TUMORS 331 



sarcoma, lymphosarcoma, et cetera to describe them is erroneous 

 and fails to indicate their embryological origin. 



Sympathogonioma. These tumors (also called sympatho- 

 blastoma) originate from the embryonic sympathogone cells 

 and occur in intrauterine life or in earliest infancy, rarely after 

 the first year of life. They are extremely malignant, invade 

 the surrounding tissues, and metastasize to the liver, bones, 

 and retroperitoneal lymph nodes. The tumor is usually bi- 

 lateral. The fine fibrillar network of the stroma of this tumor 

 resembles glial tissue and has led it to be erroneously designated 

 as an adrenal glioma. Many of the retroperitoneal tumors of 

 infants which have been described as "round cell sarcomas" 

 are, according to Goldzieher, 230 actually sympathogonioma. 



The sympathogonioma are large, soft, mottled, yellow- 

 brownish growths composed of small cells resembling lympho- 

 cytes. These cells are irregularly scattered, or formed into 

 clusters, or in perfect rosettes which are characteristic. 230 ' 335 



Sympathoblastoma. These tumors are variously designated 

 by different authors as neuroblastoma, sympathetic neuro- 

 blastoma, neurocytoma, or sympathoblastoma. They arise 

 from the sympathoblasts or chromaphiloblasts and are inter- 

 mediate as regards the degree of their differentiation between 

 the small celled sympathogonioma, described above, and the 

 mature, large-celled ganglioma and paraganglioma to be 

 described in the next section. 



The sympathoblastoma are usually divided clinically into: 

 1) the Pepper type with metastases to the liver, lungs, or 

 abdominal lymph nodes; 2) the Hutchison type, with metas- 

 tases to the orbit, skull, and long bones; and 3) the pernicious 

 type characterized by severe anemia. This classification is 

 misleading, however, for the various manifestations and metas- 

 tatic predilections for certain organs are dependent chiefly on 

 the age of the patient and the site of the initial lesion. Thus 

 due to the different channels of the venous and lymphatic 

 drainage, tumors of the left adrenal are more apt to give rise 



