Carcinoma of the Tonsil in a Common Wolf (Canis lupus).

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  • d . C:arcinoiria of tlie Tonsil in :L (*oitiinon Wolf ( Canis / u p s ) . By H. Hanor,u SCOTT, M.D., F.R.(:.l'.Loncloii, F.lLS.E., F.Z.S., Milii(3r Hesearch Fellow i n Coil*- parativc Patliology, IJonclolt Scliool of Hygiclne and Tropical Xedicine ; Pat l io l r~gis t to the Zoological Society of London.

    [Received November 14,1927 : Head February 21,1928.1

    (Plates I.-III.")

    h-o norlis on vetei inaiy pathology which J I i n ~ e been able t o conslilt make a n y irientioii of priinary maligiiant disease of tlie tonsils a& occurring among tlornestiwted animals. nur can I find any reference to such as hiiig fount1 in captive wild :xnini:xls. Cases are by no niearis frequently encountered even in h2ari-hence the follonirig i s deemed woi tliy of rpcord.

    A female Wolf, Cffimas Ztcpus, which l i d been iii tlie Gardens of tlie Society since J u l y 14th, 1922, was ieniovecl t o t h e Saiiatoiium towaids t h e riid of Bpi11 1'327, on account of a, large chschargiiig woiiiid i n connection witli a swelliiig i n the riglit sitle of the neck wntl throat . 'l'lie a r i i ~ i i ~ ~ l appexied to be iri consitleiable tlistress and, peihnps pnin, and would xlloiv no one t o appioacli it ; it was, thriefoie, lrilletl on Apri l 30th :in11 an : t u t o p y w~ds perfot nietl iiiiriiedihtely a f te rn nrds.

    i'lie giantis on the i ight side of t h e neck were s\\olleil antl 11:11 d , although they coritained treaking down iieci utic foci, ant1 t h e surrounding muscles and tissues n ere h i t 1 i ~ n d intilti-itted. Tiieio wits a n ulcer with irregiilar rnggetl iiiitigin, the exteinwl opeiiirig of wliicli measured 8 ciii. in length by 3 cm. i n its greatest widtli, ant1 dischargeil foul blood-tinged pur. 'l'iiese eiilaigecl antl breaking clowii glands 11 ere secondary t o a growth of t h e r ight tonsil. The tonsil itself liad piacticnlly disappeared (P1 I fig. 1). ant[ its p1:tce mas oc-cnpietl by w tlepressed iilcei \%itli :in nrie\eri base and a h i d , 111 parts furig:ttinS, giowtli witli eroded and everted hoitler. Bi 0111 th is R s i i i ub extended to t h e enlaigetl and neclotiLirig glands. The tori\illar eroiion was about the side of half R - C ~ O T V I I . The fai&cl pillais were practically n n i n ~ o l v r t l ; t h e base of tlie toiigue was free fioiii groirth, and t h e left tonsil naL quite norinal.

    The contlition, pc>thologicxlly, was a malignant neoplasiii of tlie riglit toniil, witli secoiitlnry irivasioii of the cert ical glantls, inliltlation into tlie s u i ~ o u n d i n g structures, adhesion to tlie overlying cutaneous tissues and hreakinq down t o open externally by it ragged ulcer.

    Foi eiplanation of the PI

  • hlici,osco~)ic;tl!y, ~ , h t : picture preseiitetl m:is iiiost iiiterestiny. Vrorti the gciiel:iI c1,;ir:rcteis :riitl tlie \t.itlespi.e:tii intiltrntion of tlic si1ii:triioiis epitlielial cells growth illust liitve originated, i io t i i 1 tlie ~):ireiiciiyiiiatous tissue of t'iie tonsil itself, b u t in its cpithe!ial covering. \Ve see gronl~s and I X I R S P ~ S o f epitiio1i;il cells, soiiie i n sitiall rreg:rtiorrs, otliers in large

    Intirig aiid iiisinmiting tlieinselres iiit,o t h e Between tlie islets

    ot tlie c.:troinorina.tous cells t h e w is a fair ly well-developetl stroiiix : L I I ~ ~ tlie celis i n n imy placeR teiid to :issiirrie an ;~lt.eoln.r (lisl)ositioii, iii others they :~ppe 1muicliiiig coluiiiiis. \There tlie 1il)roiis st ro i i i :L is abiiiitliint euclosetl areas of trne gromtli sliou. iiecrosis i t i varyiiig tlrgree.

