Primary Tumours.—Lympho-sarcoma, which may be regarded as a sarcoma starting in a lymph gland, appears in the neck, axilla, or groin as a rapidly growing tumour consisting of one enlarged gland with numerous satellites. As the tumour increases in size, the sarcomatous tissue erupts through the capsule of the gland, and infiltrates the surrounding tissues, whereby it becomes fixed to these and to the skin.
The prognosis is grave in the extreme, and the only hope is in early excision, followed by the use of radium and X-rays. We have observed a case of lympho-sarcoma above the clavicle, in which excision of all that was removable, followed by the insertion of a tube of radium for ten days, was followed by a disappearance of the disease over a period which extended to nearly five years, when death resulted from a tumour in the mediastinum. In a second case in which the growth was in the groin, the patient, a young man, remained well for over two years and was then lost sight of.
Secondary Tumours.—Next to tuberculosis, secondary cancer is the most common disease of lymph glands. In the neck it is met with in association with epithelioma of the lip, tongue, or fauces. The glands form tumours of variable size, and are often larger than the primary growth, the characters of which they reproduce. The glands are at first movable, but soon become fixed both to each other and to their surroundings; when fixed to the mandible they form a swelling of bone-like hardness; in time they soften, liquefy, and burst through the skin, forming foul, fungating ulcers. A similar condition is met with in the groin from epithelioma of the penis, scrotum, or vulva. In cancer of the breast, the infection of the axillary glands is an important complication.
In pigmented or melanotic cancers of the skin, the glands are early infected and increase rapidly, so that, when the primary growth is still of small size—as, for example, on the sole of the foot—the femoral glands may already constitute large pigmented tumours.
The implication of the glands in other forms of cancer will be considered with regional surgery.
Secondary sarcoma is seldom met with in the lymph glands except when the primary growth is a lympho-sarcoma and is situated in the tonsil, thyreoid, or testicle.