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Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes (1967)

Chapter: MALIGNANT TUMORS OF THE SOFT TISSUES

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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 80
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 81
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 82
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 83
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 84
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 85
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 86
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 87
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 88
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 89
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 90
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 91
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 92
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
Page 93
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 94
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 95
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 96
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 97
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 98
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 101
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 102
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 103
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 104
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 105
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 106
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 109
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 110
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 113
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 118
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 119
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 120
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 121
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Page 122
Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
×
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Suggested Citation:"MALIGNANT TUMORS OF THE SOFT TISSUES." National Research Council. 1967. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. Washington, DC: The National Academies Press. doi: 10.17226/18647.
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Tumors of the Soft Tissues Mycosis Fungoides SYNONYMS AND RELATED TERMS: Fibroma fungoides; granuloma iungoides. Possibly the peculiar and obscure disease known as mycosis fungoides is related in some way to the lymphosarcoma. It, too, manifests itself generally in the skin by the formation of multiple reddish patches of thickening due to the infiltration of the corium by a variety of lymphocytic and lymphoblastic cells, instead of in the guise of one of the three more characteristic lymphoblastic tumors previously mentioned. Like "Kaposi's disease," it is uncertain whether or not mycosis fungoides is a true neoplasm. It runs a long course lasting years and may eventually involve the viscera with fatal results. Plasma Cell Tumor SYNONYMS AND RELATED TERMS: Lymphocytic myeloma; plasmacytoma; plasmasarcoma; plasmocytoma; solitary myeloma. Plasma cell tumor has been reported in the skin and mediastinum, according to Hellwig. Frerichs has called to the writer's attention one case (Stout and Frerichs) that developed primarily in the corium and subcutaneous tissue of the chest wall (fig. 68). These are presumably primary growths and not extensions or metastases from plasma cell myeloma in the bone barrow. The neoplastic plasmocytoma can be distinguished from the plasma cell granuloma, because the tumor is composed solely of plasma cells to the exclusion of all others save for a very delicate fibrovascular supporting framework, while the granuloma has an admixture of other types of inflammatory cells among the preponderant plasma cells. Almost all of the extramedullary plasmocytomas have been found in the upper air and food passages, the middle and external ear, the conjunctiva and lids, and the gastrointestinal tract down to and including the anus. Their occurrence in the soft tissues is a curiosity observed only once by the writer. OTHER MALIGNANT TUMORS Osteogenic Sarcoma and Chondrosarcoma SYNONYMS AND RELATED TERMS: Chondroma myxomatodes; chondroma sarcomatodes; chondro-osteosarcoma; "malignant aneurysm"; osteoblastic sarcoma; osteoblastoma; osteocarci- noma; osteochondromyxosarcoma; osteochondrosarcoma; osteogenic fibromyxosarcoma; osteoid sarcoma; osteolytic sarcoma; sarcoma osteogenicum; sclerosing osteosarcoma; telangiectatic osteosarcoma. Obviously no bone or cartilage is found normally in the soft tissues. Never- theless, by a process of metaplasia both bone and cartilage of a differentiated aspect can be formed occasionally in healing wounds and cicatrices, in connec- tion with areas of calcification which become secondarily invaded by granu- lation tissue, and in the peculiar condition called myositis ossificans. This means that cells of mesenchymal origin, which have differentiated functionally along other lines, may find themselves transformed into osteoblasts under proper conditions of pH, vascularity, and local concentration of ferments and bone F5-110

Tumors of the Soft Tissues I £14* &•i« T' • ••. • Fig. 69 .; • *'-Afr' Fig. 70 F5-113

Tumors of the Soft Tissues SYNOVIAL SARCOMA (Plate V B and Figure 72 are from the same case) Figure 71. A 27-year-old man had a mass in the antecubital fossa for four years. Following biopsy a high amputation was done. He remained well for nine years, then lung metastases appeared and he died almost ten years after amputation. The photograph shows the position and relationships of the tumor, which was close to but did not invade the joint. (From figure 2 in Haagensen, C. D., and Stout, A. P. Synovial sarcoma. Ann. Surg., 120: 826-842. 1944.) A. F. I. P. Ace. No. 218822-67. i Figure 72. A large tumor was present for one year in the thigh of a 44-year-old man. High ampu- tation was done shortly after an attempt at local excision failed. He died with lung and bone metastases after 22 months. This tumor was not in contact with any joint (see pl. V-B). A: The tumor tends to form glandlike spaces with synovioblasts and with a fibrosarcoma-like tissue between. B: A Laidlaw silver reticulin impregnation shows the reticulin fibers in the spindle cell zones. X 680. (Figure 5 from Haagensen, C. D., and Stout, A. P. Synovial sarcoma. Ann. Surg., 120: 826-842, 1944.) A. F. I. P. Ace. No. 218822-66. F5-114

