(Reprinted from the “ Medical News ” of January 6, 1883.) 
A CASE OF SARCOMATOUS “ INFLAMMATORY 
FUNGOID NEOPLASM.” 
BY LOUIS A. DUHRING, M. D. 
Professor of Skin Diseases in the University of Pennsylvania. 
The following case of this rare and grave disease 
presented itself at my clinic for diseases of the skin at the 
University Hospital, on November 14, 1882. The patient 
was exhibited to the class and the prominent features of 
the affection pointed out in the course of the lecture. The 
disease is of such rarity and interest as to entitle the case 
to a place on record, and I shall therefore, without further 
preface, briefly describe the most important symptoms. 
The history (for which I am indebted to Dr. Van Harlingen) 
states that the man, Charles Coyne by name, is a laborer, 
fifty-two years of age, and a native of Ireland. He enjoyed 
good health until he was thirty years old, when he was 
attacked with eczema of the hands, which gradually in- 
vaded the feet and other regions until in a short time al- 
most the whole surface became involved. The eczema was 
always dry and slightly scaly, and itched severely. 
About eight years ago the disease under consideration 
made its appearance in the form of a pea-sized tubercle 
situated over the left eyebrow. It was at first the same 
color as the surrounding normal skin, but afterwards 
became pale-red, and later somewhat purplish in shade. 
It, as well as all subsequent lesions, from the beginning, 
itched violently. It grew gradually, so that by the end of 
a year it was as large as a hazel-nut, and has since increased 
to its present size. About a. year after the appearance of 
the tubercle referred to, a similar growth came upon the 
right eyebrow, which has followed the same course. Later, 
like formations, symmetrically disposed, manifested them- selves behind the ears and the jaws, and several years after- 
wards they also made their appearance on the chest, and 
later on other parts of the trunk. On the chest there first 
appeared a highly inflammatory papular eruption, “ re- 
sembling prickly heat,” which after vanishing was suc- 
ceeded by the present papular, tubercular and nodular 
formations. Latterly, a few of the older lesions have 
softened and ulcerated superficially, but this tendency is as 
yet not marked. The hemorrhagic symptoms, seen on some 
of the patches of the trunk and in places on the extremities, 
have existed only during the past six months. The general 
health has been gradually failing, and he has lost weight 
during the last year. He is now in poor health; is spare 
and somewhat emaciated, and is weak. 
Occupying the eyebrows and forehead are two perfectly 
symmetrical, circumscribed, irregularly shaped, lobulated 
tumors the size of common hen’s eggs. They are soft, 
Heshy, and have a fungoid look, and are of a dusky, dull, 
pale-red or violaceous color, and have slightly excoriated 
and scaly, rough surfaces, the result of scratching. They 
are irregularly ovoidal in shape, and project about an inch 
beyond the forehead, giving a heavy expression to the 
face. Upon the surface of either growth there exist several 
furrows or linear depressions. The color is a dull-red with 
a purplish tint,;—a pale raspberry-red. 
Immediately above the tumor on the left side there is a 
Hat, almond-sized and shaped, pale-pinkish formation, which 
when taken between the fingers is found to be defined in 
outline and firm in consistence. It is seated in the skin 
and sub cutaneous connective tissue. It illustrates the 
earliest stage of the tumors. 
On either side of the head, occupying symmetrically the 
region in front of and behind the auricles, there exist 
extensive, highly developed masses of firm infiltration, 
having the same general character as the tumors of the 
eyebrows. The disease here extends from the temporal 
region down to the angles of the lower jaw, and is so pro- 
nounced as to cause considerable deformity. Behind the 
auricles it extends into the scalp as far as the parietal 
region, and thence on either side to the occipital protuber- 
ance. The posterior aspect of the neck is also similarly in- 
vaded. The whole mass is considerably raised and is 
irregularly furrowed, tuberculated, and nodulated, though not to the extent of the prominent tumors, such as those 
on the face. 
In addition to the lesions described, there exist numerous, 
variously sized, rounded or flat, raised patches of infiltra- 
tion, of a reddish-purple or brownish-red shade, scattered 
over the trunk, the most conspicious of which are seated 
on the chest. These are five in number, two occupying the 
region of the nipples, and the others the sternum. They 
are large and prominent, varying in size from a walnut to 
an egg, and have a firm, fleshy feel, and a distinctly fungoid 
appearance., Upon various regions of the trunk, small and 
large, ill-defined patches of an inflammatory papular erup- 
tion (resembling disseminate papular eczema) exist, the 
seat of violent itching. More or less of this eruption is 
found over the whole surface, and appears to be eczematous 
in character, although peculiar in type. The general color 
of the skin of the trunk is a dusky-red, mottled, and in 
places violaceous or even bluish (hemorrhagic) in tint. 
Upon the arms and forearms are likewise patches of 
tubercular infiltration, and also of the inflammatory papular 
manifestation, some of them being distinctly hemorrhagic. 
Upon the thighs and legs there are no large tumors or 
nodular formations, but here and there are patches of diffuse 
and papular infiltration, all of which are markedly hemor- 
rhagic, so much so as to give the picture of purpura. Upon 
the hard palate, involving the uvula, is an elongate, circum- 
scribed, raised, plate-like patch of infiltration, about half an 
inch in diameter. The voice is in consequence thick. The 
cutaneous lesions are all accompanied by intense itching, 
which is almost constant. The scratch-marks, everywhere 
visible, attest this statement, and it is chiefly for this symptom 
that the man now seeks medical advice. 
The case represents the same disease that I brought before 
the American Dermatological Association four years ago, a 
full report of which case, together with the remarks made 
by the writer, and by members of the Association, may be 
found in the Archives of Dermatology, January, 1879, and 
January, 1880, with the provisional title of “ inflammatory 
fungoid neoplasm.” The inflammatory nature of the pro- 
cess was more marked in the first case than in the present 
one, although some of the lesions cannot be interpreted 
otherwite than as highly inflammatory. We shall find, 
however, without doubt, in the fully developed tumors the same formation as existed in the first case, viz.: a dense, 
small, round-cell infiltration involving the cutaneous and 
sub cutaneous tissues, possessing the general features of 
sarcoma. The disease is liable to be confounded clinically 
with syphilis and with cancer, although the microscope 
would at once differentiate it from the latter disease. The 
prognosis is grave, for altgough the progress of the disease 
up to the present time has been slow, it will surely be more 
rapid within the next few years, and will prove fatal. 
On the subject of treatment, I have but little to say. The 
various anti-pruritic remedies tbat are found useful in 
papular eczema, such, for example, as thymol, carbolic acid, 
and the tarry preparations, will in a measure relieve and 
control the itching. The larger growths that occasion in- 
convenience may be removed with the knife, or, where 
possible, by the galvano-cautery wire, a much better method 
of operation. The tumors are vascular, and by means of 
the galvano-cautery the annoyance from hemorrhage is 
lessened. The wound will probably heal without difficulty, 
and a recurrence of the growth at the point of the incision 
need not be feared, this opinion being based on my 
experience in the other case referred to.