[Neuron-specific enolase as a tumor marker in small cell bronchial carcinoma]

Neurone specific enolase (NSE) was measured in serum from 54 patients with untreated bronchial carcinoma. Serum NSE was elevated (greater than 12.5 micrograms/l) in 24 of 31 patients (77.4%) with small cell bronchial carcinoma, but in only 4 of 23 (17.4%) with non-small cell bronchial carcinoma. The median serum NSE level was significantly higher for small cell bronchial carcinoma than for the other forms (23.6 micrograms/l vs. 8.0 micrograms/l; P less than 0.001). NSE levels had a positive correlation to the tumour stage for the small cell tumour: median of 16.5 micrograms/l in "limited disease" (16 cases) and 43.2 micrograms/l in "extensive disease" (15 cases). Serum NSE levels seem to be suitable markers for documenting the course of small cell bronchial carcinoma: 15 patients with tumour regression or remission had normal NSE values while elevated levels were found in 7 of 8 patients with progression. NSE was demonstrated immunohistologically both in small cell and non-small cell bronchial carcinoma tissue, but high NSE levels were predominantly present in small cell carcinomas.

Frequency of extrathoracic metastases from bronchogenic carcinoma in patients with normal-sized hilar and mediastinal lymph nodes on CT

The only cure for bronchogenic carcinoma is complete surgical resection; the most common reason for not attempting surgical resection is mediastinal adenopathy. However, we have found that even when the lymph nodes are normal in size, the presence of extrathoracic metastases may preclude successful resection. In a series of 263 patients with pathologically proved non-small cell bronchogenic carcinoma who were seen over a 2-year period, we identified 95 patients in whom a preoperative CT scan showed only a solitary lung mass without evidence of hilar or mediastinal metastases, pleural effusion, or definite chest-wall involvement. The medical records and preoperative imaging studies were evaluated in this group. Twenty-four (25%) of these patients who had potentially resectable masses proved to have extrathoracic metastases; thus they were not candidates for surgery. Occurring in 16 (67%) of these 24 patients, adenocarcinoma was the most common cell type; squamous cell carcinoma was present in five patients (21%), and large cell carcinoma was present in three patients (13%). These findings suggest that extrathoracic metastases from bronchogenic carcinoma may occur without CT evidence of enlarged hilar or mediastinal lymph nodes. Such metastases may preclude successful surgical resection.

Electron microscopic observations in in situ and microinvasive bronchogenic squamous cell carcinoma

Seventeen cases of resected in situ and microinvasive bronchogenic squamous cell carcinoma were studied by light and electron microscopy. No definite secretory differentiation was found in any case. Examination of the tumour cells in the basal layer for electron density of cytoplasm, intercellular spaces, and degree of development of cytoplasmic processes showed a variety of cells ranging from type I, where the cytoplasm was dark, development of cytoplasmic processes was good, and the intercellular spaces were large, to type III, where cytoplasmic processes and intercellular spaces were less well developed and the cells were mostly of clear cell type. The tendency to invasion was greater in type III than type I and there was also more marked cellular atypia, more extensive dissolution of basement membrane, a larger number of mitotic figures per 3000 cells in the basal layer, and greater enlargement of nuclear and cytoplasmic areas. A good rank correlation coefficient was obtained. Small dense-core granules were observed in some cases. These finding suggest the strong possibility that cell kinetics and cellular morphology are related to the development of squamous cell carcinoma.

Metastasis-induced acute appendicitis in small cell bronchogenic carcinoma

I have reported a case of acute appendicitis with perforation caused by metastatic small cell bronchogenic carcinoma. There was no evidence of distant spread apart from that to the appendix, and at operation, there was no macroscopic evidence of other metastases in the abdomen.

A comparison of patient survival and tumour growth kinetics in human bronchogenic carcinoma

A series of 46 primary bronchogenic carcinomas for which thymidine labelling index (%TLI) (in all cases) and tumour doubling time (DTact) (in 13 cases) had previously been measured were followed up for 5 years and these data compared with length of post operative survival, tumour volume at operation and pathological staging. We found no correlation between reduced survival and higher tumour %TLI, indeed the reverse may be true. Larger tumours tended to have higher labelling indices considering either primary tumour volume or 'T'-category. Five year survivors had smaller tumours, tended to have T1 tumours and Stage I disease but did not have significantly lower tumour %TLIs. No relationship was found between DTact and any other parameter.

