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Cervical cancer with metastasis to breast
CERVICAL CANCER WITH META&TASIS TO BREAST l\LD., AKD ARTHlJR V. GREELEY, M.D., NEw YoRK, (Front the Gynecological Service of the Rooset•elt HospitaJ)
HAROLD SPEERT,
N. Y.
M
AMMARY metastasis from rareinomu of the uterine N!rvix iH either exceedingly rare or it has been overlooked. 'I'he literature containH seveml reports of cases in which malignant tumors appear·cd independently in the breast and cervix of the same patient (Smith and Bartlett, 1929; Cordua, 192n. 1936; Taylor, 1931; Schreiner and Wehr, 1934; Hellendall, 1935; FernandezColmeiro, 1946; Taylor and Guyer, 1946). A ease has also been recorded in which a probable metastasis to the cervix oeeurred in a woman with a primar~· mammary lesion ( Esch, 1929). We have heen able to find references to only four cases, however, of primary cerviral cancer associated with metastatic tumor in the breast. Three of these were mentioned briefl.v hy C. Schroeder (1887) in a review of the previously published papers of six other authors. The fourth appeared in a summary of the material in the Pathological Institute at Kiel between 1914 and 1918 (Petzold, 1922). ln none was the rase described nor were photographs shown. More recent studies of the sites of metastases from eervieal carcinoma fail to list the breast among the organs affected. Among thE'se studies are Meigs· !'eport ( 1934) of 396 cervical eancers, and Oricouroff's analysis ( 1942) of 2,07rvix l'evealecl epidermoid carcinoma (Fig. 1). A course of sixteen deep x-ray treatments was given between O<•t. 1 and Nov. 5, 1945, the patient receiving 1,500 roentgen units to each of fom pelvie portals. On Nov. 4, 1945, 140 mg·. of radium was applied in and against the cervix for a total dose of 8,000 mg. hours. The patient was hospitalized again from March 5 to 15, 1946, beeause of pelvie pain and dysuria. Roentgenogram of the chest and intravenous P.'-'elogram were negative. A mild cystitis responded to treatment with sulfadiazine and penicillin. She was readmitted on May 13, 1946, because of a sudden profuse vaginal hemorrhage, for which she was treated with vaginal packing and blood transfusion. Her final admission to Roosevelt Hospital was Nov. 15, to Der. 14, 1946, when she complained of severe low back pain. The patient had lost mueh weight and appeared chronically ill. General physieal examination was essentially negative, save for enlarged left supraclavicular lymph nodes and a small firm nodule, about 1 em. in diameter, in the upper outer quadrant of the left breast. The tumor was superficial. but not attached to the skin. Pelvic examination revealed no evidence of the previously existent cervical tumor. Roentgenograms of the skull l;lh~;>wed
two areas of decreased density which were interpreted as metastases. 894
Volume 55 Number 5
METASTASIS FROM CERYICAL CANCER
Fig. !.-Cervical carcinoma.
Fig. :?.-Me t ast asis in left breast .
895
896
SPEER'!'
A~D
GREELEY
Am . .T. Obst. & Gyncc. May, 1948
Biopsy of the nodule in the left b1·eat>t waH performed on De1·. o, Ul46. Pathologic report was ··metastatic epidermoid carcinoma in the breat>t · · (Fig. 2 1. The histologic appearanee of this tumor was identi(·al to that of the original eervical biopsy. Unsuccessful efforts were made to control the patient's back pain with large doses of testosterone propionate (50 mg. daily) and with cobra Yenom. Requiring constant narcosis, she was tmnsferred to a home for t0rminal eat·e. where she died about Peb. 1. 1947. Metastatic tumors of the breast are rare. Da·wson was able to eollcct onlv ten cases from the literature in 1936 and added one of her own, a gastric cal:cinoma. This, thr.n, represent:-; the twelfth reported case of metastatic carcinoma in the ln·east. The infrequene~· of eareinomatous metastasis to this organ was responsible in part for Virehow's generalization (1863), long since disproved, that most organs whi(•h show a strong disposition to the development of primary malignant tumors are seldom the sitE' of a secondary tumor.
