MYOBLASTOMA OF THE STRJATED MUSCLE
PAUL KLEMPERER, M.D.
(From the Division
of
Laboratories of The 1111. Siiwi Hospital, New Y o r b City)
Striated muscle does not often give rise to tumor. Neoplasms containing this tissue are chiefly observed within the kidneys and male
gonads. While the kidneys and testes do not normally contain striated
muscle fibers, embryonal muscular elements may become misplaced into
the anlagen of these organs because of their proximity to the myotome
during early evolution. The frequent association of rhabdomyomata
of the heart with developmental anomalies suggests that, in these tumors as well, an abnormal histogenetic development may play a r81e.
Neoplasms consisting of striated muscle fibers within voluntary
muscles are most unusual in human pathology. Abrikossoff was the
first to call attention to a type of neoplasm which occurs chiefly in immediate relation to striated musculature and which is composed of the
ancestral cells, the myoblasts. I n 1936 he reported five cases under the
term myoblastic myoma and in 1931 he added seven new cases. Since
his first publication many cases with an identical microscopic structure
have been recorded. All of those reporting such cases have agreed
with Abrikossoff that the neoplastic elements are derived from the
myoblasts. Only two cases have been reported in the English language, both under the title “Rhabdomyoma of the Tongue” (Keynes,
Dewey). It would seem, therefore, worth while to describe 6 cases of
this tumor observed within the past four years.
C A S 1~: J. F., a fifty-eight-year-old white male, was admitted, Jan. 10, 1930, to the
service of Dr. Edwin Beer, complaining of a mass in the left groin which had been present
for twenty years. I t was not painful and liacl undergone no noticeable alterations in
size during this period. The mnss wus felt to be about the size of a walnut, was attached to the skin, hut moved freely over the subcutaneous tissues. It was excised and
found to be a Arm, encapsulnted tumor the size of a pecan. It was not attached to a n y
of the important structures of the spermatic cord. The patient was discharged two days
after the operation. Eight months Intcr there was no evidence of recurrence.
Microscopically the capsule was foiiiitl to he composed of several concentric layers of
connective-tissue fibers. The tumor proper consists of nests and cords of large pleomorphia cells. The cells arc f o r the most part irregularly polygonal in shape, averaging
16 to 2 0 p in dinmeter. The nuclei are either round or angular, occasionally elongated,
and are situated either in the center o r at the periphery of the cells, measuring 4 to 7~
in diameter. They stain heavily and often contain a nucleolus. The cytoplasm is
coarsely granular and slightly basophilic. I n places there are ribbon-like structures, 15
to 26 in width, but of varying, often considerable length. The cytoplasm of these shows
the same coarse granules as are seen within the cells. Each “ribbon” has several nuclei
variously situated within the cytoplasm. The granules a r e either densely packed, flllirig
the entire cell body, or arc arranged in a looser manner, giving a lighter appearance to
the cells. Staining with Siitlan does not reveal the presence of any fat.? The granules
Rend before the Ncw Tork Putholagirnl Society, May 25, 1933.
The material in this and in the other cases was rcccivcd in formnlin, which ninde a stain
for glycogen unreliuble.
1
2
324
Fro. 1. CASE 1 : CEIAS A N D
FIG. 2.
CASE 1 :
CELLS A N D
RIBBON-LIKE SYNCYTIAL
NASSES
SURROUNDED
BY SLENDER
COLLAQEN FIBERS
( V A N GIESON STAIN)
RIBBONSSEPARATED
BY BUNDLES
OF LOOSECONNECTIVE
TISSUE
325
326
PAUL KLEMPERER
CELLSAND MULTINUCLEATED
BANDS(HEYAFro. 3. CASE 2: LAROEROUNDAND POLYQONAL
TOXY LIN -EOSIN)
Flu. 4.