A quantitative cytologic study of sputum in early squamous cell bronchogenic carcinoma

The abnormal cells (atypical squamous cells and cancer cells) in the sputum of 12 in situ and 20 early invasive squamous cell carcinomas were studied quantitatively and compared with the cells in 12 borderline cases and 11 frankly invasive squamous cell carcinomas, In in situ and early invasive squamous cell carcinomas, the mean nuclear diameters were larger and multinucleated cells and distinct nucleoli were more frequent than in borderline cases. Furthermore, the mean cellular diameters and the number of abnormal cells per slide were smaller, the distinct nucleoli were less frequent and acidophilic cytoplasms were more frequent than in frankly invasive squamous cell carcinomas. The results indicate that (1) in situ and early invasive squamous cell carcinomas are generally distinguishable cytologically from borderline cases and from frankly invasive squamous cell carcinomas and (2) the cytologic differentiation between in situ and early invasive squamous cell carcinomas is quantitatively insufficient.

[Results of resection treatment of locally limited bronchial carcinoma (Stages I and II)]

Of 238 patients operated upon for bronchogenic carcinoma between 1977 and 1985 the tumor was locally limited in 108, of whom, according to the new international staging system, 66 patients were in stage I (T1N0 + T2N0) and 42 in stage II (T1N1 + T2N1). 89 were male and 19 (18%) female. The mean age was 61.6 years in stage I und 63 years in stage II patients. 26 patients (24%) were aged over 70. All patients underwent potentially curative excision of the tumor. This was accomplished by partial lung resection in 97 patients, of whom 84 underwent lobectomy with 2 postoperative deaths (2.4%). Operative mortality amounted to 5.5% in the whole group (6/108), with 3% (2/66) in stage I and 9.5% (4/42) in stage II patients. The absolute survival rate at 5 years was 50% for all 108 patients, 59% for the 66 patients in stage I and 39% for the 42 patients in stage II. It was 70% for 15 patients with bronchioloalveolar carcinoma, 54% for 20 patients with adenomatous cancer and 49% for 56 patients with squamous carcinoma. At present 62 of the 108 patients are still alive (57.4%), i.e. 45 out of 66 in stage I (68%) and 17 out of 42 in stage II (40.5%). This retrospective study therefore confirms former reports that long term results are encouraging in the locally limited stages of pulmonary cancer. In addition, operative mortality is low because almost all these tumors can be removed by partial lung resection. In stage I lobectomy is the method of choice.

[Cost-benefit analysis of thoracic computerized tomography as exemplified in the N-staging of bronchial carcinoma]

In 60 selected patients affected by a limited stage of bronchial carcinoma according to clinical examinations, routine computed tomography and mediastinoscopy were performed to detect metastatic lymph-node involvement. Patients with histologically proven mediastinal lymph-node metastasis (stage N 2-3) subsequently were excluded from surgical therapy. As alternative diagnostic procedures four different strategies are discussed to estimate the greatest efficacy regarding costs and benefits in preoperative staging of malignant lung tumors: (1) primary thoracotomy, (2) routine mediastinoscopy, (3) thoracic CT-scanning and (4) CT-scanning combined with selective mediastinoscopy. Efficacy was then evaluated by the criteria of financial expenditure for each curative resection. As a result there are but small differences between the four diagnostic approaches and thoracic CT-scanning definitely does not reduce the overall costs of curative surgery or markedly improve the diagnostic yield. However, the combination of selected mediastinoscopy with CT-scanning at least increased comfort and safety in preoperative staging of patients without loss of sensitivity or specificity in detecting resectable tumors. This method should therefore be favoured for evaluating the resectability of bronchial carcinoma.

Osteolytic cortical destruction: an unusual pattern of skeletal metastases

Twenty-two histologically proven cortical metastases in 11 patients with bronchogenic carcinoma (10 squamous cell and one adenocarcinoma) were studied. The intracortical foci could be classified according to four distinctive patterns of bone destruction: small focal intracortical lesions ("cookie-bite" or "cookie-cutter" pattern); large osteolytic lesions; saucerized intracortical lesions with well-defined periosteal reaction; and lesions with predominant cortical destruction extending into the soft tissue as well as the medullary cavity. All lesions were located in the femoral bones.