Tumors of the Soft Tissues Fig. 71 Fig. 72 F5-115

Tumors of the Soft Tissues SYNOVIA! SARCOMA f Figure 73. Synovial sarcoma. A tumor in the groin of a 19-year-old man was removed alter 15 months of growth. He died with lung metastases five years and four months after operation. A: In this tumor the synovioblasts grow in solid cords with little tendency to form slits or gland- like spaces. B: A Laidlaw silver reticulin impregnation shows the reticulin fibers, which lie between the spindle-shaped cells, and the complete absence of fibers among the synovioblasts. X 680. (Figure 4 from Haagensen. C. D., and Stout. A. P. Synovial sarcoma. Ann Surg., 120: 826 842. 1944.) A. F. I. P. Ace. No. 218822-68. Figure 74. Explant in vitro from a malignant metastasizing tumor of the thigh. The outgrowth consists ol spidery cells, which characterize normal synovial outgrowths in culture. The normal cells often have more processes. Zenker,s fluid; Harris, hematoxylin. (Figure 4 from Murray, M. R., Stout, A. P., and Pogogeff, 1. A. Synovial sarcoma and normal synovial tissue cultivated in vitro. Ann. Surg., 120: 843 851, 1944.) A. F. I. P. Ace. No. 218822-69. i F5-116

Tumors of the Soft Tissues ^^SftU* C*:*L9* l.M%m&im Fig. 73 Fig. 74 F5-117

Tumors of the Soft Tissues by treatment may be accounted for in part perhaps by the fact that the mean duration of symptoms before curative treatment was attempted was 2.6 years. GROSS. These are solid and often sharply circumscribed tumors (fig. 71, pl. V-B), which occasionally show spotty areas of calcification demonstrable by roentgen ray examination (Lewis). MICROSCOPIC. The pattern is very striking, for the tumors are composed of two histologically differing tissue types inextricably intermingled. One, which may be referred to as the synovioblastic element, is made up of fairly large polygonal or sometimes cylindrical cells that grow in cords tightly packed together. Freguently these cells are oriented around slits or short tubes lending the tumor an adenomatous aspect. This is enhanced by the fact that the cells lining these spaces may secrete a mucoid material which is stained red by mucicarmine. Actually the material is hyaluronic acid, and the supposed "glands" are simply abortive attempts by the synovioblasts to form synovial structures. Between these cells there are no connective tissue fibers; but between the cords of synovioblastic tissue are areas filled with spindle-shaped cells with delicate reticulin fibers wrapped about them, which have the aspect of fibrosarcoma (figs. 72, 73). Both types of tumor cells are always present but in greatly varying amounts so that sometimes one dominates the picture and sometimes another. On explantation in vitro, the only cells that proliferate exhibit the growth characteristics of synovial tissue (fig. 74), so it may be that cells of the supposed fibrosarcomatous areas are in reality synovioblasts masquerading as fibroblasts; but this remains an unsolved problem. Malignant Mesenchymoma SYNONYMS AND RELATED TERMS: Botryoid sarcoma; capsuloma of kidney; enchondromyxo- hemangiosarcoma; embryonal myoblastoma; embryonal rhabdomyoblastoma; endothelioma; fibrosarcoma, embryonal type; hemangioblastomyxoma; lipomyxosarcoma; malignant mixed mesen- chymal tumor; mesenchymal mixed tumor; multiple mesenchymal hemendotheliomata. This term has been applied to those tumors of the soft tissues of mesen- chymal origin which are composed of tumor cells differentiating into two or more unrelated malignant forms. Since most of the tumors of mesenchymal derivation may have fibrosarcomatous areas, this form is not recognized as a separate one in evaluating tumors. It has been shown that synovial sarcomas always have a fibrosarcomatous element, and liposarcoma and rhabdomyo- sarcoma not infrequently. But an exception is made if fibrosarcoma is found associated with a neoplastic form such as lymphosarcoma in a conjunction that has never been reported for the latter tumor type. Nor does the presence of adult differentiated bone or cartilage in the framework of a malignant tumor, such as the liposarcoma, indicate that it is another malignant element. But when tumors are composed of two or more unrelated malignant elements, such as for instance a tumor of the rectus femoris muscle in which were recognized leiomyosarcoma, osteogenic sarcoma, chondrosarcoma, reticulum cell sarcoma. F5-118

Tumors of the Soft Tissues flfcsw ~PS JM I - HUB^ Fig. 76 F5-123

Tumors of the Soft Tissues MALIGNANT MESOTHELIOMA Figure 77. Malignant mesothelioma of pleura. Explant in vitro. The outgrowth consists of cells with rather fibrous cytoplasm, which form membranes and tongues characteristic of normal mesothelial tissue in vitro. Seven days in vitro. Zenker's fluid; phosphotungstic acid hematoxylin. (Figure 3 from Stout, A. P., and Murray, M. R. Localized pleural Tnesothelioma. Arch. Path., 34: 951-964, 1942.) A. F. I. P. Ace. No. 218822-71. MELANOSARCOMA (?) Figure 78. For seven years a 36-year-old man had a 4X2X0.7 cm. tumor, deep in the corium on the dorsum of the foot. There has been no recurrence eight years after the tumor was excised. The growth is composed of interlaced bands of fibers and fibroblasts scattered among which are stellate melanoblasts with long processes. Masson-Fontana stain. X 441. (Figure 2 from Stout, A. P. Sarcomas of the soft parts. J. Missouri M. A., 44: 329-334, 1947.) A. F. I. P. Ace. No. 218822-75. F5-124

Tumors of the Soft Tissues Fig. 77 < v x/: ^ wV^' ^•\v^ *?*" \*W. .*~?:^^^* ^ ^'-^^ •-• Fig. 78 F5-125

