Arthur Purdy Stout

Massive osteolysis (acute spontaneous absorption of bone, phantom bone, disappearing bone); its relation to hemangiomatosis.

1. There now exists the basis for a new syndrome which is supported by a remarkable similarity of clinical and roentgenographic findings in twenty-four cases, and by an equally convincing similarity of the histological picture in eight of these, which we have personally studied.2. However it is acco

Sarcomas Induced in Rats by Implanting Cellophane

Conclusions 1. Sarcomas were induced in albino fats by the insertion of regenerated cellulose film either subcutaneously or by wrapping it around one kidney. 2. These tumors occurred in about 35% of the rats surviving the operation more than 11 months. 3. The tumors were transplantable. 4. This is a simple method for inducing sarcomas experimentally. 5. The foregoing results in rats should be taken into consideration in the surgical use of cellophane in man.

Multiple primary bronchial carcinomas

From 50 to 208 sections of the tracheobronchial tree of each of 255 patients who died of bronchial carcinoma were microscopically examined. Lesions histologically classified as primary invasive carcinoma (other than the main tumor mass) were found in 77 sections; lesions similar but of somewhat less certain character were found in 26 sections. Such lesions were found in 37 of the 255 subjects (22 subjects had just one; 15 had two or more). The locations of the lesions were studied in relation to the location of the main tumor mass. Using strict criteria, we concluded that at least nine (3.5%) of the patients had multiple primary bronchial carcinomas (two or more including the original tumor). Using less strict criteria (i.e., the inclusion of cases where varying degrees of uncertainty existed) the number might be as high as 37 (14.5%).

Congenital Arteriovenous Fistulas of the Thoracic Wall

Arteriovenous fistulas of the thoracic wall may produce murmurs and thrills which suggest an intrathoracic vascular abnormality. Congenital arteriovenous fistulas in the precordial region, the site of the fistula in the case here reported, may be confused with anomalies of the heart and great vessels. The differential diagnosis of blood vessel tumors of the chest wall is discussed. Occasionally arteriovenous fistulas involve both the thoracic wall and intrathoracic viscera.

PATHOLOGICAL ASPECTS OF SOFT PART SARCOMAS

In order to treat the rare and unpopular malignant tumors of mesenchymal origin one must first learn to recognize them, for each variety has its own behavioral peculiarities and degrees of malignancy and needs to have the treatment tailored to combat its idiosyncrasies. This is easy to say, but so far has never been successfully carried out. There are several reasons why this should be so. For one thing there are a number of cell types that when they multiply in tumors, instead of reproducing a tissue that resembles the normal origin tissue, may produce a fibroblastic tissue-histiocytes,’ mesothelial cells,2 reticulum cells, synovial cell^,^.^ fat cells: Schwann cellss and probably others may all do this. This has been demonstrated in vitro and also it has been proved that these neoplastic connective tissue imitators will demonstrate their true nature by reproducing in v i m the cell growth characteristics of origin rather than those of fibroblasts. Not only do they do this, but in their biological behavior they will demonstrate the characteristics of their true, rather than their assumed nature.’ Thus malignant lipoblasts demonstrating fibroblastic activity will exhibit the characteristics of a liposarcoma rather than a fibrosarcoma. A second source of confusion comes from the fact that some sarcomas are composed not of one cell type, but of two or more not ordinarily found together in a single tumor. These tumors are still frequently given compound labels naming all the different elements recognized in them. By using the all-embracing names of benign or malignant rnesenchymoma,8 it has been possible to assemble groups of these tumors and learn something about their behavior, but this term is not as yet widely accepted. A third source of confusion comes from the fact that there are sometimes very wide variations in the appearance that a tumor cell may assume. For example, the smooth muscle cell in a tumor may appear as a rounded cell instead of retaining its familiar elongated shape.9 It has seemed to me that this shape change has led to more different interpretations by pathologists than any other single thing. There are many other things about mesenchymal tumors which are confusing and frequently misunderstood. For example, “sarcoma” and “malignant” are words frequently used, but there is no general agreement as to what they connote. If the term “sarcoma” is interpreted as a malignant mesenchymal tumor capable of metastasis then it is a very deceptive term applied to the great majority of socalled differentiated fibrosarcomas that may metastasize on an average of only once in 300 times.lOJ1 As a matter of fact, there is such a great difference in the behavior of tumors bearing the same name, but developing in different parts of the body, that in reporting a case the pathologist should not only give the growth a name but explain how it can be expected to behave in the region where it has arisen. There is one more feature that should be mentioned in discussing the behavior of these mesenchymal tumors, namely that there is a varying amount of difference depending upon whether the tumor develops in a child or an adult and sometimes depending upon the part of the body in which it appears. For example, synovial s a r c o m a ~ , ~ J ~ Kaposi’s sarcomas13 and l i po~arcomas~~ are less malignant in children than in adults. lei om yo sarcoma^^^ of the bladder and prostate are more