Round - Cell , Spindle - Cell , and Neurogenic Sarcomas O F the Lip

Sarcomas, or tumors derived from the connective-tissue elements, are rare among the malignancies of the lip. The only available statistics as to sarcoma of the lip are from the Gottingen Pathological Institute, where 2 cases were found among 1,248 sarcoma cases (0.16 per cent). No mention was made as to whether the lesions were on the vermilion border, and the type of sarcoma is not specified. Gurlt found two cases of lip sarcoma, one on the upper lip and one on the lower lip, among 848 sarcoma cases (0.24 per cent). I n the Stuyvesant Square Hospital 4 cases, all involving the vermilion border, were found among 111 sarcoma cases (3.5 per cent), and among 898 affections of the lip, of which 429 were malignant. One of these involved the upper lip and three the lower lip. Two of these cases were mentioned in an article by Dr. Robert H. Kennedy in a report on epithelioma of the lip (Ann. Surg. 91 : 81,1934). In the available literature we have found 20 cases described, quoted, or mentioned. Unfortunately in all but 5 of these the records are incomplete, either from a clinical or pathological point of view. Two of the 20 cases involved the upper lip ; the others all developed on the lower lip. The patients were of all ages, but most of them were advanced in years. One case of spindle-cell sarcoma of the lower lip was described in a child of a year and a half, while 3 patients were over seventy. Women predominated in the reported cases, but in our series there were 3 men and only one woman. The duration of the disease before the patient came for treatment varied from a few weeks to a few months. Many of the tumors arose spontaneously, but there was a history of injury (chemical) in one case. Sarcoma of the lip appears as a new growth, varying in size from a few millimeters to several centimeters in diameter, rarely involving the entire lip. I ts color is reddish blue or red. The surface is smooth, more or less lobulated, presenting very soon after its appearance an excoriation, bleeding easily. This becomes ulcerated and punched out in the center, with hard, indurated, infiltrated, ill-defined borders. The surrounding tissues are firm, and the lesion is not painful on palpation. In several cases hyperplasiu of regional lymph nodes was observed ; this was due probably to the ulceration, but node invasion by new growth has been described in a case of round-cell sarcoma and in one of spindle-cell sarcoma. In these two cases the regional lymph nodes