Multiple Primary Carcinoma

Abstract

MEDICAL JOURNAL297 illnesses. On November 28, 1949, at her second visit to the clinic she was noticed to have enlarged discrete rubbery glands in both posterior triangles, which were clinically typical of lymphadenoma. At this time she was approximately 18 weeks pregnant. The diagnosis was confirmed by biopsy. Chest x-ray showed enlargement of the upper group of mediastinal lymph nodes. There were no axillary or inguinal nodes to be felt. The spleen was not palpable. Red blood cells were 3,900,000 per c.mm. and haemoglobin 84%. The white cells were normal (9,200). A course of deep x-ray therapy was given to the cervical areas in January, 1950. The nodes regressed rapidly under treatment. The mediastinal glands were not irradiated, in view of the pregnancy. Further progress was uneventful, and after an easy labour of five hours she was delivered on April 29, 1950, of a male child, with the help of an episiotomy. Although the foetal heart had been heard shortly before delivery, the infant was stillborn and the umbilical cord (which measured only 14 inches (36 cm.)) was twice around the neck. Post-mortem examination of the infant showed no abnormality and gave no indication of the cause of the stillbirth other than the tightly stretched cord. Subsequently her puerperium was normal, and x-ray of the chest on May 17, 1950, showed that the mediastinal nodes had regressed considerably. Further x-ray therapy was not given, and the patient is being kept under observation. Although in this patient lymphadenoma became evident for the first time at an early stage of pregnancy, there was no clinical or radiological evidence that her condition had deteriorated during the pregnancy and puerperium. The question of a future pregnancy is debatable, but if she and her husband are desirous and her clinical state is favourable, with no evidence of a recurrence, then pregnancy could probably be allowed.-I am, etc.,