The differential diagnosis from gummata or fibrous cysts in the bones will be much more difficult. The rapid course and skiagraphy will be invaluable. Finally an exploratory excision will be derisive, and with this we must not hesitate, as rapidly growing tumors demand instant removal, while our waiting for the result of an anti-syphilitic treatment may cost us too much valuable time.
The prognosis of these bone-tumors is always unfavorable, except that of the above-mentioned (Tiflis. The most extensive resections within the healthy tissues and amputations may occasionally save a life.
The lymph-glands may become sarcomatous by metastasis, but they may also be themselves the starting point of lymphatic growths.
The /yn:pho.sarconiata with a structure similar to lymphocytes are occasionally observed in children, originating from the lymph-glands near the digestive tract or the neck. They grow rapidly and form massive tumors, which grow into the surrounding organs, destroying them.
The differential diagnosis from other similar diseases must be made by observing the course of the disease, aided by the examination of the blood and the blood-forming organs (see Japha, Diseases of the Blood, vol. ii) The malignant lymphosarcomata also consist of new formation and growth of the lymph-glands; they do not, however, break their capsule. The single tumors in the neck remain separate, but gradually the whole lymphatic apparatus of the body is affected.
The pseudoleukatinic tumors are recognized by the exuberant growth of the neighboring lymphatic glands, beginning usually in the neck. The glands are easily felt through the skin, and can be moved against each other and show no tendency to break down or to suppurate.
The intestine may also be the scat of sarcomata, which start from the connective-tissue structure of the intestine, and when the unstriated muscle fibres multiply we will have mixed tumors of sarcomata and leiomyomata (Figs. 192a, 192b, Plate 21).
In a boy of five years we removed from the valve a tumor the size of a fist by resecting the ctecum and the end of the ileum which was invaginated together with the tumor (see Invagination).
The microscope showed the above-mentioned type of mixed tumor, made up of muscle cells and spindle cells. After three months of apparent health metastases appeared in the skin and the pleura, causing death.
The kidney is also at times the seat of sarcomata, which are then frequently of congenital origin, also the bladder and the testicles, but these tumors are rarities (see Epithelial Tumors).
The treatment must attempt the earliest and most radical removal. The limits of Du• ability to operate are formed by the anatomieal condi tions, adhesions, glandular metastases, and the power of resistance of the patient. The technic follows t he generally accepted principles of
surgery, considering, however, the somatic particularities of the child.
In conformity with its connective-tissue type the sarcoma inclines toward mixed forms combined with other tumors which are also of mesodermal origin. The benign conneetive-tissue tumors, like fibromata and myxoinata, may also be mixed with sarcomatous tissue or be trans formed into this through a sudden tendency to grow (fibro8arcoma).
These tumors, which are rare in childhood, are of some importance as far as our treatment is concerned, because they should he removed as soon as possible owing to their ten dency to grow exuberantly at times.
The fibroma of the nasopharynx, which is of special diagnostic impor tance (Kiimmel), is usually observed later— between fifteen and twenty years of age.
4. Lipom a This is not frequent in childhood. The lipomata consist of fatty tissue and favor advanced years. On the shoulder or the back are they mostly found. One case of familiar appear ance of lipomata was interesting. The mother had multiple lipomat a and her history indicated that she died most likely from their sarcomatous degeneration. One of her two girls had a lipoma on the back, the other a large lipoma of the labium majus, which looked like a hernia with adhesion of the omentum (Fig. 194).
5. The degenerative growth of the cartilage more often affects the young. It is usually located in the phalanges or in the metaphyses of the long tubular bones, where it will cause interference with the growth of the bones either by affecting the bone itself or its zone of growth (01lier's disturbance of growth). The frequently mentioned bony cysts also partially belong here. Cystic degeneration of chomiromata of the tubular bones may lead to the formation of bony cysts (I.exer), though these may also start from softening of parts of the bones and inflam matory softening from the bone-marrow. Osteomalaeie conditions are also of some importance (v. Haberer).
G. Osteoma This is frequently mixed with cartilaginous tissue (cartilaginous exostoses) and is by no means rarely found near the epiphyseal lines.
The treatment of all these benign connective-tissue tumors can only be operative, and this is the more urgent if they show a more rapid growth, thus justifying us in our suspicion of their malignancy.
7. Glio Of the neuromatous tumors in children we observe the glioma, especially that of the eye, starting from the neural elements in the retina (according to Ribbert they are congenital) (Fig. 19.5).