A new versatile transbronchial cytology needle for the staging and diagnosis of bronchogenic carcinoma

A new versatile transbronchial needle, the modified type 2B retractable needle, was used for the staging and diagnosis of bronchogenic carcinoma. It combines the advantages of its predecessors, the fixed type 1A needle and the retractable type 2A needle, such as convenience of usage and the added ability to sample peripheral as well as central lesions. The new modified type 2B retractable needle provides better protection of the airways and bronchoscope than the fixed type 1A needle and eliminates the type 2A needle's requirement for total removal of the guidewire before aspiration. The new type 2B needle was compared with either the original fixed type 1A or the retractable type 2A needle in 20 patients at 34 transbronchial sites and found a similar diagnostic yield. The modified type 2B retractable needle was the most versatile needle of those studied and can be used for transbronchial needle aspiration of both central and peripheral lesions.

Neoadjuvant therapy of stage III non-small cell lung cancer

During the past several years, there has been a resurgence of interest in preoperative or postoperative chemotherapy in patients with Stage III lung cancer. The staging system for lung cancer has recently been modified, and at the present time Stage III disease is now subdivided into Stage III-A (potentially surgically resectable for cure) and Stage III-B (unresectable). This article will review five recently completed studies utilizing neoadjuvant therapy in various types of Stage III lung cancer. The thoracic surgeon is faced with the dilemma of reviewing this literature and trying to make a conclusion as to what is appropriate therapy for Stage III disease. Unquestionably, neoadjuvant therapy appears to increase the resectability rate in Stage III-A disease and can make some Stage III-B patients anatomically resectable. It is hoped that future well-designed phase III studies can be accomplished in Stages III-A and III-B disease so that we can determine whether neoadjuvant chemotherapy is or is not beneficial for these patients.

Primary malignant pulmonary neoplasia in two horses

Although primary malignant pulmonary neoplasia of horses is rarely encountered, this diagnosis was confirmed in 2 horses on the basis of necropsy and histopathologic findings. One horse, with cystic mucinous adenocarcinoma, had respiratory tract and neurologic signs directly attributable to the neoplasm, and a tentative antemortem diagnosis of pulmonary neoplasia was made. The other horse, with anaplastic bronchogenic carcinoma, did not have clinical signs of pulmonary neoplasia.

[Pathologic analysis of 302 primary bronchogenic adenocarcinomas]

Pathomorphology of 302 primary bronchogenic adenocarcinomas resected in our hospital from 1957 to 1984 was studied. It consisted of 23.5% of the total lung cancers. Gross findings are: central type 15.9%, peripheral type 82.4%, and disseminated type. 1.7%. Cancerous cavity was observed in 13.2%. According to the histologic classification of lung tumor, WHO, 1981, adenocarcinoma was divided into four subtypes: 1. acinar adenocarcinoma (132 cases); 2. papillary adenocarcinoma (73 cases); 3. bronchiolo-alveolar carcinoma (74 cases) and 4. solid carcinoma with mucus formation (23 cases). Among them, there were 16.6% of scar carcinoma and 1 case associated with asbestosis. 15 cases were studied by electron microscope. The 5-year survival rate was 19.6% (peripheral type 21.7%, central type 12.5% and disseminated type 0%). There was no significant difference in the prognoses of the histologic subtypes. The patients without metastasis to the hilum, mediastinum or positive stump had better prognosis. The relationship between adenocarcinoma and bronchiolo-alveolar carcinoma is discussed.

Tracheal sleeve pneumonectomy for bronchogenic carcinoma: report of 55 cases

From 1966 to 1986, a total of 55 patients underwent a tracheal sleeve pneumonectomy (53 right and 2 left) for bronchogenic carcinoma. Preoperative radiotherapy was given in only 5 patients. The overall operative death rate was 10.9%, but no patient has died since 1975 (32 survivors). Seven patients had a postoperative empyema (12.7%); 4 of these patients had a bronchopleural fistula. Twenty-five patients had postoperative radiotherapy, 5 of whom also had chemotherapy. The actuarial survival rate, after exclusion of the 6 operative deaths, was 38% at 3 years and 23% at 5 years. Survival was correlated to regional lymph node involvement. The actuarial survival rate among patients with tumoral spread to bronchial lymph nodes was 43% at 3 years. Among the 13 patients with only subcarinal involvement, the actuarial survival rate was 34% at 3 years. None of the 8 patients with paratracheal lymph node involvement survived more than 30 months. These results indicate that tracheal sleeve pneumonectomy for bronchogenic carcinoma with extension to the carina is now fully justified considering the low operative mortality and the good results observed when lateral tracheal lymph nodes were not involved.

