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The Cytology of Soft Tissue Tumours Monographs in
Clinical Cytology 1st Edition M. Akerman Digital Instant
Download
Author(s): M. Akerman, Henryk A. Domanski,
ISBN(s): 3805575947
Edition: 1
File Details: PDF, 8.75 MB
Year: 2003
Language: english
 nog!!phs In <II til C)'lOI09LY _ _
Ed.lor: SJt Of II
Vol. 16

-fins kerman
Henryk A. Domansk"

o f
o
· .
The Cytology of Soft Tissue Tumours
Monographs in
Clinical Cytology
Vol.16

Series Edjtor

Svante R. Orell Kent Town

KARGER
The Cytology of
Soft Tissue Tumours

Mans Akerman, Patologisk/Cylologisk Klinik, Lund

Henryk A. Domanski Patologisk/Cytologisk Klinik, Lund

Including contribution by

Anders Rydholm, Ortopedi k Klinik. Lund

Brigitta Carlen Patologisk/ ytologisk Klink, Lund

78 figures, 78 in color, and 10 tables, 2003

Basel· Freiburg . Paris· London· ew York·

KAR.GER. Bangalore . Bangkok· ingapore· Toky . ydney

The Cytology of Soft Tissue Tumours

Dr. Mi1ns Akerman

Dr. I-Ienryk A. Domanski
PatologisklCytologisk Klinik
Universitetssj ukhuset
SE-221 85 Lund
Tel. +4646 17 35 10. Fax +4646 14 33 07
E·M ai I [email protected]; henryk.Domanski@l)at.lu.se

Library of Congress Cataloging-in-Publication Data

Akerman. Mdns.
The cytology of soft tissue tumours I MAns Akennan, Henryk A. Domanski; in
collaboration with Andcrs Rydholm, Brigina Carlen.
p.; cm. - (Monogrnphs in clinical cytology; vol. 16)
Includes bibliographical references and index.
ISDN 3-8055-7594-7
I. Solllissue tumors-Cytodiagnosis. 1. Domanski. Henryk A. II. Title. Ill. Series.
[DNLM: I. Cytological Techniques. 2. Soft Tissue Neoplasms. WD 375 A314c 2003]
RC280.S66A3472oo3
616.99'207582-dc21 2003054510

Bibli"l!rnphic Indkes. This publication i. liSle<! ill bib/i_ All rights resem:d. No pon ofthi. publicalion may be
"l!J'IIlhi<; "",,·icc•. incillding eum:llt COIItrols- and Index translated inlo other Jan¥uages. reproduced 01" ulilil.ed in
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employed drull.
 Contents

IX Preface
X Acknowledgements

Chapter 1
, Soft Tissue Tumours - Basic Information

Chapter 2
2 Fine Needle Aspiration of Soft Tissue Tumours
2 Surgical Biopsy, Core Needle Biopsy or Fine Needle Aspiration in the Primary Diagnosis
3 Diagnostic Accuracy of Fine Needle Aspimlion Biopsy
4 Pitfalls in the Fine Needle Aspiration of Soft Tissue Tumours
4 Complications of Fine Needle Aspiration of Soft Tissue Tumours
4 Fine Needle Aspiration Cytology Procedure
5 Classification of the Cytodiagnosis
6 The Final Evaluation of a Soft Tissue TurnOUT Aspirate
6 Ancillary Diagnostic Methods Supplementing the Cytodiagnosis

Chapt... 3

12 The Cytology of Benign, Pseudo malignant Reactive Changes in Fibrous

Tissue,Adipose Tissue and Striated Muscle in Fine Needle Aspiration Samples
12 Fibrous Tissue
13 Adipose Tissue
14 Striated Muscle

Chapter -4

17 The Cytological Features of Soft Tissue Tumours in Fine Needle

Aspiration Smears Classified According to Histotype
17 Adipocytic Tumours
17 Benign Adipotytic Tumours
27 Liposarcoma
J4 Fibrous Tumours
34 Benign Tumours
40 Malignant Tumours
41 Fibrous Tumours in Infancy and Childhood
41 Benign Tumours
42 Malignant Tumours
 45 Fibrohistiocytic Tumours
46 Benign Tumours
46 Malignant Tumours
49 Smooth Muscle Tumours
51 Benign Tumours
53 Malignant Tumours
56 Skeletal Mu cle Tumour
56 Benign Tumour
56 Malignant Tumours
61 Tumours of Peripheral erve
62 Benign Tumours
67 Malignant Tumours
68 Vascular Tumours
71 Malignant Tumours
71 Perivascular Tumour
74 Paraganglionic Tumours
75 alignant Tumour
75 Extragastrointestinal tromal Tumours
77 Primitive euroectodermal Tumours
83 Osseous Tumours

Chapter 5

85 Tumours of Uncertain or Unknown Origin

85 Benign and Borderline Tumours
90 Malignant Tumours

Chapter 6

103 Cytological Classification of Soft Tissue Tumours Based on the Principal Pattern
103 Pleomorphic Pattern
103 pindle ell Pattern
103 Myxoid Patt rn
103 mall Round/Ovoid ell Pattern
107 Epithelioid Cell Pattern

108 Summary and Conclusions

109 References

113 Index

VI Contents
 Preface

The cytological diagnosis of soft tissue tumours, ba ed core needle biopsy offer a number of advantages when used
on fine needle a pirate , ha been debated and at times dis- in the primary diagnosis of soft tis ue tumour .
couraged except in the diagnosi of lipoma. Soft ti ue The purpo e of thi book i to facilitate the cytological
tumours are relatively rare in spite of the fact that more than evaluation ofF A smear from soft ti sue tumours and ug-
100 benign ubtypes, over 50 variant of arcoma and a gest cytological criteria for a histotype diagnosis. The aim is
number of 'border-line' entities have been described. foremost to describe and illustrate the most common entities
lndi idual cytopathologi tare thu not likely to encounter and tho e rare tumour where cytological feature have been
many of the less common variants of oft tissue tumours described in case-reports and in small series.
during their training and may only occasionally needle them The diagnostic u e of ancillary methods is also discus ed
in their later practice. It ha been trongly recommended and illu trated.
that the primary morphological diagnosis of malignant soft The selection of entities which will be presented, their
tis ue tumours as well as other investigations and treatment diagno tic features and differential diagno tic considerations
hould be performed at multidisciplinary centre. Tn prac- are mainly based on the experience with F in the primary
tice, however, it is not possible to refer all patient with soft diagnosis of soft tissue tumours in patients referred to the
tis ue tumour to a musculo keletal tumour centre for pri- Musculoskeletal Tumour Centre, University Hospital, Lund,
mary work-up. Tumours are usually considered to be u pi- Sweden over a 25-year period. Case from the oft tissue
cious if they are large (>5 cm) or deep-seated (inter-or tumour registry of the Scandinavian Sarcoma Group (a mul-
intramuscular). Till implies that the management of the tidisciplinary association with members from all Nordic
majority of oft ti ue tumour i undertaken in general ho - countrie ) have al 0 been u ed. The illu tration have been
pitals. culled from cases in the file of the Department of Pathology
The use of pedal diagnostic methods has led to greater and Cytology Lund University Hospital, which now contains
accuracy in histopathological diagno i in this tumour group. smears from more than 3,000 soft tissue tumours needled
The u e of ancillary method is al 0, no doubt, nece sary in between 1972 and 2002.
many ca e when fine needle a piration ) and cytodi-
agno i i used in primary diagno i making surgical biopsy
unnece sary. A ha repeatedly been demonstrated in other Mans Akerman
tumour entitie , the u e of F A instead of urgical biop y or HelUykA. Domanski

Preface IX
 Acknowledgements

The authors thank Dr. vante Orell, Clinpath Laboratories I would like to thank Drs. Annika Dejmek and Karin
Adelaide, Australia for hi help. Svante Grell i the cientific Lindholm of the Department of Clinical Pathology and
editor for the erie Monograph in CLinical Cytology and hi Cytology ofth Uni er ity Ho pital MA of Malmo, weden,
comments and revision of the text have been invaluable. We for introducing me to the fantastic world of cytology and
thank Dr. Walter Ryd, Division of Cytology, Department Dr. Man Akerman of th Department of Pathology and
of Pathology ahlgren's Hospital, Gothenburg, weden for Cytology, University Hospital Lund, weden, my teacher and
letting u use illustrations of hi ca e of desmoplastic small friend, for sharing his broad experience in aspiration cytology.
round cell tumour and Dr. L nnart Mellblom, D partment of
Pathology and Cytology, Kalmar Hospital, Kalmar, Sweden Henryk A. Domanski
for contributing information regarding hi ca e of 0 sifying
fibromyxoid tumour. We also thank Prof. Frederik Mertens
Department of Clinical Genetic , Univer ity Hospital Lund,
for providing figure 6 and 7.

Man Akerman
HenrykA. Domanski

x Acknowledgement
 Chapter 1

Soft Tissue Tumours -

Basic Information

The incidence of soft tissue tumours is difficult to estimate, Ewing's sarcoma (ES)/primitive neuroectodermal tumour
especially the ratio of benign to malignant. Benign Ie ion are (P ET) family of tumour, rhabdomyo arcoma and pleo-
u ually estimated to be approximately 100 times more fre- morphic liposarcoma are all high-grade malignant, while
quent than sarcomas. Sarcomas are relatively rare, constituting well-differentiated liposarcoma, paucicellular myxoid
about I% of all malignant tumours. In Sweden, the annual liposarcoma, infantile fibrosarcoma and dermatofibro-
incidence of sarcomas of the locomotor system ha been esti- sarcoma protuberans are low grade. Provided that a A
mated to be 1.4/100000. Age-specific incidence rates clearly mear from a sarcoma i technically satisfactory and moder-
demonstrate that soft ti sue sarcoma of the locomotor sy tern ately cellular it i po sible to grade most sarcomas into low-
b com mor common with increa ing age; in on study their grade or high-grade cat gories.
incidence wa 8.0/100,000 for patient 80 year or older. The diagno tic workup of a oft ti ue tumour before ur-
Generally oft ti ue arcoma is more common in males gery include site, type diagnosis and location in relation to
but gender as well as age-related incidence depends on the the surrounding tissues, especially major nerves and ves els.
hi togenetic type. Magnetic re onance imaging i usually be t for thi evalua-
oft ti ue tumour are u ually cia ified hi tog n tically tion. For patient with arcoma lung radiograph and ome-
and within each group they are divided into benign Ie ion time computed tomography scan are obtained; it is
sarcomas and intermediate or borderlin tumours. impOltant to determine whether metastatic disease is present
In this atlas we u e the classification proposed by in order to plan management.
Kemp on et al. [I] and Weis and Goldblum [2], re pectively. In an attempt to predict outcome, to determine appropriate
Since knowledge of the hi totype of a sarcoma alone i not treatment and to make compari on between the results of dif-
alway ufficient to predict clinical cour e and choice ofther- ferent centre everal taging y tern have been proposed.
apy a number of grading systems, based on a variety of However, there is no general consen u a to which one to use.
parameters have been uggested and debated. The most fre- Two which are commonly used are the American AJCC/UICC
quent parameter u ed are cellularity, differentiation, cellular system (American Joint Committee/International Union
and nuclear pleomorphism mitotic rate, necrosis and vascu- Against Cancer) which is based on depth, grade and size, and
lar invasion. The number of grades varies; two, three and four the French F CLCC system (French Federation of Cancer
grade hav been propo d. How ver the hi totype in its If enter) ba d on the arne factors but with a more detailed
may indicate tumour grad . For example, the extraskeletal definition of malignancy grade.

Soft Tissue Tumours - Basic Information

 Chapter 2

Fine Needle Aspiration of

Soft Tissue Tumours

Surgical Biopsy, Core Needle Biopsy or Fine needling of oft tissue masses in children in whom a brief gen-
Needle Aspiration in the Primary Diagnosis ral ana thesia may be needed. An evaluation of the a pirate
within 10-15 min after needling i po ible with a rapid haema-
[n the majority of mu culo keletal tumour centres the toxylin-eosin (HE) or Diff-Quik tain. The adequacy of the
definitive diagnosis of soft ti ue tumours, especially u- material can thus be checked while the patient is waiting, and a
p ct d arcoma , is bas d on the histopathological evaluation prelinlinary diagnosi i sometimes po ible. The purpo e of a
of a biop y ample or a core needle biop y with an outer prelinlinary evaluation is 2-fold: it might give important infor-
diam ter of 1.2-1.4 mm. mation on the type of ancillary diagno tic that hould be u ed
Although A with needles having an outer diameter of and the urgeon can inform the patient and sugge t further
0.4-0.8 rom has been a uIDver ally accepted diagno tic investigations or treatment at hislher flrst visit. Since the diag-
method in the definitive diagnosis of various tumour entitie nosis and treatment of soft tis ue sarcoma should preferably be
for many year, objection have been rai ed to FNA in the centralized to multidi ciplinary tumour centres, it i important
primary diagno i of oft ti sue tumours. The main objection as regard referred pati nts that the nece sary information i
has been the postulated inability to a pirate tumour material obtained rapidly and the number of visits are a few a po si-
ufficient for reliable histotype diagnosis with a thin needle. ble. Experience from the Musculo keletal Tumour Centre at the
Due to the numerou subtypes and morphological hetero- niversity Hospital of Lund has hOWD that for patients
geneity among pecific entitie, oft ti u tumour have referred to th centr for tumours suspicious ofmalignancy one
been con idered to pose some ofthe greatest diagnostic chal- vi it was usually ufficient when the tumour proved to be
lenges in surgical pathology and routine light microscopy is benign at the combined evaluation of clinical examination,
often not ufficient for a diagno tic evaluation. Additional fNA diagno i and radiographic examination, if any [3].
diagnostic methods such as histochemistry, immunohisto- ore needle biop y i a1 0 an outpatient procedure, but
chemistry, electron micro copy (EM), D A ploidy analysi a preliminary diagnosis is less feasible than with FNA. F A
and chromo omal analy i and molecular genetic often have also permits sampling of different part of large tumour to
to be applied to reach a reliable diagno is. e aluate tumour heterogeneity, pro iding important informa-
However, article and book chapters on oft tissue tion in, for example, lipomatou tumour.
tumours as a target for FNA began to appear at the beginning A novel diagnostic approach recently tested at our centre is
of the 1980 . The first ca eerie pu bli hed were often mall a combination of fNA and core needle biopsy in selected
and the diagno tic workup was not critically inve tigated. patient referred for FNA. The FNA as well a the core needle
In spite of a negative attitude to FNA among surgeons, biopsy is perform d by the cytologist at the same visit. This
oncologists and pathologists, it has been shown that the same approach combines the advantages of both sampling methods:
advantage which have made F A a fir t-choice diagno tic ampling from different parts of large tumours, a rapid prelim-
approach in breast tumour, thyroid tumour, alivary gland inary report, the po ibility to evaluate the ti sue architecture in
tumour or malignant lymphomas are al 0 applicabl in the the core biop y (often difficult in an F mear) (fig. I a, b).
diagnostic workup of a oft ti sue tumour. In addition material sufficient for various ancillary methods
FNA of a suspected soft tissue tumour is an outpatient pro- such as irnmunohi tochemistry, EM and cytogenetic/molecular
cedure. 0 ane the ia i neces ary. One exception is the genetic analyses [4] i obtained with greater certainty.

