Regression of Pulmonary Metastases of a Breast Cancer

Abstract

Spontaneous regression of breast carcinoma occurred in a patient with a malignant pleural effusion and bone metastases. The patient did not receive any form of hormonal manipulation or systemic chemotherapy. It is postulated that the spontaneous regression of the carcinoma may have been caused by immunological factors.

Case Details

Personal Characteristics

The patient was first seen at the roswell park memorial institute on october 10, 1956, at the age of 65.

Clinical Characteristics

She was referred here for the diagnosis and treatment of a mass in the right breast and axilla, a mass that had been noticed “about 2 months” before admission. Physical examination at that time revealed a firm nodular mass in the right breast at about 12 o’clock, with retraction of the nipple. Just posterior to the anterior axillary fold, there was a 2 centimeter mass, firm, nontender, and fixed to the skin. In the left breast at about 1 o’clock there was a 2 centimeter firm mass, also with skin retraction. No axillary mass was palpable on the left side. The clinical impression was one of bilateral carcinoma of the breast with right axillary metastasis. Preoperative x-ray examination of the lungs revealed a large nodular density in the right lower lung field, suggestive of a metastatic lesion.

Remission Characteristics

About 2 months after the operation, the lesion in the right lower lung field showed a marked diminution in size. Four months after the operation, the mass completely disappeared. Repeat chest films were taken at 2 month intervals thereafter. No evidence of any recurrence of the pulmonary lesion was noticed until june 1958, at which time the previously observed nodular lesion again became visible. In january 1959, the same lesion in the right lower lung field increased in size markedly, and, in addition, nodular lesions were also seen in the right upper middle lung field. By august 1959, bilateral pulmonary metastases were observed. Three months after the adrenalectomy, the patient had a spectacular response, the pulmonary lesions in the right and left lower lung fields completely disappearing. The patient continued to show regression of the pulmonary metastases until february 1961, 17 months after the adrenalectomy, when slight progression of the pulmonary metastases was again observed.

Treatment & Mechanisms

Proposed Remission Mechanisms

The highly hormone-dependent mammary cancer in this patient led me to suggest that the alteration of adrenal cortical activity following a two-stage bilateral radical mastectomy, rather than the host defense factor, was involved in the spontaneous regression of the pulmonary metastases.

Clinical Treatment

A right radical mastectomy was performed first, and after an interval of 10 days, a left radical mastectomy. Histological examination of the right breast revealed duct carcinoma with metastases to 13 of the 18 axillary lymph nodes removed, and that of the left breast a moderately well-differentiated carcinoma. In view of the marked progression of the disease, a bilateral adrenalectomy was performed on september 22, 1959.

Additional Notes

Despite progression of disease, the patient is still asymptomatic, and is living and well at the time of this report.