Carbonic anhydrase IX antigen differentiates between preneoplastic malignant lesions in non-small cell lung carcinoma

The MaTu interval (MN)/carbonic anhydrase (CA) IX tumour-associated antigen is a protein that is normally expressed in the gut and belongs to the carbonic anhydrase enzyme family (CA IX). It has been detected in tumour cell lines and in some solid tumours including cervical, oesophageal and clear cell renal carcinoma. This study determined MN/CA IX expression in 65 primary non-small cell lung cancer resected with curative intent and in 38 bronchial preneoplastic lesions, carcinoma in situ or microinvasive carcinoma as well as in normal bronchial tissue. The presence of MN/CA IX was detected using immunohistochemistry and Western blot analysis, whenever frozen material was available. Immunostaining was positive in 52/65 (80%) of the tumour samples. The staining was more often focal than diffuse. The percentage of stained cells in positive tumours was highly variable, ranging 1-85%. The pattern of immunostaining was predominantly cytoplasmic with a membranous reinforcement (87%). The intensity was mainly strong (69%). The presence of the protein in the tumour was confirmed by Western blot analysis in the eight samples tested. All the morphologically normal epithelia, except in close vicinity of tumours in some cases, as well as the preneoplastic bronchial lesions (basal cell hyperplasia, metaplasia and dysplasia) were immunonegative for MN/CA IX expression. In contrast, carcinoma in situ and microinvasive epithelioma showed the presence of MN-immunopositive tumoural cells in 5/7 and 4/5 of the samples, respectively. These data suggest that MN/CA IX is a useful marker for the differentiation between preneoplastic lesions and bronchial non-small cell lung cancer in the lung.

Atypical presentation of vertebral bone metastasis from lung cancer

The authors describe a case of lung cancer in a 55-year-old man who complained of back pain. Initial isotopic bone scanning showed no abnormality, however, magnetic resonance (MRI) imaging revealed bone metastasis in thoracic vertebral bone. Even when there is no typical findings of metastasis in bone scintigraphy, MRI imaging would be useful if vertebral bone metastasis is suspected. MRI imaging is an important modality to evaluate extraosseous extension and marrow invasion of metastatic tumors.

[Fortuitous diagnosis of an undifferentiated large cell carcinoma during cardiac surgery]

A 57 years old man was operated for aortic valve replacement. During the operation a mediastinal lymph node was biopsed with the result of undifferenciated large cell carcinoma with neuroendocrine features. Three months after surgery the patient died of non-cardiac related reasons, postmorten examination was not performed. Although the primary tumor could not be assessed, probably the lung was the original location. The histological classification of lung cancer is exposed, with special reference in the undifferenciated large cell type with neuroendocrine features.

Prognostic value of CYFRA 21-1, TPS and CEA in different histologic types of non-small cell lung cancer

The prognostic value of the tumor markers CYFRA 21-1, tissue polypeptide specific antigen (TPS) and carcinoembryonic antigen (CEA) was investigated in three histologic subtypes of non-small cell lung cancer. Pretreatment serum marker levels were measured in 38 patients with adenocarcinoma (AC), in 43 patients with squamous cell carcinoma (SQC) and in 35 patients with large cell carcinoma (LCC). Univariate analysis in AC showed significant lower survival of patients with elevated levels of TPS, CYFRA 21-1 and CEA. In LCC, elevated levels of TPS and CEA were found to predict lower survival, while in SQC--only TPS was a predictor. A multivariate analysis of survival identified CEA (Relative Risk-5.5; p = 0.004), CYFRA 21-1 (RR-3.4; p = 0.008) and TPS (RR-3.0; p = 0.02) as independent prognostic factors in AC. In SQC, only TPS (RR-2.3; p = 0.03) was such a factor whereas in LC--none of the markers studied retained statistical significance. Thereafter, the combinations of the two strongest prognostic factors in the AC group--CEA and CYFRA 21-1 were explored to divide this group into subsets with different prognosis. In cases where both markers were positive, the relative risk of death was 10.5 times higher as compared to cases where both markers were negative (p = 0.002).

Differentiation-related expression of the Thomsen-Friedenreich glycotope in developing human lung and in lung carcinoma: lack of association with malignancy

BACKGROUND

It has been proposed that the Thomsen-Friedenreich glycotope represents a general carcinoma-associated antigen and a candidate for the development of a tumor vaccine. However, the expression of the unmasked and masked (sialylated) forms in lung carcinomas, as well as in developing and adult human lung, has not been documented sufficiently.

METHODS

Sections from 82 lung carcinomas, including squamous cell carcinomas, adenocarcinomas, and large cell and small cell carcinomas, as well as sections of developing and adult human lung were studied using the lectin amaranthin and a monoclonal antibody.