2 Fine eedle Aspiration of

Soft Tissue Tumours
 a

Fig. 1. 10 combined evaluation of FNA

aspirates and core needle biopsy specimens
may be nece ary for a pecific type·diagno is
of a oft ti ue tumour. a F A mear of aJl
ela tofibroma. Two fragment of elastic fibres
are een in the partly myxoid background
(arrows). TIti material i not ufficient for a
confident diagnosis. MGG. Medium magnifi-
cation. b ore needle biopsy performed at the
same session. The serrated degenerate cia tic
fibre can be ea ily cen. Masson's trichrome. '"-- .........__ b
Medium magnification.

Diagnostic Accuracy of Fine Needle Aspiration but the case eries have been mall and the number of
Biopsy arcomas evaluated often few [5-8]. Only a few large erie
from multidi plinary centres have been publi hed. In a
Several reports of diagnostic accuracy (i.e. differentiation retrospective 20-year study of 517 tumour , 315 benign and
of benign vs. malignant proce s) have been publi hed. 202 arcoma cases of the extremities and trunk from the
Accuracy has been greater than 90% in most publications Mu culoskeletal Tumour Centre, Univer ity Ho pital of

Fine eedle Aspiration of 3

Soft Tissue Tumours
Lund, there were 28 false diagnoses (5%), 14 false-negative w Il-docum nt d diagno tic difficulti ,which hall b di-
and 14 fal e-po itive. In 29 case (6%) the material wa cussed in the following chapters. Besides misinterpretation
insufficient for diagnosis (24/315 benign tumours and 5/202 of the material there is yet another cause for a fal e diagno-
arcoma ). An inconclu ive diagno i (ullcertain whether sis. In the case of rare twnours or so-called 'new entities',
benign or malignant) was given in 13 tumours (3%) while cytological criteria which permit accurate evaluation may
a correct diagnosis of benign tumour ver u sarcoma wa not have been establi hed. Comparative histological-
given for 447/475 tumours (94%) [9]. In this material the cytological tudie of rea onably large erie are often lack-
cytological malignancy grade (low/high) was a ses ed ing. Examples of rare tumours and new entities, hitherto
in 127/202 arcoma and wa correct in 103 (81 %) and difficult to diagnose correctly as benign or malignant, a
inconclusive in 24 (19%) [9]. well a to type, are chondroid lipoma, perineurioma, aggre -
Tn another study from the Musculoskeletal Tumour entre ive angiomyxoma, olitary fibrou tumour of oft ti ue,
at the Karolin ka Ho pital, tockholm, compri ing 342 mixed tumour of soft tissue parachordoma and spindle cell
tumour, th figur for accuracy w re very imilar [10]. liposarcoma.

Pitfalls in the Fine Needle Aspiration of Soft Complications of Fine Needle Aspiration of
Tissue Tumours Soft Tissue Tumours

There are three important limitations to F A in the In our experience of F of more than 25 year in the
diagnosis of oft ti sue tumours [11-12]. primary diagnosis of soft tis ue tumours in patients referred
(I) The needle may miss the tumour and a false diagnosis to our Mu culo keletal TWTIour Centre we have ne er expe-
i made on the basi of cell aspirated from the tis ue rienced any severe complication. Patients have, at mo t,
urrounding it. Reactive cellular change in the adipo e tis- complained of tendem s and, in ca es of ubcutaneous
sue may mimick lipo arcoma and p eudomalignant reactive tumours, of haemorrhage. We have not seen a single case of
changes in fibroblasts and myofibroblasts may suggest infection and never experienced clinical signs of sarcoma
a pleomorphic arcoma. Thi diagnostic difficulty most often cell eeding in the needle track. It i to be remembered that
occur when mall, deep-seated, inter- or intramu cular F A i the lea t ti ue-de tructi e in asive diagno tic
tumour are needled. It is important that the per on perform- method.
ing the aspiration has enough experience to be able to evalu-
ate whether the material obtained might be consi tent with
th tumour in que hon (ag , history, site, ize, and palpatory Fine Needle Aspiration Cytology Procedure
findings). It i recommended that mall, deep- eated twnours
be needled with ultra ound guidance. Practical Considerations
(2) Insufficient or technically suboptimal material may The aspiration technique is the arne a for other target
result in a false diagnosis or preclude any diagnosis at all. for FNA. We have found that a syringe holder which allows
The temptation of making a diagnosis on quantitatively or aspiration with one hand is es ential for succe s. Needle
qualitatively insufficient material must be resisted. It is wider than 22 gauge (0.7 mm) are very rarely necessary. The
a fact that some tumours are difficult to diagno e by FNA. length of the needle depend on the ite of the tumour. For
Va cular tumour mo t often yield predominantly blood and deep-seated tumours, needle with a tylet are recom-
very few cells and in various tumours rich in dilated vessels mended. The stylet strengthens the needle and prevents cells
the aspirates may be very bloody but contain very few from surrounding ti sue from being included in the mear.
tumour cell . Another difficulty i to obtain a ufficient Thorough palpation and e: timation of ize, ite and con i -
number of cells from tumours with an abundant collagenous tency of the tumour is e entia!. Since the surgeon often may
or hyalinized background matrix. Extensive necrosi , cy tic want to determine the point of in ertion of the needle, close
degeneration or haemorrhage can also make diagnostic communication with the urgeon is mandatory. If the
a piration very difficult. In general, however, with adequate urgeon doe not indicate the insertion point, the twnour i
ampling, it i po sible to obtain ufficient material for needled through the vertex. In ca e of u peeted sarcoma the
diagnosis. insertion point can, at the request of the urgeon be tattoed
(3) Mi interpretation of the material is, however, the so that the needle track can be removed at urgery (fig. 2).
main cause of false diagnoses. There are a number of Our policy is to perform at most 5 F A pa se , all through

4 Fine eedle Aspiration of

Soft Tissue Tumours
Fig. 2. A subcutaneous sarcoma remo eel
with the overlying skin. The insertion point is
marked by the tattoo (arrow.

the arne in ertion point. Due to tumour ti ue heterogeneity, When the treatment include neoadjuvant therapy (radio-
e peciaJly in large tumours, it i important to ample ti ue therapy or chemotherapy followed by urgery the
from differ nt part of tbe tumour. iliagno i mu t equal that of a hi topathological e aluation
The microscopic evaluation hould be based on both wet- a regard illstotype and malignancy grade.
fixed [HE or Papanicolaou (pap)] and air-dried [May- At pre ent neoadju ant therapy i u ed for rhabdomyosar-
Griinwald-Giemsa ( GG) or Diff-Quik] smears. coma, neuroblastoma the extra keletal EwingfP ET family
The wet-fixed material i uperior for e aluation of nuclear of tumour and in om centre elected ca of oft ti ue
detail such a chromatin structure and nucleoli willie the arcoma .
MGG taining giv exceU nt information on cytopla mic On the oth r hand, in ca e of a b nign oft ti u tumour
detail and the background matrix. or reactive soft ti sue Ie ion the surgeon often want to know
the hi totype in order to inform the patient of the two treat-
Cytodiagnosis ment option : ob ervation/follow-up or local excision.
One common objection to F A in the primary diagnosi Ob ervation may be ugge ted in the pseudosarcomatou
of oft ti sue tumour is the uppo ed inability to correctly soft tissue lesions, especially nodular fasciitis and pseudo-
and reliably diagno e the numerou different histotypes in malignant myositi 0 ifican and in case of lipoma or
mear . However the nece ary diagno tic level for a soft neurilemoma and de moid fibromato i . A helling out of
ti ue tumour i determined by the primary treatment envi - the tumour is sufficient treatment for most benign soft tissue
aged in the individual case. First of all the surgeon mu t tumour except de moid fibromato i , willch require more
know whether the tumour in que tion i a true oft ti ue exten ive margin due to i infiltrative growth.
Ie ion/tumour or a oft ti ue meta ta i or a primary oft
tis ue lymphoma. In ca e of arcoma the tandard treatment
in the majority of ca e i primary radical surgery ometime Classification of the Cytodiagnosis
followed by radiotherapy. The type of surgical intervention
d pend mor on the ite ( ubcutan 01lS or d p) ize and tandardiz d reporting i an ad antag both to the urg on
the relation of the arcoma to ve el nerv bundle and and to the cytopathologi 1. At our Mu culo keletal Tumour
perio teum than on the hi totype. Thu a reliable diagno i of Centre w have for many year u ed four main diagno e :
arcoma i sufficient for the surgeon in tho e ca es where benign, sarcoma, other malignancy or inconclusive.
primary radical surgery i the propo ed treatment. lnconclu i e means either that tbe material i in ufficent for

Fine eedJe Aspiration of 5

Soft Tissue Tumours
diagnosis (poor yield, necrosis, cystic degeneration or techni- and sarcoma
cally un ati factory) or that it is not possible to reliably decide
whether a malignant tumour i a true soft tis ue arcoma or References
not, or whether a oft ti sue tumour i benign or malignant.
Tumour/lesion
In our experience the term 'inconclusive diagnosi ' is better Nodular fasciitis 13
than various expre sions of uncertainty [57]. ProLiferative myositis and fascijtis 14
The main diagno es benign or sarcoma are, if pos ible, Pseudomalignant myo itis os ificans 15
supplemented with a ugge ted histotype diagnosis and in Lipomatous tumours, benign 16-19
ca e of arcoma, malignancy grade (low or high). Neurilemoma 20-22
Cytological criteria for specific histotype diagnose have Granular cell tumour 23
Intramuscular my oma 24
been evaluated in comparative tudies ofseries of FNA mears Angioleiomyoma 25
and histopathological sections from weU-defmed histotypes,
Sarcoma
and cytological criteria for a p cific-typ diagnosis have b n MPH 26 27
ugge ted and publi hed in a number of tumour type ,benign Myxofibro arcoma 2 , 29
as well as arcoma (table I). The cytological findings in many Leiomyo arcoma 30
uncommon tumours and 'new' entitie are mainly described in Lipo arcoma 16, 17,31,32
ca e report and reliable diagno tic criteria are at pre ent lack- MP T 33, 34
ing. However, it i po ibl to give a confident diagno i of ynovial sarcoma 35-38
Rbabdomyosarcoma 39 4
benignity or malignancy in mo t of the e ca e . euroblastoma 45,46
Tn order to faciliate the diagnostic workup ofa soft tissue Angiosarcoma 47 9
tumour FNA sample, smears may be classified according Alveolar soft part arcoma 50,51
to the principal micro copic pattern. Although there is a lear cell arcoma 52
certain overlap between patterns, uch a categorization may Dermatofibro arcoma protuberan 53, 54
be u eful in the endeavour to reach a confident diagno i of Epithelioid arcoma 55,56
benignity or malignancy, to uggest a type-specific diag-
Suggested diagno tic criteria for a specific diagno is based on
nosis as well as in the recognition of important differential comparative histological and cytological tudie.
diagnoses. This approach is recommended in particular to
cytopathologi ts working in a general in titution not related
p rformed unl s th cytodiagno i i as certain as a histo-
to a pecialized orthopaedic oncology unit as a ba is for
pathological evaluation. In th r - valuation of our 20-year
appropriate referral to such a unit.
material about 5% of the sarcoma ca es underwent open biop y
In chapter 4 we propo e a classification of this type of
and in lout of 202 sarcomas the triple diagno i failed [9].
FNA samples from soft tissue tumours.