CASE 2: CELLSAND BAXDSWITH GRANULARCYTOPLASY,
HIQH-POWER
VIEW
are irregularly arranged, but occasionally short parallel cross rows of granules, suggesting an abortive cross striation, are seen at the periphery of some of the ribbons. The
individual cytoplasmic units are surrouncled by slender connective-tissue fibers, which nre
in juxtaposition to the cell body (Fig. 1). In places loose connective-tissue bundles
break up the compact cellular texture (Fig. 2). Larger nests are delimited by wide connective-tissue septa which carry the larger blood vessels, while between the cells oiily
capillaries are found.
CASE2: R. S., a twenty-three-year-old colored female, wm admitted on July 6, 1931,
to the xervice of Dr. Edwin Bcer, complaining of a mass in the left lumbar region, of one
M Y O B W T O M A OF T H E STRIATED MUSCLE
FIG. 5 .
(‘ASE
327
3 : AHEA FHObI TriE s I y R N I I C O S A N’EAH Mrr(*orys
GLANDA, GHANIJLAR
CELLS AND
BANDS
year’s duration. I t was piinless and hat1 gradually increased to its present size. Physical examination revealed n superficial Inass, about the size of a large plum, within the
lateral abdominal wall, and another, about the size of a marble, in the suprapubic region.
Both tumors were found to be encapsulated anti were excised together with their capsules.
The patient made a n uneventful recovery and was referred to the dispensary f o r further
examination. She was Iiist seen on May 20, 1933, and was in perfect health.
328
PAUL KLEMPERER
On microscopic examination, the neoplasms were seen to be composed of nests of
large, round or polygonal cells, averaging 1G p in diameter, and ribbon-like syncytial
niasses of varying length contiiining several niwlei (Fig. 3). The latter are round,
measuring about 7 p in ilinnieter, nnd containing u niotleriitc aiiioiint of chromatin and
friquenlly a nucleolns. The cytoplasm is conrsely g r ~ n u l a ~and
, only rarely are larger,
liomogei~eoiisglolmles found. The gi-nnulrs generally crowd tlic cell body, but when they
nre arranged in a looser mnnner tlie cytoplasm appears lighter, as if honey-combed (Fig.
4). Sudan stain shows the absence of fat. The neoplasm is traversed by connectivetissue fibers which form coarse septa delimiting larger cell islands. Slender fibers surround the crllv and syncytial ribbons.
FlO.
?.
CASE
1: MYORLASTSBETWEEN
THE
STRIATED MUBCLE
FIBERS
OF
THE
TONGUE
CARE3: C. R., a white man of fifty, consulted 1)r. S. Kleinfeld on August 21, 1931,
romplaining of hoarseness of two years’ duration. On examination, a flat tumor, almost
1 cm. in diameter, was seen on the right vocal cord. It was removed in several pieces at
one time. The patient WHS re-examined in May 1933 and no evidence of neoplasm was
found.
The! microscopic examination of the fragments showed a neoplasm within the submucosa extending u p to the surface epithelium. The tumor is not sharply defined from
the surrounding loose connective tissue of the submueosa. It consists of polygonal cells
averaging 17 to 21 p in diameter and multinudeatecl ribbons averaging 14 p in breadth,
and of varying length (Fig. 5 ) . The nuclei are round, occasionally angular, average G
to 7 p in diameter, and contain a moderate amount of chromatin and frequent nucleoli.
The cytoplasm is coarsely granular and slightly basophilic. Generally the granules are
crowded, but here and there they are loosely arranged. The latter cells stand out because
of their lighter color and a r e suggestive of xanthoma cells. Sudan staining, howevcbr,
reveals no fat. The individual cells and bands are surrounded by slender connectivetissue fibers which cling to the cell. Broad septa of coarser collagen fibers delimit larger
and smaller islands of the neoplastic elements. These carry the larger blood vessels. A
fragment from the surface shows tumor cells to he directly beneath the superficial
stlunmous epithelial lining which tlicy compress. I n other a r e a epithelial pegs and
islnntls dip clceply into the iintlerlying stromn. Some of the nests show distinct penrl
MYOBLASTOMA OF THE BTRIATED MUSCLE
329
formation, but the squamous cells are regular throughout and show only sporadic mitoses
(Fig. 6).
