Tokonoma

“ If the cells undergo degeneration and absorption and the stroma contracts, the tumour becomes still harder, and tends to shrink and to draw in the surrounding parts, leading, in the breast, to retraction of the nipple and overlying skin, and in the stomach and colon to narrowing of the lumen. When the cells of the tumour undergo colloid degeneration, a _colloid cancer_ results; if the degeneration is complete, as may occur in the breast, the malignancy is thereby greatly diminished; if only partial, as is more common in rectal cancer, the malignancy is not appreciably affected. ”

“ In cases of intestinal cancer associated with schistosomiasis, the locality of the cancer was predominately seen in the rectum, as was also reported in Japan [64] , followed by the sigmoid colon, and finally in the other part of the colon, while cancer in the small intestine was a rarity which coincides with relative distribution of S. japonicum eggs in the intestine of man [44] , [58] , [65] - [66] . ”

“ Also among the Arabs of Algiers sarcoma is more common than carcinoma. Among the male Arabs nine tenths of all cases of carcinoma occur in the face, which is especially exposed to the rays of the sun, and in the women carcinoma is more frequent in the vagina than in the uterus. Carcinoma of the gastro-intestinal tract is relatively rare. Also among the inhabitants of East India and Ceylon and among the Chinese we find a lower cancer rate than in Europe. In Japan however cancer seems to be relatively frequent as far as the available statistics indicate. ”

“ As one of the four major forms of advanced schistosomiasis, schistosomiasis dwarfism was quite common in endemic areas in China in the 1950s and 1960s. Nowadays, it is very rarely seen. These individuals acquire infection, usually repeated and heavy, during childhood. Their physical growth and sexual development is retarded. Lack of growth acceleration during puberty, a short stature with an older facies, a lack of secondary sexual characteristics, and underdeveloped sexual organs are common characteristics. ”

“ In a retrospective review in 1984 on mortality due to all malignancies in seven S. japonicum endemic counties in the Jiangsu Province, it was shown that the prevalence rate of schistosomiasis and the mortality rate due to colorectal cancer increased in parallel [62] , and persons with schistosomiasis had a significantly higher mortality rate due to colorectal cancer than those without [63] . ”

“ Although the cancer cells constantly attack the walls of the adjacent veins and spread into their interior at a comparatively early period, secondary growths due to dissemination by the blood-stream rarely show themselves clinically until late in the course of the disease. It is probable that many of the cancer cells which are carried away in the blood or lymph stream undergo necrosis and fail to give rise to secondary growths. Secondary growths present a faithful reproduction of the structure of the primary tumour. ”

“ Gummy tumor of bone develops either under the periostum, in the substance of bone, or in the medullary canal. It is simply an intensification of the process found in the inflammatory form just described, the difference being that the cell hyperplasia is more abundant. Much of the new material collects in a circumscribed space, and being more rapidly formed and less capable of organization, it entails more profound lesions by its retrograde metamorphosis. Generally tumor of the bone is, therefore, a much more serious form of disease than osteo-periostitis. ”

“ In addition, further studies on the pathogenesis of post-transmission schistosomiasis are necessary.
Morbidity in mammals
One outstanding presentation is that different from other Schistosoma species, many mammals can act as reservoir hosts of S. japonicum, which increases the complicity of the epidemiology and control of the disease both to humans and animal husbandry. Up until now, apart from humans, a total of 42 species in 28 genera under seven orders of mammals have been found to naturally harbor the S. japonicum infection in China [22] , [86] , [87] . ”

“ Chronic schistosomiasis
S. japonicum infected subjects may be symptomless. People in endemic areas with comparatively smaller chances of contact with infested water, and those with the infection and incomplete treatment, may enter the chronic phase. Most subjects with the infection in the endemic areas are chronic cases. Some are symptomless and some are slightly symptomatic, and the impact to their working ability is usually not significant. If not treated in time, the disease may become advanced causing higher morbidity, but some patients may be latent all their life. ”

“ Schistosomiasis in China is mainly caused by the infection of Schistosoma japonicum. Schistosomiasis japonica has a long history for more than 2100 years evidenced by the finding of the eggs in the liver of an ancient corpse. The first clinical case was discovered in 1905 confirmed by typical S. japonicum eggs found in a patient’s stool. The disease caused millions of death in the last century. Both the morbidity and mortality were considerably high. Scientific records on the morbidity of the disease were few before the founding of the People’s Republic of China in 1949. ”

“ In those projecting from the surface of a bone, both the tumour and its capsule should be removed. If in the interior, a sufficient amount of the cortex should be removed to allow of the tumour being scraped out, and care must be taken that no nodules of cartilage are left behind. In multiple chondromas of the hand, when the fingers are crippled and useless, exposure to the X-rays should be given a trial, and in extreme cases the question of amputation may have to be considered. When a cartilaginous tumour takes on active growth, it must be treated as malignant. ”

“ It is true that the simple tumours often remain stationary after attaining a certain size, but the general tendency of ali tumours is towards persistent and unlimited growth, and the cancer cell continues its career unchecked by everything save death.
The spontaneous tumours are seen in every tissue and organ of the body, though in some they are relatively infrequent. Nor are they confined to man, for they have been found throughout the vertebrate kingdom. It is often stated that a higher state of civilization has inflicted on European races a greater susceptibility to tumour formation. ”

“ Besides the sarcomata we find in young children frequently so-called mixed tumors, consisting of several kinds of tissue; in the kidney tumors for instance we may find side by side proliferating epithelial gland tissue, round cells resembling sarcoma, muscle and even bonelike tissue. In other organs also we find not rarely such mixed tumors to prevail among the cancers in children. Cancer of the female generative organs occurs in children not mainly in the uterus, as is the case in adults, but in the ovaries and in the vagina. ”

