Malignant melanoma of the rectum

A housewife, aged fifty-three, was seen on September 28, 1942, because of bIeeding from the rectum, pain in the rectum and a Iarge protrusion from the anus. The patient stated that she had had these symptoms for three months, that these symptoms were aggravated upon defecation, and that her physician was giving her injection treatments for hemorrhoids. There was no famiIy history of maIignancy and her past history was of no importance. The patient was rather obese, 5 feet 4 inches in height and weighed I 70 pounds. PhysicaI examination reveaIed no abnormaIities. Recta1 examination reveaIed a poIyp 1% inches in Iength attached to an interno-external hemorrhoid on the Ieft side of the anus; this poIyp couId easily be brought out of the anus digitaIly. The patient was sent to the Cedars of Lebanon HospitaI, and the poIyp and hemorrhoid were excised under sacra1 bIock anesthesia. She made an uneventfu1 recovery and was discharged from the hospita1 on October 5, 1942. was made. (Figs. I and 2.) On October 22, rgq2, a smaI1 piece of tissue was removed from the heaIing wound for microscopic study; the pathoIogist reported granuIation tissue onIy. LocaIIy, the patient appeared cured. However, on November 14, 1942, she compIained of pain in the chest and was referred to an internist who found some duIIness and tenderness on pressure _ _ over the manubrium sternum, and also reported that “Auoroscopy of chest reveaIs no pathoIogy in Iungs or heart; radiograph of chest shows no abnormaIities.” This patient was not seen again. It was Iearned that on January 13, 1943, she was admitted to the Los AngeIes County Genera1 HospitaI, compIaining of generaIized pain, dyspnea and a productive cough of three months’ duration; also that she had noticed a Iump in the sternum for three months. Examination reveaIed a Iarge Iump over the manubrium sternum, the entire left lung fieId flat to percussion with decreased tactiIe fremitus and breath sounds, a paIpabIe irregular and tender Iiver two finger-breadths beIow the right costaI