The Abdomen 



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what softer, particularly when the cellular elements predominate 

 over the fibrous. 



Sarcoma. Sarcoma occurs in pure form but more commonly 

 associated with osseous and cartilaginous structures. Pure sarcoma 

 is seen as a tuberculate growth, which may attain an enormous size. 

 The neighboring lymphatics and subcutis are usually infiltrated, and 

 the growth sometimes breaks through the skin. It is not common. 



Symptoms and Diagnosis. The growth is reddish in color with 

 somewhat puckered surface and exceedingly soft and succulent and 

 contains a jelly-like substance. The skin covering it may be mobile. 

 It develops with great rapidity and is extremely metastatic. 



Carcinoma. Carcinoma may arise from the glandular cells 

 proper or the epithelium of the ducts. The skin covering the glands 

 may also be primarily the seat of carcinoma which is not to be con- 

 founded with that of the glands, though in the latter case the skin 

 usually participates eventually. Myxoid transformation is not un- 

 common, and such tumors may also become cystic through retro- 

 gressive metamorphosis of the secretion of isolated normal acini. 

 Metastasis to internal and vital parts is the rule. 



Carcinoma may originate as such per se, or as has already been 

 pointed out, may become progressively such by metamorphosis 

 from pre-existing adenoma. Primary carcinoma is infrequent. 



Symptoms and Diagnosis. Carcinoma occurs most commonly 

 as a lobulated tumor, varying in size from a pea to a goose-egg, 

 which may remain quiescent for longer or shorter period, and finally 

 coalesce with the skin and degenerate. It usually occurs singly, bu*' 

 secondary smaller growths are sometimes observed in the imme- 

 diate neighborhood of the main one. More than one gland, how- 

 ever, may be involved at the same time. Sudden increase in size 

 may take place, due to interstitial hemorrhage. 



Symptoms and Diagnosis. Carcinoma is moderately hard and 

 usually knotty. When cystic degeneration has taken place, fluctu- 

 ating centers are perceived. Coalescence with the skin is recognized 

 by the bluish or reddish appearance of the latter, and usually by 

 eventual ulceration. 



Chondroma. Cartilaginous growths are common but they in- 

 variably occur associated with other tissue elements, assisting in the 

 formation of a complex structure into the constitution of which 

 osseous, fibrous, and myxoid tissues enter. In some cases complete 

 ossification takes place. These tumors are to some extent metas- 



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