Tumors of the Soft Tissues DIAGNOSIS AND TREATMENT The foregoing summary of the various benign and malignant tumors of the soft tissues, to which must be added the information contained in Fascicle 6, "Tumors of the Peripheral Nervous System," in Fascicle 3, "Melanotic Tumors of the Skin," and in Fascicle 2, "Tumors of the Skin and Accessory Structures," makes it abundantly clear that proper diagnosis and treatment demand accurate knowledge and understanding of an almost bewildering variety of tumors. While some of the benign surface tumors can be recognized clinically, the vast majority of the deep tumors cannot. It is beyond the scope of this fascicle to give in detail the treatment of benign tumors. Since the benign tumors seldom assume malignant characteristics, it is rare for them to become a menace to life. But it is altogether different in regard to the malignant tumors that are often fatal and alas very often ineffectually treated. For this reason the problems of diagnosis and treatment will be briefly discussed. The best chance of curing the malignant tumors of the soft tissues lies in the hands of the therapist who makes the first attempt. If this attempt fails, the chances that subsequent attempts will succeed are enormously reduced no matter how radical they may be. Unless the therapist is thoroughly familiar with all of the different varieties of tumor he may encounter and the proper form of treatment for each one, he will be well advised if he makes a thorough clinical study of the case and calls his pathologist into consultation from the start. The pathologist will be in a better position to interpret the biopsy if he knows in advance all about the clinical features of the case, and if he properly fulfills his functions, he will be prepared to advise the surgeon about the probable behavior and the best form of treatment of any tumor encountered. No treatment should be undertaken without biopsy, so that the therapist can proceed armed with knowledge. Without this information, treatment is usually not radical enough, but sometimes it can be more drastic than is necessary. The biopsy must be interpreted by the pathologist. If it is possible to make a diagnosis by frozen section, this may be done and the appropriate treatment instituted at once. The writer has seldom found it possible to be sufficiently accurate from a frozen section and prefers to have treatment delayed a day or two until a paraffin section properly stained can be studied If this technique is used, it is important to have the biopsy taken with the utmost care to prevent smearing tumor cells into the wound, and as small and dry a wound as possible should be sought. The treatment selected will be surgery rather than radiotherapy in the majority of cases. If the surgeon is informed by the F5-126

Tumors of the Soft Tissues pathologist of the exact nature of the malignant tumor, its method of growth, which is almost always by insidious infiltration, the probability of metastasis, and the chances of cure if the primary growth is removed, he is then armed with the necessary knowledge to enable him to decide whether it is possible to succeed by sacrifice of local tissues, or if an extremity is involved whether amputation will be necessary. If the surgeon is to succeed, he must be instructed in the principles of cancer surgery, which strives to remove a tumor by passing everywhere through normal tissues so that the knife never touches the tumor. The surgeon must think first of removing the tumor and undertake to repair the damage only after this has been done. With this preamble the potentialities of the various tumors can be briefly reviewed. For purposes of treatment, they can be considered in groups. Group 1. Tumors of the highest malignancy that call for the most drastic surgical treatment, such as: Undifferentiated fibrosarcoma Undifferentiated liposarcoma Leiomyosarcoma with many mitoses Rhabdomyosarcoma Malignant hemangioendothelioma Malignant lymphangiosarcoma Synovial sarcoma Osteogenic sarcoma Chondrosarcoma Malignant mesenchymoma Group 2. Tumors that are malignant because of infiltrative growth, but do not metastasize, such as: Skin fibrosarcoma Myxoma Differentiated liposarcoma Melanosarcoma Group 3. Tumors that are malignant and metastasize but cannot definitely be distinguished from their benign forms, such as: Malignant granular cell myoblastoma Malignant hemangiopericytoma Group 4. Tumors that are usually better treated by radiotherapy, such as: Lymphosarcoma of the lymphocytic and giant follicle type Mycosis fungoides Kaposi's sarcoma Reticulum cell sarcoma Group 5. Tumors about which insufficient information on results of different forms of treatment is available, such as: Plasma cell tumor FS-127