“ The tumour is firm and elastic in consistence, but certain portions may be densely hard from calcification or ossification, while other portions may be soft and fluctuating as a result of myxomatous degeneration and liquefaction. These tumours grow slowly and painlessly, and may surround nerves and arteries without injuring them. They may cause a deep hollow in the bone from which they originate. All intermediate forms between the innocent chondroma and the malignant chondro-sarcoma are met with. ”

“ In attempting to arrive at a conclusion as to the innocence or malignancy of any tumour, too much reliance must not be placed on its histological features; its situation, rate of growth, and other clinical features must also be taken into consideration. It cannot be too emphatically stated that there is no hard-and-fast line between innocent and malignant growths; there is an indefinite transition from one to the other. The possibility of the transformation of a benign into a malignant tumour must be admitted. ”

“ Once the skin is broken the tumour fungates through the opening. Sarcomas vary in malignancy, especially as regards rapidity of growth and capacity for dissemination. Certain of them, such as the so-called "recurrent fibroid of Paget," grow comparatively slowly, and are only malignant in the sense that they tend to recur locally after removal; others--especially the more cellular ones--grow with extreme rapidity, and are early disseminated throughout the body, resembling in these respects the most malignant forms of cancer. ”

“ A third type of tumor, the semi-malignant, is intermediate between the first two, and includes some forms of sarcomic and of melanotic tumor, the painful subcutaneous tumor or tubercle, nævi, polypi, etc. Melanosis is commoner in horses than in the human subject, and chiefly in white or gray horses. Various tumors are inter-thoracic, affecting the heart, the lungs, etc. There are also tumors of the brain, of the liver, the rectum, etc.; and in women the uterus and the vagina are specially liable to be affected with tumor. ”

“ The situation of a malignant tumour exercises considerable influence on the rapidity, as well as on the mode, in which it causes death. Some cancers, such as that known as "rodent," show malignant features which are entirely local, while others, such as melanotic cancer, exhibit a malignancy characterised by rapid generalisation of growths throughout the body. Tumours that are structurally alike may show variations in malignancy, according to their situation and to the age of the patient, as well as to other factors which are as yet unknown. ”

“ Small particles of tumors enter the blood vessels or lymph streams and are carried to distant parts of the body, where they lodge and start new tumor formations. Expansion by colonization in this manner is a rule with many tumors, and, since they exercise no function of use to the organism, this dissemination of actively growing particles becomes a menace to the system by numerically increasing the body's burden, opening new channels of drain upon the system and adding new centers for the absorption of putrefactive materials when the secondary tumors shall have degenerated. ”

“ MYCETOMA, OR MADURA FOOT.--Mycetoma is a chronic disease due to an organism resembling that of actinomycosis, but not identical with it. It is endemic in certain tropical countries, and is most frequently met with in India. Infection takes place through an abrasion of the skin, and the disease usually occurs on the feet of adult males who work barefooted in the fields. ”

“ Often, however, the whole muscular coat beneath the tumor is replaced by the cancerous growth, and can no longer be recognized. The serous and subserous connective tissue, like the submucous coat, offers a favorable soil for the growth of the tumor, which here appears usually in the form of large and small nodules projecting from the peritoneum. Adhesions now form between the stomach and surrounding parts, and opportunity is offered for the continuous growth of the cancer into these parts. ”

“ It is generally believed that the secondary growths in cancer that develop at a distance from the primary tumour, those, for example, in the medullary canal of the femur or in the diploe of the skull occurring in advanced cases of cancer of the breast, are the result of dissemination of cancer cells by way of the blood-stream and are to be regarded as emboli. ”

“ A tumor may be of any size: so small as to be invisible to the naked eye, or its weight may exceed that of the individual who bears it. The limitations to its growth are extrinsic and not intrinsic. There is no distinct color. Certain tumors have color which depends upon the presence of a dark brown or black pigment within the cells. Hæmorrhages within them are not infrequent, and they may be colored by the blood or by pigments formed from it. Usually they have a gray color modified by their varying vascularity, or the cut surface may be mottled due to areas of cell degeneration. ”

“ The tumours resemble the solitary trunk-neuroma, are usually quite insensitive, and many of them are unknown to the patient. As a result of injury or other exciting cause, however, one or other tumour may increase in size and become extremely sensitive; the pain is then agonising; it is increased by handling, and interferes with sleep. In these conditions, a malignant transformation of the fibroma into sarcoma is to be suspected. Motor disturbances are exceptional, unless in the case of tumours within the vertebral canal, which press on the spinal medulla and cause paraplegia. ”

“ The diagnosis is to be made by the slow growth of the tumour, its hardness, and by the shadow which it presents with the X-rays (Fig. 138) .
An osteoma which does not cause symptoms may be left alone, as it ceases to grow when the skeleton is mature and has no tendency to change its benign character. If causing symptoms, it is removed by dividing the neck or base of the tumour with a chisel, care being taken to remove the whole of the overlying cartilage. The dense varieties met with in the bones of the skull present greater difficulties ”

“ Neither of the tonsils is inflamed nor hypertrophied; a few cervical lymphatics on the left side are slightly indurated, but slightly sensitive—if at all.
The swelling had probably existed longer than an abscess would be in forming, and there was neither pain nor fluctuation. Still an exploratory incision was made, but with the expected negative results.
Although the tumor was situated over the principal chain in lymphatics of the pharynx, it was not nodular, but smooth. Therefore the neoplasm was probably not of lymphatic origin, but an implication of the muscular tissue behind the pharynx. ”