M aging of a11 the malignant tumors to treat. From that standpoint, the following case may be of interest. So far I have not been able to find a similar case in the English literature. R. R., a 30-year-old white woman, was first seen on February 14, 1949, for a tumor of the right breast. She had had a painless lump in the right breast for one year but in the past five months the tumor seemed to have increased rapidly in size and had become slightly painful. For three years, she had had a painless mass in the left inguinal region. About five or six months ago she had also noticed a mass in the left arm near the shoulder and, in the past three to four months, several small tumors in the abdominal wall and back. The patient stated that she had had a ringworm infection of the left shoulder, which had been successfully treated by a local physician. The medication used was not known.
The patient's last menstrual period was in September, 1948, and she thought she was about five and a half months' pregnant. She had had three previous pregnancies without complications. There was no past history of any serious illness or operations.
The physicaI examination at that time revealed a well-developed, well-nourished, white woman, not acutely ill. Only the pertinent findings will be noted. Both breasts were of average size and showed the venous engorgement of pregnancy. In the upper and outer quadrant of the right breast was a firm, slightly tender, freely movable mass, the borders of which were irregular. The mass felt somewhat cystic and measured 6x6 cm. It was not fixed to the skin or underlying tissue. No enlarged lymph nodes were felt in either axilla or supraclavicular region. The left breast appeared essentially normal for a pregnancy of five months.
The abdomen was distended and the uterus could be palpated 4 cm. above the umbilicus. Fetal heart tones were heard. In the abdominal wall there were three masses similar to that felt in the breast: one in the mid-line above the umbilicus, one over a Iower costal cartilage on the left, and a third in the left lower Jacksonville, Florida.