294: DAVID MARINE 



Sarcomas. Sarcomas and mixed carcinomas and sarcomas of the 

 thyroid are more frequently ohserved and more important than the old 

 literature would indicate. They are more frequently seen in the fifth 

 and sixth decades, and as in the case of carcinoma, are usually preceded 

 by long standing goiter. The spindle cell and the perithelial types are 

 the most common forms observed. The status of thyroid sarcoma is 

 highly involved and doubtful. There is no method of distinguishing with 

 certainty between carcinoma and sarcoma. Morphology does not offer 

 much assistance. The frequency of occurrence of these mixed tumors (sar- 

 coma and carcinoma) of the thyroid in many mammals; why these tumors 

 are not more frequently seen in other body tissues, and why the etiological 

 factors of age and preexisting goiter are the same as in undoubted cancer 

 all these facts cause one to doubt the mesoblastic origin of most of these 

 so-called sarcomas. Kaufman, Loeb (a.)? Poult, Russell and Kennedy, 

 Saltykow, Schone, Simmonds, Usui, Wells (a). 



Complications 



Hemorrhage. Hemorrhages are the most frequent pathological 

 changes in the thyroid. Small hemorrhagic areas are occasionally seen 

 in essentially normal thyroids, but they are essentially complications of 

 goiters. They rarely occur during the developmental stage but during 

 its involutionary and colloid stages. Why hemorrhages should occur 

 during the colloid phase is not difficult to understand when one recalls 

 the fact that the developing hyperplasia is soft, compressible and elastic 

 while in the colloid phase the gland is firmer and the alveoli distended 

 with colloid, so that slight trauma or manipulation or even the alveolar 

 distention is sufficient to cause the thin walled, large, sinusoid capillaries 

 to rupture. Perhaps sudden rises in blood pressure as in violent exer- 

 tions or coughing are causal factors. The thyroids of all animals are 

 subject to hemorrhages. Anatomically, the hemorrhages may appear only 

 as a reddish, brownish, greenish or yellowish discoloration of the colloid. 

 Larger areas tend to encapsulation and the cavities contain brownish 

 material, sometimes a viscid colloid mixture, while in others it is more 

 fiu id. In general, however, in the small hemorrhagic areas the colloid 

 forms the body of the mass while the extravasated blood produces the 

 discoloration. The term "hemorrhagic goiter" has been commonly used 

 to describe old nodular (adenomatous), and varicolored goiters, the result 

 of multiple small and large areas of hemorrhage of different ages. The 

 term is not descriptive, since the hemorrhages are only secondary and 

 complicating factors. Areas of hemorrhage frequently heal by scar. 

 Such scars produce many of the capsular adhesions so commonly seen 

 in old human goiters. Owing to the normal architecture of the thyroid, 

 hemorrhage forms a starting point for most thyroid cysts. Archibald. 



