The clinical findings, pathologic characteristics, and end results of 26 primary sarcomas and carcinosarcomas of uterine cervix, excluding malignant lymphomas, embryonal rhabdomyosarcomas of infancy and childhood, and four sarcomas that could not be definitely classified as to cell type, are presented. Eight neoplasms occurring in patients 31 to 61 years of age were leiomyosarcomas. Six of these patients died with massive pelvic recurrences and/or distant metastases irrespective of type of treatment within 2 years. Two patients are alive and free of disease 6 and 10 years after surgical excisions. Six patients whose age averaged 61 years had carcinosarcomas, and all succumbed to recurrent and metastatic disease within 15 months of diagnosis. In three patients, the sarcomatous component was homologous and in the other three heterologous. One neoplasm had, in addition to adenocarcinoma and squamous carcinoma, areas of adenocystic carcinoma. Twelve endocervical stromal sarcomas in patients averaging 54 years of age comprised the largest group in the series. The better differentiated neoplasms tended to remain localized and to have a better prognosis than the more poorly differentiated lesions which pursued aggressive courses. Four patients are alive and free of disease 2, 3, 11, and 18 years after surgical excisions and a fifth died of other causes after 16 years. Six patients died of recurrent and metastatic disease 2 to 24 months after diagnosis. At the present time, surgical removal of uterus and, when indicated, contiguous tissues and viscera offers the best hope of cure for cervical sarcomas and carcinosarcomas.

Fifteen cases of vulvar sarcomas were studied. The most common neoplasm was leiomyosarcoma, which also had the least favorable prognosis with a tendency to develop local recurrences and disseminated hematogenous metastases. The second most frequent sarcoma belonged to the fibrous histiocytoma group. Although they are unpredictable, they tended to be less aggressive than the leiomysarcomas. Other sarcomas encountered were tibrosarcoma, hemangiosarcoma, malignant hemangiopericytoma, epithelioid sarcoma, neurogenous sarcoma, malignant mesothelioma, and embryonal stromal sarcoma. Local recurrences were common in the series due in part to inadequate initial treatment. It was evident from the study that wide local excision or radical vulvectomy early in the disease with bilateral lymph node resection for those sarcomas that have a potential for lymphogenous metastases is the treatment of choice and gives the most favorable results. In the presence of local recurrences, aggressive surgical treatment is indicated and increases the survival rate significantly.

Forty-six thymomas, defmed as neoplasms of thymic epithelium, were assessed in respect to histologic type, clinical manifestations and e n d results. Twentythree were lymphoepithelial, 12 epithelial, and 11 spindled cell tumors. The sex distribution for all thymomas was approximately equal for males and females but the lymphoepithelial tumors were more common in females and the epithelial tumors more common in males. There was n o distribution difference in sex for the spindled cell thymomas which occurred much later in life than the other types. Twenty-five percent of patients were asymptomatic, the tumors being discovered on roentgenograms done on a routine basis or for an unrelated purpose. The most common presenting symptoms were related to myasthenia gravis, and symptoms due to pressure on mediastinal structures were next in frequency. Other endocrine abnormalities were present in 20% of patients. Two male patients also,had carcinomas of the thyroid gland. Twenty thymomas were infiltrative tumors having invaded the adjacent mediastinum. There were no examples of extrathoracic spread. Twelve of 16 patients with myasthenia gravis had lymphoepithelial thymomas and four epithelial thymomas. There were no cases of myasthenia gravis in patients with spindled cell thymomas. The crude five-year survival rate was 65%. Only 17% of patients died as a result of recurrent and infiltrative thymomas; the other 18% of patients died from a variety of causes not directly related to the thymomas. The epitheIia1 type of thymoma tended to be more extensive and to pursue a more aggressive course but histologic classification was of little value in predicting final outcome. Poor prognosis is more closely associated with tumors having an infiltrative character. Classification is of importance, however, in alerting the clinician to certain associated diseases.

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