Ancillary Diagnostic Methods Supplementing

The Final Evaluation of a Soft Tissue Tumour the Cytodiagnosis
Aspirate
The use of special diagno tic methods is often nece sary
Experience has taught us that the diagnosis and treatment to correctly a es a soft ti sue tumour. The ame method
hould be based on the combined evaluation of clinical data, u ed in histopathology are applicable to FNA aspirates.
radiographic inve tigation and cytodiagno i , the ame In spite of the widespread use of immunohistochemistry
concept of triple diagnosis that has been the consensus for in the diagno i of soft ti ue twnour the value of immuno-
brea t lesion for many years (clinical data, mammography and cytochemistry (IC) as a diagno tic aid has not yet been
cytodiagno i ) [57, 58]. The optimal workup is to di cu thi evaluated in large erie. Published case reports and our own
combined information for each patient in a multidisciplinary experience have, however, indicated that Ie is a valuable
team of a musculoskeletal tumour centre. The team decides a set in the differential diagno i between pleomorphic ar-
whether available data, including the cytodiagno is, are suf- coma and oft ti ue meta ta e from anapla tic carcinoma
ficient for definitive treatment. GeneraIJy an inconclu ive cyto- or melanoma, and between pleomorphic sarcoma and the
diagno i or a cytodiagno i not con i tent with clinical or primary soft tissue presentation of anaplastic large cell
radiographic data lead to a repeat aspiration or a core or lymphoma (AL L). We have al 0 found IC helpful in the
open biopsy. If mutilating surgery is considered a biopsy is diffi r ntial diagnosi of various pindle cell tumours such as

6 Fine eedle Aspiration of

Soft Tissue Tumours
 ~ ....
FNAJJ9b -02
-..-
FNA~,,-02
It£; (1)//7

a b

Fig. 3. The combined evaluation of routincly stained smears and

immunohistochemical taining of a cell block 'microbiop y' is often
sufficient for a specific type-diagnosis. a ytology slide and tbe
cell block 'microbiop y . b [n this particular ca e a su pected GIST
meta ta i was needled. The routinely tained mear how part of a
spindle cell arcoma. HE. High magnification. c Po iIi e taining
c with 0117, ection from the cell block.

Table 2. seful antibodies in the diagnosis

of soft tis ue sarcoma and other malignancies Tumour

Antibody'
Mu c1e- pecific actin Leiomyosarcoma - 0-90%+
Rhabdomyosarcoma -90%+
mooth mu cle actin ( MA) Leiomyosarcoma -90%+
Desmin Leiomyosarcoma -70-75%+
Rhabdomyosarcoma -9 95%+
D R T -90%+
xtrarenal malignant rhabdoid tumour (some)
Caldesmon Leiomyosarcoma
Myoglobin Rhabdomyosarcoma -40%+
MyoDI Rhabdomyosarcoma >90%+
-100 protein MP T -40-50%+
Round cell liposarcoma -60-70%+
Clear cell sarcoma -80%+
EMC -20-40%+
Synovial sarcoma -30%+

Fine eedle Aspiration of 7

Soft Tissue Tumours
Table 2 (continued)
Tumour

C034 Dermatofibrosarcoma protuberans -9 95%+

Malignant haemangiopericytoma -50%+
Epithelioid arcoma -50%+
Angio arcoma -60-80%+
GI T -80%+
031 Angio arcoma -90%+
CD99 SIP T ->95%+
ynovial arcoma -60%+
Alveolar rhabdomyo arcoma ( ome)
Solitary fibrous tumour
euron-specific enolase SE) euroblastoma
P ET
DSRCT
hromogranin eurobla toma (often in undifferentiated tumours)
PET
ynaptophysin eurobla toma (often in undifferentiated tumours)
P ET
Cytokeratin Synovial sarcoma -50-90%+
Epithelioid arcoma -90%+
Angio arcoma (epithelioid angio arcoma often +)
Leiomyo arcoma -30%+
D RCT >90%+
Extrarenal malignant rhabdoid tumour
EMA Synovial sarcoma -50-95%+
Epithelioid arcoma
Epithelioid angiosarcoma
CDll7 (c-kit) GIST (almost all)
Antibody 2
Cytokeratin Carcinoma
EMA Carcinoma
Anapla tic large cell lymphoma
C030 Hodgkin' lymphoma
Anapla tic large cell lymphoma
03, D79a, D I0, Tdt ymphoblastic lymphoma
CD45, CD3, CD20 on-Hodgkin's lymphoma in general
Alkl Anapla tic large cell lymphoma
CDI3 Plasmacytoma
MPO Granulocytic arcoma (myelosarcoma)
HMB45, Melan A Malignant melanoma

Useful in the diagnosi of soft Ii sue sarcoma.

U eful in the differential diagno is of other malignancie .

neurilemoma, leiomyo arcoma, solitary fibrous tumour and All antibodi u d in soft ti sue tumour diagno i are
occasionally in the type diagnosis of ynovial sarcoma. 1 is an uitable for formalin-fixed and paraffin-embedded ti ue
important diagno tic a et in the pecific diagno i ofangio ar- and well suited for the small tis ue of successful cell block
coma and small round cell arcomas. preparations (fig. 3a-c) (table 2).
We have found Ie on ceU block preparations from aspi- The diagoo tic value of EM is still significant in spite
rates more reliable than on cytocentrifuge preparation . of the vast u of immunostaining. EM in the diagno tic

8 Fine eedle Aspiration of

Soft Tissue Tumours
 a

Fig. 4. F A ample proces ed for EM.

a The microbiopsy from which the cells to be
examined are cho en. b Electron micrograph
of the prepared specimen. 10 this case a con-
ventional ES. The abundant cytoplasmic
glycogen is ea ily seen.

evaluation of F A a pirates ha been thorougWy investi- Flow-cytometric as well as irnage-cytometric D A ploidy

gated [60, 61]. We and others have found EM especially analyse (FCM and rCM, re pectively) have been performed on
valuable in the clas ification of mall round cell arcoma several series of soft tissue sarcomas, mixed histotypes as well
(fig. 4a, b), in the differential diagno i of variou pindle as sp cific entitie . Although an unequivocal non-diploid cell
cell tumour and in elected oft tis ue tumours which population strongly favours a high-grade arcoma (fig. 5),
exhibit specific ultrastructural features such as preme- o ploidy analysi ha prov d to be of limited value in th
lanosomes in clear cell arcoma or Weibel-Palade bodies in diagnosis and prognostication of soft tissue sarcoma. A nwnber
vascular tumours. of high-grade sarcomas may di playa diploid cell population.

Fine eedle Aspiration of 9

Soft Tissue Tumours
 NONDIPLOID
t(12;16)(q13;p11 )
Distribution of DNA mass Cell classes
4C Displayed: 1 2 3 4 5
2C 8e
48 First peak
~f Mass: 6.0 pg.

36
I-t1-----------1 DNA Index: 1.41
Area: 108.4 IL2
f --t
C Cells: 41
::> 2 3 4 5
0 Second peak
u 24
=ai
0
Mass: 0.0 pg.
DNA index: 0.00
Area: 0.0 1L2
•
12 Cells: 0

II 1.1
Field count: 75
Tolal cell count: 120
6 7 8 9 10 11/12
0 8 16 24 32 Cells displayed: 100
DNA mass picograms Cells oft scale: 0

..
11:
__ '.84
0 92
.
1.11
1.11
1.84
1.09
1.39
0

1.35
0

1.<19
0

0.00
0.07
0.00
5.21
0.83
76.67 92
, o.
13 14 15 16 \ 17 18

I
...2.22
3.66
_ _ 2.22
2.22
3.66
4.«
0.00
2.72
0.00
0.00
2.58
0.00
0.00
0.22
0.00
0.00
6.37
0.00
0.00
5.83
0.00
0
7
0
- .--,-- -- ,
17.61 2.72 2.58 0.22 6.37 5.83 7 19 20 21 22 x X

Fig. 5. Image cytometry of a high-grade malignant oft tis ue Fig. 6. FNA of a myxoid liposarcoma processed for karyotyping.
arcoma. Aneuploid cell population. The typical translocation t(12; 16) i marked.

FISH wilh cosmids

3' and 5' of the
a EWSgene

Fig. 7. a FISH prepared from an air-

dried unstained smear of a tumour of the ESI
PNET family. b RT-P R of the same case. RT-PCR demonstraling
type I EWSIFLI1
I = Patient· 2 = negative control; 3 = po i- b fusion transcript
tive control; 4 = blank.

F M as well a rCM can be performed on fine needle An unequivocal non-diploid cell population indicates
a pirate . One ad antage with r M i that previou Iy tained arcoma and furthermore a high-grade sarcoma [45] while
a pirate may be de tained, re tained with Feulgen and a diploid or tetraploid hi togram i of no diagno tic value.
analyz d. We ha found D A ploidy analysi of limit d A di advantage with FCM is that false diploid hi tograms
diagnostic value in the evaluation of a soft tissue tumour aspi- may occur [62, 63]. Through comparative FCM and ICM
rate in the differential diagnosis of benignity and malignancy. analy es on the same ti sue specimen it has become evident

10 Fine eedle Aspiration of

Soft Tissue Tumours
Table 3. Chromosomal aberrations in soft
tissue sarcoma Sarcoma Chromo omal Genes Performed on
aberration involved F A (Ref. No.)

ES/P T t(11 ;22)(q24;q 12) FLll-EWS 64,66

Alveolar rhabdomyosarcoma t(2;13)(q35;q 14) PAX3-FKHR 67
D RCT t«II;22)(p13;qI2) WTl-EWS 127
ynovial arcoma t(X; 18)(p 11.2;q 11.2) SSX1-SYT 65
SSX"- YT
Clear cell arcoma t(l2;22)(q 13;q 12) AFT1-EWS
EMC t(9;22)(q22;q 12) TEC-EWS 68

that diploid or inconclusive FCM hi tograms in ti ue transcripta e-polymera e chain reaction (RT-PCR; when the
pecimen as well a in aspirate hould be upplemented gene involved in a diagno tic chromo omal aberration, mo t
with ICM to avoid fat ere: ult . often a translocation, are known) are easier to perform on
ytogenetic analysis has emerged as a promising diag- FNA, because the number of cell necessary for these analyses
no tic adjunct in soft tis ue tumour diagno i . Karyotyping, are far Ie than for conventional karyotyping, and dividing
fluore cent in situ hybridization (Fl H) and molecular cell are not n ce ary (fig. 7). The hith rto known diagno tic
genetic analysis can be performed on FNA from muscu- chromosomal aberrations are listed in table 3.
loskel tal tumours [64-68] (fig. 6). FISH or reverse

Fine eedle Aspiration of 11

Soft Tissue Tumours
 Chapter 3

The Cytology of Benign,

Pseudomalignant Reactive Changes
in Fibrous Tissue,Adipose Tissue and
Striated Muscle in Fine Needle
Aspiration Samples

One reason for a false-positive diagnosis of sarcoma in a with elongated cytoplasmic processes. The nuclei are
soft tis ue tumour a pirate is the mi interpretation of benign, rounded, ovoid or fusiform with regular chromatin and small
reactive cellular changes in benign condition. nucleoli, if any. The cell are een either a di sociated or in
small clusters or runs of loosely attached cells. Stripped
nucl i are not uncommon (fig. ).
Fibrous Tissue Reactive fibroblasts/myofibroblasts show irrespective of
cause, a wide variation in ize and shape. The cells become poly-
ormal fibrobla t myofibrobla t appear in F A am- hedral or triangular, often with rather abundant cytoplasm. They
pies as spindle-shaped cells with slender cytoplasm, often may show angulated cytopla mic extension or cytoplasmic

Fig. 8. onnal fibroblast in an F A biop y.

A run of 100 ely cohesive cell with ovoid,
uniform nuclei, regular chromatin and bipolar
cytoplasm. MOO. Medium magnification.

12 The Cytology of Benign Pseudomalignant

Reactive Changes in Fibrous Ti ue,
Adipose Tissue and Striated Mu de in A
 a

Fig.9. Example of reactive fibroblast/myofi-

broblas1. a Larger than nonnal fibroblast with
more abundant cytopla m with angulated
extensions and large nuclei with prominent
nucleoli. b A multinucleated, ganglioncell-like
reactive fibroblast. MOO. High magnification. b

proce ses. The nuclei vary in size and shape (rounded, ovoid, Adipose Tissue
spindle- haped) and nucleoli may be large and prominent.
Binucleated cell are not uncommon (fig. 9a, b). ormal adipose tis ue i een as mall fragment or clus-
Typical example of the pleomorphic appearance of reac- ters of large cells with abundant univacuolated cytoplasm
tive fibrobla ts/myofibroblasts are seen in the pseudomalig- and small, dark, regular nuclei. A discrete network of thin
nant, benign oft tis ue Ie ion, e pecially in nodular fasciiti capillarie is often ob erved. Di ociated adipocyte are
and proliferative myositis. uncommon.

The Cytology of Benign, Pseudomalignant 13

Reactive Change in Fibrou Ti ue,
Adipo e Ti sue and Striated Muscle in F A
 a

Fig. 10. ellular change in adipo e tis ue.

a Partly myxoid background and different-
sized adipocytes. b lncrea ed cellularity due
to the presence of fibrobla t and hi tiocytes.
a, b MGG. Medium magnification. b

In reactive tates, po ttraumatic, inflammatory or in adipose Striated Muscle

tissue bordering various tumours, the adipo e tis ue may
exhibit a myxoid-like background, the capillary network i onnal triated mu de in FNA ample is een a frag-
more pronounced, th adipocyte vary in ize and th fat frag- ment of mu de fibre with small dark nuclei and a more or
ments appear more cellular than normal due to the presence of Ie evident striation. The fibre are den ely eo inophilic in
fibrobla ts and histiocyte (fig. lOa b). Histiocyte with foamy H and dark blue in GG. Regenerating muscle fibre
or vacuolated cytoplasm appear between the fat fragments. appear in FNA ample a multinucleated cell of varying

14 The ytology of Benign, Pseudomalignant

Reactive hange in Fibrou Ti ue,
Adipose Tis lie and Striated u de in A
 11a

Fig. 11. Examples of regenerating striated

mu c1e fibres. a Typical 'muscle giant cell '
with rows of nuclei and dark blue cytoplasm.
MGG. High magnification. b The cytopla m
is eo inophilic in HE. High magnification. 11b

size and shape. They are rounded, polyhedral, strap-shaped or uniform in size and often harbour a prominent nucleolus. The
tadpole-like. The cytoplasm is den ely eosinophilic in HE and nuclei are typically arranged in row, eccentrically located
dark blue in MGG. The multiple nuclei are moderately large, (fig. lla-c).

