[Bronchial carcinoma in subjects under 40]

We investigated a series of 30 patients younger than 40 years with histologically proven bronchogenic carcinoma. Most patients were symptomatic for a mean duration of 3 months before examination. The most common cell types were squamous carcinoma in 10 patients, oat cell carcinoma in 9 patients, and adenocarcinoma in 5 patients. The disease was categorized as Stage I in 3 patients, Stage II in 3, Stage III in 17, and Stage IV in 7. Ten patients underwent resection, whereas 3 patients were inoperable at surgery. The average length of survival for the nonoperated patients was 4.2 months (range 1 to 16 months). The mean survival for the surgically treated patients was 23.3 months (range 0 to 84 months). Extent of resection did not have any statistical significance in the survival rates which were mainly affected by staging of disease.

Investigation of the Applicability of Histological Classification of Bronchial Carcinoma According to the World Health Organization

According to the World Health Organization histological classification of bronchial tumors, clear and giant cell carcinomas are two subtypes of large cell carcinoma. As clear and giant cells can also be observed in other types of bronchial carcinoma, we investigated the frequency of the finding of these cells in different histological types. The tumor size and degree of differentiation, the amount of necrosis and keratinization, and the presence of giant and clear cells were analyzed. Statistical analysis by χ2 test showed (for all classified histological types of bronchial carcinomas, except small cell carcinoma) that: 1) larger tumors had a great quantity of giant cells (P < 0.05; P < 0.01), 2) large tumors had more clear cells (P < 0.05; P < 0.01) and 3) tumors with a greater amount of necrosis had a larger number of giant and clear cells (P<0.05; P < 0.01). Findings of an identical cytological characteristic can cause some difficulty in determination of bronchial cancer.

DNA-content, inflammatory tissue response and tumour size in human lung carcinoma

Tumour imprints of 75 resection specimens with human lung carcinoma (lobe and lungs) were fixed with alcohol and Feulgen-stained. Resection specimens were cut into serial sections 6 mm thick and tumour mass, tumour involvement into intrapulmonary and extrapulmonary lymph nodes, detailed pTN-stage were determined. DNA-content, DNA-index, percentage of diploid/hyperploid tumour cells, and morphometric nuclear features were measured using an automated image analyzing system (VISIAC). Only 10% of the measured carcinomas were diploid. The DNA-index showed the broadest variance in large cell anaplastic carcinoma (1.2-3.3). Carcinomas growing predominantly within the alveolar space, i.e. without destroying the interstitial tissue showed a lower DNA-content above 3c and above 5c compared to carcinomas destroying the interstitial tissue. Carcinomas with severe stroma reaction were found to have 33%-48% of DNA above the 3c value whereas carcinomas without stromal reaction had a percentage above 3c ranging 46%-64% (confidence limits, p less than 0.05). DNA-index increases with increasing tumour volume and decreases for large tumours (greater than 100 ccm). Hyperploid and polyploid tumours were found more frequently in case of pT2 and pT3-stages compared to pT1-stages. No relation of DNA-content or ploidy was found to lymph node involvement and inflammatory response of host tissue.

Spontaneous lymphokine activated killer (LAK) activity in bronchoalveolar lavage cells from patients with bronchogenic carcinoma

Bronchoalveolar lavage cells (BAC) are considered to be representative of cells that are in the interstitium and in patients with lung cancer, may represent, in part, cells that infiltrate cancerous tissue. We used bronchoalveolar lavage (BAL) specimens to test the hypothesis that cells within this region might be regulated locally by factors and show activities that are dependent on these growth and activation mediators. We showed previously that Natural Killer (NK) activity and IL2 titers were proportional. As compared to normal subjects, patients with all stages of bronchogenic carcinoma consistently had very high levels of IL2 in their bronchoalveolar lavage (BAL) fluid and this titer correlated with an increase in NK activity in the BAC both in absolute level and in relative level to the blood. Now, we report results that show that spontaneous lymphokine activated killer (LAK) activity also can be measured in most patients, but not all patients, that express IL2 titers. These findings support the hypotheses that different types of nonspecific cytotoxic cells are present and active in cancerous lung specimens secondary to the secretion of lymphokines from activated T lymphocytes in that region and that LAK activity is a physiological phenomenon that may be expressed in regional rather than systemic areas of the body.