Computed tomography of mediastinal lymph nodes in nonsmall cell lung cancer. A new approach based on the lymphatic pathway of tumor spread

Computed tomography was used to evaluate mediastinal lymph nodes in 97 patients with nonsmall cell lung cancer. All patients had thorough surgical-pathological determination of mediastinal node status. Twenty-three patients were found to have metastatic lymph nodes. The usual lymphatic pathways of tumor spread into the mediastinum were defined using the node mapping scheme suggested by the American Thoracic Society. We considered mediastinal nodes abnormal when the short axis of the largest mediastinal node in the lymphatic drainage territory of the cancer was greater than or equal to 10 mm and the difference between this node and the largest node in the other territories is greater than 5 mm. The sensitivity was 78%, the specificity 99%, the positive predictive value 95%, the negative predictive value 94%, and the accuracy 94%. Comparing our method to those that used the size criterion alone, the number of false positives was reduced.

Metastasis to the colon from primary bronchogenic carcinoma presenting as occult gastrointestinal bleeding--report of a case

A case of colonic metastasis in a 69-year old man detected due to positive fecal blood tests is presented. Histologic and clinical findings suggested bronchogenic small cell carcinoma as the primary tumor. Metastatic involvement of the colon is an unusual feature of primary bronchogenic carcinoma which is rarely recognized during lifetime.

Mediastinal nodes in bronchogenic carcinoma: comparison between CT and mediastinoscopy

Computed tomography (CT) and mediastinoscopy were compared in 151 patients with bronchogenic carcinoma. In all patients in whom findings at mediastinoscopy were negative, all accessible nodes were either removed or sampled at thoracotomy. Several size criteria for identifying nodes as enlarged on CT scans were compared. The long axis greater than or equal to 15 mm and short axis greater than 10 mm had very low sensitivity (61%), and the long axis greater than 5 mm had a low specificity (23%). CT (long axis greater than 10 mm) allowed sensitivity equal to that of mediastinoscopy (79%) in the detection of mediastinal metastases, but the specificity with CT was lower (65% vs. 100%). In seven of 44 patients with nodes greater than 10 mm on CT scans and with positive findings at mediastinoscopy, tumor was present not in the enlarged nodes but rather in normal-sized nodes in a different nodal station. The sensitivity of CT for actual nodal stations involved with tumor was only 66%. Eighty-three percent of patients with false-negative findings at mediastinoscopy but only 33% of patients with false-negative findings at CT had surgically resectable stage IIIa disease.

[A preliminary study for cellular, albumin and immunoglobulin components of bronchoalveolar lavage fluid in normal control, pulmonary T.B. and malignant lung diseases]

Bronchoalveolar lavage (BAL) is a new diagnostic tool which could be applied repeatedly to investigate the nature of lesion in pulmonary diseases. To evaluate the clinical significance of the difference in immunoglobulin content for the differential diagnosis between benign and malignant pulmonary diseases, we performed bronchoalveolar lavage for 64 patients. They included 12 patients with bronchogenic carcinoma, 12 patients with pulmonary tuberculosis, 20 patients with benign non-specific bronchopulmonary diseases (these including 6 patients with pneumoconiosis, 6 patients with bronchietasis, 2 patients with paraquate intoxication, 6 patients with pneumonia) and 20 healthy persons as of the control group. We analyzed the following items: (1) cell count (2) differential count (3) protein content (4) immunoglobulin content. The results showed that there were increase in PMN cells in paraquate intoxication, pnuenmonia and bronchiectasis. While there was lymphocytosis in pulmonary tuberculosis. In comparison with the control group, there was elevation of statistical significance in the IgA/Albumin ratio in bronchogenic carcinoma and pulmonary tuberculosis. Although the IgG/Albumin ratio would be elevated with statistical significance among a variety of pulmonary diseases, it was particularly high in pulmonary tuberculosis. In contrast, the IgA/IgG ratio was significantly increased only in bronchogenic carcinoma. In conclusion, there were differences in the cell number, differential cell count, protein content and immunoglobulin content among various pulmonary diseases. It may be useful in making differential diagnosis between benign and malignant pulmonary disease and the prediction of prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)