RESULTS

All lung carcinomas but one bronchiolo-alveolar carcinoma were unreactive for the Thomsen-Friedenreich glycotope, whereas its sialylated form was detectable in well-differentiated squamous cell carcinomas and adenocarcinomas, including bronchiolo-alveolar carcinomas. Both unmasked and masked Thomsen-Friedenreich glycotopes were undetectable in large cell and small cell lung carcinomas. In all developmental stages of lung, the Thomsen-Friedenreich glycotope was expressed only in epithelia of the most peripheral parts of the bronchial tree, whereas its sialylated form was expressed in epithelia of all parts of the bronchial tree. In adult lung, the Thomsen-Friedenreich glycotope was expressed in pneumocytes, whereas its sialylated form was expressed ubiquitously in all epithelia.

CONCLUSIONS

The Thomsen-Friedenreich glycotope in human lung represents a differentiation antigen, rather than a carcinoma-associated antigen. The sialylated form is expressed constitutively in both developing and adult lung and well-differentiated lung carcinomas. Thus, the Thomsen-Friedenreich glycotope is of limited value in the diagnosis of lung carcinoma, and there is no rationale for a Thomsen-Friedenreich glycotope-based immunotherapy for patients with this disease.

[The frequency of atopy in lung cancer patients]

The controversial opinions on adverse correlation between atopy and incidence of lung cancer made us to undertake the research in that field in patients, treated in Department of Lung Diseases of University School of Medicine in Bydgoszcz. In 45 histologically diagnosed lung cancer patients in III and IV stage of the disease the tendency to atopy was assessed. In above mentioned patients the serum level of total IgE, the number of eosinophyls in peripheral blood and skin tests with popular allergens such as: home-dust, feather, grass particles, fungus and mould. It was established, that atopy in 25% of lung cancer patients was observed. That percents similar in persons without cancer burden. These findings suggest, that pathologically increased immunologic reactions, observed in atopic patients do not protect from lung cancer. From the other hand, the results of these examinations suggest also, that depressions of immunologic reactions, connected with lung cancer are selective in their nature.

Prognostic factors in surgical treatment of solitary brain metastasis after resection of non-small-cell lung cancer

Patients with brain metastasis after resection of non-small-cell lung cancer usually have poor prognosis. A few such patients, however, survive for long periods after surgical resection of brain metastases. To evaluate the prognostic factors in resection of solitary brain metastasis from non-small-cell lung cancer, we reviewed 24 cases undergoing resection of solitary brain metastasis after resection of the primary site from 1977 to 1993. The patient population consisted of 20 men and four women ranging in age from 40 to 75 years old (average, 57.8 years old). None of the patients had systemic metastasis except in the brain at the time of brain surgery. The overall survival rates were 12.5% at 3 years and 8.3% at 5 years after brain surgery. The longest survival periods were 11.5 years after brain surgery and 15.4 years after lung surgery. The interval between lung and brain surgery (< or =360 days vs. >360 days), differentiation of primary cancer (poor vs. moderate), size of primary site (< or =5.0 cm vs. >5.0 cm), and operation of primary site (lobectomy vs. pneumonectomy) significantly affected survival as shown by univariate analysis (P<0.05). Other clinical factors (age, gender, histology, T- and N-status, 'resectability with curative intent' of the primary site, location of the brain metastasis and postoperative radiation therapy) did not affect survival. Multivariate analysis using Cox's proportional hazards model indicated that an interval of more than 360 days between the two surgical procedures (hazard ratio = 0.2351, P = 0.0136) and lobectomy (hazard ratio = 0.5274, P = 0.0416) were independent prognostic factors. In conclusion, patients with solitary brain metastasis from non-small-cell lung cancer without other organ metastasis, in whom relapse in the brain occurred more than 1 year after resection of the primary site and in whom lobectomy was performed, should be treated surgically to maximize the chance of prolonged survival.

Diffuse metastatic infiltration of a carcinoma into skeletal muscle

Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report a patient with rapidly progressive contractures due to metastatic infiltration of a carcinoma of unknown origin into the skeletal muscle. This 61-year-old man presented with a 1-month history of rapidly evolving, painful restriction of mobility of his right arm and his legs. Computed tomography showed diffuse metastatic nodules in all muscles, particularly in the hip abductors. Muscle biopsy revealed extensive infiltration of the muscle with carcinoma cells.

Exfoliative cytology of a lymphoepithelioma-like carcinoma in a cervical smear. A case report

BACKGROUND

Lymphoepithelioma-like carcinoma of the cervix (LELC) is cytologically identical to its counterparts at other sites, such as the nasopharynx. LELC can be suspected on a cervical cytologic smear. The differential diagnosis includes nonkeratinizing squamous cell carcinoma with prominent stromal inflammation, carcinoma with intense stromal eosinophilia, glassy cell carcinoma, malignant lymphoma (especially lymphoepitheloid-Lennerts lymphoma) and metastatic Schmincke-Regaud tumor.

