THE SIMULTANEOUS OCCURRENCE OF TUMORS IN THE THYROID, UTERUS AND BREAST

THE SIMULTANEOUS OCCURRENCE OF TUMORS IN THE THYROID, UTERUS AND BREAST

MAX BALLIN, M.D. AND R. C. MOEHLIG, M.D.

DETROIT

article source: Journal of the American Medical Association, 1922


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Every surgeon who operates upon goiters must have noticed the frequent occurrence of tumors in the thyroid, uterus and breast. Apparently there has been very little written on the subject, however, for we could find only two references in the literature. Falta's 1 "Ductless Glandular Diseases" contains this note:

"There seems to exist a certain relationship between goiter and myomata of the uterus. At least it has been observed that in strumous women who also suffer from myomata the struma also decreases in size with the retrogression of the myoma at the menopause."

Falta's note is quoted from an article by Ullman 2  of Vienna. This article reads:

 thyroid gland

It has been known for a long time that a relationship exists between the uterus and the normal thyroid gland. The nature of this relationship is, of course, enshrouded in darkness; we only know that in a not infrequent number of women a transitory enlargement of the thyroid gland takes place at the time of menstruation. After the cessation of menstruation, the thyroid returns to normal. ... In many women during pregnancy an enlargement of the thyroid takes place, which still exists after childbirth. ... A third fact which concerns the question of the relationship between uterus and thyroid is that as to whether strumas develop more frequently in females then in males. ... I wish to emphasize that in women affected with myomas I was able to show a distinct enlargement of the thyroid gland, an enlargement that could be spoken of partly as struma parenchymatosa, partly as the result of degeneration, as colloid struma. ... I was then able to determine that these strumas following complete myomectomy became decidedly smaller; in many cases they disappeared entirely.

1. Falta, Wilhelm: Ductless Glandular Diseases, Philadelphia, P. Blakiston's Son & Co., 1916, p. 156.

2. Ullman. Emmerich: Ueher Uterusmyom and Kropf, Wicn. ktin. Wchnschr. 23: 58S, 1910.

In looking over our own records, we find that of the last 100 female patients who consulted us for goiter, eighteen had fibroids;  four of them also had breast tumors; and of the last 100 patients who consulted us for fibroids, thirty-five had goiter; six had breast tumors. Thus, of the total 200 patients, fifty-three, or 26.5 per cent., had tumors of both thyroid and uterus. Ten of these 200 patients required operations on both the thyroid and the uterus. This large number of multiple lesions is obviously much more than a coincidence; yet, as noted above, very little mention of it has been made.

The matter therefore seemed important enough to call attention to again. Three points suggest themselves:

(a) It is possible, as suggested by Ullman, that certain goiters might be reduced in size or even cured by removal of a fibroid.

(b) Thyroid extract and iodin might be beneficial in preventing the development of fibroids as well as of goiters.

(c) These relationships might have some bearing on the etiology of these tumor groups.

fibrocystic breast tissue

In the eighteen goiters found in the examination of 100 fibroids, fourteen were adenomas of the thyroid, three were colloid goiters, and one was an exophthalmic goiter. Of the four breast tumors which accompanied goiters, an adenofibroma with cyst-areas accompanied an adenomatous goiter; an adenoma of the left breast accompanied an adenomatous goiter; an intracanalicular adenofibroma in the right breast, and a similar tumor with hyaline changes in the left breast accompanied a colloid adenomatous goiter. Another goiter which is not tabulated showed virginal hypertrophy of the right breast. Of the six breast tumors which accompanied fibroids, three were interstitial mastitis; one was a fibro-adenoma; one was a carcinoma of the left breast and fibro-adenoma of the right breast, and one was a cystadenoma.

uterine fibroids

Of the fifty-three patients with the combination of goiter and fibroid, the youngest was 25 years old, this patient being the only one below 30. Fully two thirds were over 35. We may say, therefore, that the incidence mounts with age, the simultaneous occurrence of goiter and fibroid being most prevalent in the latter half of the third decade and during the fourth decade. Of the 100 goiter patients, twenty-one were under the age of 25. There were no fibroids among these patients, so that the percentage of eighteen fibroids is borne by seventy-nine patients more than 25 years of age. In other words, the fibroid-goiter combination shows its entire incidence after 25 years of age, and increases rapidly after 35 years.