CASE4: M. K., a white man of forty, was admitted, on March 11, 1933, to the serviee
of Dr. W.Harris, because of a pea-sized growth a t the left lateral border of the dorsum
of the tongue. This had been present for five or six months. The nodule was removed
with a wide rim of muscle tissue. Because of its white color, it contrasted with the surrounding musculature, but was not sharply delimited.
On microscopic section the neoplasm was seen to extend up to the superficial
squamous epitlicliuni and below to radiate between the musele fibers. The neoplastic
elements staid out from the surrounding muscle because of their lighter color and the
h’l0. 8.
CASE
6: LOW-POWER
PROIJFERATION,
FIELDOF SURFACE AND UNDERLYINO
TVMOUCELLS EXTENDINU
UP TO T H E
NEOPLASM;
SURFACE
EPITHELIAL
slightly bluish tint of thcb rytoplasm (Fig. 7). There are polygonal and round cells
averaging 23 to 2 6 8 in diameter. The nuclei are for tlie most part round, moderately
pyknotic, frequently contain nucleoli, atit1 arc situated in the center of the cells. The
cytoplasm contains ileiisely parked p-nnules, hut oecaoionully these show a looser arrangement. Stuining with Siitlan stuin does not reveal any fat droplets. Besides these
cells, the iieoplnsm also slio\vs spiicytiul ribhoiis averaging 14 p in width and of varying
length, with several nurl& The cytoplusmic striwture of these is identical with that of
the smaller units. The grrinulex are tlensely packed and arranged in disorderly fashion,
with no suggestion of row formutioil. Tlie cells and hancls are surrounded by fine eollagen fibers. The surfncae c.pithc4ium is vonsiclerubly thiekrned and shows parakeratosis
with rumifying rpitlieliiil pegs wliic4 extend derply into tlir underlying neoplasm. On
cross-section Iiortiification is oftcw seen, and the sqiiumous crlls show frequent mitoses
but no atypism.
330
PAUL KLEMPERER
Cam 6 : A. S., a male of forty-one years, was admitted to the Beth Israel Hospital *
on Nov. 27, 1931, because of a small tumor situated in the upper part of the thigh. The
mass had existed f o r many years, but of late it had hem increasing in size, and itching had
occurred in that region. The tumor wns excised with sufncient margin of normal skin
tissue.
The main portion of the tumor lay within the deep layers of the corium and war
sharply delimited from the subcutaneous f a t tissiie. It extended up to the epidermis,
where nests of tumor cells were found within the papillae (Fig. 8). The neoplasm is
formed by round or polygonal cells averaging 13 x 15 p in diameter; the round nuclei
with an average diameter of 5 to 7 p nre generally within the center of the cells. They
stain rather slightly with hematoxylin and frequently nucleoli are seen (Fig. 9). Tlie
cytoplasm is coarsely granular, occasionally containing homogeneous globules. Besides
the cells, elongated ribbon-like syncytial elements, 10 to 13 p wide and containing several
nuclei, are observed. The cells and bands form larger and smaller islands separated by
connective-tissue septa. Slender collagen Ahers snrround the individual neoplastic units.
&'Ill. 9.
CASE 5 : CELLS AND
BANDS\\'IT€% GEANULES AND HOMOQENEOLTS GLOBULES,
H ~ ~ H MA~NIFICATION
ER
UNDER
The epidermis overlying the tumor is thickened, and the epithclial pegs are distinctly
elongated.
C A ~ E6: A. L., a forty-two-year-old female, was admitted on J u n e 7, 1932, to the
service of Dr. It. Lewisohn because of a tumor of the right calf. This mass, about the
size of a chestnut, was flrst noticed by the patient twelve years ago. For seven years it
remained constant in size, and then began to &Towvery slowly. On admission, the mass
wns ahout 7.5 em. in diameter and was attached to the calf muscles. When the tumor
was exposed, i t seemed to lie within the belly of the calf muscles. The excised neoplasm was about the size of a n orange, nnd of a fleshy, pale brown appearance. Some
portions apppared to have a well deflnecl capsule, while in other parts no cnpsule was
visible. The patient mude a n uneventful recovery. She was last seen April 26, 1933,
and wan free of complaints.