References Cordua, R.: Zentralbl. f. Gynak. 53: 1/11-1/L'l, 19:2H. Cordua, R.: Zentralbl. f. Gynak. 60: 322, 19:i6. Dawson, E. K.: J. Path. & Bact. 43: 53-(iO, 193<). Esch: Zentralbl. f. Gynak. 56: 556·558, 19:20. Fernandez-Colmeiro, J. M.: Bull. assoc. fraw;. p. l '(•tude clu <'Hlll'l'r 33: lti-:15, 1!146. Gricouroff, G.: Bull. assoc. fran~. p. 1 'etude du cancer 30: 90-.117, 1H4:2. Hellen.dall, H.: Zentralbl. f. Gynak. 59: 2554-2560, 1935. Hellendall, H. Nochmals: Zentralhl. f. Gynak. 61: 1642-1645, 103i. Meigs, J. V.: 'l'umors of the l<'emale Pelvie Org-ans, New York, 19:14, 'l'he Macmillan Co. Petzold, H.: Ztschr. f. Krehsforsch. 19: 24•i·262, 1922. Schreiner, B. F ..• and Wehr, W. H.: Am .•T. Cancer 20: 418-424, 1934. Schroeder, C.: Handbuch der KrankheitPn der W t•iblichen Ge8chlechtsorgane, ed. 8, Leipzig, 188i, pp. 202-2!):1. r'. C. W. Yog-el. Smith, G. V. S., and Bartlett, M. K.: Surg., GynPc. & Obst. 48: :114-320, 1929. Taylor, H. C., Jr.: Am. J. CancPr 15: 277·27!l, 19:11. Taylor, H. C., Jr., and Guyer, H.: A:vr. J. OllsT. & GYNEc. 52: 451-455, 1946. Virchow, R.: Die Krankhaften Gesclmiil~tt>, Berlin 1: 69, 1863.
X ole.-A n•(·ent tabulation of the sites of metastas
STREET
HAROLD SPEERT,
N. Y.
M
AMMARY metastasis from rareinomu of the uterine N!rvix iH either exceedingly rare or it has been overlooked. 'I'he literature containH seveml reports of cases in which malignant tumors appear·cd independently in the breast and cervix of the same patient (Smith and Bartlett, 1929; Cordua, 192n. 1936; Taylor, 1931; Schreiner and Wehr, 1934; Hellendall, 1935; FernandezColmeiro, 1946; Taylor and Guyer, 1946). A ease has also been recorded in which a probable metastasis to the cervix oeeurred in a woman with a primar~· mammary lesion ( Esch, 1929). We have heen able to find references to only four cases, however, of primary cerviral cancer associated with metastatic tumor in the breast. Three of these were mentioned briefl.v hy C. Schroeder (1887) in a review of the previously published papers of six other authors. The fourth appeared in a summary of the material in the Pathological Institute at Kiel between 1914 and 1918 (Petzold, 1922). ln none was the rase described nor were photographs shown. More recent studies of the sites of metastases from eervieal carcinoma fail to list the breast among the organs affected. Among thE'se studies are Meigs· !'eport ( 1934) of 396 cervical eancers, and Oricouroff's analysis ( 1942) of 2,07rvix l'evealecl epidermoid carcinoma (Fig. 1). A course of sixteen deep x-ray treatments was given between O<•t. 1 and Nov. 5, 1945, the patient receiving 1,500 roentgen units to each of fom pelvie portals. On Nov. 4, 1945, 140 mg·. of radium was applied in and against the cervix for a total dose of 8,000 mg. hours. The patient was hospitalized again from March 5 to 15, 1946, beeause of pelvie pain and dysuria. Roentgenogram of the chest and intravenous P.'-'elogram were negative. A mild cystitis responded to treatment with sulfadiazine and penicillin. She was readmitted on May 13, 1946, because of a sudden profuse vaginal hemorrhage, for which she was treated with vaginal packing and blood transfusion. Her final admission to Roosevelt Hospital was Nov. 15, to Der. 14, 1946, when she complained of severe low back pain. The patient had lost mueh weight and appeared chronically ill. General physieal examination was essentially negative, save for enlarged left supraclavicular lymph nodes and a small firm nodule, about 1 em. in diameter, in the upper outer quadrant of the left breast. The tumor was superficial. but not attached to the skin. Pelvic examination revealed no evidence of the previously existent cervical tumor. Roentgenograms of the skull l;lh~;>wed
two areas of decreased density which were interpreted as metastases. 894
Volume 55 Number 5
METASTASIS FROM CERYICAL CANCER
Fig. !.-Cervical carcinoma.