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Tumors of the Soft Tissues Stout. A. P. Sarcomas of the soft parts. J. Missouri M. A., 44: 329-334, 1947. • Rhabdomyosarcoma Cappell. D. F., and Montgomery, G. L. On rhabdomyoma and myoblastoma. J. Path. & Bact, 44: 517-548, 1937. De, M. N., and Tribendi. B. P. Skeletal muscle tissue tumor. Brit. J. Surg., 28: 17-28, 1940., Glasunow, M. Uber tfnreife, begrenzt und destruierende wachsende Rhabdomyoblastome. Frank- furt. Ztschr. f. Path., 45: 328-345, 1933. Harper, H. Y., and Feder, J. M. Rhabdomyosarcoma. Report of a case presenting unusual features with reference to age, race, site of origin, and manner of growth. Surgery, 6: 76-79, 1939. Jonsson, G. Malignant tumors of the skeletal muscles, fasciae, joint capsules, tendon sheaths and serous bursae. Acta radiol., Supp., 36: 1-304,1938. Montpellier. J. Les rhabdomyomes. Caracteres generaux et varietes anatomocliniques. Bull. Assoe. franc, p. 1'etude du cancer, 18: 538-602, 1929. Moulonguet, P., and Pollosson, E. Sarcomes des muscles et des coulees conjonctives des membres. J. de chir., 52: 501-525. 1938. Peyron, A. Les tumeurs des muscles. Atlas du Cancer, Fase. 7. Paris: Felix Alcan. 1929. Pogogeff, I. A., and Murray, M. R. Regeneration of adult mammalian skeletal muscle in vitro. Science, 101: 174. 1945. Rakov. A. I. Malignant rhabdomyoblastomas of the skeletal musculature. Am. J. Cancer, 30: 445-476, 1937. Roskin. G. La cellule myomateuse et quelques problemes relatifs a la cellule musculaire. Bull. Assoe. franc. p. 1'etude du cancer, 23: 172-218, 1934. Stout, A. P. Rhabdomyosarcoma of the skeletal muscles. Ann. Surg., 123: 447-472, 1946 (Bibl.). Wolbach, S. B. Centrioles and histogenesis of the myofibril in tumors of striated muscle origin. Anat. Rec., 37: 255-273, 1928. A malignant rhabdomyoma of skeletal muscle. Arch. Path., 5: 775-786, 1928. Granular Cell Myoblastoma Abrikossoff, A. L. Uber Myome, ausgehend von der quergestreiften willkurlichen Muskulatur. Virchows Arch. f. path. AnaU260: 215-233, 1926. Weitere Untersuchungen Liber Myoblastenmyome. Virchows Arch. f. path. Anat., 280: 723-740. 1931. Ackerman, L. V., and Phelps, C. R. Malignant granular 'cell myoblastoma of the gluteal region. Surgery. 20: 511-519. 1946. Christopherson, W. M., Foote. F. W., Jr., and Stewart, F. W. Alveolar soft-part sarcomas. Struc- turally characteristic tumors of uncertain histogenesis. Cancer, 5: 100-111, 1952. Crane. A. R., and Tremblay, R. G. Myoblastoma (granular cell myoblastoma or myoblastic myoma). Am. J. Path., 21: 357-375. 1945. Fust. J. A., and Custer, R. P. On the neurogenesis of so-called granular cell myoblastoma. Am. J. Clin. Path., 19: 522-535, 1949. Gullino, P. Sui considetti "tumori di mioblasti" interpretati come granulomi di probabile origine parassitaria. Tumori, 32: 102-128, 1946. Haagensen. C. D., and Stout, A. P. Granular cell myoblastoma of the mammary gland. Ann. Surg., 124: 218-227. 1946. Horn, R. C., Jr., and Stout, A. P. Granular cell myoblastoma. Surg., Gynee. & Obst., 76: 315-318, 1943. Howe, C. W., and Warren, S. Myoblastoma. Surgery, 16: 319-347, 1944. Keraan, J. D., and Cracovaner, A. J. Rhabdomyoma of the vocal cord—report of a case. Laryngo- scope, 45: 891-893, 1935. F5-132

Tumors of the Soft Tissues Klemperer, P. Myoblastoma of the striated muscle. Am. J. Cancer, 20: 324-337,1934. Martin, J. F., Dina, M. A., and Feroldi. J. La questione dei tumori a cellule granujose; studio istogenetico e sperimentale sui cosiddetti miomi mioblastici di Abrikossoff. Arch. ital. di anat. e istol. pat., 24: 205-253, 1950. Murray, M. R. Cultural characteristics of three granular-cell myoblastomas. Cancer, 4: 857-865, 1951. Pearse, A. G. E. The histogenesis of granular-cell myoblastoma (? Granular-cell perineural fibroblastoma). J. Path. & BacL. 62: 351-362, 1950. Powell, E. B. Granular cell myoblastoma. Arch. Path., 42: 517-524,1946. Ravich, A., Stout. A. P., and Ravich, R. A. Malignant granular cell myoblastoma involving the urinary bladder. Ann. Surg., 121: 361-372, 1945. Roffo. A. H. Knotige Zungenmyolyse. Ztschr. f. Krebsforsch., 39: 464-470, 1933. Ross, R. C., Miller, T. R., and Foote, F. W., Ji. Malignant granular-cell myoblastoma. Cancer, 5: 112-121, 1952. Simon, M. A. Granular cell myoblastoma (myoblastic myoma, rhabdomyome granulocellulaire). Am. J. Clin. Path., 17: 302-313, 1947. Smetana, H. F., and Scott, W. F. Malignant tumors of nonchromaffin paraganglia. Mil. Surgeon, 109: 330-349, 1951. Stout, A. P. Rhabdomyosarcoma of the skeletal muscles. Ann. Surg., 123: 449, 1946. (Comment on tissue culture of granular cell myoblastoma.) Granular cell myoblastoma of lumbar region. (Tumor Seminar.) Texas State J. Mod., 41: 580-582. 1946. Angiomatoses Cobey, M. C. Hemangioma of joints. Arch. Surg., 46: 465-468, 1943. Fulton, M. N., and Sosman, M. C. Venous angiomas of skeletal muscles. J. A. M. A., 119: 319-324, 1942. Geschickter, C. F., and Keasbey, L. E. Tumors of blood vessels. Am. J. Cancer, 23: 568-591, 1935. Goldstein, H. I. Goldstein's heredofamilial angiomatosis with recurring familial hemorrhages (Rendu-Osler-Weber's disease). Arch. Int. Mod., 48: 836-865, 1931. Gross, R. E., and Wolbach, S. B. Sclerosing hemangiomas. Am. J. Path., 19: 533-551, 1943. Harkins, H. N. Hemangioma of tendon or tendon sheath. Report of case with study of 24 cases from the literature. Arch. Surg., 34: 12-22, 1937. Lattes, R., and Bull, D. A case of glomus tumor with primary involvement of bone. Ann. Surg., 127: 187-191, 1948. Lehman, W., and Kraissl, C. Glomus tumor within bone. Surgery, 25: 118-121,1949. McCarthy, W. D., and Pack, G. T. Malignant blood vessel tumors. A report of 56 cases of angiosarcoma and Kaposi's sarcoma. Surg., Gynee. &Obst., 91: 465-482, 1950. Maier, H. C., and Stout. A. P. Congenital arteriovenous fistulas of the thoracic wall. Circulation, 1: 809-812, 1950. Mason, M. L. Tumors of the hand. Surg., Gynee. & Obst., 64: 129-148, 1937. Masson, P. Les glomus cutanes de I'homme. Bull. Soe. franc, de dermat. et syph., 42: 1174-1245, 1935. Les glomus neuro-vasculaires. Paris: Hermann et Cie, 1937. Matas, R. Congenital arteriovenous angioma of tne arm; metastases eleven years after amputation. Ann. Surg., Ill: 1021-1045, 1940. Murray, M. R., and Stout, A. P. The glomus tumor. Investigation of its distribution and behavior, and the identity of its "epithelioid" cell. Am. J. Path., 18: 183-203, 1942. Oughterson, A. W., and Tennant, R. Angiomatous tumors of the hands and feet. In: Pack, G. T. Tumors of the Hands and Feet, pp. 81-108. St. Louis: The C. V. Mosby Co., 1939. F5-133