CASE

A 55-year-old female presented with an ulcerated endophytic tumor in the cervix. Exfoliative cytology showed uniform, large tumor cells, often associated with inflammatory cells, with round or oval nuclei and one or more prominent nucleoli. The cytoplasm was finely granular to flocculent, and the nuclei were uniformly vesicular. The chromatin was peripherally marginated. The cell borders were indistinct. There was no evidence of dyskeratotic or keratinized cells, koilocytes or glandlike formations. These findings were highly suspicious for LELC and were confirmed by biopsy. Flow cytometry showed DNA aneuploidy, with a DNA index of 1.08. In situ hybridization was negative for human papillomavirus 16 and 18.

CONCLUSION

LELC of the uterine cervix has cytologic features that are sufficiently characteristic for a specific cytologic diagnosis. The diagnosis, nevertheless, has to be proven by histology.

PD-ECGF, bFGF, and VEGF expression in non-small cell lung carcinomas and their association with lymph node metastasis

The angiogenic factors PD-ECGF, bFGF and VEGF were determined immunohistochemically in 168 non-small cell lung carcinomas to investigate whether the expression of these parameters is correlated with lymph node metastasis of patients. The expressions of the above mentioned factors was indeed associated with lymph node metastasis, but the results were not statistically significant. However, a combination of the factors PD-ECGF, bFGF and VEGF significantly improved the prognostic information. The number of tumors with lymph node involvement increased with the number of angiogenic factors. Only 43% of the patients had-lymph node involvement when all factors were negative whereas 77% showed metastasis when all factors were positive (one factor positive: 53%, two factors positive: 68). This result is statistically significant (p = 0.002, test for trend).

[Study of mast cell, eosinophil and fibroblast activation in bronchoalveolar lavage fluid in patients with lung cancer]

To assess the role of some pro-inflammatory cells in inflammatory processes in lung cancer by measuring their respective activation markers in different portions of bronchoalveolar lavage (BAL) fluid. Prospective study in a university hospital. We studied 52 BAL samples, 37 from patients with lung cancer and 15 from a control group, using a radioimmunoassay technique to analyze for tryptase (T), hyaluronic acid (HA) and eosinophil cationic protein (ECP) in separate bronchial and bronchoalveolar samples from BAL fluid. Statistical analysis was performed using the R-SIGMA program. Patients with tumors had significantly higher T and HA levels in BAL fluid than did control patients, in both bronchial and bronchoalveolar portions. Lung cancer patients had higher T and ECP levels in bronchoalveolar portions. Mast cells and fibroblasts, at least, play a part in lung cancer, mainly in the distal portions of the bronchial tree.

Intrapulmonary metastasis of lung cancer: soft x-ray investigation of inflated and fixed lung

BACKGROUND

Intrapulmonary metastasis (IPM) of lung cancer is thought to be an important factor influencing patient prognosis. It is not easy to detect a small IPM by preoperative examination and sometimes even by postoperative pathologic investigation. We applied soft x-ray investigation to inflated and fixed lungs for the detection of IPM.

STUDY DESIGN

From 1990 to 1992, 75 patients with lung cancer who had no metastatic lesions on preoperative whole CT, MRI, and technetium-99m bone scintigram examinations underwent lung resection. The resected lungs were fixed in an inflated condition, sliced at the corresponding CT levels into 10-mm-thick sections, and submitted for soft x-ray examination. When an accessory nodular shadow(s) was detected on the soft x-ray images, the size of the nodule and its distance from the primary tumor were measured.

RESULTS

In 23 of the 75 patients, accessory nodular shadows were detected on the soft x-ray images. Six nodules in 6 patients proved to be IPM, 2 of which were also detected by postoperative macroscopic examination. Another 2 microscopic IPM were found only by postoperative pathologic examination. The total detection rate of IPM was 10.7% (8 of 75 patients) in this series. The detection rate of IPM at our institute was 5.4% before this study (1979 to 1989). The mean diameter of the IPM detected by the soft x-ray method was 2.8 +/- 1.5 mm, and this was significantly smaller than that of the macroscopically detected nodules (7.2 +/- 3.2 mm).

CONCLUSIONS

Our data show that soft x-ray investigation is an effective procedure to detect relatively small intrapulmonary metastatic nodules and will contribute to precise postoperative staging of patients with lung cancer.