The simultaneous occurrence of goiters, fibroids and breast tumors is more frequent than is usually supposed. The thyroid, breast and uterus have different anatomic structures and are different in their embryologic origins, but we note that the function of the thyroid is closely related to, and influences the function of the sexual organs. The interrelationship of uterus and breast is obvious. Since these organs are related to each other only by function, it must be that physiologic interdependence is a factor in the tumor formation.

normal breast tissue

When sexual function ceases or begins to wane, usually the time arises for the growth of all these

tumors. The symptoms of fibroids usually become more alarming toward the end of the reproductive period. The adenomatous goiter, in the great majority of cases, does not give much discomfort until the menopause. Then pressure and toxic symptoms arise. Small tumors in the breast have often existed from the age of 20 to the age of 40 without giving any symptoms, or without having been noticed at all; still, their long-standing existence usually is clear when their presence becomes obvious through growth or discomfort. Because of the aforementioned functional (physiologic) relationship which exists between thyroid, uterus and breast, we may be able to understand why growth or irritation in one of these organs may induce growth or irritation in another. For instance, when a small fibroid which has existed innocently for many years suddenly begins to grow, it may induce growth or irritation in the thyroid or breast (and vice versa).


CONCLUSIONS:


1. In a series of 200 cases (100 fibroids and 100 goiters), fifty-three patients, or 26.5 per cent., had both goiter and fibroid. Five per cent, had breast tumors.

2. The age of incidence of these combinations was greatest after 35.

3. Since these three organs are not related anatomically or embryologically, the simultaneous occurrence of tumors in the thyroid, uterus and breast may be explained by their physiologic interrelationship.

4. The prophylactic treatment now advocated, of giving iodids for goiter, may likewise prove beneficial in the prevention of fibroid.

5. Perhaps certain goiters can be reduced in size or even cured by the removal of a fibroid (as suggested by Ullman).

all images- wiki commons

Toxic Breasts

BENIGN MAMMARY TUMORS AND INTESTINAL TOXEMIA*
By William Seaman Bainbridge


•Read at the Thirty-third Annual Meeting of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons, held at Atlantic City, N. J., September 20-22, 1920.


Wow, just wow. It seemed to be well-known, back in the day, that digestion was key. This physician cured lumpy breasts with adjustments in diet, laxatives, colonic irrigation and enemas. He also cured the condition with various surgeries, occasionally removing cysts but in the majority of cases the surgery was abdominal, removing adhesions and generally rearranging the organs and such. I have chosen to include only those cases that were cured by hygienic methods, if you wish you can follow this link and read all about the cases which required surgery:


American Journal of Obstetrics and gynecology, Volume 1



 It is worth noting that Dr. Bainbridge was able to save women's breasts via these abdominal surgeries, in fact saving breasts that had been deemed cancerous by other physicians.







The present paper purposes to record a series of twenty-five eases of abnormal mammary changes apparently caused by autointoxication. When these cases are seen in their early stages the breast condition is often overlooked; when they have developed into a more easily recognized state, frequently a diagnosis of malignant disease is made.


Each of the cases reported herein suffered from a coexistant chronic intestinal toxemia, and the amount of poisoning was reflected, in many instances, in the degree of change in the mammary tissue. When the autointoxication was relieved the breasts either markedly improved or returned entirely to the normal.


These cases classify themselves, more or less, into three groups. 1. Those with a condensation or lobular induration of the upper, outer quadrants of the breasts, usually along the edge of the large pectoral muscle, and where the dependent breast drags on the upper axillary margin. This occurs in both mammae, but more frequently in the left. Such terms as "toxic breasts," "lumpy breasts" or "stasis lumps" are descriptive of this condition. 2. Those cases that have, in addition to the above, and in the same region, localized degeneration with adenomata or cystomata. 3. Those that have an abnormal discharge from the nipple in conjunction with one or the other of the above conditions.


