Foreign body carcinogenesis

Abstract

A recent report' of a malignant fibrous histiocytoma developing 44 years after severe injury and implantation of metallic fragments is pertinent to the general phenomena of foreign body (FB) carcinogenesis. Rarity of this event in human patients in contrast to other species is noteworthy, but has great biologic interest. For example, less than 20 malignancies associated with joint replacements have been reported, and a global registry of FB malignancies has been proposed. FB associated with subsequent site-related malignancies include the following: bullets, steel fragments of various sorts, implanted protheses at fracture sites, metallic sutures, nylon mesh, and various fibers (including asbestos). The organ sites of such malignancies include the soft tissues, bone and bone marrow, lungs, pleural and peritoneal linings, and perhaps other organs such as the urinary bladder, gall bladder, and colon.The predominant diagnosis of such conditions has been sarcoma and related sarcomatous lesions.2 Different FB mechanisms may be related to carcinomas of the lung, breast, and bladder and mesotheliomas.Physical form rather than chemical composition is the critical factor for asbestos carcinogenesis in humans and for the FB malignancies in other species. The predominance of smoking in asbestos-related lung cancer probably results, in part, from the inability of the impaired and replaced ciliated epithelium to expel the fibers. In brief, the rules of Ames for carcinogenic (mutational) chemicals and those of the much maligned (and rightly so) Delaney Clause are not applicable.The first observation of FB carcinogenesis was the serendipitous development of sarcomas at the site of bakelite discs inserted in rats and, subsequently, kidney wrapping with plastic for a study of hypertension. A comprehensive review of early FB research is fascinating.' From the Division of Surgical Oncology, Denver General Hospital Address for rcprints: George E. Moore, MD, PhD, Department of Denver, Colorado. Surgery, Denver General Hospital. Denver. CO 80204.Bland4 and others have reported a series of studies involving the insertion of glass, plastic, and metal sheets in rodents. An important observation was the decrease in carcinogenecity as the surface area of flat, smooth, thin forms was decreased. For example, the fragmentation of cover slips, but insertion of the same amount of material, resulted in a sharp decrease and even absence of malignancies. In one such experiment an implanted sheet of nylon caused sarcomas in 58% of rats, whereas the same amount of powdered nylon caused none. Dr. Bland confirmed major differences in the susceptibility of various mouse strains and hybrids to FB carcinogenesis and the length of precancerous latent period.In other experiments, filters with smaller pores induced more sarcomas than those with larger pores. Smooth surfaces that inhibit cell adherence were far more carcinogenic than rough ones.5 Similar sarcomatous lesions could be elicited much less successfully in other species and in primates.It is aston...

A Case of Squamous Cell Carcinoma of Skin Subsequent to Subcutaneous Foreign Body

“…[8][9][10] Development of foreign body carcinogenesis is rarer in humans and has been well studied in animal models. 1,11,12 In Kashmir, Kangri cancer is a well known entity, which develops on inner thighs after chronic use of Kangri. 5 Our patient also developed SCC at the classical site of Kangri cancer, but also had a subcutaneous non metallic foreign body, probably augmenting the development of SCC.…”