Cancer of the Lung in Infancy

Abstract

Cancer of any type is an uncommon condition in childhood or infancy. Dargeon (6) states that only 20 cases were encountered in 10,000 children admitted to St. Luke's Hospital in New York City. Primary cancer of the lung in infancy is an exceptionally rare entity. The case reported in this communication is the only example of primary lung carcinoma in an infant in over 14,000 autopsies performed at Cleveland City Hospital in the last twenty-eight years. Lund (13), in a survey of 25,000 autopsy records of the Philadelphia General Hospital from 1867 to 1933, found no instance of primary bronchogenic carcinoma occurring before the age of twenty. Fischer (7), in the Henke-Lubarsch series, reports 4 cases in children under ten years of age and 18 in patients between eleven and twenty years of age out of a total of 1,888 primary lung cancers. McAldowie (14), in 1876, was the first to report a primary cancer of the lung in a child, a five-and-a-half-month-old boy. At autopsy, a gross diagnosis of primary carcinoma of the lung was made. The bronchial lymph nodes were large and hard and were considered to be the only site of metastasis. McAldowie stated that he had been unable to find in the literature any report of primary cancer affecting the lungs at such an early age. His case cannot be considered truly authentic, however, since microscopic proof of carcinoma was not obtained. Schwyter (15), in 1928, reported a case of primary adenocarcinoma involving the entire left lung in a sixteen-month-old girl. Metastases were present in the pleura, heart, diaphragm, bronchial and bifurcation lymph nodes, and soft tissues of the back, the last thought to represent inoculation metastasis from repeated lumbar spinal punctures. The roentgenogram showed a diffuse shadow, over the whole left side of the chest, the heart shadow reaching the middle of the right lung field. The entire left lung was involved in this case with the exception of the central portion, which was the seat of compression atelectasis. Schwyter also reported a primary carcinoma of the lung in a girl of five months, originating from the lining of a cyst involving the right lower lobe. This tumor was a squamous-cell carcinoma developing in a congenital lung cyst. Beardsley (2) published in 1933 a detailed report of a case of primary adenocarcinoma of the left lung in a female infant sixteen months of age. The disease first manifested itself as a metastatic nodule, 2 cm. in diameter, in the lumbar region, when the patient was ten months old. A biopsy of this lump proved it to be adenocarcinoma. Later, recurrent carcinomatous nodes were found in this same region and were excised. Seven months following the onset of the disease, pulmonary symptoms developed. Signs of consolidation were elicited over the left chest and a firm mass measuring 2.5 cm. in diameter was present in the left supraclavicular area. A roentgenogram revealed a dense homogeneous shadow obscuring all the details in the thorax.