Osteosarcoma, before and after operation

Osteosarcoma are cancerous bone tumors found in immature bone, most often in those over 10 and under 25 years old. This particular case is in a man named Robert Penman, who was twenty-four. 

These days, in those whose tumor is non-malignant (has not spread beyond its original tumor site), the five-year survival rate is about 75%. Back in 1839, I cant imagine this lad was quite as lucky, but it appears that at least the primary tumor was removed for a time.

Case of Osteo-sarcoma of the lower jaw, as operated upon Robert Penman, aged twenty-four years. 1839.

Mesothelioma of the Kidney

Thanks to television commercials, most people in the US are probably aware of the main cause of mesothelioma - up to 85% is caused in the lungs from asbestos exposure, especially in people who worked in mines or construction prior to the 1980s.

However, mesothelioma can form in any mesothelium, which is a tough membrane of simple squamous epithelium that makes up the peritoneum, mesentery, pleura, and pericardium.

When it comes to renal (kidney) cancers, it turns out that renal cell carninoma can mimic the appearance of mesothelioma more frequently than renal mesothelium becomes malignant.

Genito-Urinary Surgery and Venereal Diseases. Edward Martin and Benjamin Thomas, 1918.

Pelvic deformities leading to dystocia

1. Exostoses (”outgrowths”) at the sacro-iliac junctions 2. Knob-like exostosis on the promontory 3. Acanthopelys (”spine-bowl”) 4. Rachitic (ricket-affected) pelvis with abnormal blunt projection of ileo-pectineal eminences 5. Endochondroma (”tumor of the cartilage”) 6. Fracture of the pelvis 7. Fracture of the acetabula in consequence of coxalgia 8. Fracture of the right ala of the sacrum

Dystocia comes from the roots dys-, meaning “bad”, and -tocia, meaning “to birth”.

Anything that obstructs labor can be considered a dystocia, and the most common cause in today’s world is girls who are married at a young age. The pelvis is only fully formed, on average, around age 20-22. While many women successfully give birth before then, the younger the pregnancy, the more risky the birth is. Prolonged labor can lead to fetal mortality, maternal mortality, and obstetric fistula, which can have lifelong consequences.

An American Text-Book of Obstetrics for practitioners and students. Edited by Richard C. Norris, 1895.

Top: Rodent ulcer of twelve years duration (spontaneous cicatrization [sealing off; stopping spreading])

Bottom: Rodent ulcer of sixteen years duration (Terebant [Piercing] type)

"Rodent ulcers" (also known as Jacobi ulcers) are so named due to their rat-gnawed appearance. They are a manifestation of basal-cell carcinoma (BCC), and while they're rarely fatal, they have the potential to be extremely disfiguring. Unlike most BCCs, rodent ulcers have significant central necrotization, leading to more tissue damage.

While the extreme destruction seen on these two patients is no longer commonplace in the developed world, treatment and removal of these ulcers can be very expensive, and they often recur, even with treatment. As they don't often kill and often strike the very elderly, with removal frequently being more painful than the ulcer itself, basal-cell carcinoma is of the few cancers that is often simply monitored, rather than aggressively treated.

In Caucasian people, up to 30% of adults will develop some form of this cancer in their lifetimes. The most common cause is significant unprotected sun exposure, but genetics also plays a role in susceptibility. Thankfully, rodent ulcers are one of the less-common presentations.

Diseases of the Skin. James H. Sequeira, 1919.

Osteo-chondro-myxosarcoma before and after surgical intervention

Osteogenic tumors develop bone that displaces soft tissue. Osteo- means "bone", and -genic means "to form". In addition to the osteogenic behavior, this patient's tumor has caused disordered cartilage (chondro-) and mucous membrane (myxo-) growth.

The case report states that it took "many" surgeries to completely remove the tumor and partially reconstruct the jaw, but that the patient lived a further 8 years after removal, and experienced no recurrence of the tumor in that time. While his vision suffered, as the left eye was unsalvagable, and his speech was impeded by both the incomplete jaw reconstruction and the excess skin remaining on the face, he was able to hold down a steady job and communicate. He was reported to be of "average-to-high" intelligence.

Tumors of the Jaws. Charles Locke Scudder, 1912.

Osteosarcoma of the upper jaw in 10-year-old boy

Sarcomas are relatively rare tumors in humans, formed from mesenchymal cells, rather than epithelial (surface) cells. Epithelial cell tumors are called "carcinomas". Since sarcomas are relatively uncommon, but hard tumors or cysts on the bones are not, patients are often misdiagnosed at first.

In children, osteosarcomas (sarcomas of the bone) comprise approximately 2.4% of cancer cases. Most of these tumors occur in the leg bones, but around 8% originate in the jaw. The standard treatment of osteosarcoma is resection of the affected bone - that is, removal of the tumorous section, and joining together the two sections of bone on either side of the removed area. If the tumor has spread or the bone is too overtaken by it, amputation of the limb is called for. Obviously, you can't amputate the face, but detection of facial tumors is often much less delayed than in the leg, and the removal and resection of the jaw bone is usually possible.

