Chinese Medical Journal

64 THE CHINESE MEDICAL JOURNAL

On the night of the eighteenth day after admission, the patient woke up with an excruciating pain caused by a pathological fracture in the right humerus. Seven days later, he vomited about 75 cc coffee ground substance, which was acidic in reaction. On November 10, 1952, he died after another attack of massive hemorrhage. Our diagnosis was carcinoma of the stomach with metastasis to the right humerus.

CAsE 38. W. A. T., a woman farmer of 33 years of age was admitted on March 5, 1955 complaining of soreness in the lumbar region for eight months and two movable masses in the lower abdomen for two months. Nine months prior to admission, the soreness became incapacitating although it was relieved after resi. Three months later, pain occurred in the cervical and the shoulder regions. The two movable masses in the lower abdomen had grown to the level of the umbilicus. Some four months prior to admission she had occasionally tarry stool but no other gastrointestinal symptoms.

The patient appeared healthy. Two oval-shaped movable masses with nodular surface were felt at the left upper and the right lower abdomen. The left mass was bigger than the right. Multiple skin nodules were noticed over the scalp, axilla, and the upper abdomen. The inguinal glands on both sides were palpable. Both pelvic and rectal examinations revealed that the masses occupied the pelvic cavity. Roentgenogram of the stomach showed a large filling defect at the pyloric antrum along the greater curvature. Filling of the duodenum cap was normal. Roentgenogram of the chest was negative, except for some obliteration of the left phrenic angle. Scouting films of bones revealed multiple circumscribed osteolytic lesions with moth-eaten appearance in the humeri, radii, ulnae, necks of scapulae, femora, ribs, vertebral bodies and the skull. :

The red cell count was 2,020,000 per cu mm, hemoglobin was 6.5 gm per cent, and immature red cells were found. Blood Wassermann reaction was negative, Alkaline phosphatase was 82.8 King-Armstrong units and acid phosphatase was 4.95 King-Armstrong units. Urinalysis was negative. Stool for occult blood was 2 plus. Biopsy of the skin nodule revealed groups of cancer cells with presence of mitotic figures. The smear of the aspirated material from the right ilium revealed clusters of tumor cells of varying sizes and shapes. Signet ring cells could also be seen.

The patient was discharged on March 17, 1955 but did not return for follow up. Our diagnosis was carcinoma of the stomach with Krukenberg’s tumor of both ovaries and wide-spread bone metastases.

DISCUSSION

Our 2 cases of carcinoma of the stomach and 1 case of carcinoma of the rectum with metastases to the humerus were diagnosed either by roentgenography or by biopsy. Though we were not able to perform necropsy, the clinical evidence was strong enough to determine the primary site of malignancy. Case 1 was proved by biopsy from the rectum and aspiration biopsy from the humerus. The metastatic lesion of Case 2 was also proved by biopsy from the humerus, while the clinical picture, gastric analysis and the roentgenogram of the stomach were consistent with our diagnosis of carcinoma of the stomach. Case 3 had multiple foci of metastases in the skeleton and the aspiration biopsy from the right ilium