Intracranial Metastasis as Earliest Evidence of Carcinoma of the Lung
During the past four years it has been my experience in two cases to disclose metastatic carcinomatous lesions of the brain unexpectedly at operation. At autopsy later on these were shown to have originated from primary bronchogenic carcinoma of the lung. In both cases the final preoperative diagnosis was primary brain tumor. Although a metastatic lesion of the brain was suspected in Case I, no primary tumor could be revealed by a most exhaustive clinical investigation; in fact, the primary site of the tumor in this case was not revealed until autopsy, one year and ten months after the intracranial operation. In the second case, the presence of a metastatic lesion of the brain was not suspected until the ventricular cannula encountered unusual brownish mucoid material deep in the brain substance during the operation of ventriculography. Chiefly because of the diagnostic problems presented by these cases, it has been considered worth while to report and discuss them in some detail. Surgical therapy in such cases will also be discussed briefly.
Case 1: A white woman, aged 49 years, was referred to the Clinic on January 11, 1932, by Dr. J. S. Zimmerman of Youngstown, Ohio. Her chief complaints were “pains in the head” and vomiting. She had been in good health until the summer of 1931, when she began to have suboccipital headaches which lasted for an hour or two and recurred about once a week. The headaches became more frequent and more severe, and in November, 1931, they were. . .