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Ulcers associated with Malignant Disease. Cancer and sarcoma when situated in the subcutaneous tissue may destroy the overlying skin so that the substance of the tumour is exposed.
Cases of pseudocyesis in women convicted of murder are not uncommon, though most of them are imposters hoping for an extra lease of life. Croon speaks of a child seven years old on whom he performed ovariotomy for a round-celled sarcoma. She had been well up to May, but since then she had several times been raped by a boy, in consequence of which she had constant uterine hemorrhage.
A similar form of osteomyelitis may occur apart from a wound for example, infection may spread to the jaws from lesions of the mouth; to the skull, from lesions of the scalp or of the cranial bones themselves such as a syphilitic gumma or a sarcoma which has fungated externally; or to the petrous temporal, from suppuration in the middle ear.
In another case, in a white male of thirty, the same author successfully performed a hip-amputation for a large sarcoma of the left femur. The removed member was sent entire to the Army Medical Museum at Washington. The fatality and incurability of malignant growths has done much to stimulate daring and marvelous operations in surgery.
These are most frequently situated in the lungs, except when the primary growth lies within the territory of the portal circulation, in which case they occur in the liver. The secondary growths closely resemble the parent tumour. Sarcoma may invade an adjacent vein on such a scale that if the invading portion becomes detached it may constitute a dangerous embolus.
The conditions likely to be mistaken for surgical actinomycosis are sarcoma, tubercle, and syphilis. In the early stages the differential diagnosis is exceedingly difficult. In many cases it is only possible when suppuration has occurred and the fungus can be demonstrated.
To take, therefore, a skiagraph of a brain through two thicknesses of skull, with our present methods, is an impossibility. Even should the difficulty be overcome, it is very doubtful whether there would be any possibility of discovering diseases of the brain, since diseased tissues, such as cancer, sarcoma, etc., are probably as permeable to the X rays as the normal tissues.
Finally, there are cases in which removal by operation is impossible, the so-called inoperable sarcoma; a tube of radium, to which a silk thread is attached, is inserted into the substance of the tumour, either through an opening made by a large trocar, or, when necessary, by open dissection.
In the syphilitic lesion, skiagrams usually show a more abundant formation of new bone, but in many cases the doubt is only cleared up by observing the results of the tuberculin test or the effects of anti-syphilitic treatment. Sarcoma of a phalanx or metacarpal bone may closely resemble a dactylitis both clinically and in skiagrams, but it is rare. Treatment.
Radium causes a reaction in the tissues attended with exudation from the vessels, for the escape of which provision must be made. If radium is not available, the affected area is repeatedly exposed to the action of the X-rays as soon as the wound has healed. The employment of these measures has diminished to a remarkable degree the recurrence of sarcoma after operation.
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