Pulmonary Metastasis: A Pathologic, Clinical, Roentgenologic Study Based on 78 Cases Seen at Necropsy

Abstract

IN THE ten-year period from November, 1924, to November, 1934, pulmonary metastasis was found in 78 patients coming to autopsy at the Jefferson Hospital. Many of the patients had had roentgenograms of the chest made prior to death; this study is based on the x-ray findings, the necropsy protocols, and the clinical histories. Most of the necropsies were performed by Dr. Baxter L. Crawford, Pathologist to the hospital, or his assistant, Dr. Carl J. Bucher, though some were performed by other members of the staff. Type of Primary Tumor.—Sixty-one, or 78 per cent, of the primary tumors were classified as carcinoma; 12, or 15.3 per cent, as sarcoma; two, or 2.4 per cent, as melanoma; one as an endothelioma; one as a teratoma, and one as a thymic tumor (Table I). Site of the Primary Tumor.—The site of the primary tumor was determinable in all but five instances; the 56 carcinomas in which it was determined may be classified under six systems (Table II). The breast was the primary site in seven, or 11.4 per cent of the cases; the ductless glands in four, or 6.5 per cent; the generative organs in eight, or 13 per cent; the respiratory tract in seven, or 11.4 per cent, and the urinary organs in nine, or 14.7 per cent. In four cases it was impossible to determine the primary site, and in one the necropsy was limited to the thorax. The large number arising from the gastro-intestinal tract (21, or 34.4 per cent) is of interest, and it should be noted that none had origin distal to the duodenum. In spite of the fact that the large intestines, notably the rectum, sigmoid, and descending colon are frequently the site of primary malignant disease, none of the cases in this series were from tumors arising at these sites. One-third, or 7 per cent, of the metastasizing carcinomas of the gastro-intestinal tract had their origin in the stomach. Three were classified as adenocarcinoma, one as colloid, and one as anaplastic; in the other two the histologic structure was not specified. The widely recognized high incidence of pulmonary metastasis from malignancy of the prostate is confirmed in this study. Of the seven cancers arising in the male generative organs, six arose in the prostate. Analysis of the sarcomas is not so informative because of the small number of cases. The 12 sarcomas were classified according to origin as arising in the frontal sinus, neck, chest-wall, thigh, leg, lung, pleura, spleen, or uterus. According to the histologic type, they were classified as round-cell, spindle-cell, mixed-cell, lymphosarcoma, metastatic melanotic sarcoma, myosarcoma of the uterus, and sarcomatosis. Extent of Metastasis.—In nine, or 14.7 per cent, of the carcinomas, metastasis was limited to the lungs.