Five-year survival rates of pediatric osteosarcoma are still one of the lowest of all the childhood cancers, at an average of 68% across all the different manifestations. However, given that the survival rate was hovering around 5-10% at the beginning of the 20th century (and that's being generous), we've come a long way. Early detection and eliminating misdiagnoses of leg tumors is critical to survival in all age groups.

Tumors of the Jaws. Charles Locke Scudder, 1912.

Ecchondroma of the ilium

Chondromas are benign cartilaginous tumors, which are formed by errant chondrocytes (cartilage-creating cells) creating encapsulated lobular growths either within bones (enchondromas), or outward from the bones (ecchondromas). Ecchondromas are much more uncommon than cartilage tumors which grow from within the bone.

American Text-Book of Surgery. Edited by J. William White and William W. Keen, 1894.

Horny growth of the penis

Horny growths on the skin, also known as cornu cutaneum, are keratinous skin tumors, caused by overgrowth of keratin in the dermis. Since they're avascular (they have no bloodflow), they can be easily removed with a scalpel or sharp razor, but the underlying condition will almost always reappear if the site is not treated with radiation, chemotherapy, or (occasionally) cryotherapy.

Diseases and Surgery of the Genito-Urinary System. Francis Watson, 1908.

Because maybe I shouldn't correct/blindly accept corrections when I'm half-awake.

Yes yes yes. I realize that -itis means inflammation. Maybe I should have looked at my own posts, first. The person who corrected my "fever" (which would have been "pyro-", by the way) to "swelling" wasn't any more wrong than me, but gave a good illustration of a common misconception about what "inflammation" is.

Acute inflammation isn't just swelling. It's is characterized by four signs: rubor (redness), dolor (pain), calor ("fever" - hotness at the site), and tumor (swelling). I guess if you combined my original incorrect definition with the first correction, you're halfway there?

Thanks to Dan Urbach for the interesting etymological lesson on "-itis" and everyone else who submitted posts and questions giving me the *actual* correct definition, and reminding me that sometimes I should go back and look at my definitions before hitting "post".

Here's Jesus trying to destroy Darwin (and failing, I might add), because I can. You have earned it.

[cyriak]

Left: Large chondroma of lower left jaw in situ. Right: Patient after recovery, post chondroma removal.

Note the tumor hung from the jacket, presumably to give a sense of size in relation to the now-healed jaw.

Oh, you want actual information about the pictures? Well, chondromas are benign tumors, formed by cartilaginous tissues. They can form anywhere that cartilage exists, and can cause significant skeletal problems, but are not malignant, and unlike many other benign tumors, are not considered to raise the risk of cancer.

A Text-Book of Surgical Principles and Surgical Diseases of the Face, Mouth, and Jaws, For Dental Students. H. Horace Grant, 1902.

Ganglion cyst, aka "Bible bump", aka "Let's hit you with a large book!"

Given the name "Bible cyst" or "Bible bump" from the original "treatment" of hitting the deformity with a Bible or other large book, ganglion cysts are actually considered tumors. Over 60% of the non-cancerous tumors of the hand are ganglionic, but their etiology is still not completely understood.

The first description of these tumors was given by Hippocrates as "knots of tissue containing mucoid flesh", but the first theories of their origins weren't put forth until 1746, when one Dr. Eller wrote a descriptive paper on them. He believed that they came from synovial herniation,  or rupture through the tendon sheath, and that they were true cysts.

Later theories recognized that the tumors were growths arising from ganglionic sheaths and not encysted fluids or mucoid tissues, but the old theory of "just smack it with a heavy object to burst it and make the body reabsorb it" still stuck around for a long time. Though bursting the tumor can cause temporary disappearance, this often causes more serious recurrence and additional growth. As these tissues are not cancerous, it's generally recommended to leave them alone when they're not interfering with normal function. Sometimes they can press against other tendons or nerves and necessitate aspiration or surgical removal, but the incidence of recurrence is over 40%. In about 75% of cases, the "cyst" will disappear or significantly decrease on its own.

So, yeah, don't let anyone convince you to let them smack you with a heavy object, just because you have one of these growths! It's a bad idea to let people smack you with heavy objects, just as a general rule...

[Source: Medscape Reference: Ganglions]

[Image: Iconograms. Prof. Bockenheimer, 1913.]

Molluscum fibrosum (Neurofibromatosis 1)

neu·ro·fi·bro·ma·to·sis

n.

A genetic disease characterized by multiple neurofibromas and pigmented spots on the skin, sometimes accompanied by bone deformity and a predisposition to cancers, especially of the brain. Also calledmultiple neurofibroma, neuromatosis, Recklinghausen's disease, von Recklinghausen's disease.

Image from: An Introduction to Dermatology. Norman Purvis Walker, 1905.

Definition: American Heritage Medical Dictionary 2004.

Exophthalamos of the left eye due to voluminous orbital cancer

Partial atrophy of the ocular muscles, partial sight still present in left eye. Right eye still functional. Cancer originated from superior levator muscle and grew back into other muscular tissues of the orbit. 

This kind of cancer is much more common in adults than in children, who tend to get retinoblastomas (in the ocular nerve) more than anything.

Iconographie Ophthalmologique. J. Sichel, 1858.

Leukemic deposits on the heart

Neoplastic Diseases: A Treatise on Tumors. James Ewing, 1922.