Fig. 96. An Intrinsic Sarcoma of the Skull.
The gap in the bone may be covered in, at a later date, if the patient’s condition is favourable.
The operation may be a formidable one, but records are to hand of 35 cases in which radical measures were adopted. Ten cases died from the operation, 13 were well for periods varying from six months to six years; and recurrence took place soon after the operation in 21 cases.
Chloromata.
Chloroma, a peculiar type of sarcoma characterized by the pale green hue of the tissues, usually develops in the young. The cells are small and round, the pigment distributed in and around the cell elements. The colour, said to be dependent on the presence of a pigmented fat, is most intense immediately after the removal of the tumour, fading rapidly on exposure to light.
The tumour develops from the periosteum of bones, more especially from those which enter into the formation of the orbit and base of skull. In fact, nearly all the cases reported have originated from the temporal and orbital regions. Great rapidity of growth and early dissemination throughout the viscera are conspicuous features—no organ of the body can be said to be exempt from metastatic deposits. The meninges and brain are early involved by direct extension.
Proptosis, as the result of cavernous sinus thrombosis and orbital invasion, is a prominent and early symptom. Death results within six months. No treatment, surgical or otherwise, is of any avail.
Carcinoma
can only involve the skull-bones as a metastatic deposit—more commonly in association with mammary cancer—or by direct invasion from an overlying epitheliomatous scalp ulcer. In the former instance, any radical treatment would be contrary to all surgical principles. In the latter case, presuming that the cervical glandular region is unaffected or capable of removal, the scalp ulcer should be freely excised together with the whole thickness of underlying bone. The resultant osseous gap may be covered in by means of a plastic flap derived from neighbouring healthy tissue.