I. UNION FOLLOWING PATHOLOGICAL FRACTURE OF THE FEMUR DUE TO SECONDARY CARCINOMA. II. SPONTANEOUS DISAPPEARANCE OF CARCINOMA OF THE LIP
Journal of the American Medical Association (JAMA)
Spontaneous fractures have long been known to occur occasionally in the presence of carcinomata of various portions of the body. Particularly is this true of the harder varieties of carcinoma of the breast. Too much stress must not be placed, however, upon the older reports, because carcinoma and osteosarcoma were formerly confused under the generic term of "bone cancer." It is generally admitted that these fractures may be due to metastasis or to abnormal fragility of the bones. The latter
... nes. The latter does not depend on the presence of carcinoma elements, but upon the development of a more or less general, simple osteoporosis, intimately but obscurely associated with the existence of the primary carcinoma, Richet and Verneuil being inclined to connect the phenomenon with the phosphaturia often existing in the later stages of carcinoma. The bone most frequently broken is the femur, the humerus coming next, while multiple fractures are sometimes met with. In spite of the peculiar nature of the accident, union occasionally takes place, and it would perhaps he seen more often if the average duration of life subsequent to the injury were greater. In cases of simple osteoporosis repair is not infrequent, but it is extremely rare in the presence of secondary carcinoma. Ricard1 even insists that but one unquestionable instance has been recorded (Krister) ; while Cornil and Ranvier2 seem to doubt its occurrence at all. These, however, are extreme views. Gurlt3 has collected thirty-eight cases of spontaneous fracture in cancerous individuals-3 men, 35 womenamong which were ten instances of union, apparently a remarkably large proportion. But, as Ricard justly remarks, it is impossible to say in how many of these simple fragility existed without the local presence of malignant deposits. In August. 1897, I examined a well-developed Swedish woman, aged about 35 years. There was a firm carcinomatous nodule of moderate size in the upper outer quadrant of the right breast, which had attracted the patient's attention some six weeks previously. The axillary glands were enlarged and the skin slightly adherent, although the nipple was not sunken. In operating, I removed the entire breast, a considerable portion of the pectoral muscles, including all the fascia, and the entire axillary contents. Union was by first intention. The growth soon returned locally, although I did not see the patient again until April, 1898. I again operated, removing the remainder of both pectorals and a portion of rib, which appeared to be slightly involved, and skin grafted the large denuded surface. The patient returned during the following August, about one year from the time of the first operation. There was no local recurrence, but severe pain existed in the dorsolumbar region, and especially over the left kidney posteriorly and the left external surface of the pelvis. In turning over in bed the left femur broke at the level of the lesser trochanter, producing marked shortening and deformity. There had been no pain or tenderness as low down as this, and nothing to call attention to the process going on within the bone.