The diminishing of the gastrointestinal fermentation by diet, digestives, intestinal antiseptics, high alkaline colonic irrigations, and certain physiotherapeutic measures, is of distinct value. The use of these agents, together with a support to the breasts and a proper uplifting abdominal corset, often result in a complete disappearance of the breast lumps or tumors. However, some of the cases require surgical intervention of the underlying abdominal condition before the toxic poisoning is sufficiently relieved as to noticeably benefit the breasts.


In those cases where there is a cyst or adenoma in addition to a general lobular condition of the breasts, the removal of the growth and the correction of the intestinal stasis, by medical or surgical means, often result in the mammae becoming completely normal. A preliminary lessening of the general toxic condition, in some cases, materially helped in locating the real existing benign neoplasm, and hence it was made possible to save a considerable amount of curable breast tissue. By this means the patients were saved the mental and physical shock of an unnecessary amputation.


Case 1.—I. I.; age thirty-five; female; single. First seen May 12, 1919. Constipation with usual symptoms of intestinal stasis; backache. On examination, found floating right kidney; general enteroptosis; mass of feces in lower colon; considerable gas in ascending and transverse colon; marked lumpy condition in upper, outer quadrant left breast. Prescribed tonic, laxatives, uplifting corset belt; special abdominal exercises, and general hygienic regime. June, 1920: Patient in excellent health; constipation relieved; no longer any lumps in breast. September 1920, passed examination to enter training school for nurses of large metropolitan hospital.


Case 2.—E. S.; age thirty-three; female; single. First seen September, 1898. Marked constipation; frequent attacks of intestinal gas; distinct lumps in upper, outer quadrant of left breast; nipple normal. Very much worried about cancer. Prescribed diet, cathartics, and support to breasts, with very careful and frequent examination. Six months after treatment was begun lumps in breasts disappeared. For some years, patient noticed that if she became constipated and had "indigestion," there was a return of the lumpy condition. This was relieved by thorough catharsis. August, 1920: Breasts perfectly normal.



Case 3.—J. L.; age thirty; female; single. First seen January, 1919. Subacute attack of rheumatic fever; feet extremely swollen; painful; intestinal indigestion; headaches; nausea; marked constipation. On examination found intestinal stasis; large lumps in both breasts; enlarged glands of neck; swelling of feet and ankles. Prescribed diet; high alkaline colonic irrigations; salicylates, for a short time, cathartics, with physiotherapy as able to take it. September 1920: Under treatment, swelling and pain in joints of feet and elsewhere gradually disappared. Lumps in breasts entirely gone after two months. Twice she allowed herself to become constipated and to be indiscreet with diet and at both times noticed a soreness and distinct lumpy condition of breasts, which disappeared upon resorting to careful treatment.

Case 4.—W. R.; age twenty-eight; female; married. First seen November 27, 1906. Rectal abscess and cyst of perineum removed. In 1919 complained of intestinal gas; loss of weight; constipation; soreness of breasts, worried about cancer. On examination, found gastroptosis; ascending colon and hepatic flexure clogged with fecal matter; considerable gas; distinct lumpy condition throughout breasts, more marked in upper, outer quadrant. Prescribed abdominal and breast supports; laxatives; high alkaline colonic irrigations several times a week; diet; tonic; special exercise. June, 1920: Patient stated she was no longer a "nervous wreck"; when careful of diet and bowels there is no soreness in breasts. Considers herself well. August, 1920: Excellent condition; breasts normal.

Case 5.—A. G.; age forty-eight years; female; married. First seen December 9, 1918. Complained of pain and discomfort in left breast. On examination, found breasts very large, dependent, and the inner quadrant of left one slightly lobulated; no real tumor formation. Prescribed breast support; laxatives, with usual hygienic regime and careful watching. June, 1920: Lumpy condition of breasts entirely relieved—still a little soreness; constipation improved.