    1';trts of tlie growt,li tleitionsti*a.te very well t h e polyiiiorphic l i ~ ~ ~ ~ ~ : l o p ~ l e ~ l t of' c:rrcinornntous cells and t h e xu:iylnstic c1i:triges wliicli :ire :i coninioii fea,tiire of uiany 1ii:tligrinnt epithelial iiw1)I:isiiis. :Clius, i r i places we c i ~ n irlinost trace the stages of t,i.:iiisition froin t h e nsmtl romitletl type of scliin,lnio~is cell i,o t,Itt+ tlrn.\vii-out spiritlie-cell (Pl. 11. fig. 3 & PJ. 111. fig. 4). Lig,iiii. :it i,lie pr ipl iery of soine of the i r i g w b tltc cells are seen i;o be sepii,ratetl, becoiiiiiig iiiore loosely disposed, [ierli;11);j frayetl out,, :~nt l a picture st,mngly snggestive of: :I. sar- coiii:itons cli:i.iige of sti.orna is presentetl.

    'l'lit: lytttp\ioi(l torisiilar reninaiits i n most w e a s where titey ;ire lirc'seent, e;isily tlistiiiguisliabie from th is looseiiing of c~:ri~ciiiorn~~t,oiis crlls :i,iicl polyiiiorphisiii by t h e closeness with witicit t h e gl:~~itlalar lyniplioicl cells itre packed. I n soiiie sitnations t'lie :i.tlvaricing clrimp of epitlielinl cells is nlriiost abruptly siiri-ouiicled by such masses of small ronritl lyinphoid cells, wliiolr Z take to be t h e iiornia.1 lymphoid tissue of the gI:r~rtl beiitg inr7:ltletl hiit iiot get r(+cetl by t h e growth.

    Aii:ii)lzisi:i, is f iir%lier evidenced by t h e defective keratinizat>ion iii (~)nsitler;il)le xre:~s of the growth, thougli in other par ts th i s is fairly ilinrlted itnd cell-nest foriiia.tion extensive (PI. 111.

    Y t t oiie otliei. point of interest is I.)~eseiited---rinmely, t h e re-tlifjl.eiitiatiuii mliich exists, some of the sqiiairioiis epitlielio- 1ii:i t;oris foci hcconiiiig tra.iisformec1 into a.pp:trent adenocnrcino- iii:LtJoiis islets.

    W i t ere we lmow 1)ra.cticnlly nothing of the history, as in tliis cme, owing t,o tlie iirtpossibility o f exaniination during lifca, i r e can only infer tliat tlie ra te of growth in t h e original s i k ~v: i s probiibly iiot very rapid ; iii some parts t h e stroma

    ely ul)imdant a r i d not very vascular, ba t , on t h e other 1i:ri i 1 only n fern giant-cells :ire met witli. There was very

    is not iiiiusnal, different rates of growth i n different the tiiiiioiir, for, ill contrast mitli what has just been

    iiteiitionetf, in otlier sites the stronin is much less a.nd, moreover, is (quite riclll~7 crl1nl;tr.

    opinions aye at, vwiance regarding the frequency of neoplnsms

    il (PI. 11. fig. 2).

    fi::s. 4 fi 5).

  • TIIK TO.\'sIL IS A co!.:?Jox TYC'LF. 45

    of tlie t,ousils i n &Tan: bgt,, generally spe:tl&ig, it woiiltl appe:rr tki:it turnours of these glands are iincoiiiinon. Of the k)eliigii foims pa,piIloniatn arid fibrous polyps occur, wliile both carciiro- rrlatous aiitl sa,rcoiiiii.tous forms of inalignant growtli are met, with. hccortling to liett,le, tlie tmisil is liable to two forrlis of sa,rcoiiia.--n:tmely, t h e round-celled and t h e Igniplios:~rcorn:r,- while Eexttie and I)ickson speak of a lympliosarconin mid it iiiixetl-relletl sarcoma. 'Fire dubious group, endothelioma, lias :i.lso been clescribetl as occnrring i n the tonsil.

    Wit11 reglrd t o c:ircinoiii:L, arising, of cowse! in tlie epitliclinl coveririg of t,he gl:r.iitl, the tluniour is genernlly i~ squariious epit1reIioin:t developing ei ther from t h e cells of t h e surface 01' i i i a. tonsillar crypt. Bland-Sntton stiites tlint squamous- celie,! c:Incer wising in tlie faiiciid pi1lai.s or in tlie tonsii is not, iincoiriinori, but Beattie and DicBsori ni:iintiLin tliai8, tlioiigli tlir coiiclition does occiir, it is nearly always a secoritl:ii,y inroloenieiit i n t h e tonsil. In S U C I I , t h e priniaiy site i s iisiiziliy t,hr h s c of t,tie toiigiie or the piilars of the fauces.

