The headache and discharge continue for a year, and the swelling continually increases through life, although the symptoms gradually disappear, the skin not becoming involved, and no pain being present. It has been noticed in young chimpanzees. The illustration represents a man of forty who suffered from the disease since puberty. Pressure on the eyeball had started and the native said he expected that in two years he would lose his sight. Figure 251 shows an analogous condition, called by Hutchinson symmetric osteomata of the nasal processes of the maxilla. His patient was a native of Great Britain.
Among neuromata, multiple neurofibroma is of considerable interest, chiefly for the extent of general involvement.
According to Senn, Heusinger records the case of a sailor of twenty-three in whom all the nerves were affected by numerous nodular enlargements. Not a nerve in the entire body was found normal. The enlargement was caused by increase in the connective tissue, the axis-cylinders being normal. In this case there was neither pain nor tenderness.
Prudden reports the case of a girl of twenty-five who, during convalescence from variola, became paraplegic, and during this time multiple neuromata appeared. At the postmortem more than a thousand tumors were found affecting not only the peripheral branches and the sympathetic, but also the cranial nerves and the pneumogastric. Under the microscope these tumors showed an increase in the interfascicular as well as perivascular fibers, but the nerve-fibers were not increased in size or number.
Virchow collected 30 cases of multiple neurofibromata. In one case he found 500, in another from 800 to 1000 tumors.
Plexiform neuroma is always congenital, and is found most frequently in the temporal region, the neck, and the sides of the face, but almost any part of the body may be affected. Christot reports two cases in which the tumors were located upon the cheek and the neck. Czerny observed a case in which the tumor involved the lumbar plexus. Quoted by Senn, Campbell de Morgan met with a plexiform neuroma of the musculo-spiral nerve and its branches.
The patient was a young lady, and the tumor, which was not painful, had undergone myxomatous degeneration.
Neuroma of the vulva is a pathologic curiosity. Simpson reports a case in which the tumor was a painful nodule situated near the urinary meatus. Kennedy mentions an instance in which the tumor appeared as extremely tender tubercles.
Tietze describes a woman of twenty-seven who exhibited a marked type of plexiform neurofibroma. The growth was simply excised and recovery was promptly effected.
Carcinomatous growths, if left to themselves, make formidable devastations of the parts which they affect. Warren pictures a case of noli-me-tangere, a destructive type of epithelial carcinoma. The patient suffered no enlargement of the lymphatic glands. The same absence of glandular involvement was observed in another individual, in whom there was extensive ulceration. The disease had in this case originated in the scar of a gunshot wound received during the Civil War, and had destroyed the side of the nose, the eye, the ear, the cheek, including the corresponding half of the upper and lower lips.
Harlan reports a most extraordinary epithelioma of the orbit in a boy of about five years. It followed enucleation, and attained the size depicted in a few months.
Sarcomata, if allowed full progress, may attain great size. Plate 10 shows an enormous sarcoma of the buttocks in an adult negro.
Fascial sarcomata are often seen of immense size. Senn shows a tumor of this variety which was situated between the scapulae.
Schwimmer records a curious case of universal small sarcomata over the whole body of a teacher of the age of twenty-one, in the Hungarian lowlands. The author called the disease sarcomata pigmentosum diffusum multiplex.
The bones are a common seat of sarcomatous growths, the tumor in this instance being called osteosarcoma. It may affect any bone, but rarely involves an articulation; at times it skips the joint and goes to the neighboring bone.
A case of nasal sarcoma is shown by Moore. The tumor was located in the nasal septum, and caused a frightful deformity. In this case pain was absent, the sense of smell was lost, and the sight of the right eye impaired. Moore attempted to remove the tumor, but in consequence of some interference of respiration the patient died on the table.
Tiffany reports several interesting instances of sarcoma, one in a white female of nineteen following a contusion of tibia. The growth had all the clinical history of an osteosarcoma of the tibia, and was amputated and photographed after removal. In another case, in a white male of thirty, the same author successfully performed a hip-amputation for a large sarcoma of the left femur. The removed member was sent entire to the Army Medical Museum at Washington.
The fatality and incurability of malignant growths has done much to stimulate daring and marvelous operations in surgery. The utter hopelessness of the case justifies almost any means of relief, and many of the visceral operations, resections of functional organs, and extraordinary amputations that were never dreamed of in the early history of medicine are to-day not only feasible and justifiable, but even peremptorily demanded.
Varicose veins sometimes become so enlarged and distorted as to simulate the appearance of one varicose tumor. Adams describes a curious case of congenital dilatation of the arteries and veins in the right lower limb, accompanied by an anastomosis with the interior of the os calcis. The affected thigh exceeded the other in size by one-third, all the veins being immensely swelled and distorted. The arteries were also distorted and could be felt pulsating all over the limb. The patient died at thirty from rupture of the aneurysm.