Tumors of the Soft Tissues Pemberton. J. de J., and Saint, J. H. Congenital arteriovenous communications. Surg., Gynee. & Obst., 46: 470-483, 1928. Purcell, F. H., and Gurdjian, E. S. Hemangiomata of peripheral nerves, with report of a case of cavernous hemangioma of the sciatic nerve. Am. J. Surg., 30: 541-544, 1935. Reid, M. R., and Conway, H. G. Congenital cirsoid aneurysm of the leg. J. A. M. A., 101: 1391 1393. 1933. Stout, A. P. Tumors of the neuromyo-arterial glomus. Am. J. Cancer, 24: 255-272,1935. The painful subcutaneous tubercle (tuberculum dolorosum). Am. J. Cancer, 36: 25-33. 1939. Tumors of blood vessels. Texas State J. Mod., 40: 362-365. 1944. Watson, W. L. Blood and lymph vessel tumors in children. J. Pediat., 15: 401-407, 1939. Weaver, J. B. Hemangiomas of the lower extremities. With special reference to those of the knee-joint capsule and phenomenon of spontaneous obliteration. J. Bone & Joint Surg., 20: 731-749, 1938. Willis, R. A. Pathology of Tumours. St. Louis: The C. V. Mosby Co., 1948. Hemangioendothelioma Borrmann, R. Metastasenbildung bei histologisch gutaragen Geschwulsten. (Fall von metasta- sierendem Angiom). Beitr. z. path. Anat. u. z. allg. Path., 40: 372-392, 1907. Byars. L. T. The "malignant" hemangioma. Surg., Gynee. & Obst., 77: 193-198, 1943. Caro, M., and Stubenrauch, C. H. Hemangioendothelioma of the skin. Arch. Dermat. & Syph., 51: 295-304. 1945. Costa, A., and Campos, J. de Oliveira. Hemangioendotelioma muscular da coxa. J. de soc. de ciencias med. de Lisboa, 110: 1-21 (No. 3). 1946. Gloggengiesser, W. Angiomartige Unwandlung des Gefdssmesenchyms als Systemerkrankung. Beitr. z. path. Anat. u. z. allg. Path., 103: 256-270, 1939. Harvey. W. F., Dawson, E. K., and Innes, J. R. M. Debatable tumours in human and animal pathology. DC. Endothelioma. Edinburgh M. J. (N. S. IVth), 47: 513-540, 1940. Konjetzny, G. E. Zur Pathologic der Angiome. Munchen. med. Wchnschr., 59: 241-242. 1912. Leubner, H. Seltene Geschwulstbildungen des Gefdssendothels. Franldurt. Ztschr. f. Path., 49: 63-75. 1935. Mallory, F. B. The results of the application of special histological methods to the study of tumors. J.Exper. Med., 10: 575-593, 1908. Masson. P. Hemangioendotheliome vegetant intravasculaire. Bull. Soe. anat, de Paris, 93: 517-523, 1923. Murray, M. R., and Stout, A. P. Cultural characteristics of a hemangioendothelioma. Am. J. Path., 20: 277-289. 1944. Rabson, S. M. Multiple mesenchymal hemendothelioma. Arch. Path., 25: 185-199, 1938. Robinson, J. M., and Castleman, B. Benign metastasizing hemangioma. Ann. Surg., 104: 453-459, 1936. Sal, J. Uber einen Fall von endemischer Hamangiosarkomatose bei Huhnem. Virchows Arch. f. path. Anat., 279: 62-70. 1930. Stout, A. P. Hemangio-endothelioma: a tumor of blood vessels featuring vascular endothelial cells. Ann. Surg., 118: 445-464. 1943. Willis, R. A. Pathology of Tumours. London: Butterworth & Co., Ltd., 1948. Wollstein, M. Malignant hemangioma of the lung with multiple visceral foci. Arch. Path., 12: 562-571. 1931. Hemangiopericytoma Eggston, A. A . and Wolff, D. Histopathology of the Ear, Nose and Throat, p. 771 and plate zv. Baltimore: Williams & Wilkinc Co., 1947. FS-134