The neoplasm appeared to be subdivided by thin connective-tissue septa (Fig. 10)
into round, o w l , and occasionally cylindrical nests of various sizes. These units consist
of round o r polygonal cells, 31 to 2 6 p in diameter, with moderately chromatic round
nuclei, B to 109 in diameter, containing n large nucleolus. The cytoplasm of the cclls is
3
I a111iiiclrbtccl to Dr. A. Pliiut fur pwitiission to inzluclo this rase.
MYOBLASTOMA OF THE STRIATED MUSCLE
FIQ.10. CASE 6 : NESTSOF ROUNDou POLYQONAL
CELLS
FIQ.11.
CASE
6:
CELLS AND
BANDS(AT
THE PERIPHERY)
filled with densely packed coarse granules. Occasionally the granules are more loosely
arranged, giving the cells a conspicuously lighter appearance. With Sudan stain no fat
is demonstrnble. Frequently tlie cells are strikingly large and contain several nuclei.
I n addition to siicli rouiicl or polygoiial c*ells, c.longatet1, prismatic cells and occasionally
ribbon-like syncytial masses arc encountered (Fig. 11). The nuclei arc frequently hyperchromatic, and only a n occasional mitotic figure is seen. Sections taken from the periphery do not show any iiivasion of the adjacent striated muscle.
(0
w
w
-be
30
Newborn
50
8 days
55
36
55
29
case 1
40
Dewey
42
Derman, G. L. and
Golbert, J. R.
Dawydow
case 4
case 3
Ceelen
case 1
case 2
Case 7
case 4
case 5
Case 6
A brikossoff (1926)
Adult
Case 1
case 2
30
Case 3
25
Case 4
Adult
Adult
case 5
Abrikoesoff (1931)
case 1
37
21
case 2
24
Case 3
Author
2months
Female
Female
Male
Male
Female
Male
l%yrs.
Female
1 year
1year
At birth
34years
At birth
10 years
Male
Female
Male
2months
1 year
Male
Male
Male
1 year
Short time
1 year
Slow
Fast
Duration
Male
Female
Male
Male
Male
Sex
Microscopy
Epithelial proliferation. Carcinoma superticiale incipiens
Typical
Typical
Typical. DesMitoses mentioned
cription of transition betw-een
myoblasta and
mature cross
striated fibers
Pesgized
1.5 cm. diameter
0.8 X 1.3 cm.
Tongue
Left side of
tongue
Congenital epulis
Bean-sized and shaped Typical picture
Typical picture
Atypical epithelial proliferation
Tumor cells with mitoses
Congenital epulis
Atypical epithelial proliferation
Atypical epithelial proliferation
(reaembles early stages of squamous-cell carcinoma)
Recurrence after 3 months
Remarks
Tongue
Maxillary alveolar process
Skin of pelvic
@on
Right maxillary
alveolar process
Right vocal cord
Pigeon’s egg
Hen’s egg
Left mandible
Typical picture
Typical picture
Typical
Typical
Typical giant
myoblasta
Giant myoblasta,
cells smaller
2 X 1.5 cm., round
Pea-Sized
Fist-sized
Breast (left)
Upper WPhagUs
Right mandible
Pea 0.75 cm.
Typical
Typical
Typical
0.3 X0.5 cm.
1.5 cm. diameter
1 cm. diameter
0.5 cm. diameter
Typical
Typical
Typical
0.8X0.5 cm., irregular Typical
6 x 10 cm., oblong
Typical
Size and Shape
of Strialed Mwcle
Tongue
Skin
Right vocal cord
Tongue
Calf
Tongue
LiP
Tongue
Localization
Repded Cases o j Myobhiama
w
W
W
38
case 2
Case 2
Case 3
Case 5
Meyer, R.