The ytology of Benign, Pseudomalignant 15

Reactive Change in Fibrou Ti ue,
Adipo e Ti sue and Striated Muscle in F A
Fig.llc. uninuclear, tadpole-like regener-
ating striated muscle fibre. MGG. High mag-
,
nification. llc

Table 4. A ulllluary of benign 'pseudomalignant changes' in aspirated material from fibrous and adipose tissue and striated muscle

Ti ue Cellular change Le ions

Fibrobla tslmyofibroblast Variation in size, variation in shape; elongated,

triangular, polygonal, plump with cytoplasmic
exten ions; variable nuclear hape and size;
binucleation; prominent nucleoli
Adipose tissue Increased vascularity; increased cellularity tatus after fat necrosis
(fibroblasts, endothelial cells, histiocytes); Po ttraumatic state
multi acuolated cytoplasm in adipocytes; uni- or Adipose tissue surrounding various
multinucleated histocyte between fat fragment non-adipose tumours
(lipophage)
triated mu c1e Multi- or uninucleated regenerating muscle fibres A pirate from tumour Ie ion infiltrating
('muscle giant cells'); occasionally presence of striated muscle
tadpole-like regenerating muscle fibres; prominent; Examples: intramuscular lipoma, intramuscular
nucleoli; dense eosinophilic (HE) or dark blue myxoma desmoid, fibromatosis colli
(MGG) cytopla m

Regenerating muscle fibres are mainly found within A A summary of the reactive cytological changes in fibrou
sample from tumour infiltrating striated mu cleo Typical tissue, adipose tissue and striated muscle is pr sented in
example are infantile fibromato is colli and desmoid fibro- table 4.
matosis.

.16 The Cytology of Benign Pseudomalignant

Reactive Changes in Fibrous Ti ue,
Adipose Tissue and Striated Mu c1e in A
 Chapter 4
..........................................................................................................
The Cytological Features of Soft
Tissue Tumours in Fine Needle
Aspiration Smears Classified
According to Histotype

AdipocyticTumours Subcutaneous lipomas are well vascularized.

Fibrous connective tissue is occasionally admixed with
Adipocytic tumours arc the most common soft tissue the lipoma tissue, in which case the lesion is classified as
tumours due to the common subcutaneous lipoma. Further- fibrolipoma. Subcutaneous lipoma may also be partly myxoid
more liposarcoma is one of the most frequent soft tissue sar- (myxolipoma) or exhibit cartilaginous metllplasia (chon-
comas. The diagnosis of adipocytic tumours by FNA is drolipoma).
predominantly based on the examination of routinely stained Secondary changes such as focal fat necrosis may also
smears, as is the case with the histopathological diagnosis. occur with the presence of clusters or strands of macrophages
Ie is a useful adjunct in some of the lipoma variants. with foamy or vacuolated cytoplasm (Iipophages).
Cytogenetic analysis, however, is gaining importance as a
diagnostic asset in the evaluation, and most probably FISH
analysis of FNA smears will be of value in the type-specific Cytological features of subcutaneous lipoma (fig. 12a, b)
diagnosis uf lipomatous turnuurs ill tIll: futun:. Rdalivdy Adipose tissue fragments of variable size
type-specific chromosomal aberrations in adipocytic tumours Few dissociated adipocytes
are listed in table 6. Fragments composed of large univacuolated mature
Subcutaneous tipoma is a common target for FNA, intra- adipocytes with eccentric small dark, uniform nuclei
muscular lipoma is relatively common while lipoma variants Capillary strands present in the adipose tissue fragments
such as angiolipoma, spindle cell and pleomorphic lipoma, Differential diagnosis
hibernoma, and lipoblastoma are infrequently needled. Normal subcutaneous adipose tissue
Chondroid lipoma as well as myelolipoma are, due to their Chondroid lipoma
rarity, only occasionally the target for FNA. Well-differentiated liposarcoma (atypical lipomatous
tumour)
Myxoid liposarcoma
Benign Adipocytic nllllO/lrS
Comments
Subcutaneous Lipoma As aspirates from subcutaneous lipoma have principally
The proximal extremities and the trunk are the most the same appearance in FNA smears as normal subcutaneous
common sites. Size is variable but seldom exceeds IOcm. adipose tissuc it is important to certify that thc necdle has
Subcutaneous lipoma is uncommon in children but docs occur. been placed within the lipoma.
Many subcutaneous lipomas exhibit reactive cellular
Histopathology changes such as increased vascularity, scattered or clustered
Subcutaneous lipomas have a lobular pattern and are com- adipocytcs with multivacuolated cytoplasm and histiocytcs
posed of mature fat cells, which vary slightly in shape and with foamy cytoplasm (Iipophages) betwccn fragments.
size. The nuclei are small and uniform. The microscopic These reactive changes may suggest a well-differentiated
appearance is very much like that of normal subcutaneous fat. liposarcoma.

The Cytological Features of Soft Tissue 17

Tumours in Fine Needle Aspiration Smears
Classified According to Histolype
 .... -'- "-10

Fig.12. Detail of a smear ofa subcutaneous

lipoma. a Fragment of adipose tissue com-
posed of univacuolatcd mature adipocytes.
Thin capillaries traverse the fragment
(arrows). There arc no dissociated adipoeytes
in the background, HE. Low magnification.
b Under high power the adipocytcs appear as
large univaeuolated uniform cells with
............. ...._ _........ b
small. dart nuclei. HE. High magnification.

Myxolipomas have neither the branching capillary Intramuscular Lipoma

network typically seen in smears of myxoid liposarcoma, Intramuscular lipoma is a slow-growing tumour. Most are
nor typical lipoblasts. localized in the thigh and trunk. At histological examination
In lipomas with chondroid mctaplasia fragments of chon- intramuscular lipoma is composed of mature fat cells, the
dromyxoid matrix (bluish-bluish-red in MGG) arc mixed adipose tissue infiltrating between muscle fibres. Rarely,
with the tissue fragments, Chondrocytes may be observed in intramuscular lipomas may be well circumscribed and not
lacunae in these fragments. Lipomas with chondroid meta- infiltrating.
plasia have been misdiagnosed as myxoid liposarcoma.

18 The Cytological Features of Soft Tissue

Tumours in Fine Needle Aspiration Smears
Classil1ed According to Histotype
Cytological features of intramuscular lipoma mg. 13a, b). Spindle eel/lipoma
Fragments of large univacuolated, mature adipocytes Histopathology
mixed with more or less atrophic muscle fibres There is a variable mixture of mature fat and fascicles
Multinucleated regenerating muscle fibres ('muscle giant or rows of bland spindle cells in a variably myxoid stroma.
cells') may be observed Brightly eosinophilic hyaline collagen fibres are a typical
feature. A variable number of mast cells is seen. The spin-
Comments dle cells are strongly positive for CD34.
Smears from subcutaneous lipoma may contain inadver- The cytological features of spindle cell lipoma have been
tently aspirated normal muscle fibres if the needle is inserted published, based on a re·examination of 12 patients [19].
too deeply. The presence of 'muscle giant cells' is the best
evidence that the smears are derived from an intramuscular
lipoma. Smears from an intramuscular haemangioma can Cytological features of spindle cell lipoma (fig. 150, b, 160, b, c)
occasionally mimic those from an intramuscular lipoma A mixture of mature adipose tissue and dispersed or
since atrophic muscle fibres adjacent to haemangioma can be clustered, bland-looking spindle cells. often in a myxoid
replaced by fat tissue. background
Fragments of brightly eosinophilic (HE) collagen-hyaline
fibres
Allgiolipoma
Mast cells (particularly when the background is myxoid)
Angiolipomas are almost always subcutaneous, often mul-
Differential diognosis
tiple and not seldom painful or tender. The majority are
Neurilemoma
smaller than 2 em.
Dermatofibrosarcoma protuberans
Low-grade myxofibrosarcoma
Histopathology
Myxoid liposarcoma
Angiolipomas arc encapsulated and composed of a mix·
ture of mature fat cells and a branching network of small ves·
Comment
sels. The vascular channels characteristically contain fibrin
Tumours showing a mixture of spindle cell and pleomor-
thrombi. Some angiolipomas consist almost entirely of
phic lipoma pancrns arc not uncommon. They most often
the vascular channels. Mast cells are often numerous in angi-
resemble spindle cell lipomas containing multinucleated
olipoma.
cells with hyperchromatic nuclei. Due to the variable
proportions of fatty tissue, spindle cells and myxoid back-
ground substance, smears of spindle cell lipoma may, in
Cytological features of ongiolipomo (fig. 14) some cases, be misinterpreted as several other types of
Aggregates or strands of thighly packed small vessels in benign or malignant spindle cell or myxoid tumours.
the fat tissue fragments Smears with an abundant myxoid background may easily be
Occasionally fibrin thrombi in individual vessels misinterpreted as myxoid liposarcoma or low-grade myxo-
Variable number of mast cells fibrosarcoma. Neither the branching network of thin capil-
laries typical of myxoid liposarcoma, nor the coarse vessel
Spindle Cel/ and Pleomorphic Lipoma fragments seen in myxofibrosarcoma are, however, present
These two examples of benign lipoma variants share clin- in spindle cell lipoma. The spindle cells in spindle cell
ical, morphological and cytogenetic features. They may be lipoma are CD34-positive and S-IOO-negative, which helps
essentially the same tumour, but lying at the extremes of a to exclude neurilemoma. As the spindle cells in dermato-
morphological spectrum. fibrosarcoma protubcrans also are CD34 JXlsitivc, IC is of
Both arc slowly growing and occur typically in the subcu- no help in this differential diagnosis.
taneous tissue of middle-aged men, most frequently in the
upper back, the neck and over the shoulders. PleomOlphic Lipoma
Rare cases can be seen in the head and neck region, Histopathology
including the mouth. Both variants exhibit the same chro- Pleomorphic lipoma is composed of mature adipocytes
mosomal aberration, involving the long ann of chromo- mixed with a variable amount of scattered bizarre giant cells
somes 13 and 16 (monosomy 16 with or without partial loss with hyperchromatic nuclei and multinucleated large cells
of 16q). with rounded dark nuclei forming rings ('floret cells').

The Cytological Features of Soft Tissue 19

Tumours in Fine Needle Aspirnlion Smears
Classified According to Histotype
 ~ ~_""a

Fig. 13. Intramuscular lipoma. Fragments of

adipose tissue composed of mature adipo-
cytes and fragments of striated muscle.
a Overview. low magnification. b High mag-
nification. a, b HE. b

Pleomorphic lipomas may have a myxoid stroma and collagen A variable number of large cells with hyperchromatic
bundles similar to those in spindle cell lipoma are often pres- nuclei and eosinophilic cytoplasm (HE) both in the back-
ent. Transitional forms between pleomorphic and spindle cell ground and in tissue fragments
lipoma are fairly commOll. The giant cells stain for C034. A variable number of 'floret cells'
Clusters or runs of spindle cells seen in transitional forms
Differential diagnosis
Cytological features of pleomorphic lipoma (fig. 170, b) Well-differentiated liposarcoma (atypical lipomatous
Fragments of mature fat tumour)

20 The Cytological Features of Soft Tissue

Tumours in Fine Needle Aspiration Smears
Classified According to Histotype
Fig. 14. Smcar of angiolipoma, Numerous
strands of thin capillary vcssels traversc thc
adipose tissue in cvcry direction. MGG. High
magnification.

Conunent with eosinophilic gmnular cytoplasm. Mature adipocytes are

The most important differential diagnosis of pleomorphic the most common cellular componcnt and may dominate the
lipoma is atypical lipomatous tumour/well-differentiated microscopic picture entirely. Hibemomas are well vascular-
liposarcoma, which often displays large cells wifh hyperchro- ized. The cyfology of hibernoma has been evaluated in case
matic nuclei and occasional 'floret cells' in smears. The main reports and small series [16-18].
differences hetween these two entities are the clinical presenta-
tion and the occurrence of atypical lipoblasts in liposarcoma.
Cytological feowres of hibernoma (fig. 180, b)
Pleomorphic lipomas are subcutaneous tumours while atypical
Fragments of mature fat tissue intermingled with 'hiber-
lipomatous tumours/well-differentiated liposarcomas usually
noma' celis (rounded celis with abundant finely vacuolaed
arc deep-seated tumours of the limbs or the retroperitoneum.
or granular cytoplasm and centrally located. small. uniform
Cytogenetic findings are also helpful, since atypical lipomatous
nuclei)
twnour/well-differentiated liposarcoma typically displays giant
The fat fragments often contain numerous capillary vessels
marker chromosomes while the pleomorphic lipoma shows
Differential diagnosis
involvement ofchromosomcs 13 and 16, similar to spindle cell
Subcutaneous lipoma
lipoma.
Granular cell tumour
Adult rhabdomyoma
Hibernoma Liposarcoma
Hibernoma, derived from brown fat, is a rare lipomatous
tumour, which occurs mainly in patients between 20 and 50 Commcnts
years of age. If 'hibernoma cells' dominate the smears, granular cell
Most hibernomas occur in the back but some in the thigh tumour as well as adult rhabdomyoma can be diagnostic
and in the annpil. Though usually subcutaneous, they can be pitfalls. Ie is helpful since the cells of granular cell tumour
intramuscular. show double positivity for NSA and S-IOO, and rhabdomy-
Histopathology oma cells stain positive for myoglobin. Hibcrnoma cells have
Hibernomas are usually well circumscribed and show a tan- becn misinterpreted as lipoblasls but nuclei arc ncither atyp-
brown cut surface. They arc lobulated and composed of a vari- ical nor scalloped.
able amount of mature adipocytes mixed with large rounded Hibernomas with a large proportion of mature fat cells are
cells having a finely vacuolated cytoplasm and similar cells oflcn diagnosed as common lipoma.