Tumors of fhe Soft Tissues Kaplan. E. B. Hemangiopericytoma of the hand. Bull. Hosp. Joint Dis., 10: 69-74. 1949. Murray. M. R., and Stout. A. P. The glomus tumor. Investigation of its distribution and behavior and the identity of its "epithelioid" cell. Am. J. Path., 18: 183 203, 1942. Stout. A. P. Hemangiopericytoma. (A study of 25 new cases.) Cancer. 2: 1027 1054, 1949. 'and Cassel, C. Hemangiopericytoma of the omentum. Surgery, 13: 578-581, 1943. and Murray. M. R. Hemangiopericytoma (a vascular tumor featuring Zimmcr- mann's pericytes). Ann. Surg., 116: 26-33, 1942. Warren, S., and Ackerman, L. V. Hemangiopericytoma of retroperitoneal space. (Tumor Seminar.) J. Missouri M. A., 45: 380-382, 1948. Zimmermann, K. W. Der feinere Bau der Blutcapillaren. Ztschr. f. Anat. u. Entwcklgsgesch., 68: 29-109, 1923. Kaposi's Sarcoma Aegerter, E. £., and Peale, A. R. Kaposi's sarcoma. A critical survey. Arch. Path., 34: 413-422, 1942. Becker, S. W., and Thatcher, H. W. Multiple idiopathic hemorrhagic sarcoma Kaposi. Historical review, nomenclature; and theories relative to the nature of the disease, with experimental studies of two cases. J. Invest. Dermat., 1: 379-398, 1938. Lang, F. W., and Haslhofer, L. liber die Auffassung der Kaposischen Krankheit als systematisierte Angiomatosis. Ztschr. f. Krebsforsch., 42: 68-75, 1935. MacKee, G. M., and Cipollaro, A. C. Idiopathic multiple hemorrhagic sarcoma (Kaposi). Am. J. Cancer, 26: 1-28. 1936. Sachs, W., Azulay. R. D., and Convit, J. Multiple idiopathic hemorrhagic sarcoma of Kaposi. Histopathologic study. J. Invest. Dermat., 8: 317-326, 1947. Tedeschi, C. G., Folsom, H. F., and Carnicelli, T. J. Visceral Kaposi's disease. Arch. Path., 43: 335-357, 1947. Lymphangiosarcoma Martorell. F. Tumorigenic lymphedema. Angiology. 2: 386-392, 1951. Stewart, F. W., and Treves, N. Lymphangiosarcoma in postmastectomy lymphedema. A report of six cases in elephantiasis chirurgica. Cancer, 1: 64-81,1948. Myositis Ossificans, Osteoma, Chondroma Osteogenic Sarcoma, Chondrosarcoma Dietrich, C. Osteomatosis cutis. Arch. Dermat. & Syph., 41: 562-567, 1940. Geschickter, C. F., and Copeland, M. M. Tumors oi Bone. Chap. XVI. Variants of neoplastic ossification, pp. 363-384. 3d ed. Philadelphia, ete.: J. B. Lippincott Co., 1949. Hopkins, J. G. Multiple miliary osteomas of the skin. Report of a case. Arch. Dermat. & Syph., 18: 706-715, 1928. Kautz, F. G. Capsular osteoma of the knee joint, report of four cases. Radiology, 45: 162-167, 1945. Lilc/a, H. V., and Burns, D. C. Osteomatosis cutis. Report of a case. Arch. Dermat. & Syph., 46: 872-874, 1942. Mair, W. F. Myositis ossificans progressiva. Edinburgh M. J., 39: 69-92, 1932. Mallory, T. B. A group of metaplastic and neoplastic bone- and cartilage-containing tumors of the soft parts. Am. J. Path., 9: 765-776, 1933. Pack, G. T., and Braund, R. R. The development of sarcoma in myositis ossificans. Report of three cases. J. A. M. A., 119: 776-779, 1942. Rhoads, C. P., and Blumgart, H. Two osteoblastomas not connected with bone, histologically identical with osteogenic sarcoma, and clinically benign. Am. J. Path., 4: 363-369, 1928. Riley. H. D., Jr., and Christie, A. Myositis ossificans progressiva. Pediatrics, 8: 753-767, 1951. F5-135

