Accidental Trauma and Tumor Metastasis

Abstract

Among the numerous reports on the subject of trauma and cancer, few deal with the relationship of accidental injury and metastatic deposits, and such opinions as are expressed are confusing and contradictory. Any clinical or experimental observation contributing to the clarification of this unsettled problem is therefore worthy of presentation. The matter is especially important from the medicolegal standpoint. Many cases involving this question reach the higher courts partly because of contradictory medical testimonies and partly because of the large sums of money involved. Two cases are presented with contributory clinical and experimental data. Case Reports Case 1: F. D., white male, age 55, was admitted to the St. Francis Hospital (Olean, N. Y.) on March 23, 1942, because of injuries. On the day of admission, while the patient was helping unload parts from a box car, the bed section of a scavenger hooked onto the crane tipped over and fell against him, damaging his right arm especially. He suffered severe injuries of the right wrist and forearm, with lacerations along the radial and flexor surfaces, as well as brush burns of the right thigh and leg, with a fairly deep laceration at the lower lateral aspect of the right thigh, a few inches above the knee joint. A slightly painful sprain of the left thumb was also present. Four sutures were inserted to close the largest laceration of the right forearm. On the day of admission, the patient's temperature was 98° F., pulse 80, respiration 20. The physical examination revealed nothing of significance except for the injuries mentioned above. The blood count showed 4,000,000 red cells, 84 per cent hemoglobin, and 7,400 white cells with 80 per cent poly-morphonuclears. The urinary findings were essentially normal. Roentgenograms of the right wrist region, made on the following day, showed a slightly comminuted oblique fracture of the radius about an inch above the articular surface, probably not involving the latter. There was moderate angulation of the major fragments dorsally; otherwise they were in good position and alignment. Save for a small, apparently old ununited chip fracture of the radial styloid process, there was no evidence of a bone lesion. Small pockets and streaks of gas were noticed in the subcutaneous tissues of the radial aspect of the forearm. The soft tissues were moderately and diffusely swollen, as usually occurs with this type of trauma (Fig. 1). Under intravenous anesthesia with pentothal sodium (given into the left cubital vein), reduction of the right radial fracture was attempted by traction and angulation of the distal fragment. A cast was applied, extending to the arm, with the elbow at 90° flexion. On the same day a soft pedunculated tumor, about 2 cm. in diameter, was removed from the flexor surface of the left forearm by knife dissection.