SARCOMA OF THE SPERMATIC CORI), 
WITH 
HERNIA OF THE VERMIFORM APPENDIX. 
By GEORGE W. MASON, M.D., 
OF BLOOMINGTON, ILLINOIS. 
b KUM 
THE MEDICAL NEWS, 
May 19, 1883. DORNAN, PRINTER, SARCOMA OF THE SPERMATIC CORD, 
WITH HERNIA OF THE VERMI- 
FORM APPENDIX. 
The following case is reported because of the 
rarity of hernia of the vermiform appendix, and the 
still greater rarity of the complication of that con- 
dition with a sarcoma arising from the spermatic 
cord and surrounding the hernia. 
P. B., colored; laborer; set. about forty years, 
and unmarried. Says his health has always been 
good, except the present trouble. His family his- 
tory, so far as is known, is good; there being no 
evidence of the existence of cancer, tumor, or any 
hereditary disease in the family. 
While in the army he had a direct inguinal her- 
nia, which was reduced, and for which he subse- 
quently wore a truss. At times, since then, he has 
had a hernial protrusion which he has always re- 
duced himself. 
The first symptoms of the present trouble ap- 
peared about two years ago, when he felt a soreness 
in the right groin. Later there occurred an aching 
pain in the right testicle. He ascribed these symp- 
toms to partial descent of the hernia at times, and 
to the pressure of a poorly fitting truss of his own 4 
manufacture. In December, 1881, he first ob- 
served a tumor growing at the place where the sper- 
matic cord emerges from the inguinal canal at the 
external abdominal ring. This was hard and at 
times quite tender. 
A short time previous to his coming under my 
observation, he had consulted several physicians, 
under the belief that his hernia had " come down " 
so that he could not reduce it. He said that every 
means, except the knife, was used to effect its re- 
duction. Forcible taxis was practised several hours, 
causing him great suffering. All efforts for its re- 
duction proving ineffectual, he received no further 
attendance for five or six days. 
On June i, 1882, I was called, and found a tumor 
of considerable size occupying the lower part of the 
right inguinal region, and extending along the 
spermatic cord to the testicle. The testicle was 
movable upon the lower end of the tumor, which 
was hard, heated, and tense, showing signs of inflam- 
mation. There was no impulse communicated to it 
by coughing, nor any change in its size on muscular 
exertion or change of position. It could not be 
forced into the external ring to any perceptible ex- 
tent. There was no gurgling, tympanitis, or fluctu- 
ation. The bowels had not moved for four days, 
but there was no vomiting. There was anorexia, 
and the tongue was furred and somewhat dry. The 
pulse was 100, and the temperature a little above 
normal. 
If the tumor contained intestine, I concluded that 
a constriction must exist at the neck of the sac. 5 
For diagnosis, I administered a cathartic. The 
next day the patient was feeling much better; his 
bowels had been moved freely without any un- 
pleasant symptoms in the tumor or elsewhere. The 
tumor was a little softer and showed signs of fluctua- 
tion. The treatment was an anodyne and flaxseed 
poultice to the tumor. 
June 5.-A free incision was made, from which 
about four ounces of pus were discharged, leaving 
a cup-shaped tumor. The treatment was quinine 
and the tincture of the chloride of iron, with an 
anodyne when necessary. The poultice was con- 
tinued. A discharge was kept up for about two 
weeks, at the end of which time there still remained 
an indurated tumor the size of a hen's egg. All 
further treatment failed to reduce it in size. Other- 
wise, the patient felt quite well. A suitable truss 
was adjusted in place of the one previously worn. 
September 9.-The tumor was hard, firm, and 
much enlarged; the skin over it was quite tense. 
The patient was suffering intensely and wanted it 
"cut out." An opiate and a poultice were pre- 
scribed. 
17th.-The tumor was very painful. The pulse 
and temperature were nearly normal. There was 
no evidence of inflammation. Upon consultation, 
and at the urgent request of the patient, it was de- 
cided that it should be removed at once. 
On the same day, assisted by my colleague Dr. 
Lee Smith, I operated as follows : 
The patient being etherized, an incision about 
three inches in length was made, commencing at 6 
about the point of exit of the spermatic cord from 
the external abdominal ring, and extending parallel 
to the cord down to the scrotum. The integument 
and fascia were carefully dissected from the tumor 
and testicle. At the hernial ring the convexity of 
a knuckle of intestine was seen presenting itself. 
This was readily pushed into the abdominal cavity. 
A round prolongation of the tumor extended through 
the hernial ring, which appeared like a pedicle, with 
some resemblance to intestine. It being firmly ad- 
herent to the mass, and there being no return 
portion to it, it was decided not to be intestine 
proper, but possibly the vermiform appendix. It 
was accordingly secured with a carbolized-silk liga- 
ture and divided, and the ligated end dropped into 
the abdominal cavity. A stout ligature was placed 
around the spermatic vessels and cord, and the 
growth severed high up, so as to include as much of 
the diseased structure as possible. A portion of the 
redundant scrotum was excised. 
The tumor, as removed, including the testicle, 
was four and one-half inches long by one and three- 
fourths inch thick. It was somewhat kidney-shaped. 
Along its posterior and external portion extended 
the spermatic vessels and cord. Anterior to the 
middle was the vermiform* appendix, about four 
inches of which were removed, and which extended 
to within an inch of the testicle. A small sac of 
pus was found anterior to and near the end of the 
vermiform appendix. Elsewhere it was adherent 
to the body of the tumor. Numerous bloodvessels 
existed throughout the growth. Microscopic examination showed it to be a fibro- 
sarcoma, the outer portions being fibrous. The 
7 
i. Body of tumor. 2. Vermiform appendix. 3. Sac containing pus. 
4. Testicle. 
inner portion of body of the tumor was made up of 
large spindle and stellate nucleated cells, contained 
in a homogeneous intercellular substance. Near 
the fibrous portion, this intercellular substance was 
in the form of fibrillae, separating the individual 
elongated spindle-cells. The accompanying dia- 
gram shows the relation of the parts of the tumor. 
The edges of the wound were united with carbo- 
lized-silk sutures and dressed with absorbent cotton, 
saturated with carbolized oil. The patient rallied 8 
without great shock, but considering his squalid 
abode and unhygienic surroundings, the prognosis 
was not good. Quinine was given freely, and the 
bowels were kept constipated for eight days with 
tincture of opium. At the end of that time they 
were moved by an enema. At no time after the 
operation was the pulse above 108, or the tempera- 
ture above ioi°. There was considerable suppura- 
tion around the ligature to the cord, which did not 
separate until the fourteenth day. 
October 6.-The patient was walking around 
the house and yard. Pulse and temperature were 
normal. The wound was suppurating a little, but 
nearly healed. 
At the present time the patient is free from pain, 
which was almost constant before the operation. 
The hernial opening has been completely closed 
by the cicatrization. There is some induration and 
enlargement in the groin, indicating that the growth 
will probably recur at that point. Otherwise he is 
in good health.