    Authorities m e , iro\\erer, practica.lly unaninions iii iiotiiig tlitl rapitiity of growtli, t h e early extension t o arljaceiit striict,iires, :mtl iiivolvenient of t h e regional 1y1i;pliatic g h t i s . In 11iiiiin.ri C N S ~ S destruction is great :rrd the pi1iai.s of tlie fauces ant1 t h e palate are often iniplicaterl aiitl t l i e r ~ is a tentleiicy t o invasioii of t,lie tongue. As regartls tlie exact site or so:irce of ovigiri, this is often iintleterniinetl j the epitlrelioiiia

    :ii.ise in the posterior par t of t]lie tongue, i n the pI~arpiipe:il eliiiin, o r in tlint of tlie tonsil. 111 fnct,, i t may grow iii

    :ally part of t h e inontli a n d wlieri in the r ~ x t e i i o r regions nearly d w a y s invades t h e fa.nces arid tlie toiisils. 1 1 1 Man t h e coii1'se is rnpid, death occurs withiii tlie yew, oEteii iir six 1-0 eight niontlis, t h e iininecli:vce caiise Leiiig a septic pnc~unionia, :I pivfuse h:enioi-rlinge from erosion of a 1:irgr vessel, or cedeni:~ of t l ~ c glottis. '!'he ra te of growth, holx-ever, is vei'y vari:il)le ;

    been sliown t o be rapid in a well-c!erelopetl inan of midd ie ;rge, a i i d glands a.re involved early, whei~ens in those of n t l ~ i n c e t l \ T A : L ~ S it niay be remarlraddy slow. Thus, R case i s on record of 8, in;in of 70 in wlioiri t h e cIiseuse 1x1~1 iieen present for tllree ypars ; nevertheless, rlestrnction was not great and tlie g$.l:%ndiil:rr involvement w:i s sligli t.

    111 the vast majority of tlniirals-1 SI3ea.k pnrticiilarly of mild :~,niuials,-the age is a mat ter of conjecture, nilless bir th lias t&en place (luring t h e mother's captivity. Wet,, again, we a,re still quite i n the clarli as to t h e correspondence, if :my exists, hetween t h e age of r7.n nnimr7.l and tllat of man. Even in human cases the age at wl~icli t h e condition has been met with varies within very wide limits. L. 1. Smith s ta tes tllut among his forty cases there were t)wenty-foiir hetween 50 n,nrl (jO years of age, t h e limits being 28 and 82, and the average 55 years. The youngest patient he could trace was only 18 years old.

  • 46 Dll . 11. 11. SCOTY' : CARCINOMA O F

    111 wiltl aniiiials tlie rapidity of growth of a neoplasm can orily I w seeii in its teriiriual stn.ges. A thyroid turnour may, after it :rppm,i~s as R tlefinite swelling, r:ipitlly progress in a. wiltl aniiii:~l to :L f u t d issue, h ~ i t i re (lo not h o w how long it 1i:itl bet:ii iii existence before it attjained ii. size sufficiently great to :r.tti:tct t h e attentioLi of those in clinrge, for it is only oljjective signs of mhicli we ciiii ti&e cogiiizmce. So with

    nt case. After ;L residelvce in the Gardens of nea.rly , :I Ilischrging wouritl W:LS noticed in the neck which

    \v:\s t,he result of it secondarily involved broken-down glaiid opeiiiiig 011 ttlie surface. How lorig the growth had been in esist,ence prior to tliis i t is impossible to state. The attention of t h e keeper had not been drawn to it from any difficulty in tile taking of foocl antl there W N M r>o noticeable emaciation. \\re C;LII orily infer, therefore, that the growth liad been of vi,i)icL evolution. Those observers who have met with a large iiiiiiiber o f cases in Man h v o noted the iiiuch greater pre- poiiiler:i,rice :i,niong males. Thus L. 13. Smith found that; of forty cases t,Iiirty-six were males, and Wiir tz puts the proportion of iilales to femdes as high :IS 24 to 1. It is, perhaps, strange t l i ; > t tlie wolf, the subject of this paper, was a female.