Tumors of the Soft Tissues Stout. A. P. Undiagnosed tumor ol the thigh. J. Missouri M. A., 44: 341-342. 1947. Uehlinger. E. Myoaitis ossificans progressiva. Ergebn. d. med. Strahlenforsch., 7: 175-220, 1936. Vastine, J. H., II, Vostine, M. F., and Arango, O. Myositis ossificans progressiva in homoiygotic twins. Am. J. Roentgenol., 59: 204-212.1948. Vero, F., Machacek, G. F., and Bartlett. F. H. Disseminated congenital osteomas of skin, with subsequent development of myositis ossificans. Report of case in infant. J. A. M; A., 129: 728-734. 1945. Wilson, H. Eztraskeletal ossifying tumors. Ann. Surg., 113: 95-112. 1941. Synovial Sarcoma and Benign Synovioma Bennett. G. A. Malignant neoplasms originating in synovial tissues (synoviomata). J. Bone & Joint Surg., 29: 259-291, 1947. Berger, L. Synovial sarcomas in serous bursae and tendon sheaths. Am. J. Cancer, 34: 501-539, 1938. Briggs, C. D. Malignant tumors of synovial origin. Ann. Surg., 115: 413-426. 1942. De Santo, D. A., Tennant, R., and Rosahn. P. D. Synovial sarcomas in Joints, bursae. and tendon sheaths: «-tin</vtl and pathologic study of sixteen cases. Surg., Gynec. 4 Obst., 72: 951-981, 1941. • and Wilson. P. D. Xanthomatous tumors of joints. J. Bone & Joint Surg., 21: 531 556. 1939. Eisenberg, R. B.. and Horn, R. C. Synovial sarcoma of the chest wall. Ann. Surg., 131: 281-286, 1950. Fisher, H. R. Synovial sarcomesothelioma (sarcoendothelioma). Am. J. Path., 18: 529-553. 1942. Haagensen. C. D., and Stout, A. P. Synovial sarcoma. Ann. Surg., 120: 826-842, 1944. Harvey, W. F., Dawson. E. K., and Innes. J. R. M. Debatable tumours in human and animal pathology. IX. Endothelioma. Edinburgh M. J. (N. S. IV). 47: 513-540, 1940. Hunter, W. C. Benign polymorphocellular tumors of the knee region. Am. J. Path., 7: 13-30, 1931. Lewis. R. W. Roentgen recognition of synovioma. Am. J. Roentgenol., 44: 170-174, 1940. Murray, M. R., Stout, A. P., and Pogogeff, L A. Synovial sarcoma and normal synovial tissue cultivated in vitro. Ann. Surg., 120: 843-851, 1944. Sabrases, J., Montpellier. J., Duboucher, D., and de Grailly, R. Synovialomes metatypiques et tumours articulaires primitives, benignes et malignes. sans characteres organoides marques. Gas. hebd. d. sc. med. de Bordeaux. S3: 769-778, 1932. Smith. L. W. Synoviomata. Am. J. Path., 3: 355-364, 1927. Stewart, M. J. Benign giant-cell synovioma and its relation to "xanthoma." J. Bone & Joint Surg., 30 B: 522-527. 1948. Mixed Tumors Gates, O., Warren. S., and Warvi. W. N. Tumors of sweat glands. Am. J. Path., 19: 591-631, 1943. Morehead, R. P. Mixed tumors of the skin. Report of cases, with a consideration of the histogenesis of mixed tumors of organs derived from the ectoderm. Arch. Path., 40: 107-113, 1945. Simard, L. C. Tumour of the palm having the structure of a mixed tumour of the salivary glands. Am. J. Cancer, 33: 182-195,1938. Mesenchymoma Amolsch. A. L. Mixed mesodermal tumors of the uterus and vagina. With report of six cases. Am. J. Cancer, 37: 435-444, 1939. Carey, E. J. Studies in the dynamics of histogenesis. Tension of differentiated growth as a stimulus to myogenesis. VII. The experimental transformation of the smooth bladder muscle of the dog, histologically into cross-striated muscle and physiologically into an organ manifesting rhythmicity. Am. J. Anat., 29: 341-378.1921. Gllmour, J. R. A recurrent rumour of mesenchyme in an adult. J. Path. & Bact., 55: 495-499, 1943. F5-136