Radical radiotherapy for bronchogenic carcinoma: five year survival rates

A total of 443 patients with bronchogenic carcinoma were treated by radical radiotherapy. Their 5-year survival rate was 10.5%, median survival 57 weeks. Of these patients 42 (9.5%) had postoperative residual or recurrent tumour. Their 5-year survival rate was 14.3%, median 80 weeks. The corresponding figures for the 401 patients who had had no previous therapy were 10.2% and 54 weeks. The tumour was histologically confirmed in 277 patients; their 5-year survival rate was 6.9%, median 54 weeks. The corresponding figures for the 166 patients who had no positive histology were 16.9% and 61 weeks. The 5-year survival rate of 235 patients with positive histology who had no surgery was 5.5%, median 51 weeks. Age and sex had no significant influence on survival. Tumour size and regional lymph node status had a marked influence on survival. The 5-year survival rate was 27.5% for patients who had T1 tumours and 8.2% for those with T2/3 tumours (P less than 0.001), median 125 and 51.5 weeks, respectively. The lymph node status was recorded in 72% of patients. The 5-year survival rate of patients who had nodal involvement was 7.4% (median 44 weeks) and 18.6% for those who had no apparent lymph node involvement (median 71 weeks), P less than 0.001. Histological type and grade had no influence on survival; in particular the survival of patients who had small cell carcinoma was similar to those of other carcinomas. Dose had no influence on survival in this series.

A contribution on the prognostic significance of the tumor formula (pTNM) in squamous cell carcinoma of the bronchus

Analysable data on survival time could be obtained in the context of a follow-up investigation for 435 of 518 patients who had been operated on for squamous-cell carcinoma of the bronchus in the period 1976 to 1986. For better comparison, all tumors were staged retrospectively according to the fourth edition (1987) TNM schedule of the UICC. The mean survival time after potentially curative operation was 7.15 years in stage I, the five-year actuarial survival was 60.8%. The corresponding values were 2.68 years and 31.6% respectively in stage II, compared to 1.14 years and 13.4% respectively in stage IIIa. The differences between tumor stages are statistically significant. The nature of the resection treatment within the tumor stages did not have any effect on the survival times. Tendency to keratinize, lymphangiosis carcinomatosa, and infiltration of tumor cells into vessels also had no prognostic significance. It was also analysed to what degree tumor size and extent as well as lymph-node involvement influence the prognosis after potentially curative operation. In the absence of lymph-node involvement, the prognosis of patients with T1 and T2 tumors was significantly better than that of patients with T3 tumors. However, when metastatic spreading into bronchopulmonary lymph nodes was present (N1), the prognoses of patients with T1, T2 and T3 tumors no longer differed significantly from each other. In mediastinal lymph-node involvement (N2) and T1 tumor, the survival times were significantly better than in mediastinal lymph-node involvement and T2 or T3 tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation

The computed tomographic (CT) scans of 80 patients with bronchogenic carcinoma classified as indeterminate for direct mediastinal invasion were retrospectively reviewed after the patients had undergone thoracotomy. Forty-eight (60%) of the masses were resectable, without invasion of the mediastinum, 18 (22%) focally invaded the mediastinum but were technically resectable, and 14 (18%) invaded the mediastinum and were not technically resectable. Although in most circumstances in this relatively small subset of patients CT was not helpful in differentiating masses with and without mediastinal invasion, CT was able to separate a large group of masses that were likely to be technically resectable. Thirty-six (97%) of 37 masses with one or more of these CT findings were considered technically resectable: contact of 3 cm or less with mediastinum, less than 90 degrees of contact with aorta, and mediastinal fat between mass and mediastinal structures. Of these 36 masses, 28 were resectable without mediastinal invasion, and eight were resectable with focal limited mediastinal invasion.

[Usefulness of determining 2 cell membrane enzymes in bronchial aspirate and lung tissue in patients with cancer of the lung]

The cell membrane enzymes, Alkaline Phosphatase and Gamma Glutamyl Transferase, have been studied in lung aspirates from healthy subjects and lung cancer patients. These enzymes were studied, in the latter, both in healthy and in neoplastic tissue. The enzymatic activity both in the lung aspirate and in the neoplastic tissue was significantly lower in poorly differentiated cancers when compared to well or moderately differentiated tumors. Similarly, analysis revealed that there was a statistically significant decrease in the activity of both enzymes in lung aspirates from patients with bronchogenic tumors when compared to healthy controls. The results obtained in this present work, together with the easiness of obtaining a lung aspirate suggest that these enzymes should be determined in order to obtain further information about the histological origin of lung cancer. These enzymatic changes could be explained with the "fatalism" theory for neoplastic tissue as we explain in this work.