The Cytological Features of Soft Tissue 2\

Tumours in Fine Needle Aspiration Smears
Classified According 10 Histotype
 •

• • ••
• • • •
• •

• •
•
•

• •

•
- • •
•
.-
•
• •
•
•
•
- •
•
•

Fig. 15. Spindle cell lipoma. The variable

proportions of fatty tissue and spindle cells
is evident in low magnification. a. b HE. _",,-_--, b

Lipoblastoma Individual cases of FNA of lipoblasloma have been published

Most cases of lipoblasloma are present in infants under [16, 18].
the age of 3 years. TIley have been occasionally reported in
children up to 8 years. The majority of lipoblastomas are Histopathology
suoculaneous, well circumscribed and slowly growing. The The lipoblastoma is a lobular tumour composed of a
mrc cases of deep-sealed, often intramuscular lipoblastomas mixture of mature and immature fat cells in varying pro-
thai are diffusely infiltrative are known as lipoblaslomatosis. portions. A myxoid stroma, lipoblast-like cells, primitive

22 The Cylulugil:al Fl:alufl:s uf Sufi Tissul:

Tumours in Fine Needle Aspiralion Smears
Classified According to Hislotype
a b

Fig. 16. pindle cell lipoma. a Scattered pindle cell and fTagment
f lIagen-hyaline fibre in a myxoid background with mall fatty
vacuole. MGG. High magnification. b niform population of spin-
die cells with bland nuclei. HE. High magnification. c The collagen-
C ...... ""-.....:3 :;...._....:z"-- -='--_....;..._ hyaline fibre are brightly eo inophilic with HE.lligh magnification.

spindle-shaped mesenchymal cells and capillaries are typical Comment

featur s of immatur areas of lipobla toma. Th mor matur Th mo t important pitfall from the cytological point of
component resembles a common lipoma with occa ional view is myxoid lipo arcoma (myxoid background ub tance,
hibernoma-like cells. Lipoblastoma may mature towards capillary network, lipoblast-like cell ). Myxoid lipo arcoma
common lipoma and the characteristic immature area may has been described in children under 10 years of age, albeit
be very mall and focal. very rare. The most common error made is to misdiagnose a
lipoblastoma as a common lipoma when smear are domi-
nated by ordinary large univacuolated fat cell . The chromo-
Cytological features of lipoblastoma mg. 19a, b) omal ab rration 8q 11-13 seen in lipoblastoma i a reliable
Fatty tissue fragments with variable amounts of myxoid diagnostic aid.
background matrix
Branching strands of thin capillaries Chondroid Lipoma
Uni- or multivacuolated lipoblast-like cells mixed with Chondroid lipoma i a recently de cribed rare variant
small and large univacuolated fat cells with uniform nuclei of benign lipoma. Chondroid lipoma is mainly found in
Differential diagnosis adults between 30 and 40 year of age and i predominantly
Common lipoma a ubcutaneous Ie ion in the limbs, trunk, head and neck
Myxoid liposarcoma r gion.

The Cytological Features of Soft Tissue 23

Tumour in Fine eedle Aspiration mears
CIa ified According to Hi totype
Fig. 17. Pleomorphic lipoma. i\ Mature
adipocylcs. scattered cells with large hyper-
chromatic nuclei and a single florel cell. UE.
Low magnification. b Typical floret cell. UE.
High magnific:uion.

HislOpathology lipoblasts, Olhers have an eosinophilic granular cyloplasm.

Chondroid lipoma is a \.:ell-dcmarcated at times encapsu- Foci of mature fat cells are also present The nuclei are often
Ialcd IUmour. It has a lobular pattern and is composed of irregular with a folded nuclear membrane.
rounded cells arranged in nests or Slrands in a chondroid-like The cylological features of chondroid lipoma are
malrix. The lUmour cells may rescmble multivacuolatcd described in FNA smears based on individual cases [70, 71].

24 Thc Cytological Features of Soft Tissuc

Tumours in Fine Needle Aspiration $mcllrs
Classified According 10 Histotype
 --..................

Fig. 18. Hibcrnoma. a The typical mixture

of mature fUI and clusters of 'hibcmoma'
cells is evident under low power. MGG. Low
magnification. b The °hibcrnoma' cells have
an abundant finely vacuolated cytoplasm and
centrally located uniform nuclei. MGG. High
magnification. b

Cytological features or chondroid lipoma ((Ig. 20a-d) Chondrocyte-like cells sometimes seen in the back-
Variable amount of myxo-chondroid background matrix ground matrix
Clusters or groups of mature large adipocytes mixed with Differential diagnosis
clusters or groups of uni- or rnultivacuolated lipoblast- Myxoid liposarcoma
like cells Extraskeletal myxoid chondrosarcoma
Lipoblast-like cells have irregular nuclei of varying sizes.
often lobulated or grooved

The CytuJugi.:al F.:alur.:s urSull Tissue 25

Tumours in Fine Needle Aspiration Smears
Classified According to HistolYpe
Fig. 19. Lipoblastoma. a Myxoid back-
ground with fatty vacuoles and frngmcnlS of
tightly packed small fat cells. MGG. Low
magnification. b A thin capillary strand in a
myxoid background surrounded by lipoblast-
like cells. MGG. High magnification.

Comments Extra-Adrenal Myelolipoma

In the few cases hitherto described, the bmnching capil- Extm-adrcnal myelolipoma, a tumour-like lesion composed
lary network seen in myxoid liposarcoma has not been pres- of mature fat and bone marrow cells, is mainly found in the
ent. In addition the myxoid matrix is less abundant and the adrcnals. These lesions may also arise in the pelvic region and
nuclei of the lipoblast-like cells are more irregular compared retroperitol1eum. In cytological practice myelolipoma is part of
10 the rounded slightly atypical nuclei seen in myxoid the differential diagnostic spectrum when tumour-like masses
liposarcoma. in the pelvic region or retroperitoneum are needled [72].

26 The Cytulogical Fcalures uf Suft Tissue

Tumours in Fine Needle Aspiralion Smears
Classified According to Histotype
 •

• b

,'---- d

Fig. 20. Chondroid lipoma. a Low power vicw of groups of vacuo- background. MGG. High magnificlltion. c Lipoblast-like cells.
lated cells with a partly myxoid. partly fatty background. MOG. Low MOO. High magnification. d Wet-fi....ed smear showing irregular
magnification. b A group of chondroblast-like cells in a myxohyaline nuclei with folded nuclear membranes. HE. High magnification.

The histogenesis of myelolipoma is nOl clarified. One Comment

hypothesis is that myelolipoma originates from rests of FNA smears from a myelolipoma do not differ micro-
haematopoietic stem cells. scopically from smears obtained from bone marrow of
the pelvic bones. It is thus important to make sure that
Histopathology the needle has sampled a soft tissue mass and not bone.
Myelolipomas arc composed of a mixture of mature fat Most oftcn a myclolipoma is an incidental finding on a
cells ami hone marrow cells in varying proportions. The hone CT SCali or MRI ill tile investigation of abdolllillal paiu or
marrow elements consist of erythropoietic and myelopoietic discomfort.
cells and mcgakaryocytcs.

Cytological (eatures of myelolipoma (~g. 110, b) Liposarcoma

Mature fat cells and normal bone marrow cells in varying
proportions Liposarcoma is one of the most common soft tissue
Often possible to identify bone marrow cells from all sarcomas. It has been estimated that about 20% of soft
three haematopoietic lines tissue sarcomas in adults are liposarcoma. [n the Central Soft

The Cytological Features of Soft Tissue 27

Tumours in Fine Needlc Aspiration Smears
Classificd According to Histotypc
 • -
••
•• •

Fig. 21. Extra-adrenal myelolipoma. a. b

Mature rat cells and numerous hat:matopoi·
clic cells. All three lineages are evident.
MGG. Low magnification.
• b

Tissue Sarcoma Registry of the Scandinavian Sarcoma Three large groups of liposarcomas arc identified: well-
Group (a multidisciplinary group with members from all differentiated/dedifferentiated, myxoid/round cell, and
Nordic coulitries) liposarcoma was the third moSI common pleomorphic.
sarcoma.
The majority of liposarcomas arc deep-seated, intra- or Well-Differemiated alld Dediffiremiated LiposG/Y:oma
intermuscular, and the most common sites are the extremi- Well-differentiated liposarcoma occurs most commonly
ties, trunk and retroperitoneum. in late adult life (age 60-70). About 75% are intramuscular

28 The Cytulogieal Features uf Sufi Tissue

Tumours in Fine Needle Aspiralion Smears
Classified According to HislOlype
tumours of the extremities. up 10 25% develop in the Comment
rctroperitoneum and of the remaining cases the groin and We suggest that the term atypical lipomatous tumour pro-
spermatic cord are the most frequent sites. Subcutaneous posed by Kempson et at [1] for these tumours be used by
tumours may occur in the extremities but are rare. Three sub- cytologists. As many atypical lipomatous tumours may
types of ....-ell-differentiated liposarcoma have been recog- include large areas of lipoma-like tissue. extensive sampling
nized: lipoma-like. sclerosing and inflammatory. Mixed from large tumours. especially intra-abdominal tumours. is
fonns are often diagnosed. Well-differentiated liposarcoma is imponam.
considered to be a non-metastasizing tumour and is diag- The cytoplasm of lipophagcs in fat necrosis is usually
nosed as a low-grade sarcoma. Limb tumours have a low foamy or filled with small vacuoles. The nuclei are rather
recurrence rate while retroperitoneal tumours often recur and small and not indented (scalloped).
may dedifferentiate to a high-grade sarcoma with metasta-
sizing capabilities. It is estimated that 10-15% of retroperi- Dedifferentiated Liposarcoma
toneal tumours dedifferentiate while limb tumours, mainly Histopathology
intramuscular rumours, dedifferentiate in 5--6%. Based on The dedifferentiated areas in well-differentiated liposar-
this site-dependent behaviour it has been suggested that the coma are often sharply demarcated and predominantly com-
term atypical lipoma should be used for the limb tumours posed of atypical spindle cells resembling a fibrosarcoma
but the retroperitoneal tumours should be diagnosed as or of a pleomorphic cellular population like that found in
liposarcoma. pleomorphic sarcoma of the malignant fibrous histiocytoma
The World Health Organization has suggested that the rarc (MFH) type.
subcutaneous tumours should be diagnosed as atypical
lipoma. the deep-seated limb IUmours as well-differentiated
liposarcoma/atypical lipoma and the retroperitoneal tumours Cytological feawres of dedifferentiated liposorcomo
as well-differentiated liposarcoma (73). Kempson et a1. [I) Highly atypical spindly or pleomorphic sarcoma cells.
ha\'c proposed a different lerminology: atypical lipomatous dispersed or in clusters or groups
tumour including atypical lipoma and wc1l-differcntiated Variable numbers of dusters or groups of mature fat cells
liposarcoma. The histological features are the same irrcspa:- Differential diognosis
tive of site as is the typical cytogenetic aberration (giant High-grade spindle or pleomorphic. sarcoma of another
marker and ring chromosomes). lineage

Histopathology Comment
There is a predominance of mature fat cells combined The cytological diagnosis of dedifferentiated liposarcoma
with a variable amount of atypical cells with irregular hyper- is based on the presence of mature fat cells and a highly
chromatic nuclei and multi vacuolated lipoblasts. The atypical cellular population. As these tumours are often large
lipoblasts are usually infrequent. The atypical cells are either it is important to collect material from various areas. espe-
situated among the mature fat cells or in fibrotic strands or cially from sites which arc considered non-lipomatous by
trabeculae, and are also commonly seen in the perivaseular radiographic imaging.
tissue or within the vessel walls.
Myxoid/Round Cell Liposarcoma
About 500!o of liposarcomas are diagnosed as myxoidl
Cytologicol feawres ofwelkJifferenrioted liposarcoma (~g.llo-d) round cell liposarcoma. These two variants share the same
A predominance of mature fat cells arranged in clusters cytogenetic abnormality: t( 12; 16)(q 13;p II) with fusion of
or sheets the CHOP gene on chromosome 12 with the TlS gene on
Variable presence of fusiform. rounded or polygonal. large chromosome 16.
atypical cells with irregular hyperchromatic nuclei
Rare multivacuolated lipoblaslS MYXOid Liposarcoma
Variable presence of fragments of fibrous tissue with I-listopathology
atypical cells Myxoid liposarcomas are multilobulated tumours with an
Differential diagnosis abundant myxoid matrix. A plexiform capillary vessel oct-
Upoma work is a typical finding and cellularity is rather low. The
Fat necrosis with lipophages tumour cell population is composed ofboth spindle cells and

