There is no evidence of any disease of the thoracic or abdominal viscera. The patient is not strongly built, but looks well nourished. He complains of various pains, but whether these are related to the disease or not is doubtful.
Figure 2
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]]
The prognosis in the present case is not altogether unfavourable, considering that the patient’s general health is good, that the disease is probably seldom of itself fatal, and that in some cases improvement or spontaneous care has, apparently, occurred after the disease has lasted twenty years or more.
SOCIETY INTELLIGENCE.
THE DERMATOLOGICAL SOCIETY OF LONDON.
An Ordinary Meeting of the above Society was held on March 8th, 1905, at 5.15 p.m., Dr. J. H. STOWERS in the chair.
The following cases were demonstrated: