Spontaneous Cure of Epidermoid Carcinoma with Widespread Metastases

Abstract

A case is reported of a patient with intraepithelial (Bowenoid) carcinoma of the vulva in which spontaneous regression of the lesions occurred. A 15-year-old girl gave birth to a normal term infant with an episiotomy on August 13, 1970. She was seen on September 7 and 14 because of rupture of the episiotomy incision. There was no evidence of vulvar or perineal lesions at that time. Two months later (November 24, 1970) she returned with perineal pruritus. Examination revealed numerous 1 x 1 centimeter pigmented lesions on the posterior region of the vulva and in the perianal area. Biopsy showed Bowenoid changes in the squamous epithelium. Two months later (January 19, 1971), the appearance of the lesions was unchanged. On March 24, 1971, the patient was admitted to the hospital for tests. Chest x-ray, cytology, VDRL, pregancy tests and proctoscopic examinations were all negative. Biopsy was performed and reconfirmed the Bowenoid atypia. No virus could be recovered from the lesions. On May 18, 1971, upon re-examination, there was a change in the appearance of the perineal lesions. Biopsy showed hyperkeratosis and nonspecific chronic vulvitis, no Bowenoid atypia. Repeat biopsies have continued to show chronic vulvitis. The patient had no evidence of infection with Herpes virus hominis type 2. (Permission to reproduce case report denied by author.)

Case Details

Personal Characteristics

40-year-old truck driver, smoker, moderate drinker, weight 148 pounds, height 66 inches

Clinical Characteristics

Low back pain radiating to the left leg, dull pain in the left arm, forearm and shoulder, mass in right inguinal region, hard nodular mass in the right inguinal region, small cervical lymph node, enlarged left inguinal lymph node, enlarged, hard bilateral epitrochlear and axillary lymph nodes, neutrophilic leukocytosis of 12,450, atrophied and weak left leg muscles, degenerated disc between l-4 and l-5, erythrocyte sedimentation rate within normal range, leukocytosis of 11,500 with 7 eosinophils, hemoglobin 16.4 gm/100 ml

Remission Characteristics

Almost complete disappearance of the glands, reactive hyperplasia found in re-biopsy of the original site

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Heat and traction, body cast, laminectomy, surgical removal of nodes from right inguinal region, physical therapy

Additional Notes

Patient was discharged without treatment of any kind, as it was decided to keep him under observation. The patient’s wife was appraised of the diagnosis and prognosis. She did not inform the patient who to this day is unaware of his condition.