Tumors of the Soft Tissues Hueck. W. Uber das mesenchym. III. Mesenchymale Tumoren. Beitr. z. path. Anat. u. z. allg. Path., 103: 308-349. 1939. Mallory, T. B. A group of metaplastic and neoplastic bone- and cartilage-containing tumors of the soft parts. Am. J. Path., 9: 765-776 (Supp.), 1933. McFarland, J. Dysontogenetic and mixed tumors of the urogenital region—with report of a new case of sarcoma botryoides vaginae in a child and comments upon the probable nature of sarcoma. Surg., Gynee. 4 Obst., 61: 42-57. 1935. Rocher, H. L, and Uzae. Angiome diffuse des muscles anterieurs de 1'avantbras. Gaz. hebd. d. se. mod. de Bordeaux, 52: 380-382. 1931. Speder, E., and Lafforet, J. Tumeur geante de la cuisse. (Conjonctivome des anciens.) Ann. d'anat. path., 14: 431-441. 1937. Stout, A. P. Mesenchymoma, the mixed tumor of mesenchymal derivatives. Ann. Surg., 127: 278-290, 1948. Takacs, F. Eine eigenartige von der Gebdrmutter ausgehende Geschwulst. (Mesenchymoma embryonale angioplasticum.) Virchows Arch. f. path. Anat. 309: 550-560, 1942. White. I. E., and Stout, A. P. Mesenchymoma of the mesentery. Cancer, 3: 653 656. 1950. Mesothelioma Barrett, N. H., and Elkir.gton, J. S. Two cases of endothelioma of the pleura. Brit. J. Surg., 26: 314-319, 1938. Cornil, L., Audibert, V., Montel, L,, and Mosinger, M. Considerations anatomiques sur le cancer de la plevre. Bull. Assoe. franc, p. 1'etude du cancer. 27: 51-89, 1938. Evans, N. Mesothelioma of the epididymis and tunica vaginalis. J. Urol., 50: 249-254, 1943. Golden, A., and Ash. J. E. Adenomatoid tumors of the genital tract. Am. J. Path., 21: 63-79, 1945. Klemperer, P., and Rabin. C. B. Primary neoplasms of the pleura. Arch. Path., 11: 385-412. 1931. MacMahon. H. E., and Mallory. G. K. Fibrosarcoma of the pleura. Am. J. Path., 4: 387-394. 1928. Masson, P., Riopelle, J. L., and Simard, L. C. Le mesotheliome benin de la sphere genitale. Rev. canad. de bioL. 1: 720-751, 1942. Maximow, A. Uber das mesothel (Deckzellen der serosen Haute) und die Zellen der serosen Exudate. Untersuchungen an entziindetem Gewebe und an Bewebskulturen. Arch. f. exper. Zelllorsch., 4: 1-42, 1927. Morehead, R. P. Angiomatoid formations in the genital organs with and without tumor formation. Arch. Path., 42: 56-63. 1946. Sano, M. E., Weiss, E., and Gault, E. S. Pleural mesothelioma. Further evidence of its histo- genesis. J. Thoracic Surg., 19: 783-788, 1950. Stout, A. P. Solitary fibrous mesothelioma of the peritoneum. Cancer, 3: 820 825, 1950. Mesothelioma of pleura and peritoneum. Tenn. State M. A. J., 44: 409-411, 1951. Tumors ot (he pleura. Harlem Hosp. Bull., 5: 54-57, 1952. and Himadi. G. Solitary (localized) mesothelioma of the pleura. Ann. Surg., 133: 50-64. 1951. and Murray, M. R. Localized pleural mesothelioma; investigation of its char- acteristics and histogenesis by method of tissue culture. Arch. Path., 34: 951-964, 1942. Willis, R. A. Metastatic deposit of bronchial carcinoma in a hydrocele misdiagnosed "endothelioma," with a review of supposed "endotheliomas" of serous membranes. J. Path. & Bact., 47: 35-42, 1938. Malignant Lymphoid and Reticuloendothelial Tumors Ash, I. E. Epibulbartumors. Am. J. Ophth., 33: 1203-1219. 1950. Hellwig, C. A. Extramedullary plasma cell tumors as observed in various locations. Arch. Path., 36: 95-111. 1943. F5-137

Tumors of the Soft Tissues Lewis, H. M. Henschel. E. J., Frumess. G. M. Extromedullory plasmocytoma. Report of a case. Arch. Dermat. & Syph., 63: 474-477. 1951. McCavic, J. S. Lymphomatoid diseases involving the eye and its adnexa. Arch. Ophth., 30: 179-189, 1943. Post, C. F., and Lincoln, C. S. Mycosis fungoides. Report of two unusual cases with autopsy findings. J. Invest. Dennat., 10: 135-153. 1948. Reimann. H. A., Havens, W. P., and Herbut, P. A. Hodgkin's disease with specific lesions appearing first in the skin. Arch. Int. Mod., 70: 434-443,1942. Robb-Smith. A. H. T. The reticular tissue and the skin. Brit. J. Dennat., 56: 151-176, 1944. Stout. A. P. The results of treatment of lymphosarcoma. New York State J. Med., 47: 158-164. 1947. Sarcomas of the soft parts. J. Missouri M. A., 44: 329-334, 1947. Lymphosarcoma and Hodgkin's disease. Rhode Island M. J., 32: 436-439 and 448. 1949. and Frerichs, J. B. Plasmocytoma of inframammary region. (Tumor Seminar.) J. Missouri M. A., 46: 275-277. 1949. and Kenney, F. R. Primary plasma-cell tumors of the upper air passages and oral cavity. Cancer, 2: 261-278, 1949. Wertheim, L., and Smith, G. S. Mycosis fungoides. Arch. Dennat. & Syph., 57: 625-635, 1948. Winer, L. H. Mycosis fungoides. Benign and malignant reticulum cell dysplasia. Arch. Dermat. & Syph., 56: 480-498. 1947. Blue Nevus and Melanosarcoma Goldberg, S. A. The melanoblast as a mesodermal cell. In: Gordon, M., and others. The Biology of Melanomas. New York Academy of Sciences, Special Publications, Vol. IV, pp. 126-136. New York: The Academy, 1948. Masson, P. Neuro-nevl "bleu." Arch. "deVecchi," anat. pat., 14: 1-28, 1950. Montgomery, H., and Kahler, J. E. The blue nevus (Jadassohn-Tieche): its distinction from ordinary moles and malignant melanomas. Am. ]. Cancer, 36: 527-539, 1939. F5-138 Army - AFIP -Washington, D. C.

PROFESSIONAL NOTES AND FINDINGS

PROFESSIONAL NOTES AND FINDINGS

.-.*>., '

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