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.Uliig | i iii|ii i

« I . III .

Primary Sarcoma of the Eyelitl

»v

CASEY A. WOOD, M.D.

CflKACO

R*frittt from OpktkiUmtf Jltctndt Alurch^ iSifS

lX2f

Is '

...

Primar)' Sarcqma of the Eyeliu

av
CA-SEY A. WOOD, M.D.

CHICAGO

jR0fHnl/ri>m OpMtkatmtc Rmordy A/ttrcA, i8gS

I* w

yJL

PRIMARY SARCOMA OF THE KVELID.*

I5Y CASKY A. WOOD, M. 1).,

OK CiriCACiO.

Sarcomatous tumors of the eyelids are so exceedini,'Iy rare that 1 make
no apology for presenting the following short history. Most English
authors pass the subject over with but bare mention of the possibility of
their occurrence, and even the transactions of the various ophthalmolog-
ical societies rarely contain the history of an example. A very good account
of these growths in the lid is given by (Iraefe, under the title Cylindroma
(proposed by Billroth), in Vol. X, 2, p. 184, of his own Arc/iiv. In the
British Medical Journal {w 1870, page 161, Samelson describes a case of
sarcoma of the lid in a child ten months old. .Schirmer gives an account
{Kliiiischc MoiiatshUxttcr fitr Au^tj^cf/licilkiimlf, Vol. I, p. 162) of multiple
sarcomata affecting all four lids in a patient seventy years of age. Hirsch-
berg also reports an example of this disease, in which there was a recur-
rence shortlv after removal.

Baby A., aged 7 months, an onlv chikl.was horn a healthy anil well-developed
Infant, and, although nnrsed on the bottle, has al\va\ s been vigorous and to all
appearances free of anv hereditary disease. There is no historv of malignant
neoplasms affei-ting immediate ancestors. When she was six weeks old the mother
noticed a very slight elevation on the right ui>per lid. It was firm to the touch,
rolleil about untier the linger, and was not surrounded by a red or swollen area,
on the skin surface, at least. It remained in .i/titii quo until the child was 3
months old. Then the mother believed it to be growing and consulted a well-
known ophthalmologist, who, although he would not give a jiositive opinion as to
its exact nature, ad\ ised that the jiatient be kept under obser\ation for about a
motitb longer, before advising its imn.ediate removal. As the familv were about
to remove to Chicago, nothing was ilone. The condition of affairs was about this,
wiien I first saw her, two m()nth> ago: The right upper lid is slightlv swollen
throughout and of a darker pink than the corrc'^ponding left lid. There is a
roundeil prominence occupying the junction of the middle and inner third of the
lid. On palpation, an irreguiarlv mal, a|)parentlv movable body, of rather tiini
consistence anil of the si/e of a white bean is felt not unlike the ordinarv
chalazion. 'i"he dermal \■es^el^ are slightly more numerous and larger than are
those of the opposite side. On e\erting the lid the body seems to project some-
what on the conjuiicti\ al aspect of the lid, ami corresponding to the jirojection
is a round mass con ered with red and thickencii mucosa. The \:iscular supph is

* I'reseiiliHl to tlie t.'liic,ii»ii t >plitlialinoloKical .Society. January, IMtS.

decidedly greater than in the ordinary non suppurating chalazion. The mas*
appears to involve the tarsus. There is apparently no pain in the eye and no
increased conjunctival secretion.

The tumor was completely removed, under chloroform narcosis, from
the conjunctiva surface, using a fenestrated forceps. There was free
hemorrhage and the tumor appeared to be imperfectly encapsulated. It
involved the tarsus, part of which was removed at the time of operation
Macroscopically, it resembled a piece of muscular tissue. Dr. Evans, of
the Columbus Medical Laboratory, examined the growth and gives the
following report:

"Fresh specimen, 6x4x2 mm. No epithelial covering. Microscope
shows it to be composed of round and spindle cells — more of former —
with considerable intercellular substance, some pre-existing fibrous tissue,
an artery with unusually thick walls. The growth is a sarcoma."

The sections exhibited showed no naked vessels communicating di-
rectly with the cells. So far, three months after removal, there has been
no recurrence of the growth.

mtrn^^

haluxion. The maifo
n in the eye and no

Form narcosis, from
s. There was free
J encapsulated. It
time of operation
ue. Dr. Evans, of
)wth and gives the

ering. Microscope
-more of former —
isting fibrous tissue,
1 sarcoma,"
communicating di-
Dval, there has been

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