The Cytological Features of Soft Tissue 29

Tumours in Fine Needle Aspiration Smears
Classified According 10 HistolYpe
• '-----' b

,-----:>.
Fig. 22. Wcll-difTCTCnlialcd liposarcoma (atypical lipomatous magnification. c Multivacuolatcd lipoblasls may be presenl but are
d

lumour). a Scallered large cells with hyperchromatic nuclei within a not necessary for the diagnosis. MGG. High magnification.
fragment of mature adipose tissue. HE. Low magnification. b The d Multinucleated noret cells may also be present in well-differentiated
atypical cells often have irregular, hyperchromatic nuclei. HE. High liposarcoma. HE. High magnification.

uni· or multivacuolated lipobiasis. Cellular atypia is moder- Differential diagnosis

ate and mitoses are few. Myxoid liposarcoma has been fairly Spindle cell lipoma with abundant myxoid matrix
extensively described in FNA material [16, 17,32]. Intramuscular myxoma
Low-grade myxofibrosarcoma
Cytological features of myxoid liposarcoma (fig. 230-<.)
Abundant myxoid matrix Comment
Variable number of vacuolated tumour tissue fragments The clue to the diagnosis of myxoid liposarcoma is the
with a branching netwOrk of capillary vessels diagnostic triad ofa background of abundant myxoid matrix,
Few or no dispersed tumour cells fragments of tumour tissue with a branching network of thin
Uni- or multivacuolated lipoblasts within tissue frag- capillaries, and slightly atypicallipoblasts in fragments often
ments, especially alongside capillary vessels along the capillary vessels.
Spindly or rounded tumour cells other than Iipoblasts The presence of vessels in the smears and their site and
Slight to moderate nuclear atypia size are important diagnostic criteria. In intramuscular
No mitotic figures myxoma only scal1ered vessel fragments are present in the

30 Thc r'ytological FcalllTCs of Soft TisSllC

Tumours in Fine Needle Aspiralion Smears
Classified According to Histotype
 - \
• .. . ,-..-;"':'-~""----"
• ,
• •
•• • ~I •
.". .",j. • '
• .~ • f • :';,.
• •• J.. .. -.-:-
,+ .
~ JO';'

"
....
...., ,." . ---
oO.
. . .••' . "
I" - ; ...
°
".-
'3 ...." ••• i • •
• ""'.- ••~.II\" ,••
~

. -"
~.,

... " .
o .... .
I
• ..,...
u'll· ..
+ t ' ·'t.~~
··
~,
._~

."..
'
.. ,,~
"'oO,.,.,..~
"'"

-
,I'"
.1..",....
"

4~
'"

-
,

'0'-
~ •
,-

.
."..... "J'
-..."
~
..
-
il"
110'
.....
•

..
. . • ' ..
:_ • • ": " • • 1:_
'
• b

Fig. 21. Myxoid liposarcoma. a Low power view showing the typi-
cal appearance of myxoid liposarcoma. MGG. Low magnification.
b Another low power view stained with HE. Note that the myxoid
background is less evident. Low magnil1cation. c This high pQY.'er
viC\\' shows a capillary network. muhivacuolatcd lipoblasls and
rounded tumour cells embedded in myxoid matrix. MGG. High
magnification.

myxoid background. The vessel fragments in myxofibrosar- Myxoid matrix and capillary network less conspicuous
coma are found in the background matrix and are non- than in myxoid liposarcoma
branching coarse fragments. Rounded tumour cells with scanty cytoplasm and
rounded nuclei with irregular chromatin
Round cell Liposarcoma Atypical lipoblam
Histopathology Mitoses may be found
Pure round cell Iiposllrcoma or foci of round cell liposar- Differential diagnosis
coma in myxoid liposarcoma arc composed of sheets of Other types of round cell sarcoma infiltrating adipose
rounded cells with scanty cytoplasm and rounded, atypical tissue
nuclei oOen with nucleoli. The myxoid background is lcss evi· Soft tissue metastasis of renal carcinoma
dent or absent. Atypical lipoblasts are present among the
tumour cells but may be difficult to identify. Comment
True round cell liposarcomas are rare. Most are com-
posed of both typical myxoid liposarcoma tissue and highly
Cytological features of round cell liposarcoma (fig. 240, h} cellular areas as described above. [n histopathology the
Variable proportions of dispersed tumour cells and highly terms paucicellular and cellular myxoid liposarcoma,
cellular tumour fragments respectively, have been proposed instead of myxoid and
Stripped nuclei common round cells. The metastatic potential is increased if 25% or

The Cytological Features of Soft Tissue 3\

Tumours in Fine Needle Aspiration Smears
Classified According to Histotype
Exploring the Variety of Random
Documents with Different Content
place. I was convinced that the greatest calamity that ever befell the
benighted nations of the ancient world was in their having passed
away without a knowledge of the actual existence of Duluth; that
their fabled Atlantis, never seen save by the hallowed vision of the
inspired poesy, was, in fact, but another name for Duluth; that the
golden orchard of the Hesperides, was but a poetical synonym for the
beer-gardens in the vicinity of Duluth. I was certain that Herodotus
had died a miserable death, because in all his travels and with all his
geographical research he had never heard of Duluth. I knew that if
the immortal spirit of Homer could look down from another heaven
than that created by his own celestial genius upon the long lines of
pilgrims from every nation of the earth to the gushing fountain of
poesy opened by the touch of his magic wand, if he could be
permitted to behold the vast assemblage of grand and glorious
productions of the lyric art called into being by his own inspired
strains, he would weep tears of bitter anguish that, instead of
lavishing all the stores of his mighty genius upon the fall of Illion, it
had not been his more blessed lot to crystalize in deathless song the
rising glories of Duluth. Yes, sir, had it not been for this map, kindly
furnished me by the legislature of Minnesota, I might have gone
down to my obscure and humble grave in an agony of despair,
because I could nowhere find Duluth. Had such been my melancholy
fate, I have no doubt that with the last feeble pulsation of my
breaking heart, with the last faint exhalation of my fleeting breath, I
should have whispered, “Where is Duluth?”
But, thanks to the beneficence of that band of ministering angels
who have their bright abodes in the far-off capital of Minnesota, just
as the agony of my anxiety was about to culminate in the frenzy of
despair, this blessed map was placed in my hands; and as I unfolded
it a resplendent scene of ineffable glory opened before me, such as I
imagined burst upon the enraptured vision of the wandering peri
through the opening gates of Paradise. There, there, for the first
time, my enchanted eye rested upon the ravishing word, “Duluth!”
This map, sir, is intended, as it appears from its title, to illustrate the
position of Duluth in the United States; but if gentlemen will
examine it, I think they will concur with me in the opinion, that it is
far too modest in its pretensions. It not only illustrates the position
of Duluth in the United States, but exhibits its relations with all
created things. It even goes further than this. It hits the shadowy vale
of futurity, and affords us a view of the golden prospects of Duluth
far along the dim vista of ages yet to come.
If gentlemen will examine it, they will find Duluth not only in the
center of the map, but represented in the center of a series of
concentric circles one hundred miles apart, and some of them as
much as four thousand miles in diameter, embracing alike, in their
tremendous sweep the fragrant savannas of the sunlit South and the
eternal solitudes of snow that mantle the ice-bound North. How
these circles were produced is perhaps one of those primordial
mysteries that the most skilled paleologist will never be able to
explain. But the fact is, sir, Duluth is pre-eminently a central point,
for I am told by gentlemen who have been so reckless of their own
personal safety as to venture away into those awful regions where
Duluth is supposed to be, that it is so exactly in the center of the
visible universe that the sky comes down at precisely the same
distance all around it.
I find, by reference to this map, that Duluth is situated somewhere
near the western end of Lake Superior, but as there is no dot or other
mark indicating its exact location, I am unable to say whether it is
actually confined to any particular spot, or whether “it is just lying
around there loose.” I really cannot tell whether it is one of those
ethereal creations of intellectual frostwork, more intangible than the
rose-tinted clouds of a summer sunset; one of those airy exhalations
of the speculator’s brain which, I am told, are very flitting in the form
of towns and cities along those lines of railroad, built with
government subsidies, luring the unwary settler as the mirage of the
desert lures the famishing traveler on, and ever on, until it fades
away in the darkening horizon; or whether it is a real, bona fide,
substantial city, all “staked off,” with the lots marked with their
owners’ names, like that proud commercial metropolis recently
discovered on the desirable shores of San Domingo. But, however
that may be, I am satisfied Duluth is there, or thereabouts, for I see it
stated here on the map that it is exactly thirty-nine hundred and
ninety miles from Liverpool, though I have no doubt, for the sake of
convenience, it will be moved back ten miles, so as to make the
distance an even four thousand.
Then, sir, there is the climate of Duluth, unquestionably the most
salubrious and delightful to be found anywhere on the Lord’s earth.
Now, I have always been under the impression, as I presume other
gentlemen have, that in the region around Lake Superior it was cold
enough for at least nine months in the year to freeze the smoke-stack
off a locomotive. But I see it represented on this map that Duluth is
situated exactly half way between the latitudes of Paris and Venice,
so that gentlemen who have inhaled the exhilarating air of the one,
or basked in the golden sunlight of the other, may see at a glance that
Duluth must be the place of untold delight, a terrestrial paradise,
fanned by the balmy zephyrs of an eternal spring, clothed in the
gorgeous sheen of ever blooming flowers, and vocal with the silvery
melody of nature’s choicest songsters. In fact sir, since I have seen
this map, I have no doubt that Byron was vainly endeavoring to
convey some faint conception of the delicious charms of Duluth
when his poetic soul gushed forth, in the rippling strains of that
beautiful rhapsody—
“Know ye the land of the cedar and the vine,
Whence the flowers ever blossom, the beams ever shine;
Where the light wings of Zephyr, oppressed with perfume,
Wax faint o’er the gardens of Gul in her bloom;
Where the citron and olive are fairest of fruit,
And the voice of the nightingale never is mute;
Where the tints of the earth and the hues of the sky,
In color though varied, in beauty may vie?”

As to the commercial resources of Duluth, sir, they are simply

illimitable and inexhaustible, as is shown by this map. I see it stated
here that there is a vast scope of territory, embracing an area of over
two millions of square miles, rich in every element of material wealth
and commercial prosperity, all tributary to Duluth. Look at it, sir,
(pointing to the map.) Here are inexhaustible mines of gold,
immeasurable veins of silver, impenetrable depths of boundless
forest, vast coal measures, wide extended plains of richest pasturage
—all, all embraced in this vast territory—which must, in the very
nature of things, empty the untold treasures of its commerce into the
lap of Duluth. Look at it, sir, (pointing to the map); do not you see
from these broad, brown lines drawn around this immense territory,
that the enterprising inhabitants of Duluth intend some day to
inclose it all in one vast corral, so that its commerce will be bound to
go there whether it would or not? And here, sir, (still pointing to the
map), I find within a convenient distance the Piegan Indians, which,
of all the many accessories to the glory of Duluth, I consider by far
the most inestimable. For, sir, I have been told that when the small-
pox breaks out among the women and children of the famous tribe,
as it sometimes does, they afford the finest subjects in the world for
the strategical experiments of any enterprising military hero who
desires to improve himself in the noble art of war, especially for any
valiant lieutenant-general whose
“Trenchant blade, Toledo trusty,
For want of fighting has grown rusty,
And eats into itself for lack,
Of somebody to hew and hack.”

