John T. Farrell

Pulmonary Metastasis: A Pathologic, Clinical, Roentgenologic Study Based on 78 Cases Seen at Necropsy

IN THE ten-year period from November, 1924, to November, 1934, pulmonary metastasis was found in 78 patients coming to autopsy at the Jefferson Hospital. Many of the patients had had roentgenograms of the chest made prior to death; this study is based on the x-ray findings, the necropsy protocols, and the clinical histories. Most of the necropsies were performed by Dr. Baxter L. Crawford, Pathologist to the hospital, or his assistant, Dr. Carl J. Bucher, though some were performed by other members of the staff. Type of Primary Tumor.—Sixty-one, or 78 per cent, of the primary tumors were classified as carcinoma; 12, or 15.3 per cent, as sarcoma; two, or 2.4 per cent, as melanoma; one as an endothelioma; one as a teratoma, and one as a thymic tumor (Table I). Site of the Primary Tumor.—The site of the primary tumor was determinable in all but five instances; the 56 carcinomas in which it was determined may be classified under six systems (Table II). The breast was the primary site in seven, or 11.4 per cent...

The Roentgen Diagnosis of Intrathoracic Neoplasms

WHILE there is undoubtedly an actual increase in the incidence of intrathoracic newgrowths, as attested by the study of postmortem statistics (Staehelin, 1, Barron, 2, Berblinger, 3), the increase is in some measure relative and due to improved methods of diagnosis, notably the X-ray and bronchoscope. Improved surgical procedures and roentgen therapy in malignant disease of the lungs are factors which have increased the general interest. From the point of view of roentgen diagnosis pulmonary neoplasms fall into two groups: first, those which are recognized readily and permit of accurate diagnosis; second, those in which the diagnosis is made with difficulty and then only by a consideration of all data. There is no sharp line of distinction between the two groups, though, in general, benign and metastatic lesions and those arising from the mediastinum are diagnosed more directly than are primary malignant changes. In the first group, presenting definitive characteristics, are cysts, teratomata, many tumors...

Diagnosis of Bronchial Carcinoma: A Clinical and Roentgenologic Study of 50 Cases

IT IS generally believed that prognosis would be improved in malignancy of the viscera if the diagnosis were made earlier. In order to determine the clinical and roentgenologic features of carcinoma of the bronchus which might be helpful in early diagnosis, 50 cases, seen on the x-ray service of Dr. Willis F. Manges, have been studied. This series should not be considered a new group of bronchial cancers; for some of them have been included in groups reported previously from other angles, notably the diagnostic by McCrae, Funk, and Jackson (1), the Radiologie by Manges (2,3,4), and the bronchoscopic and pathologic by Clerf and Crawford (5). The study is wholly diagnostic, no attempt having been made to analyze the results of treatment. The diagnosis in each instance has been based on the histologic examination of tissue removed from the tumor. Forty-nine patients were examined bronchoscopically by Dr. Louis H. Clerf, and the tissue which he removed was studied histologically by Dr. Baxter L. Crawford or D...

Primary Bronchial Carcinoma and Pulmonary Metastasis Compared Clinically and Roentgenologically1

THE increasing occurrence of primary bronchial carcinoma and the high incidence of metastasis to the lungs makes a comparison of the two conditions of interest. In 1934 the author presented before this Society a study of 78 cases of pulmonary metastasis discovered at necropsy at the Jefferson Hospital in the ten-year period from November, 1924, to November, 1934 (1), and in 1935 a study of 50 cases of primary bronchial carcinoma in which the diagnosis was made by histologic examination of tissue removed from, the tumor (2). This presentation is based on re-examination of the material and a comparison of primary and metastatic pulmonary malignancy as to the age and sex of the patients, the initial and general symptomatology, the roentgen signs, the duration and the prognosis. Histologic Classification.—Of the primary group, 23 (or 46 per cent) were classified as squamous-cell carcinoma, three (or 6 per cent) as adenocarcinoma, and 24 (or 48 per cent) as undifferentiated carcinoma. The metastatic tumors wer...

Pulmonary Abscess, Bronchiectasis, and Pulmonary Neoplasms: Roentgenologic Aspect

The roentgenologist must assume definite responsibilities in the diagnosis and treatment of pulmonary abscess, bronchiectasis, and pulmonary neoplasm. His team associates, the internist, the bronchoscopist, and the surgeon, may expect from him assistance in diagnosis, help in localization, graphic recording of change, and, in certain types of newgrowth, aid in treatment. Abscess The roentgen appearance of pulmonary abscess is determined by the stage of the disease, the site of involvement, the presence of complications, and the technic of examination. At the onset it presents an almost homogeneous density, due to localized pneumonitis. The shape of the shadow depends upon the site. Near the hilum it is usually small and may resemble a collection of enlarged lymph nodes; in the center of a lobe, unlimited by an interlobar fissure or visceral pleura, it is of irregularly rounded shape, without distinct margin, dense at the center and fading off into normal tissue. Limitation by the interlobar fissure produc...

Roentgen Diagnosis of Cancer of the Esophagus

THE hope of cure in malignancy lies in early recognition. Bloodgood (1) has compared the stage at which patients to-day present themselves for diagnosis of lumps in the breast with the stage at which they appeared some twenty-five years ago. In his clinic he finds that only 17 per cent of patients presenting themselves to-day for diagnosis of a lump have cancer, whereas, in the earlier period, 80 per cent had cancer, and less than 50 per cent were operable. Other observers have noted a similar increase in recent years in the incidence of benignity and operability of breast tumors (Gibbon, 2), (Klopp, 3). This change is due to increase in diagnostic acumen and to an increased popular knowledge of the course of cancer of the breast, leading patients to seek examination earlier. This is not the case in cancer of the esophagus. Hickey (4) says that the status of the diagnosis and treatment of esophageal malignancy is an indictment of modern medicine. Jackson (5) believes that this is due in part to the physic...

The Results of Post-Operative X-ray Therapy in Carcinoma of the Ovary

During the past several years numerous reports have appeared in the literature concerning the efficacy of roentgen therapy in the treatment of carcinoma of the ovary. Beginning with von Franque (1), who, in 1912, reported temporary improvement in a girl of 16 with ovarian cancer with metastasis, many authors have reported series, the most recent having been reported by Wintz (2). An accurate comparison of results reported by the different observers is impossible because of a lack of uniformity in the listing of data which influence response to any form of cancer therapy. We believe the following facts should always be recorded: the histologic diagnosis, grade of malignancy, degree of operability, and the radiation factors. Of these, the first three can always be grouped in patients treated post-operatively. Comparison of the radiation factors may not be possible in a small series of patients because of the varying clinical response and post-operative course. It may be impossible, because of the patients ...

Integration of Clinical and Roentgenologic Findings in the Diagnosis of Carcinoma of the Esophagus

THERE are few locations in which cancer is attended by such a hopeless prognosis as in the esophagus. Except in isolated cases, methods of treatment successfully employed in other organs are unavailing here. Irradiation, whether administered as radium or x-ray, has not been successful. At present, surgery probably offers the best method for coping with the condition. Surgical procedures in carcinoma of the esophagus are accompanied by high mortality, because usually when the patient is first seen the condition is so far advanced as to make surgery impossible. This study was undertaken in an attempt to determine if correlation of the clinical and roentgenologic findings might reveal signs by which carcinoma of the esophagus could be diagnosed earlier and at a time when it would be amenable to surgery. One hundred cases were selected; in 78 the histologic diagnosis was squamous-cell carcinoma, in 18 adenocarcinoma, and in four undifferentiated carcinoma. Thirteen of the tumors occurred in the upper third of...