Primary gastric sarcoma is not so rare as it. is generally thought to be. It is probable that a num-ber of cases described as cancer have been truly sarcoma; this we may conclude from the fact that a number of museum specimens classed as cancer have on microscopic examination proved to be sarcoma.

Fenwick (5) stated in November, 1900, that out of sixty recorded cases, fifty-three at least ought to be regarded as genuine, and he thought that they constituted from 5 to 8 per cent, of all primary neoplasms of the stomach.

The recognised varieties are round-celled, spindle-celled, myosarcoma, and angio-sarcoma.

Round-celled sarcoma constitutes 62 per cent, of all the recorded cases. It occurs as a rule as a dense infiltration of the pyloric third of the stomach, and, unlike cancer, tends to render the pylorus patulous, though in some cases the thickening leads to partial stenosis. In about one sixth of the cases the growth involves the entire stomach, invading both oesophagus and duodenum. The mucous membrane presents signs of chronic inflammation and ulceration. In only two of Fenwick's cases was there a circumscribed tumour with secondary nodules in the surrounding mucous membrane. These growths have a tendency to soften and break down.

In a case of round-celled sarcoma, SchopE (1) removed a tumour the size of a child's head, leaving the cardiac and pyloric ends of the stomach, which he sutured together. The patient was alive twelve months later.

Spindle-celled sarcoma constituted 22 per cent, of the fifty-three cases. It presents itself usually as a round or circumscribed tumour in the neighbourhood of the greater curvature, and tends to project towards the serous coat, ultimately forming a very large tumour, sometimes becoming pedunculated. The size attained may be enormous, so as to fill the whole of the abdomen.

Billroth successfully removed a cystic sarcoma of this variety. Cantwell (2) removed one weighing 12 lb., but it recurred eight months later.

Myosarcoma

Five out of fifty-three recorded cases were of this variety. They form smooth or slightly nodular tumours, and usually occur near the greater curvature. They may attain an enormous size, Brodowski having met with one of 12 lb. They are apt to undergo cj'stic degeneration and to be accompanied by severe hamiorrhnge.

Angiosarcoma

Two cases have been recorded. In one case the tumour was the size of a child's head ; it contained many cysts due to haemorrhage. Kosinski (3) successfully removed a tumour of this kind.

Symptoms

Sarcoma of the stomach may occur at any time of life, from infancy to extreme old age. The symptoms are similar to those of carcinoma-progressive loss of flesh with debility and anaemia. Pain is usually present. Pyrexia slight, but persistent. Albumen in the urine may be present. Haematemesis is apt to occur and may be so free as to cause death. Free HCl is usually absent and lactic acid present as in cancer. The small round-celled sarcoma resembles cancer in all respects except in less frequently leading to stenosis; but in spindle-celled sarcoma gastric symptoms maybe entirely absent, and when operative treatment is undertaken in a rapidly-growing tumour the growth may be discovered unexpectedly to be arising from the stomach. Perforation is apt to occur in round-celled sarcoma in from 10 to 12 per cent, of all cases. Metastases in glands, in distant organs, and especially in the skin, are prone to occur. According to Kundrat, the tonsils are apt to enlarge and the follicles on the side of the tongue to become swollen and ulcerated.

The prognosis varies with the nature of the growth; in round-celled sarcoma the average duration of life is fifteen months; in spindle-celled sarcoma and myosarcoma the average is two years and eight months.

References

1. Schopf. - Centr.f. Chir., 1899, p. 1163.

2. Cantwell.-Annals of Surgery, 1899, vol. ii, p. 596.

3. Kosinski.-Deutsch Gesellsch. f. Chir., 1892.

4. Lecene and Petit.-" La Sarcoine Primitif de FEstomac," Rev. de Gyn. et de Chir., Alxl. November and December, 1904, p. 965.

5. Fenwick.- Cancer and Tumours of the Stomach.

Treatment

Surgical treatment of gastric sarcoma has met with considerable success so far as the immediate effect of operation is concerned. The solid tumours are especially favourable for extirpation, especially when pedunculated, but in all cases it is desirable to remove the portion of stomach wall from which they spring very freely.

In the round-celled variety a wide removalof_the stomach by partial or complete gastrectomy is required in order to give any hope of success. Torok, Dock, Schopf, and others have removed considerable tumours, and in Schopf's case the patient was living a year later.

Early diagnosis and early thorough surgical treatment must be the great aims in the treatment of sarcoma.

Statistics

Lecene and Petit (4) report ten deaths out of twenty-four collected cases, but only one out of seven proved fatal, where the resection of the gastric walls was around a circumscribed tumour.