v.— THE LIMBS. 



OSSIFYING PERIOSTEAL SARCOMA OF THE SHOULDER- 

 GENERALISATION. 



138. A six-year-old Danish bitch entered hospital nth June, i8g8, 

 suffering from a tumour of the shoulder, which had developed without 

 apparent cause in less than two months. 



The patient was extremely depressed, and remained lying on the 

 right side, apparently in acute pain ; at certain times the respiration 

 was moaning. As the animal could not be moved it was brought to 

 the school in a carriage. 



State on Examination. — The entire left shoulder was greatly swollen. 



Opposite the cervical angle of the scapula traces of firing were 

 visible. The tumour formed a compact, lobulated, hard mass, not 

 painful on manipulation, extending from the central portion of the 

 neck to the middle of the thorax ; above it projected beyond the 

 shoulder ; below beyond the line of the sternum. Having developed 

 beneath the scapula, which it had thrust outwards, it appeared to be 

 adherent to the neck and trunk. The skin covering it was moveable. 

 The physical characters were those of a sarcoma. 



In order to confirm the diagnosis two exploratory punctures were 

 made into the tumour with a trocar, after disinfection of the skin. 

 From the first puncture, which was made in the upper lobe, no liquid 

 escaped ; the point of the trocar passed through friable, osseous 

 tissue, producing crepitation. A second puncture, made into the 

 inferior lobe, below the elbow, gave exit to a little blood-stained liquid. 



Successful treatment was impossible. The patient was killed by 

 intra-venous injection of chloral. 



Autopsy. — The upper portion of the tumour was situated beneath 

 the shoulder. The lower half of the scapula was intact, but the upper 

 was infiltrated by new growth. Detached from adjacent tissues, the 

 tumour appeared covered over the greater portion of its surface by a 

 thin fibrous capsule. It measured eighteen and a half inches from 

 before backwards, seventeen inches from above downwards, was four 

 and three quarter inches in thickness, and weighed nearly fourteen 

 pounds. Sections showed numerous interstitial haemorrhages, par- 

 ticularly in the central part and bony trabeculae. In the spaces 

 surrounded by these trabeculae the tissue was soft, friable, greyish at 

 certain points, rose-red or reddish at others, but everywhere very 

 vascular. The trabeculae were numerous near the bone, but became 