    I'erwtal of tlie recortls of liunian cases supplies a potent w:r.riiing aga.iiist applying too strictly to anirnnl c'isease the Factors which have been tleerned ca.usa1ly active in Man. Thus Wiir tz lioltls that there is a. very definite relation betwcen hyphilis and carcinoina of the tonsil, and Stuart L o w is quoted :is hv i i ig not>ed fifteen cases, id1 of which were syphilitic. L. IT. Smith st:i.tes tlint in 75 per cent. of cases there is a iiistory of excessive use of t o h c c o , :I fact remarked also by 1Viiitiz. Carious teeth are recorded as being found ill 50 per

    l i t . , as if tliis were also a factor, together with pyorrhea.. u.11 conditions cannot. however, he regarded a s an uriusii:tl

    coiioomitnnt, of ;illy disease which occurs in persons averaging 55 years. The teeth of the wolf in question were remnr1mt)ly soriir t l . Other factors setiologically iiriplicnted :we the frequent i,:~king of hot food antl the Iiahit of eating salt to excess at iue:il-tinies. The only evidence adcluced for the former is t , l int c;i,rcinoiiia, of the tonsils is common iiinongst the Chinese, wlisre the nieri partake of their food before the women. It iii:r,V be confidently stated t1i:i.t none of t,liese factors played :inp pait in protlucing the cnrcinoirie of the tonsil in this tvolf.

    ~ZEFERENCES. ASCIIOFP, L. I ~ E R , II., and DICESON, 1%'. E. C. Text-book of Pathology. 3rd Ed.

    I ~ L A Y D - Q U T T O N , Sir J. Tumours Innocent and Malignant. I:O\VI,BY, Sir 8. A, ~ n d ANDREWES, Sir B. W.

    Aiiatoilij. 7th Ed. 1920, p. 610.

    Pathologisclic Anatomie. ('arcinonla of the Tonsil.

    4th Ed. 1919, vol. ii. p. 786 N e d . l lec. & Ann. 1926, vol. six. p. 486.

    1925, p. 743. 7th Ed. 1922, p. 336.

    Surgical Pathology and Pathological

  • T H E TOXSIL I N A CONMON VOL1. 47

    ~ ~ T I X G , J . JACQUES, 1. C h n c t ~ of Toiibil aiid Tongne. Pr niecl. 1925, vol. sssii i .

    KETTT.E:, 13. H. ~ I A C C ! A I , T , U M , T V . G.

    Neoplastic I)iac:isc*, 1919. p. 821.

    pi. 1617-18. Tlie PatIiolo0;y of Tnn~oms . 21111 Ed. 1925, pp. 117, 323.

    2i1d Ed. 1022, 1). 10%. Test-hook of Iatliology.

    pp. 15-20, Sc~rxaus, 11. WGRTR, W. J . 31. Xalignaiit Ilisrnse of t,lie : i d lliront, with Special

    ltefcrence to Chrcer of N n e d lpo-sze, ~hary i i s , iiiiii Toiisil. New York JIeil. Jonrn:il, 1921. vol. csrii. 11

    New York State .Journal Rfed. voi. xsiv. No. 7, pp. 289-292.

    ({riiiiilriss der pathnlogisclien Anatomin. 7th Ii:d. 1004, P. 391.

    S V I T ~ T , 1,. 1. Epitlielioma of the Ionsil.

    ESPLAKATION O F THE PLATES.

    Ikmfi I. igli sliowing the normal tonsil on t i l e left side, ; r i d on t h e riglit a e~~itlieliom:r replacing the tonsil an(l i i ivd ing the sarroiinding

    PLATE 11. Fig. 2. llicropliotograpli of smtion 01 growth iir tonsil showing infiltrating groups

    of sqiiainous epit l~elion~:rtoii~ i:t~lls. To t h e lef t a n d below ;ire remain? of tonsillar Iymplioid tissne.

    I3pithcliornatoas cells (1isl)oied i n sti ands and some HIVPOIR~IJ. : suiroiiiiding parts compressed :ind revenliiig liere and there a tendency to spindle cell foriiiation partly, yerliaps, the coniiectire tissue of the tonsil, partly transformed carcino- 1n:ltollS elelnellts.

    ( x 120.) kig. 3. Portioii of tlir same under Iiiplicr n~apnification ( x 169).

    PLATE 111. Fig. 4. Section of ccrvicxl gland, secondarily invaded ( X 120). Scattered masses of

    t~pithelioniatous cells with interspersed spindle-celled sarcoma-like trnns- formation. Ilemnants of lymphoid glandiilar tissue present liere and there. Foci of keratinization and cell-nest tormation seen.

    Fig. 6 . Iortioii of the same under higher inegnification ( X 160) showing tlie features descrihed above.

    Fig. 1 was t;rken from the specimen by Xi-. F. Iittock in the laboratory a t University College, b3- kind permission of Professor J. P. Hill, F.11.S.. the micro- photograplis (figs. 2-6) by Jlr. F. bfartin-l)uncan, F.R.M.S., F.Z.S. I wish here t o express my indehtecliiess to theiii for their kindness.--R. H. 9.

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