Utility of the Wang 18-gauge transbronchial histology needle in the staging of bronchogenic carcinoma

Use of the Wang 18-gauge histology needle in TBNA was employed as a staging procedure in 29 patients with bronchogenic carcinoma and mediastinal adenopathy demonstrated on chest CT. Twenty patients had malignant aspirates; 12 had both histologic and cytologic specimens demonstrating malignancy; six patients had malignant histologic specimens; two had cancerous cytologic specimens as their only evidence of mediastinal disease. Of the nine negative aspirates, four were true negative at surgery. Five patients had false-negative aspirates. Overall sensitivity of the Wang 18-gauge histology needle in the mediastinal staging of patients with bronchogenic carcinoma was 80 percent. When patients with small cell carcinoma were excluded, sensitivity was 82 percent. The enhanced yield of the 18-gauge histology needle warrants its use in mediastinal staging of bronchogenic carcinoma. We conclude that all patients with bronchogenic carcinoma and mediastinal adenopathy demonstrated on chest CT accessible via TBNA should undergo histology needle aspiration as an initial staging procedure.

[Primary bronchial tumor in childhood--a case report]

Primary bronchial tumors are a rarity in childhood. According to the WHO-classification of 1981 Bronchial Carcinoid tumors and Mucoepidermoid carcinoms are listed as the most frequent histological types of the malignoma group and will be not longer associated with attributed benign tumors. In the literature especially the prognostic important early diagnosis and the difficulty of histological differentiation ist emphasized. In this paper is described a 12-year old girl suffering from a bronchial tumor. Throughout the 3 months of disease the diagnosis had been establisted by endoscopy. Surgically the resection of right middle and lower lobe was necessary. 7 years after bilobectomia the patient is without trouble of problems. The classification of the tumor ist problematic within the frame of in the WHO-classification and was discussed.

Bronchogenic carcinoma. A study of 109 cases

The clinical profile of 109 cases of bronchogenic carcinoma has been studied. Definite histopathological typing of malignancy was possible in 61 patients, squamous cell carcinoma being the commonest tumour in 27 followed by small cell carcinoma in 16, adenocarcinoma in 11 and large cell carcinoma in 7. Another 23 patients showed changes suggestive of malignancy on histological/cytological examination. Definitive diagnosis was obtained in half of the patients by bronchial biopsy, in 16% by bronchial aspiration fluid cytology, in 13% by pleural biopsy, in 11% by lymph node biopsy and in others by pleural fluid cytology, lung biopsy and skin biopsy. Commonest radiological involvement among different cell types was hilar involvement in small cell carcinoma in 62%, evidence of bronchial obstruction (collapse/consolidation) in squamous cell carcinoma in 56%, peripheral mass in adenocarcinoma in 54% and cavitation in a mass in squamous cell carcinoma in 15% cases.

[The liquefactive behavior of bronchial carcinomas and their metastases from the radiological viewpoint]

Necrosis in bronchial carcinomas and in their soft tissue metastases was studied in 368 patients by means of CT and ultrasound. In primary bronchial carcinomas (59 cases) there was clear correlation between tumour necrosis and the histology. There was a significant preponderance amongst squamous carcinomas, whereas small cell carcinomas rarely show radiologically visible necrosis (p less than 0.01). Amongst metastases in the liver (128 cases), central nervous system (164 cases) and suprarenals (23 cases) there was no correlation between histology and the recurrence of necrosis. Necrosis in deposits in suprarenals and in the brain depends on the size of the lesion and could be demonstrated in more than 50% of cases. Liver metastases show necrosis in less than 5% of the cases by the imaging methods used.

Minimal resection for bronchogenic carcinoma. Should this be standard therapy?

