Regression and Calcareous Degeneration of Carcinoma

Abstract

Chorionepithelioma has long been considered a rare malignancy, and it remains one of the most challenging disease entities in medicine. Since the condition was first recognized by Sanger in 1889, the literature reveals numerous case reports which emphasize the difficulties of diagnosis and of prognosticating the clinical course in a given patient. Complete spontaneous regression of proved cancer is extremely rare (or nonexistent). Possible exceptions occur in chorionepithelioma. Even in this disease the reported instances of regression are rare. A case is presented in which complete spontaneous regression of chorionepithelioma and pulmonary metastases occurred. This case is presented, not to confuse the literature further, but rather to emphasize a phase of this disease which occasionally takes place.

Case Details

Personal Characteristics

Patient was a nullipara, aged thirty-three, but looked much older. No history of any pelvic inflammation, syphilis, gonorrhea, or tuberculosis. Physical examination showed heart, lungs, kidneys, urine, liver normal; spleen not enlarged; upper abdomen normal.

Clinical Characteristics

Uterus was immovable in the pelvis with the fundus extending about two inches above the pubis and rough, irregular, and nodular in outline. Bimanual examination caused bleeding. On opening the abdomen the fundus of the uterus was found enlarged and nodular, the nodules presenting the granular roughness and yellow-pink appearance common in carcinoma. These masses extended into the broad ligaments and to adherent coils of intestine and omentum. The accessible pelvic glands were enlarged.

Remission Characteristics

Instead of growing worse she improved for a time. On june 25, 1903, four and a half years later, she came into my office. She was thin, pale, and weak. The lower abdomen occupied by a hard, irregular mass and above this many hard, irregular, movable bodies of varying size. The vagina filled with a soft, friable, easily bleeding mass, whose base could not be reached, which distended the canal and came down to the perineum.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Exploratory abdominal section. The abdomen was closed after having removed a small nodule for examination. The microscopic examination of this nodule showed carcinoma of the glandular type.

Additional Notes

The patient was operated on by an irregular in Brooklyn, who guaranteed to cure her for $1400, and she was operated on by him by way of the vagina. She did not know what was done but thought her womb was removed. She was not cured, however, and had come back to me for an examination and an opinion.