Sir, the great conflict now raging in the Old World has presented a
phenomenon in military science unprecedented in the annals of
mankind, a phenomenon that has reversed all the traditions of the
past as it has disappointed all the expectations of the present. A great
and warlike people, renowned alike for their skill and valor, have
been swept away before the triumphant advance of an inferior foe,
like autumn stubble before a hurricane of fire. For aught I know the
next flash of electric fire that simmers along the ocean cable may tell
us that Paris, with every fibre quivering with the agony of impotent
despair, writhes beneath the conquering heel of her loathed invader.
Ere another moon shall wax and wane, the brightest star in the
galaxy of nations may fall from the zenith of her glory never to rise
again. Ere the modest violets of early spring shall ope their
beauteous eyes, the genius of civilization may chant the wailing
requiem of the proudest nationality the world has ever seen, as she
scatters her withered and tear-moistened lilies o’er the bloody tomb
of butchered France. But, sir, I wish to ask if you honestly and
candidly believe that the Dutch would have overrun the French in
that kind of style if General Sheridan had not gone over there, and
told King William and Von Moltke how he had managed to whip the
Piegan Indians.
And here, sir, recurring to this map, I find in the immediate
vicinity of the Piegans “vast herds of buffalo” and “immense fields of
rich wheat lands.” [Here the hammer fell.]
[Many cries: “Go on!” “go on!”]
 The Speaker—Is there any objection to the gentleman from
Kentucky continuing his remarks? The chair hears none. The
gentleman will proceed.
Mr. Knott—I was remarking, sir, upon these vast “wheat fields”
represented on this map in the immediate neighborhood of the
buffaloes and Piegans, and was about to say that the idea of there
being these immense wheat fields in the very heart of a wilderness,
hundreds and hundreds of miles beyond the utmost verge of
civilization, may appear to some gentlemen as rather incongruous, as
rather too great a strain on the “blankets” of veracity. But to my mind
there is no difficulty in the matter whatever. The phenomenon is very
easily accounted for. It is evident, sir, that the Piegans sowed that
wheat there and ploughed it in with buffalo bulls. Now, sir, this
fortunate combination of buffaloes and Piegans, considering their
relative positions to each other and to Duluth, as they are arranged
on this map, satisfies me that Duluth is destined to be the best
market of the world. Here, you will observe, (pointing to the map),
are the buffaloes, directly between the Piegans and Duluth; and here,
right on the road to Duluth, are the Creeks. Now, sir, when the
buffaloes are sufficiently fat from grazing on those immense wheat
fields, you see it will be the easiest thing in the world for the Piegans
to drive them on down, stay all night with their friends, the Creeks,
and go into Duluth in the morning. I think I see them, now, sir, a vast
herd of buffaloes, with their heads down, their eyes glaring, their
nostrils dilated, their tongues out, and their tails curled over their
backs, tearing along toward Duluth, with about a thousand Piegans
on their grass-bellied ponies, yelling at their heels! On they come!
And as they sweep past the Creeks, they join in the chase, and away
they all go, yelling, bellowing, ripping and tearing along, amid clouds
of dust, until the last buffalo is safely penned in the stock-yards at
Duluth.
Sir, I might stand here for hours and hours, and expatiate with
rapture upon the gorgeous prospects of Duluth, as depicted upon this
map. But human life is too short, and the time of this house far too
valuable to allow me to linger longer upon this delightful theme. I
think every gentleman upon this floor is as well satisfied as I am that
Duluth is destined to become the commercial metropolis of the
universe and that this road should be built at once. I am fully
persuaded that no patriotic representative of the American people,
who has a proper appreciation of the associated glories of Duluth and
the St. Croix, will hesitate a moment that every able-bodied female in
the land, between the ages of eighteen and forty-five, who is in favor
of “woman’s rights,” should be drafted and set to work upon this
great work without delay. Nevertheless, sir, it grieves my very soul to
be compelled to say that I cannot vote for the grant of lands provided
for in this bill.
Ah, sir, you can have no conception of the poignancy of my
anguish that I am deprived of that blessed privilege! There are two
insuperable obstacles in the way. In the first place my constituents,
for whom I am acting here, have no more interest in this road than
they have in the great question of culinary taste now, perhaps,
agitating the public mind of Dominica, as to whether the illustrious
commissioners, who recently left this capital for that free and
enlightened republic, would be better fricasseed, boiled, or roasted,
and, in the second place, these lands, which I am asked to give away,
alas, are not mine to bestow! My relation to them is simply that of
trustee to an express trust. And shall I ever betray that trust? Never,
sir! Rather perish Duluth! Perish the paragon of cities! Rather let the
freezing cyclones of the bleak northwest bury it forever beneath the
eddying sands of the raging St. Croix.
 Henry Carey’s Speech on the Rates of
Interest.

In the Pennsylvania Constitutional Convention, 1873.

In the Constitutional Convention, in Committee of the Whole on
the article reported from the Committee on Agriculture, Mining,
Manufactures, and Commerce, the first section being as follows:—“In
the absence of special contracts the legal rate of interest and discount
shall be seven per centum per annum, but special contracts for
higher or lower rates shall be lawful. All national and other banks of
issue shall be restricted to the rate of seven per centum per annum.”
Mr. H. C. Carey made an address in favor of striking out the section.
The following is an abstract of his remarks:—
Precisely a century and a half since, in 1723, the General Assembly
of Pennsylvania reduced the legal charge for the use of money from
eight to six per cent. per annum. This was a great step in the
direction of civilization, proving, as it did, that the labor of the
present was obtaining increased power over accumulations of the
past, the laborer approaching toward equality with the capitalist. At
that point it has since remained, with, however, some change in the
penalties which had been then prescribed for violations of the law.
Throughout the recent war the financial policy of the National
Government so greatly favored the money-borrower and the laborer
as to have afforded reason for believing that the actual rate of
interest was about to fall permanently below the legal one, with the
effect of speedily causing usury laws to fall into entire disuse. Since
its close, however, under a mistaken idea that such was the real road
to resumption, all the Treasury operation of favoring the money-
lender; the result exhibiting itself in the facts that combinations are
being everywhere formed for raising the price of money; that the
long loans of the past are being daily more and more superseded by
the call loans of the present; that manufacturer and merchant are
more and more fleeced by Shylocks who would gladly take “the
pound of flesh nearest the heart” from all over whom they are
enabled to obtain control.
Anxious for the perpetuation of this unhappy state of things, these
latter now invite their victims to give their aid towards leveling the
barriers by which they themselves are even yet to a considerable
extent protected, assuring them that further grant of power will be
followed by greater moderation in its exercise. Misled thereby,
money borrowers, traders, and manufacturers are seen uniting, year
after year with their common enemy in the effort at obtaining a
repeal of the laws in regard to money, under which the State has so
greatly prospered. Happily our working men, farmers, mechanics,
and laborers fail to see that advantage is likely to accrue to them
from a change whose obvious tendency is that of increasing the
power of the few who have money to lend over the many who need to
borrow; and hence it is that their Representatives at Harrisburg have
so steadily closed their ears against the siren song by which it is
sought to lead their constituents to give their aid to the work of their
own destruction.
Under these circumstances is it that we are now asked to give place
in the organic law to a provision by means of which this deplorable
system is to be made permanent, the Legislature being thereby
prohibited, be the necessity what it may, from placing any restraint
upon the few who now control the supply of the most important of all
the machinery of commerce, as against the many whose existence,
and that of their wives and children, is dependent upon the obtaining
the use thereof on such terms as shall not from year to year cause
them to become more and more mere tools in the hands of the
already rich. This being the first time in the world’s history that any
such idea has been suggested, it may be well, before determining on
its adoption, to study what has been elsewhere done in this direction,
and what has been the result.
Mr. Carey then proceeded to quote at great length from recent and
able writers the results that had followed in England from the
adoption of the proposition now before the convention. These may
be summed up as the charging of enormous rates of interest, the
London joint stock banks making dividends among their
stockholders to the extent of twenty, thirty, and almost forty per
cent., the whole of which has ultimately to be taken from the wages
of labor employed in manufactures, or in agriculture. At no time, said
Mr. Carey, in Britain’s history, have pauperism and usury traveled so
closely hand in hand together; the rich growing rich to an extent that,
till now, would have been regarded as fabulous, and the
wretchedness of the poor having grown in like proportion.
After discussing the effects of the repeal of the usury laws in some
of the American States, Mr. Carey continued:—
“We may be told, however, that at times money is abundant, and
that even so late as last summer it was difficult to obtain legal
interest. Such certainly was the case with those who desired to put it
out on call; but at that very moment those who needed to obtain the
use of money for long periods were being taxed, even on securities of
unexceptionable character, at double, or more than double, the legal
rates. The whole tendency of the existing system is in the direction of
annihilating the disposition for making those permanent loans of
money by means of which the people of other countries are enabled
to carry into effect operations tending to secure to themselves control
of the world’s commerce. Under that system there is, and there can
be, none of that stability in the price of money required for carrying
out such operations.
Leaving out of view the recent great combination for the
maintenance and perpetuation of slavery, there has been none so
powerful, none so dangerous as that which now exists among those
who, having obtained a complete control of the money power, are
laboring to obtain legal recognition of the right of capital to perfect
freedom as regards all the measures to which it may be pleased to
resort for the purpose of obtaining more perfect control over labor.
Already several of the States have to some extent yielded to the
pressure that has been brought to bear upon them. Chief among
these is Massachusetts, the usury laws having there been totally
repealed, and with the effect, says a distinguished citizen of that
State, that “all the savings institutions of the city at once raised the
rate from six to seven per cent.; those out of the city to seven and a
half and eight per cent. and there was no rate too high for the greedy.
The consequence,” as he continues, “has been disastrous to industrial
pursuits. Of farming towns in my county, more than one quarter
have diminished in population.” Rates per day have now to a great
extent, as I am assured, superseded the old rates per month or year;
two cents per day, or $7.30 per annum, having become the charge for
securities of the highest order. What, under such circumstances,
must be the rate for paper of those who, sound and solvent as they
may be, cannot furnish such security, may readily be imagined. Let
the monopoly system be maintained and the rate, even at its
headquarters, New England, will attain a far higher point than any
that has yet been reached; this, too, in despite of the fact that her
people had so promptly secured to themselves a third of the whole
circulation allowed to the 40,000,000 of the population of the Union
scattered throughout almost a continent. How greatly they value the
power that has been thus obtained is proved by the fact that to every
effort at inducing them to surrender, for advantage of the West or
South, any portion thereof, has met with resistance so determined
that nothing has been yet accomplished.
Abandonment of our present policy is strongly urged upon us for
the reason that mortgages bear in New York a higher rate of interest.
A Pennsylvanian in any of the northern counties has, as we are told,
but to cross the line to obtain the best security at seven per cent.
Why, however, is it that his neighbors find themselves compelled to
go abroad when desirous of obtaining money on such security? The
answer to this question is found in the fact that the taxation of
mortgages is there so great as to absorb from half to two-thirds of the
interest promised to be paid.
Again, we are told that Ohio legalizes “special contracts” up to
eight per cent. and, that if we would prevent the efflux of capital we
must follow in the same direction. Is there, however, in the exhibit
now made by that State, anything to warrant us in so doing? Like
Pennsylvania, she has abundant coal and ore. She has two large
cities, the one fronting on the Ohio, and the other on the lakes, giving
her more natural facilities for maintaining commerce than are
possessed by Pennsylvania; and yet, while the addition to her
population in the last decade was but 306,000, that of Pennsylvania
was 615,000. In that time she added 900 to her railroad mileage,
Pennsylvania meantime adding 2,500. While her capital engaged in
manufactures rose from 57 to 141 millions, that of Pennsylvania grew
from 109 to 406, the mere increase of the one being more than fifty
per cent. in excess of the total of the other. May we find in these
figures any evidence that capital has been attracted to Ohio by a
higher rate of interest, or repelled from our State by a lower one?
Assuredly not!
What in this direction is proposed to be done among ourselves is
shown in the section now presented for our consideration. By it the
legal rate in the absence of “special contracts” is to be raised to seven
per cent., such “contracts,” however ruinous in their character, and
whatsoever the nature of the security, are to be legalized; the only
exception to these sweeping changes being that national banks,
issuing circulating notes are to be limited to seven per cent. Shylock
asked only “the due and forfeit of his bond.” Let this section be
adopted, let him then present himself in any of our courts, can its
judge do other than decide that “the law allows it and the court
awards it,” monstrous as may have been the usury, and discreditable
as may have been the arts by means of which the unfortunate debtor
may have been entrapped? Assuredly not. Shylock, happily, was
outwitted, the bond having made no provision for taking even “one
jot of blood.” Here, the unfortunate debtor, forced by his flinty-
hearted creditor into a “special contract” utterly ruinous, may, in
view of the destruction of all hope for the future of his wife and
children, shed almost tears of blood, but they will be of no avail; yet
do we claim to live under a system whose foundation-stone exhibits
itself in the great precept from which we learn that duty requires of
us to do to others as we would that others should do unto ourselves.
By the English law the little landowner, the mechanic who owns
the house in which he lives, is protected against his wealthy
mortgagee. Here, on the contrary, the farmer, suffering under the
effects of blight or drought, and thus deprived of power to meet with
punctuality the demands of his mortgagee, is to have no protection
whatsoever. So, too, with the poor mechanic suffering temporarily by
reason of accidental incapacity for work, and, with the sheriff full in
view before him, compelled to enter into a “special contract”
doubling if not trebling, the previous rate of interest. Infamous as
may be its extortion the court may not deny the aid required for its
enforcement.
The amount now loaned on mortgage security in this State at six
per cent. is certainly not less than $400,000,000, and probably
extends to $500,000,000, a large portion of which is liable to be
called for at any moment. Let this section be adopted and we shall
almost at once witness a combined movement among mortgagees for
raising the rate of interest. Notices demanding payment will fly thick
as hail throughout the State, every holder of such security knowing
well that the greater the alarm that can be produced and the more
utter the impossibility of obtaining other moneys the larger may be
made the future rate of interest. The unfortunate mortgagor must
then accept the terms, hard as they may be, dictated to him, be they
8, 10, 12, or 20 per cent. Such, as I am assured has been the course of
things in Connecticut, where distress the most severe has been
produced by a recent abandonment by the State of the policy under
which it has in the past so greatly prospered. At this moment her
savings’ banks are engaged in compelling mortgagers to accept eight
per cent. as the present rate. How long it will be before they will carry
it up to ten or twelve, or what will be the effect, remains to be seen.
Already among ourselves the effects of the sad blunders of our great
financiers exhibit themselves in the very unpleasant fact that sheriffs’
sales are six times more numerous than they were in the period from
1861 to 1867, when the country was so severely suffering under the
waste of property, labor, and life, which had but then occurred. Let
this section be adopted, giving perfect freedom to the Shylocks of the
day, and the next half dozen years will witness the transfer, under the
sheriff’s hammer, of the larger portion of the real property of both
the city and the State. Of all the devices yet invented for the
subjugation of labor by capital, there is none that can claim to be
entitled to take precedence of that which has been now proposed for
our consideration.
Rightly styled the Keystone of the Union, one duty yet remains to
her to be performed, to wit: that of bringing about equality in the
distribution of power over that machinery for whose use men pay
interest, which is known as money. New England, being rich and
having her people concentrated within very narrow limits, has been
allowed to absorb a portion of that power fully equal to her needs,
while this State, richer still, has been so “cabined, cribbed, confined,”
that her mine and furnace operators find it difficult to obtain that
circulating medium by whose aid alone can they distribute among
their workmen their shares of the things produced.—New York,
already rich, has been allowed to absorb a fourth of the permitted
circulation, to the almost entire exclusion of the States south of
Pennsylvania and west of the Mississippi; and hence it is that her
people are enabled to levy upon those of all these latter such
enormous taxes. To the work of correcting this enormous evil
Pennsylvania should now address herself. Instead of following in the
wake of New Jersey and Connecticut, thereby giving to the monopoly
an increase of strength, let her place herself side by side with the
suffering States of the West, the South, and the Southwest,
demanding that what has been made free to New York and New
England shall be made equally free to her and them. Let her do this,
and the remedy will be secured, with such increase in the general
power for developing the wonderful resources of the Union as will
speedily make of it an iron and cloth exporting State, with such
power for retaining and controlling the precious metals as will place
it on a surer footing in that respect than any of the powers of the
Eastern world. The more rapid the societary circulation, and the
greater the facility of making exchanges from hand to hand, and
from place to place, the greater is the tendency toward reduction in
the rate of interest, toward equality in the condition of laborer and
employer, and toward growth and power to command the services of
all the metals, gold and silver included.
It will be said, however, that adoption of such measures as have
been indicated would tend to produce a general rise of prices; or, in
the words of our self-styled economists, would cause “inflation.” The
vulgar error here involved was examined some thirty years since by
an eminent British economist, and with a thoroughness never before
exhibited in reference to any other economic question whatsoever,
the result exhibiting itself in the following brief words of a highly
distinguished American one, published some twelve or fifteen years
since, to wit:
“Among the innumerable influences which go to determine the general rate of
prices, the quantity of money, or currency, is one of the least effective.”
Since then we have had a great war, in the course of which there
have been numerous and extensive changes in the price of
commodities, every one of which is clearly traceable to causes widely
different from those to which they so generally are attributed. Be
that, however, as it may, the question now before us is one of right
and justice, and not of mere expediency. North and east of
Pennsylvania eight millions of people have been allowed a greater
share of the most important of all powers, the money one, than has
been allotted to the thirty-two millions south and west of New York,
and have thus been granted a power of taxation that should be no
longer tolerated. The basis of our whole system is to be found in
equality before the law, each and every man, each and every State,
being entitled to exercise the same powers that are permitted to our
people, or other States. If the Union is to be maintained, it can be so
on no terms other than those of recognition of the existence of the
equality that has here been indicated. To the work of compelling that
recognition Pennsylvania should give herself, inscribing on her
shield the brief words fiat justitia, ruat cœlum—let justice be done
though the heavens fall!
 Speech of Gen. Simon Cameron.

