332 CLINICAL CONSIDERATIONS 



to the Hutchison type while those of the right gland give rise to 

 the Pepper type. 215 



The tumors described by Hutchison 327 in 1907 are character- 

 ized by the appearance of ecchymosis of one or both eye-lids, 

 followed by unilateral exophthalmos, and an involvement of 

 the auricular and submaxillary lymph nodes. The primary 

 growth in the adrenal often remains small, but may invade the 

 kidney and metastasize to the bones and viscera. Tumors of 

 the orbit in infants are almost pathognomonic of a primary 

 medullary tumor of the adrenal. 



In the tumors described by Pepper 494 in 1901, the first symp- 

 tom to attract attention is usually a rapidly enlarging abdomen 

 caused by diffuse nodular growths in the liver which may reach 

 an enormous size. The primary growth in the adrenal may 

 remain small. 



In the pernicious type of medullary tumor, the chief symp- 

 tom is an extreme anemia resembling that observed in per- 

 nicious anemia. 230 



Most abdominal tumors in infants are usually renal or 

 adrenal in origin. The appearance of the symptoms character- 

 izing the above described three types of medullary tumors 

 or of the abnormalities to be described in the next chapter, 

 makes easy the differential diagnosis between renal and adrenal 

 tumors in most cases. 



The usual clinical course of sympathoblastoma is progressive, 

 with a rapidly fatal termination. The average duration of 

 symptoms in 17 patients described by Askin and Geschickter 22 

 was 6 months and in half of the cases death followed surgical 

 intervention within a month. In only one patient among the 

 almost 200 cases cited in the literature has surgical removal of 

 the tumor proven effective. Irradiation or other forms of 

 treatment have not proven of value in altering the course of 

 the disease. 22 



Ganglioneuroma. The ganglioneuroma are derived from the 

 sympathetic cells. They are exceedingly rare, usually give 



