viii, B, 2 Hammack: Primary Sarcoma 95 



The small intestine is evidently more commonly the site of 

 origin of sarcoma than is the large intestine, since Jopson and 

 White, (4) in 1901, could collect but 22 cases of sarcoma of the 

 large intestine, while Libman(5) the year before had brought 

 together 64 of the small intestine. The ileum is the portion 

 most commonly affected. 



Of the types of sarcoma found, lymphosarcoma is the most 

 frequent, but spindle-celled, round-celled, and melano-sarcomata 

 as well as endotheliomata occur. 



The tumor most frequently occurs as a spreading, infiltrating 

 growth, completely or nearly encircling the intestine, but may 

 occur as a polypoid mass projecting into the lumen. The growth 

 is usually confined to the intestinal wall, leaving the serosa in- 

 tact. Ulceration, on the other hand, is frequent and may cause 

 perforation. It is remarkable, however, that very extensive in- 

 filtration of the intestinal wall, including the mucosa, can take 

 place without ulceration, as is exemplified by case 1 of this 

 series. Dilatation is more frequent than stenosis. This is ap- 

 parently due to the widespread infiltration and destruction of 

 the muscular coats with possibly the additional factor of accu- 

 mulation of intestinal contents on account of the absence of per- 

 istalsis. The annular form of the tumor, however, can cause 

 constriction as is shown also by case 1. When complete ob- 

 struction occurs, it is most often due to intussusception. 



Metastases from intestinal sarcomata occur most frequently 

 in the abdominal lymph nodes, particularly with lymphosarco- 

 mata, but metastases in the intestine, liver, spleen, kidneys, 

 lungs, and brain have been recorded. Involvement of other 

 abdominal organs seems to occur most often by direct extension 

 from the metastatic growths in the lymphatic glands. 



All of the cases here presented have been lymphosarcomata, 

 and all have exemplified the annular form, while one shows the 

 infrequent condition of stenosis. In all there have been met- 

 astatic growths in the abdominal lymphatic glands with more 

 or less widespread extension from these. In but one case, in 

 which there was a small nodule in the heart, was there metastasis 

 beyond the abdomen. 



LITERATURE 



(1) Smoler. Prager meet. Wochenschr. (1898^, 23, 145. 



(2) Corner and Fairbank. Trans. Path. Soc. London (1905), 56, 20. 



(3) Kaufmann. Lehrbuch der Speziellen Pathologischen Anatomie (1912), 



528. 



(4) Jopson and White. Am. Journ. Med. Sci. (1901), 122, 807. 



(5) LffiMAN. Ibid. (1900), 120, 309. 



(6) Rademacher. Inaug. Dissert. Jena (1908). 



