A CASE OF CARCINOMA OF THE CERVIX WITH A BLOOD

A CASE OF CARCINOMA OF THE CERVIX WITH A BLOOD

A CASE OF CARCINOMA OF T H E CERVIX WITH A BLOOD
PICTURE SIMULATING CHRONIC ALEUKEMIC
EOSINOPHILIC LEUKEMIA
ANGEL0 M. SALA, M.D.,
AND
ROBERT J. STEIN, M.S.
(Fvom the Pathology Laboratory o f the New York C i t y Cancer Institute, New York C i t y ' )
The occurrence of blood eosinophils in conspicuous numbers in and around
a tumor is not an uncommon finding, but their presence over a long period
as the predominant element in the peripheral circulation, in cases of cancer,
is a rare observation and worthy of report.
FIG.1. EOSINOPHILIC
LEUKOCYTES
SURROUNDING
NEOPLASTIC
TISSUE
Eosinophilia in epidermoid carcinomas of the cervix, penis, lip, and
tongue has been reported by many (Przewoski, 1896; Feldbausch, 1900;
Weill, 1919; Schoch, 1925; Goforth and Snoke, 1928; Roca da Vifials, 1931),
but a general blood eosinophilia occurring at the same time has been described
but seldom, Kappis (1907) reported a case of carcinoma of the lung in which
the total leukocyte count was 50,000 per cu. mm., with 39 per cent eosinophils.
Dunger (1910) in a case of carcinoma of the colon found a total leukocyte
count of 35,000 cells per cu. mm., of which 21,000 were eosinophils. Weiss
( 1926) observed pronounced eosinophilia with adenocarcinoma of the stomach. As far as can be determined, carcinoma of the cervix occurring simul1Division of Cancer, Department of Hospitals, Dr. Ira I. Kaplan, Director.
125
126
ANGEL0 M. SALA AND ROBERT J. STEIN
taneously with a blood picture simulating a chronic eosinophilic aleukemic
leukemia has never been reported.
CASEREPORT
A. S., a white woman aged forty-seven, entered the New York City Cancer Institute in
June 1932. She had had pain in the right lower quadrant, radiating to the back and both
lower extremities, for over four years; chronic constipation for the past ten years; purpuric
eruptions over the entire body for a period of eight months, and metrorrhagia for over six
months. There was a history of a cholecystostomy and of five miscarriages, the last one
eighteen years earlier.
On physical examination the patient appeared to be anemic and moderately wasted.
The eyes, ears, nose, and throat were negative, and there was no cervical adenopathy. The
heart and lungs were essentially negative. The abdomen was not rigid, and no masses
could be felt; the liver and spleen were enlarged. Over the entire body were small areas
of purpuric eruption. Vaginal examination showed the cervix to be transformed into an
extensive ulcerative neoplastic mass. Rectal examination revealed involvement of the broad
ligament and the posterior cul-de-sac. The clinical diagnosis was carcinoma of the cervix
with adnexal metastases.
High-voltage and radium therapy was given, the patient receiving, during her stay a t
the hospital, three courses of high-voltage radiation consisting of 1OOOr to each of four
fields of the pelvis and 4500 millicurie hours of radon, in the form of a tandem.
Roentgen examination of the pelvis revealed nothing abnormal.
The laboratory findings were both interesting and instructive. The Wassermann and
Kahn tests were negative. Blood chemistry tests at different intervals showed:
Glucose
88 mg.
92 mg.
89 mg.
91 mg.
Urea Nitrogen
12 mg.
10 mg.
12 mg.
11 mg.
Creatinine
1.1 mg.
1.0 mg.
1.2 mg.
1.1 mg.
The blood platelet counts taken on three different occasions showed a definite thrombocytopenia with counts of 23,860,of 19,450,and of 21,800 platelets per cu. mm. of blood.
Blood counts and differential blood smears made between June 1932 and May 1933 were
as follows:
Neutrophilic
Polynuclears Lymphocytes
Hemoglobin
White Cells
Eosinophils
Red Cells
4,860,000
3,765,000
3,750,000
3,180,000
3,250,000
3,860,000
3,150,000
2,840,000
2,500,000
2,420,000
2,100,000
2,000,000
2,000,000
2,640,000
85%
80%
80%
75%
75%
70%
70%
70%
65%
60%
60%
50%
40%
60%
2,noo,ooo
55%
2,400,000
60%
18,600
17,200
17,450
18,000
16,900
18,350
19,200
19,650
20,250
20,000
20,950
21,500
24,300
28,800
33,500
36,800
20%
15%
25%
20%
22%
19%
28%
30%
16%
29%
33%
22%
28%
22%
21%
33%
20%
15%
10%
20%
18%
12%
15%
11%
17%
8%
15%
14%
16%
20%
18%
6%
60%
70%
65%
60%
60%
69%
57%
59%
67%
63%
52 %
64%
56%
58%
61%
61%
I n the differential smears most of the neutrophilic granulocytes were of the non-segmented type with an absence of myeloblasts and myelocytes. The eosinophilic granulocytes were almost all of the segmented type. The erythrocytes presented a progressive
CARCINOMA OF CERVIX SIMULATING LEUKEMIA
127
secondary anemia characterized by anisocytosis, polychromasia and poikilocytosis. There
was an absence of basophilic punctation and megalocytosis.
Biopsy of the cervix showed a spindle-cell epithelioma. I n the connective-tissue stroma
were numerous islands composed entirely of blood eosinophils surrounding the neoplastic
tissue (Fig. 1).
DISCUSSION
Splenomegaly, tissue infiltration with eosinophilic leukocytes, and a preponderance of one type of blood element in the peripheral circulation are
usual diagnostic features of a true leukemia. But the fact that many other
conditions, such as parasitic infestations, allergies, skin diseases, acute infections, and sometimes Hodgkin’s lymphogranuloma may also produce a generalized blood eosinophilia, suggests caution in making a diagnosis. The case
reported showed the salient features of a true eosinophilic leukemia, but the
consistent presence of mature eosinophils in the peripheral blood stream makes
it doubtful if this be a picture of a true leukemia. The eosinophilia here
is probably a secondary reaction resulting from a possible effect of the carcinoma of the cervix on the hematopoietic apparatus.
BIBLIOGRAPHY
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FELDBAUSCH,
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