Mesenchymatous Tumors of The Lung and Pleura

Within the past ten years a greater incidence in primary carcinoma of the lung has been observed (1). Mesenchymatous tumors, both benign and malignant, however, continue to be considered very rare primary newgrowths of the lung. Adler (2) states that primary sarcoma of the lung is a great rarity, and he did not observe a single case, but he believed the extreme rarity of such growths might be exaggerated. He collected 94 sarcomas from the literature and in reviewing these in his monograph observed that many were not well differentiated from carcinoma and only a few could be considered as true primary sarcomas. Hickey and Simpson (3) reported two chondromas of the lung and reviewed 40 cases. Other authors (4) emphasize the great infrequency of the primary tumors of the lung and pleura. Kaufmann (5) describes the occurrence of small chondromas but considers malignant tumors such as spindle-cell, or small or mixed cell sarcoma, as very rare primary growths. He also points out, as has been our experience, that it is difficult to recognize their origin, whether from the lung or from the pleura. He considers primary tumors of the pleura as rare, reporting one large sarcoma in a woman. He quotes Mehrdorf, who described a huge fibrosarcoma which filled the right pleural cavity of a woman 42 years of age. Adler, Ewing (6), and Kaufmann emphasize the necessity of careful study of various portions of lung tumor and their metastases to determine their mesoblastic origin. It is needless to point out that a thorough search for growths elsewhere in the body is necessary before one may assume a tumor to be primary in the lung or pleura. Ewing further suggests that histologic appearances, which inflammatory lesions such as abscesses, tuberculosis, and syphilis may assume, might readily be mistaken for primary round cell and spindle-cell sarcomas. Again, many observers have shown that in the lung primary carcinomas may reveal areas of spindle-cells and round cells which represent typical carcinoma cells and not sarcoma. In the following report five tumors are described —one chondroma, two fibromas, one fibromyoma, and one fibrosarcoma—primary in the lung or pleura, all of which from their gross and microscopic appearances are without doubt of neoplastic nature, and of connective tissue origin. All have been observed since 1925. The chondroma, which was small and found in the routine of the autopsy, gave no clinical symptoms. Case 1. Chondroma of the lung (from the Research and Educational Hospital of the University of Illinois College of Medicine; autopsy by Dr. R. H. Jaffe). Male, 41, white, had an acute perforation of a chronic duodenal ulcer, with a recent acute fibrino-purulent peritonitis. In the center of the lower lobe of the left lung, a nodule 7 mm. by 4 mm. by 3 mm. was found, which, on section, appeared white, homogeneous, and elastic like cartilage.