254 REPORT OF THE HARVARD AFRICAN EXPEDITION 
mation in the center, but the smaller nodules exhibit little or no scarring. Some 
of the larger ones are covered by areas of normal skin, while over many of the 
other swellings, the skin is tense, shiny, and translucent in appearance. The color 
of the skin is not materially altered, but there is a lack of normal elasticity. 
The consistency is firm to hard, and some of the large swellings pit very slightly 
on pressure. A watery secretion exudes from a crevice in one of the swellings 
and another crevice is crusted. The skin sensation is generally apparently 
normal. The lymphatic glands are not enlarged. Excision of portion of a nodule 
from the back caused pain, but one excised from an overhanging edge of another 
lesion caused no pain. The bleeding was slight. 
Pieces of tissue were excised from both the larger and smaller growths, some 
of the latter appearing to be of more recent origin. On removal and incision of 
portions of one of the larger tumors, they were found to be of tough consistency 
and tendinous-white in appearance, while the smaller tumor was of softer con- 
sistency and of a pale rose tint upon section. The tissues were hardened in 
Zenker’s solution and in formalin. Film preparations made at the time from 
the cut section of the nodules showed upon examination that they were rich in 
cells, and in films stained with Giemsa’s solution, on account of the richness in 
character of the cells, a sarcomatous condition was suggested. In a few of the 
films, blastomycetic forms were observed in some of the epithelial cells from the 
surface of the skin. However, the occurrence of Blastomyces in superficial layers 
of the corneal layer is not uncommon in many individuals in parts of Africa not 
afflicted with keloids. Mention is made of this fact because Legendre! and 
Montel and Pons ” have reported upon cases of keloid formation where a Blasto- 
myces was believed to have had etiological significance. 
The sections from the tumors of Case 384 were stained in haematoxylin eosin, 
Giemsa’s solution, Mallory’s connective tissue stain, and Levaditi’s silver im- 
pregnation method. A histological study of the four pieces of tissue removed 
shows that the lesions which he beneath the epidermis are composed almost en- 
tirely of fibrous connective tissue. However, there are slight variations observed 
in the different tumors, and also in different parts of the sections of the same 
tumor. Thus in the larger tumor in places the papillary bodies over large areas 
have entirely disappeared, whereas in another part of the same section they are 
retained. In the areas where no evidence of the papillae remains, the epidermis 
above is not, apparently, altered pathologically. The corneal layer above is not 
increased in thickness and the stratum lucidum and granular and mucous layers 
also appear normal. In the basal portion of the mucous layer, pigment is still 
present in the cells in about normal amount. In the areas where the papillae 
have entirely disappeared, the stratum mucosum consists of a wide, even, very 
slightly or broadly-waving band resting directly upon the altered reticular layer 
in which the connective tissue fibers run more or less parallel to the surface of the 
skin. 
The normal rete is replaced in many areas by coarser bands of fibrous connec- 
1 Legendre: Bull. Soc. Path. Exot. (1927), XX, 323. 
? Montel and Pons: Bull. Soc. Path. Exot. (1926), XIX, 876. 
