Chinese Medical Journal

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METASTATIC CARCINOMA OF HUMERUS ~ 63

REPORT OF CASES

Case 1. GC. T. S., a male electrician, aged 54, came to the hospital on July 16, 1952 after a sudden onset of severe pain in his right arm two hours before admission. He was unable to move his right arm after attempting to throw an electric cable up a pole. In the summer of 1951 he fell from a bicycle. Since then he had occasionally experienced soreness in the right shoulder. He had constipation and tarry stool for five years. i

Examination showed that the patient was well developed. The right humerus was found to be fractured. On rectal examination, a mass was found 1% inches above the anal opening. Proctoscopic examination revealed a hard irregular mass inyolving the posterior wall and the right side of the rectum. Roentgenogram of the right humerus taken immediately after admission revealed a transverse fracture at the junction between the upper and the middle third without much displacement. There was bony destruction. Roentgenogram of the chest was negative.

The blood picture was within normal limit. The sedimentation rate was 25 mm at the end of one hour (Westergren method). The value of alkaline phosphatase was 2.6 Bodansky units. Findings of urinalysis and the Wassermann reaction were

negative. Result of examination of stool for occult blood was strongly positive.

Biopsy of the rectal lesion (Fig. 1A) revealed large groups of tumor cells of unequal sizes. Some of them were hyperchromatic while most of them were vacuolated with their nuclei pushed to one side forming signet ring cells. A smear (Fig. 1B) of the aspirated material from the site of fracture of the humerus consisted of a large number of round or polyhedral tumor cells with large hyperchromatic nuclei. These tumor cells were of unequal sizes and were scattered in groups among large numbers of red blood cells. ;

The patient returned to the hospital three months later. Further roentgenological examination of the right humerus showed generalized bony absorption with marked destruction. He died on May 18, 1953, ten months after the first visit. Our diagnosis was carcinoma of the rectum with metastasis to the right humerus.

Case 2. S. M. Y., a male worker, aged 59, was admitted on October 13, 1952, complaining of intermittent soreness and pain in the right shoulder for one month. There was a history of gastric disturbance with tarry stool for four years and also venereal exposures.

The patient was well developed. There was severe tenderness at the middle third of the right arm, which presented no local swelling or reddening. Roentgenogram of the right humerus revealed an osteolytic lesion in the shaft with little periosteal reaction and that of the stomach showed a filling defect in the antrum. The chest film showed normal lungs.

The blood picture was normal. Alkaline phosphatase was 7.2 King-Armstrong units. The total cell count of the cerebrospinal fluid was 67 per cu mm with 12 per cent polymorphonuclear cells and 88 per cent lymphocytes. Pandy’s test was 2 plus; the sugar was 80 mg per cent and the Wassermann reaction was negative. Gastric analysis showed high acidity, the free acid being 60 units and the total acid 112 units. Sections (Figs. 2A and 2B) prepared from the biopsy material of the lesion in the right humerus showed large sheets of cancer cells which were polyhedral with variation in size, shape and staining. The nucleoli of the tumor cells were prominent and mitosis was frequently observed. These cells were either in groups separated by a scanty amount of fibrous stroma or in cords surrounded by more abundant stroma.