Sarcoma

The word literally means a fleshy tumor, and embraces in its scope a variety of new growths, which present certain common features, but which differ, however, among themselves in many essential particulars, both as to form and constitution.

In general, it may be stated that a sarcoma is a tumor composed in the main, of cellular tissues, the cells themselves being either round or fusiform, and partaking of the characters of embryonic rather than fully organized adult tissue. The new growth is usually exceedingly vascular, being permeated with large vessels, some of which are doubtless extensions from pre-existing vessels of the neighboring parts, while others are doubtless first and independently formed in the new growth itself, and connect themselves later with the older vessels. In some instances there is a considerable deposit of pigmentary particles, probably derived from the blood coloring matter throughout the growth. These histological changes give rise to three types of tumor, namely, the round-cell sarcoma, in which the round cells greatly predominate over the fusiform; the spindle-cell sarcoma in which these cells make up the greater part of the growth; and, thirdly, the melano or pigment-sarcoma, which may resemble either of the addition of the foregoing with the addition of the pigmentary deposit. As a rule, neither of these types is met with in its purity, the majority of sarcomata being of a mixed type, with one or the other greatly predominating.


The earliest noticeable lesion of sarcoma may be a macule or a tubercle. The macule may develop into a tubercle, or, on the other hand, may spread laterally in the skin, forming a patch or blotch one, two, or more inches in diameter. These patches are heightened in color, the hue being a bluish-brown, are hardly at all elevated, and differ in consistence but little from the surrounding integument. In fact, they appear to be patches of chronic congestion rather than filtration. The evolution of the macules is tardy, and a year or more may be occupied before they attain any considerable size. It is possible that these macules may exist singly, but they are usually multiple. These macules may undergo complete resolution, and leave little trace of their previous existence. Under these circumstances the propriety of classing them as a variety or lesion of sarcoma might be seriously questioned were it not for the fact that they not infrequently become the starting-point of typical sarcomatous growths. After the macule has attained a certain size, an elevation at one point occurs, developing into a tubercle and ultimately into a tumor.

The primary tubercle of sarcoma may develop at the site of some long-standing innocent growth, as a mole, etc., or may take its origin in apparently normal skin. The former is the more usual course in persons advanced in years, while the latter is commonly the case in children and young persons.

The progress of sarcoma is usually rapid, and a tubercle in a few weeks may deserve the title of tumor, and after the lapse of some months may attain the size of a child's head or even larger.

The sarcomatous tubercles and tumors present one character which is in striking contrast with carcinomatous growth. I allude to their consistency. Sarcomata are soft, sometimes of almost jelly-like consistence, while carcinomata are hard.

After sarcomata have attained a certain size, they usually soften in the more central and older portions, and break down, forming a fungoid ulcer, from the base and edges of which secondary sarcomata may spring. Occasionally the margin of the ulcer becomes epitheliomatous.

No age is exempt for the development of sarcoma, but it isdecidedly more frequent before the age of fifteen and after forty-five than during the intermediate period. When we compare the three most important tumor types - namely, carcinoma, fibroma, and sarcoma - we are struck with their peculiarities and contrasts. Carcinoma is especially prone to occur late in life; it is a malignant growth, composed of tissue elements which are little viable, and do not form permanent tissue, but ultimately break down with ulceration. Fibroma, on the other hand, prefers the middle period of life, is benign, and is composed of viable and permanent tissue; while sarcoma, as we have seen, prefers the extremes of life, and is malignant, its elements not going to the formation of permanent tissue.

Sarcoma may be characterized by the development of either single or multiple tumors. When single and not interfered with they may attain a considerable size. When multiple the tumors vary in size from that of a pea to that of a hen's egg.


Hemorrhages accompany advanced cancerous disease, but they are insignificant compared with those which may occur in sarcoma. The extreme vascularity of the new growth and the unsubstantial character of the vessel's walls are sufficient to account for this pronounced hemorrhagic feab re, which is met with not only in old and advanced tumors, but even in those that are small and have had but a few weeks' growth.

Sarcomata may appear on any portion of the integument, and exhibit little preference for any particular location, and after they have existed for some time are liable to develop on the mucous membranes, and also invade the viscera.

The general health and vigor may be apparently unimpaired during the early periods of the existence of sarcoma; but as the disease advances, these gradually fail, but without however, the development of a cachexia, as marked as in the latter stages of cancer.