Multiple Primary Carcinomata Simultaneously Involving the Alimentary Tract

Abstract

MULTIPLE primary carcinomata of the alimentary tract are sufficiently uncommon to stimulate interest in a review of the literature. That such may exist in one or more organs has been proven by autopsies in some of the reported cases. In a thesis by Pierre Bernard, he cites, among a number of autopsies, that of a man, aged 77 years, who had primary cancer of the esophagus and primary cancer of the ampulla of Vater. It is interesting to note that Billroth emphasized three factors essential for the consideration of multiple primary carcinomata, namely: each must be of a different histological structure; each must spring independently from epithelium of basic surface, and each must make its own metastasis. These three conditions have been held too rigid by some authors. Ruben states as follows: “We have found the following statistics as to the frequency of multiple primary carcinomata. In 507 autopsies on patients dying with carcinoma, Feilchenfeld found not less than 10, or 2 per cent, with multiple primary carcinomata; Hansemann in 1,000 autopsies found only 5, or 0.5 per cent; Redlich found the same percentage; in 711 cases, Riechelmann found only 2 cases, or 0.3 per cent. Still these figures show that the possibility of two different carcinomata in the same patient is something the surgeon should bear in mind. With the exception of carcinoma of both breasts, which is the most common of the multiple primary carcinomata, the surgeon seldom finds multiple primary tumors.” Rosenbach cites the autopsy of a man, aged 65 years, in whom were found two primary carcinomata, one of the esophagus and the other a typical adenomatous carcinoma of the pylorus. He concludes by stating that both formed metastases, chiefly that of the esophagus. While fulfilling one of the essential factors of Billroth but not entirely confined to the alimentary tract, M. Lannois and Paul Courmont give an instance of a case, reported by Kretz, of an endothelioma of the dura mater and a cancer of the esophagus, with metastases to the femur, where were found two metastatic nuclei, the one coming from the endothelioma and the other from the esophageal cancer. A. Renaudquotes Göttingen as to a case of triple primary cancers existing simultaneously, consisting of squamous-cell carcinoma of the pharynx, adeno-carcinoma of the rectum, and medullary carcinoma of the stomach. Carman reports a case of double carcinomata of the colon in a male, aged 54 years, in whom at operation were found carcinoma of the descending colon and carcinoma of the sigmoid. Both were visualized as filling defects in the roentgenogram.