On the benefits derived by Pennsylvania from the Policy of Internal

Improvements.
Any one will see, who will take the trouble to read the debates on
the location of the National Capital, that the decision of that question
seems to have been made solely with reference to a connection of the
East with the then great wilderness of the West. All the sagacious
men then in public life looked to the time when the West, with its
wonderful productive soil brought under subjection by industry,
would exercise a controlling influence on the destiny of the country.
Columbia, in the State of Pennsylvania, was at one time within one
vote of becoming the site of the Capital; and Germantown, near, and
now a part of, Philadelphia, was actually decided on as the proper
location by a majority of one. The first of these was favored because
it was believed to be a favorable point from which to begin a slack
water route to the west. Germantown near the Schuylkill, was chosen
for the same reason. All looked forward to a system of canals which
would accomplish this desirable object, and experience has fully
demonstrated their wisdom in that great design. About 1790, General
Washington and the great financier Robert Morris, traveled on
horseback from Philadelphia to the Susquehanna river, with a view
of deciding whether a canal could be built over that route.
Shortly after this, some gentlemen near Philadelphia actually
began building a canal to the west, did some work on its eastern end,
built one or two locks on the dividing ridge near Lebanon, and for
want of sufficient funds and knowledge of the subject the work was
stopped. The money expended on the enterprise was lost.
But the progressive men of the country, keeping their minds on the
subject, continued to agitate the popular mind on it until 1820, when
the Legislature of Pennsylvania chartered the Union Canal Company,
and appropriated one million dollars to aid its construction. In a few
years the canal was completed between the Schuylkill and
Susquehanna. Although very small, this improvement did a great
deal of good. And the most remarkable thing about it was its
unpopularity with the masses. Not only the members of General
Assembly who passed the bill, but Governor Heister, who signed the
act of incorporation, were driven from office at the first opportunity
legally presented for testing public opinion, and the party to which
they belonged went into a minority. I remember well what a mighty
sum a million dollars seemed to be; and the political revolution
caused by this appropriation showed me that the idea of its vastness
was not confined by any means to myself.
Our system of canals was completed, and the benefits derived from
them were incalculable. When they were commenced our State was
poor. Industry languished. The interchange of her products was
difficult. Population was sparse. Intelligence was not generally
diffused. Manufactures struggled weakly along. Work was not
plentiful. Wages were low. When they were finished the busy hum of
industry was heard on every hand. Our population had grown until
we numbered millions. Our iron ore beds were yielding their
precious hoards for human use. Coal mines, unknown or useless
until means were provided for transporting their wealth to market,
now sent millions of tons in every direction. Progress in every walk of
advanced civilization was realized, and we were on the high road to
permanent prosperity. But in the meantime a new and better means
of communication had been discovered, and the building of railroads
quickly reduced the value of canals, and the works we had completed
at so much cost, and with such infinite labor, were suddenly
superseded. We lost nearly all the money they had cost us, but this
investment was wisely made. The return to our State was many times
greater than the outlay.
Like all great projects intended for the public good, that of Internal
Improvement progressed. In 1823, the New York canal—which had
been pushed through against the prejudiced opposition of the
people, by the genius of De Witt Clinton—was opened. Its success
caused a revolution in the public mind all over the country. The
effect was so marked in the State, that in 1825 a convention was
called to consider the subject. Every county in the State was
represented, I believe. That body pronounced in favor of a grand
system of public works, which should not only connect the East and
West, but also the waters of the Susquehanna with the great lakes,
the West and the Northwest. Appropriations were recommended to
the amount of three millions of dollars, and in 1826, I think the work
began. This sum seemed to be enormous, and the estimates of the
engineers reached a total of six millions of dollars. Meeting an ardent
friend of the system one day, he declared that a sum of that
magnitude could never be expended on these works. I ventured to
reply, with great deference to his age and experience, that I thought
it would be insufficient, and before they were completed I would not
be surprised if ten millions would be found necessary. Looking at me
steadily for a few moments, he closed the conversation by
exclaiming, “Young man, you are a d——d fool!” I was thus left in full
possession of his opinion of me. But after we had spent
$41,698,594.74 in the construction of these works, I found my
estimate of his judgment was singularly in harmony with my opinion
of his politeness. His candor I never doubted.
In the convention of 1825, there were two gentlemen who voted for
railways instead of canals. One was professor Vethake of Dickinson
College, Carlisle; and the other was Jacob Alter, a man of very little
education, but of strong understanding. The professor was looked
upon as a dreamer, and was supposed to have led his colleague
astray in his vagaries. But they both lived to see railroads extended
over the whole world. As a part of our system of public works, we
built a railroad from the Delaware to the Susquehanna, from
Philadelphia to Columbia, and one from the eastern base of the
Allegheny mountains to their western base. They were originally
intended to be used with horse power. In the meantime the railroad
system had been commenced, and the Pennsylvania Railroad, under
the charge of a man of extraordinary ability, John Edgar Thompson,
was rapidly pushed to completion. Another great railway, the
Philadelphia and Reading, was built to carry anthracite coal from the
Schuylkill mines to the market. A railroad was built each side of the
Lehigh river, that another part of our coal territory might find a
market in New York. Another was built from the north branch of the
Susquehanna, connecting with the New York roads, and leading to
the northern coal field. And yet another was built along the
Susquehanna, through the southern coal basin, to the city of
Baltimore. The total cost of these roads, independent of the
Pennsylvania railroad, was $95,250,410.10, as shown by official
reports. Their earnings last year are officially given at
$24,753,065.32. Each of these was forced to contend with difficulty
and prejudice. All were unpopular, and all were looked upon with
suspicion until they actually forced their usefulness on the public
mind. Those who made the fight for canals were forced to go over the
whole ground again for railroads, and their double victory is greater
than the success generally vouchsafed to the pioneers in any cause.
These roads, with the Pennsylvania railroad and the lesser lines of
improvements running through the coal region cost over
$207,000,000.
The Reading Railroad will serve to illustrate the struggle of these
great schemes. Its stock, now worth over par, once sold for twenty
cents on the dollar; and at one time it was forced to sell its bonds at
forty cents on the dollar to pay operating expenses. The vindication
of the sagacity of the pioneers in these great enterprises is complete.
All these lines are now profitable, and it has been demonstrated
everywhere in the United States, that every new railroad creates the
business from which its stockholders receive their dividends. It
seems, therefore, scarcely possible to fix a limit to our profitable
railroad expansion. They open new fields of enterprise, and this
enterprise in turn, makes the traffic which fills the coffers of the
companies.
I cannot now look back to the struggle to impress the people with
the advantages of railways, without a feeling of weariness at the
seeming hopeless struggle, and one of merriment at the general
unbelief in our new-fangled project. Once at Elizabethtown in this
State a public meeting had been called for the purpose of securing
subscriptions to the stock of the Harrisburg and Lancaster Railroad.
This road was intended to complete the railway between
Philadelphia and Harrisburg, one hundred and five miles. A large
concourse had gathered. Ovid F. Johnson, Attorney-General of our
State, and a brilliant orator, made an excellent speech; but the effect
was not in proportion to the effort. I determined to make an appeal,
and I gave such arguments as I could. In closing I predicted that
those now listening to me would see the day when a man could
breakfast in Harrisburg, go to Philadelphia, transact a fair day’s
business there, and returning, eat his supper at home. Great
applause followed this, and some additional subscriptions. Abram
Harnly, a friend of the road, and one of the most intelligent of his
class, worked his way to me, and taking me aside whispered, “That
was a good idea about going to Philadelphia and back to Harrisburg
the same day;” and then, bursting with laughter, he added,—“But you
and I know better than that!” We lived to see the road built; and now
people can come and go over the distance twice a day, which Abram
seemed to consider impossible for a single daily trip.
The peculiar condition of the States then known as “the West” was
the subject of anxiety to many. They had attracted a large population,
but the people were exclusively devoted to agriculture. Lacking
diversified industry, they were without accumulated wealth to enable
them to build railways; nor were the States in condition to undertake
such an onerous duty, although several of them made a feeble
attempt to do so. At one time the bonds of Illinois, issued to build her
canals, sold as low as thirty cents on the dollar. So with Indiana. Both
States were supposed to be bankrupt. It became, therefore, an
important problem as to how means of communication should be
supplied to the people of the West. Congress, in 1846, gave a grant of
land to aid in building a railroad in Illinois. Every alternate section
was given to the Company, and each alternate section was reserved
by the Government. The road was built; and the one-half of the land
retained by the government sold for a great deal more than all was
worth before the road was constructed. This idea was original, I
think, with Mr. Whitney of Mass., who spent two winters in
Washington, about 1845, endeavoring to induce Congress to adopt
that plan for the construction of a Trans-Continental Railway.
He died before seeing his scheme succeed. Others have built a road
across the continent on the Central route. Another on the Northern
route is now progressing, and the wealth and enterprise of those
having it in charge renders its completion certain. And it yet remains
for us to give the people of the Southern route a road to the Pacific
which shall develop the magnificent region through which it will
pass, and give the country one route to the great ocean protected
from the ordinary difficulty of climate with which railroads must
contend over so large a part of our territory. But I am admonished by
the value of your space to confine myself to the limits of my own
State.
 I have said that the outlay we have made in building our public
works was of great benefit to us even when the canals had been
rendered almost valueless through the competition of railroads. This
is paradoxical, but it is true nevertheless. That expenditure gave our
people a needed knowledge of our vast resources. It familiarized
them with large expenditures when made for the public good. And it
showed them how a great debt may be beneficially incurred, and yet
not break down the enterprise of the people. We at one time owed
$41,698,595.74. By a steady attention to our finances, it is now
reduced to $31,000,000, with resources,—the proceeds of the sale of
public works—on hand amounting to $10,000,000. And while we
have been steadily reducing our State debt, we have built 5,384 miles
of railway on the surface of the earth, and 500 miles underground in
our mines, at a cost of not less than $350,000,000, for a mile of
railroad in Pennsylvania means something. We sent 368,000 men to
the Federal Army. And our credit stands high on every stock
exchange. Gratifying as this progress is, it is only a fair beginning.
There is a large part of our territory rich in timber and full of iron,
coal, and all kinds of mineral wealth, so entirely undeveloped by
railroads that we call it “the Wilderness.” To open it up is the
business of to-day, and I sincerely hope to see it done soon.
Forty years ago George Shoemaker, a young tavern-keeper of more
vigor and enterprise than his neighbors, came to the conclusion that
anthracite coal could be used as fuel. He went to the expense of
taking a wagon load of it to Philadelphia, a hundred miles away, and,
after peddling it about the streets for some days, was forced to give it
away, and lose his time, his labor and his coal. He afterwards saw a
great railway built to carry the same article to the same point, and
enriching thousands from the profits of the traffic. But his experience
did not end there. He saw a thousand dollars paid eagerly for an acre
of coal land, which at the time of his venture to Philadelphia, no one
would have, and he could not give away.
I have thought that a retrospective survey of our wonderful
development might point plainly to the duty of the future. For if the
experience of what has gone before is not useful to cast light on what
is yet to come, then it will be difficult indeed to discover wherein its
value lies. It teaches me to devote time and labor for the
advancement of all Public Improvements, and I trust it may have a
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