Minimal resection with curative intent for bronchogenic carcinoma was performed at our institutions in 15 patients from 1977 to 1987. All patients were stage I (T1N0 or T2N0). The five-year actuarial survival was 77 percent. The median length of follow-up for patients remaining alive was 41 months. There was a 6 percent (n = 1) local recurrence rate and a 27 percent (n = 3) distant recurrence rate. Both survival and recurrence rates are similar for minimal resection and for that being reported for lobectomy and pneumonectomy for stage I bronchogenic carcinoma. In our series, both median length of operating time and median length of postoperative hospital stay was less for those patients undergoing minimal resection for stage I bronchogenic carcinoma than for those undergoing lobectomy or pneumonectomy. Minimal resection can be considered as an acceptable treatment for bronchogenic carcinoma when technically possible in selected patients.

[Asbestos and bronchogenic carcinoma: a search for fibers in the pulmonary tissue of 3 patients with bronchogenic carcinoma]

Based on the highly suspicious radiological findings of exposure to asbestos (case 1) or on a positive occupational history (cases 2 and 3), the authors looked for the presence of fibers in blocks of lung tissue removed in autopsy or surgical biopsies of three cases of bronchogenic carcinoma. The blocks were submitted to sodium hypochloride digestion followed by fiber identification in phase contrast light microscopy. The authors were able to demonstrate the presence of fibres in the three cases. The likelyhood of those carcinomas being caused by exposure to asbestos is very high, as two out of the three cases showed pulmonary fibrosis (cases 1 and 2) and the other case showed typical parietal pleural plaques at thoracotomy.

Invasive and metastatic potential of a v-Ha-ras-transformed human bronchial epithelial cell line

The in vivo growth behavior and invasive potential of normal and "immortalized" human bronchial epithelial cells were studied by xenotransplantation procedures, an in vitro assay of invasiveness, and determinations of type IV collagenase activity and mRNA expression. BEAS-2B cells, immortalized after hybrid virus infection (adenovirus 12-simian virus 40), reconstituted a columnar epithelium when xenotransplanted into de-epithelialized rat tracheas transplanted sc into athymic BALB/c mice. A few adenomatous growths could be seen 16 weeks after transplantation. BZR cells, obtained by transfer of the v-Ha-ras oncogene into BEAS-2B cells, were tumorigenic in this xenotransplantation model. BZR-T33 cells, obtained from a tumor produced after injection of BZR cells, were also tumorigenic; however, they exhibited a shorter latent period. When these same cell lines were injected sc and iv into athymic BALB/c mice, BEAS-2B cells were not tumorigenic, and the BZR-T33 cells were more tumorigenic than the BZR cells. The incidence of spontaneous metastases after sc inoculation was zero for BEAS-2B cells, 33% for BZR cells, and 100% for BZR-T33 cells. Similar increasing values that correlated well with the data on in vivo growth were noted in the in vitro invasion assay, the collagenolytic ability, and the mRNA expression of type IV collagenase. Normal human bronchial epithelial cells showed the lowest values in all the assays. These progressive changes occurring in cells derived from the same parental line indicate that the presence of the v-Ha-ras oncogene in immortalized bronchial cells is associated with a full-fledged malignant phenotype, which is further enhanced by in vivo passaging.

The role of magnetic resonance imaging in the assessment of patients with lung cancer: a comparison with computed tomography

In general, computed tomography (CT) is superior to magnetic resonance imaging (MRI) as an all-around tool for imaging the wide range of thoracic abnormalities that can be present in patients with lung cancer. However, CT and MRI should not necessarily be viewed as competitive imaging modalities in this clinical setting. If MRI is used selectively as a secondary imaging study to answer specific questions raised or unanswered by CT, its value can be optimized. It can be of particular value in demonstrating chest-wall invasion in the lung apex as well as elsewhere, in defining mediastinal masses, which are hard to distinguish from vessels on CT, in detecting hilar masses, in distinguishing causes of adrenal mass, and in distinguishing recurrent tumor from fibrosis in patients who have had prior radiation.

[Results of nutrition diagnostic studies in patients with bronchial cancer]

A group of 71 patients with bronchial carcinomas are submitted to nutritional assessment in this trial. A 6-point valuation scan from Schmoz et al. for the nutritional assessment is used. Especially the results of protein assessment and the skin tests with 4 recall antigens are worked out. These results are compared with reference ranges. In the pathological values, both the protein assessment and the skin tests are classified in 3 interference degrees. In the following interpretation, the group of patients are subdivided in one group, which undergoes conservative therapy (26 patients) and a second one, which is treated operationally (45 patients). The results showed that more than half of the patients had disturbed nutrition indices, more than 2/3 showed disturbed protein status and more than 90% of the patients showed pathological results in the skin tests.