A Further Consideration O F Ewing’s Sarcoma

Since Ewing’s first report of a previously unrecognized tumor of bone derived from endothelial elements (1)’ there have been numerous reports of tumors which have conformed with his endothelial myeloma, and others which have sought to deny the existence of such a tumor. Among these was an article by the present writer (2) agreeing almost entirely with Ewing’s conclusions. Kolodny (3) believed that this tumor should be put into a different group from the purely endothelial or angio-endothelial tumors. Geschickter and Copeland (4)’ in 1930, suggested that Ewing’s tumor might arise from the vessels of the haversian system, but in their book (5 ) ’ published the following year, classified it as a primary lymphosarcoma. Hirsch and Ryerson (6) have taken particular exception to the contention that the Ewing sarcoma may be a specific type of tumor and have reported cases to support their opinion that most or perhaps all of these growths are metastatic from an internal or visceral source. More recently Colville and Willis (7) have reported tumors of the neuroblastoma type which gave rise to bone metastases simulating Ewing’s tumor of bone. These writers believe that many such tumors have been erroneously classified as endotheliomas. I am now certain that among the group of tumors reported by me in 1926 (2) as Ewing’s tumor, there were a number which were undoubtedly cases of multiple myeloma or lymphosarcomatosis with metastases to bones. The usual and just criticism has been that autopsies were not performed on most of the recorded cases, and that without a complete examination post mortem, a primary visceral tumor could not be excluded. Since my earlier report I have had the opportunity of performing autopsies upon several important cases which may clarify the subject somewhat.