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SUMMARY

1. There are definite abnormal changes in the breast tissue, as in the thyroid gland, from intestinal toxemia.

2. Treatment by medical and mechanical means, or surgical intervention for the cure of the intestinal stasis, often means complete return to the normal of the lumpy or toxic breasts.

3. At times it is necessary to remove a definite, localized tumor from the breast, in addition to the above, before the mammary tissue regains its normal texture.

4. Care must be taken that these abnormal changes are not overlooked in their early stages; and not diagnosticated as cancer when well developed.

5. In this connection, an important question must be noted: Would an early recognition of a toxic breast and timely and efficient treatment of the underlying intestinal causes, tend to lessen the danger of malignant degeneration? If this is so, then we have here an important contributory factor in the etiology of cancer of the breast.

Hydrocele, encysted hydrocele and iodine

It seems that topical preparations of iodine were being used VERY early on in iodine history as a treatment for hydrocele. There is a lot of info on an improvement on this method, which involves injecting a tincture of iodine into the emptied cyst OR running a thread that has been saturated in an iodine through the cyst in order to get the iodine to the interior. As far as topical iodine usage, this is the only reference I could find:


"Having learned that the preparations of iodine had been employed as topical remedies in hydrocele"...


source: The London Medical Gazette, 1837


And here are a couple of references on iodine and hydrocele. Please note that the second link specifies "encysted hydroceles" aka testicular cysts, I presume.



"Hydrocele, a swelling of the scrotum, caused by the effusion of fluid into the coverings of the testicle or of the spermatic cord. While it may result from inflammatory conditions or from an injury such as a blow, the cause cannot always be ascertained. It forms a tense, elastic, smooth swelling, and it is distinguished from other conditions in the same situation by its translucency, which is agparent when the tumour is held between the observer’s eye and a lighted candle or a strong lamp. It may be mistaken for a rupture; but a hydrocele swelling gives no impulse under the hand when the sufferer coughs. Again, it is not, like strangulated hernia, associated with vomiting or pain. Congenital hydrocele, however, may give an impulse with coughing.


Palliative treatment consists in frequent tapping with a trocar and cannula: in the hydrocele of young children, cure may be effected by constant wearing of a truss, or by the external application of iodine. Radical cure in adults is effected by tapping and subsequently injecting iodine ; or by incising the sac, turning the covering not the outside skin) inside out, and stitching it in that position. The injection of a ten per cent. solution of chloride of zinc has lately been recommended as eflicacious, and as causing no pain or inflammation."


source: Nelson's Encyclopedia, Volume 6, 1907



A MORE EFFECTUAL MODE OF APPLYING IODINE TO THE INTERIOR OF CERTAIN CYSTS.


"Mr. Furneux Jordan, in some notes in the Lancet, remarks that he has found in practice two classes of scrotal-hydroceles, in which the ordinary methods of treatment are either difficult to use or uncertain in their result. In boys and men there are occasionally encysted-hydroceles of the testis, or the cord, which continue to increase in size, or in which treatment is urgently requested. In such cases, except in early infancy, acupuncture, or the use of a fine trocar, often fails to cure. The walls of the cysts are usually thin, and collapse so much, when their contents are withdrawn, that the injection of a fluid is uncertain. The end of the canula may be outside the cyst, and the iodine solution be consequently injected into the connective tissue at its exterior. In such cases the following is a reliable method of treatment:


"The cyst being well isolated, made tense, and brought near the surface, I pass through its centre a stout needle, armed with silk, and leave the threads hanging. The fluid quickly oozes away, especially if a little traction be made on the threads. I then, at one opening, wet the threads with iodine-liniment (liniment, because the quantity required is so limited), and draw the threads so as to leave moistened portions within the cyst. A little gentle friction will help to spread the iodine thoroughly over the lining membrane of the cavity. An hour later, freshlymoistened portions may again be drawn through, if the cyst be large, or if other methods of treatment have failed. On the other hand, in a very small cyst, a single thread, moistened and kept in one hour, will suffice."


source:  Medical Brief: A Monthly Journal of Scientific Medicine and Surgery, Volume 4, 1876