Case 1
case 3
csae 4
Case 2
69
23
Newborn
Female
Male
Female
Male
Jaulin and Grand42
Claude
Keynes, G.
26
Klinge, F.
case 1
Female
Male
19
Heurtaux, M.
59
Diss, A.
case 1
Male
Female
32
case 3
Sex
Male
.4ge
Golbert (mt.)
Case 2
30
Derman and
Author
3 weeks
At birth
Several months
Wmonths
2 years
1 year
Ihration
Left breast
Tongue
Inner maxilla
Tongue
Tongue
Tongue
Skin
Skin
Tongue
Tongue
Tongue
Tongue
Tongue
Tongue
Right vocal cord
Localization
Typical
Typical
Typical
Typical
Typical
Typical
Typical picture
lcidophile cells
resemble xanthoma cells
Acidophile cells
resemble xant homa cells
Pictures suggestive
T-ypical. Description of transition between
myoblasts and
mature cross
striated fibers.
Occasional transition of myoblasts in cross
striated fibers
Microscopy
Pedunculated, kidney Typical bands
shaped, 4 X 6 X 9 cm.
absent
Typpl
Nut
Typical
4 x 8 mm.
0.5 cm.
Pea-sized
Lentil-sized
S u e and Shape
Rspmba Caecs pf MyoMoslanur of Stdated Musdc (Continued)
[Table cont. on page ,7341
Living and well 1 year 8%
months
Well 6% months after operation
Well 3% months after operaation; possibly only regeneration
neoplasm
Syphilitic glossitis
Epithelial proliferation.
Granuloproteinic degeneration
of the muele fibers
Recurrence three years later
with typical structure
Sporadic mitoses. Hypertrophic
epithelium
Incomplete removal. Xo recurrence after 7 months. Atypical
epithelial proliferation. (Diagnosis: carcinoma supeficiale incipiens Iarpgis)
Remarks
P
E
Male
Male
Male
Sex
40
41
case 4
case 5
Case 6
Male
Male
Female
Male
Male
Female
6months
Many years
12 years
2 years
20years
1 year
A t birth
Somemonths
7w&
Duration
Plum-sized
Hazel nut
1 cm. diameter
12 X 12 X 10 mm.
Size and Shape
Tongue
Skin of thigh
Calf
Pea
Cherry stone
7% cm. diameter
Remarks
Marked epithelial proliferation.
Well after 1% years
Typical
Epithelial proliferation
Typical
Epithelial prolieration
Early myoblastic Well after 1 year
Well after 8 months
Well after 2 years
Myoblastic sar- Recurrence, local malignancy,
coma
hemorrhage, death
Typical
Diagnosed xanthoma
Combined with squamous-cell
carcinoma
Microscopy
Skin, left groin
Pecan
Typical
Skin of abdomen
Typical
and suprapubic
region
Right vocal cord About 1 cm. diameter Typical
Maxilla
Tongue
Tongue
Tongue
Localization
The following cases which were casually mentioned in the course of a discussion should be added to the above table. Fischer-Wasels: 2 skin t w o r e ;
Chon: several tongue tumors, one causing carcinoma; Peyron: 2 tongue tumors.
42
50
23
58
Newborn Female
Case 3
Volkmann, J.
Klemperer, P.
case 1
case 2
30
Moschcowitz, E.
Schirmer
36
57
Age
v. Meyenburg
Author
Reported Cases of hfyoblustoma of Striufed Muscle (Continued)
MYOBLASTOMA OF THE STRIATED MUSCLE
335
DISCUSSION
The microscopic examination in all six cases reported revealed a
uniform structure which corresponded in detail with the descriptions
and figures of Abrikossoff and other authors. The characteristic histologic feat iires are the polygonal cells and ribbon-like syncytial masses
with conspicuous granular cytoplasm. Cross or longitudinal striations
were not secn, although in one case there was a suggestion of a transverse arrangement of the granules a t the periphery of some of the
bands. Abrikossoff noted striations in only 2 of his 12 cases. Derman
and Qolbert and Diss showed drawings suggesting a transition of the
granular cclls into striated fibers. However, Scliirmer and hleyer correctly maintained that such findings were most likely due to erroneous
interpretation of the relation between neoplastic elcmeiits and pre-existing strintetl muscle fibers. Invasion of the musculature of the tongue
by neoplasm was present in Case 4. One frequently encountered
syncytial bands in vcrp close approximation to the striated muscle
fibers. Such pict urcs could have easily been misinterpreted as evidence of transition phases. More critical examination, however, always showed a strict separation of muscle fibers and tumor cells.