Fig. :?.-Me t ast asis in left breast .
895
896
SPEER'!'
A~D
GREELEY
Am . .T. Obst. & Gyncc. May, 1948
Biopsy of the nodule in the left b1·eat>t waH performed on De1·. o, Ul46. Pathologic report was ··metastatic epidermoid carcinoma in the breat>t · · (Fig. 2 1. The histologic appearanee of this tumor was identi(·al to that of the original eervical biopsy. Unsuccessful efforts were made to control the patient's back pain with large doses of testosterone propionate (50 mg. daily) and with cobra Yenom. Requiring constant narcosis, she was tmnsferred to a home for t0rminal eat·e. where she died about Peb. 1. 1947. Metastatic tumors of the breast are rare. Da·wson was able to eollcct onlv ten cases from the literature in 1936 and added one of her own, a gastric cal:cinoma. This, thr.n, represent:-; the twelfth reported case of metastatic carcinoma in the ln·east. The infrequene~· of eareinomatous metastasis to this organ was responsible in part for Virehow's generalization (1863), long since disproved, that most organs whi(•h show a strong disposition to the development of primary malignant tumors are seldom the sitE' of a secondary tumor.
References Cordua, R.: Zentralbl. f. Gynak. 53: 1/11-1/L'l, 19:2H. Cordua, R.: Zentralbl. f. Gynak. 60: 322, 19:i6. Dawson, E. K.: J. Path. & Bact. 43: 53-(iO, 193<). Esch: Zentralbl. f. Gynak. 56: 556·558, 19:20. Fernandez-Colmeiro, J. M.: Bull. assoc. fraw;. p. l '(•tude clu <'Hlll'l'r 33: lti-:15, 1!146. Gricouroff, G.: Bull. assoc. fran~. p. 1 'etude du cancer 30: 90-.117, 1H4:2. Hellen.dall, H.: Zentralbl. f. Gynak. 59: 2554-2560, 1935. Hellendall, H. Nochmals: Zentralhl. f. Gynak. 61: 1642-1645, 103i. Meigs, J. V.: 'l'umors of the l<'emale Pelvie Org-ans, New York, 19:14, 'l'he Macmillan Co. Petzold, H.: Ztschr. f. Krehsforsch. 19: 24•i·262, 1922. Schreiner, B. F ..• and Wehr, W. H.: Am .•T. Cancer 20: 418-424, 1934. Schroeder, C.: Handbuch der KrankheitPn der W t•iblichen Ge8chlechtsorgane, ed. 8, Leipzig, 188i, pp. 202-2!):1. r'. C. W. Yog-el. Smith, G. V. S., and Bartlett, M. K.: Surg., GynPc. & Obst. 48: :114-320, 1929. Taylor, H. C., Jr.: Am. J. CancPr 15: 277·27!l, 19:11. Taylor, H. C., Jr., and Guyer, H.: A:vr. J. OllsT. & GYNEc. 52: 451-455, 1946. Virchow, R.: Die Krankhaften Gesclmiil~tt>, Berlin 1: 69, 1863.
X ole.-A n•(·ent tabulation of the sites of metastas
STREET