Page:The Texas Medical Journal, vol. 18.djvu/327

Rh patient’s general health rapidly improved after this operation, and she was able to leave the hospital at the end of three weeks. From that time until the present, three years and seven months after the operation, her health has continued good and there is no evidence of a return of the disease. At the time she left the hospital, her weight was 98 pounds, at the present time it is 180 pounds. The tumor was examined by Dr. Paul F. Morf, whose report upon its histologic structure is as follows:

“Microscopically, the tumor is seen to be mainly made up of round or more or less polyhedral cells which resemble young hyperplastic periosteal cells in appearance. Some which have apparently reached a more mature stage resemble young cartilage cells. The former are for the most part closely bunched together, and vary in size from two to three times the size of a red blood corpuscle. The protoplasm is not abundant, and the nuclei are separated by a small amount of coarsely fibrous intercellular substance, and where this intercellular substance becomes more abundant, the tumor cells tend to resemble cartilage cells more in structure. They become more circular in outline, the protoplasm is more abundant and the nuclei relatively smaller. Yet in other parts, there are dense bands of fibrous tissue, so the tumor tissue has more the appearance of periosteum. Scattered through the tumor tissue are islets of irregular outline, which, in the gross specimen, contained lime salts, and which had to be decalcified in order that the tissue could be cut. These areas stain deeply with hematoxylin, and are made up of a homogeneous intercellular substance containing large round cells with a large amount of protoplasm and a small nucleus, the cells themselves surrounded by a capsule. These islets have an irregular dentate and branched outline, and have apparently developed from the areas just described where the intercellular substance is abundant. In a very few places, there are islets which resemble true bone, the decalcified intercellular substance being arranged in lamelle, and between these remain a few small shrunken stellate cells, resembling bone cells, and lying in small lamelle like those of normal bone. The blood vessels are very few in number, their walls, as is usual in sarcomas, are made up of tumor cells.”

Before discussing the diagnosis and prognosis of sarcoma of the femur, it is essential that we have a clear idea of the origin and histologic structure of these tumors.

According to their point of origin from the bone, they may be grouped into central, myelogenic or intraosseous and peripheral or periosteal.