The identification of the characteristic tumor cells as the ancestral
cells of the striated muscle is strongly suggested by the granular cytoplasm a s wcll as by the presence of the ribbon-like syncytial masses.
These latter imitate the early embryonal evolutionary phase of the
muscle fibers (Oodlewski). This histogenetic interpretation was first
proposed by Abrikossoff and has been accepted by the majority of
authors. Only IXss believes that the tumor originates from striated
muscle fibers which first have undergone a granular degeneration and
then have acquired neoplastic qualities. Accordingly, he proposes the
term ‘‘rhabtlomyome granulo-cellulaire.”
The large granular cells of which thcse neoplasms are composed may
suggest the diagnosis of xanthoma. The differential diagnosis rests
upon the presence or absence of fat within the tumor cells. Absence of
fa t always rules out a diagnosis of xanthoma. That mistakes in diagnosis may occur is shown by the remark of Peyron, who, in discussing
the paper of Diss (1927), mentioned that he had erroneously diagnosed
two identical cases a8 xanthomata. E. hfoschcowitz presented a case
under the title Xantliclaenia of fAc Tongue, before the New York Pathological Society, but the figures appended to his report fully resemble a
typical myoblastoma. I t is suggested that this case should rather be
included in the group here discussed.
A review of the literature reveals that 37 cases have been fully reported to date (see Table). If one adds to these the cases of Benda,
Fischer-Wasels, Ghon and Peyron, which were casually mentioned in
the course of discussion, the case of E. hloschcowitz, one reported by
Heurteaux as early as 1881 under the title Tumczir de la langiie (degenerescennce granulo-proteiques des fibres viusculaires), and the six observations here recordcd, the total reaches at least 50 cases. With two
336
PAUL KLEMPERER
except ions, tliese have hccn asscmbled within a period of seven years.
This indicates that tliese iumors are probably not uncommon.
A review of the cases sliows that the myoblastic tumors arise most
frequently within tlic third aiid fonrth decade. However, they may
even occur a t birth, inasmuch as the so-called “congenital epulis of
the new-born” is histologically a myoblastoma ( Sternberg, Lauche,
Abrikossoff). The male sox is more frequcntly affected, 25 to 12 according to the records.
As regards localization, the distribution of the reported cases is as
follows: tongue 29, skin 7, maxilla (congenital epulis) 4, vocal cords 4,
mamma 2, muscles of the calf 2, mandible 2, lip and upper esophagus 1
case each. A predilection for the upper digestive and respiratory
tract is striking.
As regards thc question of malignancy, it is important to note that
the myoblastomata are generally innocent neoplasms, even though
composed of immature muscle cells. Only one case in the literature
reported a s a myoblastic sarcoma (Meyenburg) repeatedly recurred at
the original site and tcrmiiiated fatally after erosion of blood vessels.
This case showed atypism of the cells and numerous mitotic figures,
especially in the recurrences. Two other cases recurred, but apparently because of incomplete excision at the first operation. The
cases here reported have been followed for various periods from six
months to three years and all the patients were perfectly well when last
seen. I n three of this series the neoplasm had existed for two, twelve,
and twenty years respectively, which fact also points to their benign
nature.
An interesting feature of many myoblastomata of the tongue,
larynx, and skin is an active proliferation of the epithelium overlying
the tumor. This was ollserved in 3 of the cases reported here and is
recorded in the literature in 7 instances. In 4 of these cases this feature was so conspicuous that a diagnosis of early squamous-cell carcinoma was made (Abrikossoff, case 3, 1931; Schirmer ; Derman and
aolbert, case 2 ; Damydow). In 3 of these cases the lesion was localized
to the vocal cord.
