in cluding. it. The optic nerve seemed to be .swollen behind its entrance. :Micro scopically the.se patches were found to consist of small round cells. some spindle cells, many blood-vessels., and channels. Examination of the choroid revealed sarcomatous nodules in practically al most all of the vicera. Wiener (Jour. Amer. Med. Assoc., Nov. S. 1902).
Case of melanosarcoma of the choroid. The patient presented a nodular mass of tbe left eye which could be seen pro truding between the widely opened eye lids. The nodule, which was somewhat mobile, was vascular and pig,mented. Its internal surface was covered with numermis seab.s, beneath which bleeding areas could be exposed. The skin of the lower lid was excoriated and excreted a thin, sanions fluid. The mass was pain less, and the right eye was normal in every respect. Tile orbital contents were removed and the patient made an uneventful recovery. A very careful microscopical examination of a large ntunber of sections from the removed mass was made. The preponderance of the cells over the intercellular substance (as is usual in such growths), the gross infiltration into the surrounding tissues, and the thorough destruction of all the soft ocular elements are of the utmost importance. The long period of time, possibly more than twenty-six years in this case, that the growth had been in existence and the almost certain surety of the failure of extension or metastasis for a period of more than three years' time after the removal of the orbital mass are of great importance in the prognosis of such an affection. C. A. Oliver (Univ. Med. Mag., Feb., 1901).
For many months or years uveal sar coma grows slowly, giving rise to 110 other symptoms; this is its first, or latent, stage. Then it causes increased tension of the eyeball and inflammation; the second, or inflammatory, stage. The third stage begins when it perforates the sclera and begins to invade neighboring tissues. It now grows rapidly. The fourth stage begins with the extension of the disease by metastasis to other organs.
Treatment.—The earliest possible re moval of the tumor is indicated. In a few cases of sarcoma of the iris this may be accomplished by iridectomy, removing the growth with the iris from which it springs. in all other cases the eye must be enucleated, and if perforation of the sclera has occurred the orbit should be emptied of its contents.
If a ease of primary sarcoma in the iris be seen in the first stage of the disease, before any signs of surrounding irritation have appeared, it is best to immediately remove the by an iridectomy so placed as to include the tumor in the coloborna; whereas, in those cases in which the second stage has been reached, enucleation should be performed. An drews (N. Y. Med. Jour., June 1, '89).
Twenty-four cases of sarcoma of the uveal tract observed in the C1Ittingen University clinic. In view of tbe pro portion of 37 '/..„ per cent. of definite cures personally witnessed, the prog nosis does not seem to be so unfavorable as is generally supposed. It is recom mended that operation should be done early as possible. If no recurrence is noticed within three or four years, the patient is tolerably safe; not absolutely so, however, as was show n in 1 case in