_Microscopic examination._—One of the growths, of the size of a large
pea, was removed from the left ankle, and a smaller one (lentil-sized)
from the left knee. Sections of both were stained with hæmatoxylin and
eosin-hæmatoxylin. The growths are seen to be situated in the corium,
and are circumscribed. The epidermis over one of them is thickened. They
consist of oval and spindle cells, which, in some parts, are more or
less grouped into strands or bundles, and are cut in various directions.
In some parts of the sections there are empty spaces (? lymph spaces)
and in some parts there is homogeneous substance between the cells; in
other parts there is extravasated blood. The cells in the larger and
older of the two nodules are decidedly more elongated and
fibrous-looking than in the smaller and more recently developed one. Dr.
J. M. H. MacLeod is kindly going to make a further report of the
microscopical features.
_Remarks._—It seems to us clear that the case is a typical but
relatively early one of the so-called idiopathic multiple pigment
sarcoma (idiopathic multiple hæmorrhagic sarcoma) of Kaposi and later
writers. For the literature on the subject we refer to the English
summaries of Dr. J. H. Sequeira[3] and Dr. Radcliffe-Crocker.[4] The
patient in our case is a male, as in nearly all other recorded cases of
this disease; he is of the favourite age (between 40 and 50), and it may
likewise be noted that he is a Galician Jew, as the patient of Sir
Stephen Mackenzie[5] and Dr. J. J. Pringle was. The minute bluish
nodules in the corium may be regarded as the primary feature of the
disease. They either remain for a long time without undergoing much
obvious change, or they undergo spontaneous involution and completely
atrophy, leaving behind them only a little brownish cutaneous
pigmentation; or else (thirdly) they may increase in size, become much
elevated, and form definite sessile tumours, which, later on, become
pedunculated, and finally drop off. This is the cycle in regard to the
development of the little pendulous tumours which constitutes one of the
most characteristic features of the disease. Another characteristic
feature of the disease, probably sooner or later present in every case,
is the œdema which occurs in the parts most affected, especially in the
lower extremities. It is persistent œdema, and results in an
elephantiasis-like condition. It is well marked in the left foot and
ankle of our case. The striking blue or purple colour of the small
nodules (which is absent in the pendulous tumours) seems, as in other
cases, to be due to the venous blood contained in the blood-vessels or
extravasated. What pigment there is in the growths is probably derived
from blood. In our patient there is no evidence of gout as in certain
cases described by Mr. Hutchinson.[6]
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