Finally the question of the probable evolution of these tumors
should be touched upon. Abrikossoff regarded them originally as neoplasms due to faulty excessive regeneration. Klinge, who first observed this type of tumor within the skin, opposed this belief because
striated muscle does not occur within the skin and maintained a dysontogenetic origin of the myoblastic tumors. Abrikossoff accepted this
point of view, at least for the cutaneous types. He still insists, however, that the tumor formation may be the result of excessive regeneration subsequent to injury, wliicli would account for thc striking frequency of tongue tumors.
MYOBLASTOMA OF THE RTRIATED MUSCLE
337
SUMMARY
Six cases of myoblastomata of striated muscle are reported, and the
literature is reviewed. About 50 cases have been recorded since the
first description of this tumor seven years ago. This high figure in
such a comparatively short time indicates that myoblastomata of this
nature are not uncommon. The chief localization is in the upper digestive and respiratory tract. I n the differential diagnosis the xanthomata have chiefly t o be considered.
REFERENCES
ABRIKOSSOFF,A. J. : Uber Myome, ausgehend von der quergestreiften willkiirlichen Muskulature, Virchows Arch. f. path. Anat. 260: 215, 1926.
ABRIKOSSOFP,
A. J. : Weitere Untersuchungen iiber Myoblastenmyome, Virchows Arch. f.
path. Anat. 280: 723, 1931.
CEELEN,W. : Uber Myoblastengesehwiilste, Virchows Arch. f . path. Anat. 280: 741, 1931.
DAWYDOW,I. : Zur Frage der unausgereiften Rhabdomyome des Kehlkopfes, Ztschr. f.
Hals-, Nasen- u. Ohrenh. 30: 231, 1931.
DERYAN,(3. L., AND GOLRERT,Z. W.: Uber unreife, aus der quergestreiften Muskulatur
hervorgehende Myome, Virchows Arch. f. path. Anat. 282: 172, 1931.
DEWEY,K. W.: Rhabtlomyoma of the tongue, Arch. Path. 3: 645, 1927.
DIES, A. : Un nouveau type de tumeur musculaire ; le rhabdomyome granulo-cellulaire,
Bull. de 1’Assoc. frnny. p. 1’8tude du cancer 16: 863, 1927.
DIES, A.: Le rhabdomyome granulo-cellulaire de la langue, Ann. d’anat. path. 7 : 1071,
1930.
GODLEWSKI,E. : Die Entwicklung des Skelet- und Herzmuskelgewebes der Saugetiere,
Arch. f . mikrosk. Anat. 60 : 111,1902.
HEURTAUX,
M. : Tumeur cle la langue (DBgBnhscence granula-proteique des Abres musculaires), Bull. de la Roc. anat. cle Nnntes 4 : 98, 1881.
JAULIN
A N D QRANDCLAUDE:
Un ens cle rhabclomynme grnnulrux de la langue, Bull. de
I’ASSOC.
franc. p. I’Btutle clu cancer 18: 395, 1929.
KEYNES,
0.: Hhabdomyoma of the tongue, Brit. J. Surg. 13: 570, 1926.
KLINGE, F. : Uber die sogrnannten unreifen, nicht quergestreiften Myoblastenmyome,
Verhandl. (1. deutsch path. Qesellsch. 23 : 376, 1928.
v. MEYENBURG,
H.: in Henke and Lubarsch: Handbuch der spez. pnth. Anat. u. Histol.,
1929, vol. 9, pt. 1, p. 468.
MEYER,R. : lIyoblastentumnren (“ Myoblastenmyome ” Abrikossoff ), Vircliows Arch. f.
path. Anat. 287: 55, 1932.
ELI: Santhoma (Xanthelasma) of the tongue, Proc. N. Y. Path. SOC.22:
MOSCHCOWITZ,
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SCRIRMER,
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