[Cystic pulmonary metastasis simulating a diagnosis of histiocytosis X]

A case of cystic pulmonary metastases from a renal origin simulating lung histiocytosis on high-resolution CT is presented. This diagnosis was suggested because of the presence of cystic lung lesions, micronodules and recurrent pneumothoraces in a male smoker. The diagnosis was reviewed after lung biopsy and demonstration of a renal mass.

Epidemiology of lung cancer

Lung cancer incidence is now decreasing in US men. Although rates continue to increase in women, the rate of increase is declining. Most lung cancer in men and women is attributable to cigarette smoking. Histologic patterns are consistent with smoking trends for gender, race, and age. Trends in adenocarcinoma may be related to an increase in exposure to tobacco-specific nitrosamines from low-tar cigarettes. Other risk factors, including exposure to residential radon, occupational exposures, diet, and family history, have been shown to increase risk of lung cancer independent of cigarette smoking. Recent research in molecular epidemiology has greatly increased our understanding of the mechanism of lung carcinogenesis and the interactions between exposure to lung carcinogens (smoking, occupational exposures, radon), diet, and heritable variations in susceptibility.

Fine-needle aspiration biopsy of large-cell undifferentiated carcinoma of the salivary glands: presentation of two cases, literature review, and differential cytodiagnosis of high-grade salivary gland malignancies

Primary undifferentiated carcinoma of the salivary glands is a rare, high-grade neoplasm which accounts for a very small number (1-5.5%) of malignant salivary gland tumors. The large-cell variant (LCU) is less well-characterized than the small-cell form. We report on the fine-needle aspiration (FNA) biopsy findings of 2 cases of LCU, one arising in the parotid gland, and the other in a buccal mucosa accessory salivary gland. The 2 cases were similar in composition: isolated and loosely cohesive large cells with abundant cytoplasm, and variability pleomorphic nuclei with prominent nucleoli. One case also featured multinucleated tumor giant cells and macrophage polykaryons; the latter has not previously been described in FNA biopsies of LCU. There was no evidence of squamous, myoepithelial, or widespread mucinous differentiation by morphological, cytochemical, or immunohistochemical analyses (focal rare mucin production identified on special stains in one case). The differential diagnosis is lengthy and consists of other high-grade primary salivary gland malignancies as well as metastatic lesions, including melanoma. The pattern of immunohistochemical reactivity (positive keratin, negative S-100, and HMB-45 antigens), and lack of conspicuous mucin production of significant lymphoidinfiltrate, were useful in establishing the correct diagnosis.

[Primary large cell carcinoma of the lung in the patients undergoing pulmonary resection: a comparison between pre- and post-operative diagnosis]

Between 1981 and 1995, 591 patients with primary lung cancer underwent operations. Of these, 19 patients (3.2%) was diagnosed as a large cell carcinoma pathologically. Clinicopathologically, we analyzed a discrepancy between pre- and post-operative diagnosis of these patients. This study showed as follows: 1) Accuracy of preoperative diagnosis was 73.7%; 2) No patients with primary site in right upper lobe had a correct diagnosis; 3) Accuracy of preoperation was not depending on tumor size; 4) In retrospective findings of the biopsied specimens, 'incomplete glandular differentation' caused preoperative diagnosis to adenocarcinoma, and modification of the specimens by pneumonia caused it to squamous cell carcinoma; 5) Inadequatespecimens originated from the right upper lobe or pneumonia lobe; 6) The five-survival rate was 27.3%.

Quick response of advanced cancer to chemoradiation therapy with antineoplastons

Antineoplastons A10 and AS2-1 exhibit growth inhibition of cancer cells by diverse modes of action. We observed antitumor responses within 2-3 weeks of a combination treatment of chemoradiation therapy and antineoplastons A10 and AS2-1 in phase I clinical study being conducted in Kurume University Hospital. We reviewed 3 clinical cases of advanced cancer (multiple metastatic lung cancer, thalamic glioma and primary lung cancer) in which we believed antineoplaston A10 and AS2-1 may be contributing to the rapid antitumor response. The possible use of this combination for induction therapy in advanced cancer is discussed.

Clinicopathologic characteristics of patients with nonsmall cell lung carcinoma with elevated serum progastrin-releasing peptide levels

BACKGROUND

Progastrin-releasing peptide (proGRP) is a specific tumor marker in patients with small cell lung carcinoma (SCLC). It has been reported that serum proGRP levels rarely are elevated in patients with nonsmall cell lung carcinoma (NSCLC); the reported frequency is <3%. The purpose of this study was to examine the clinicopathologic features of NSCLC patients with high serum proGRP levels.

METHODS

The authors measured serum proGRP levels with a TND-4 kit, a newly developed enzyme-linked immunoadsorbent assay, in 544 NSCLC and 206 SCLC patients. Pathologic features were examined using conventional hematoxylin and eosin staining and histochemical and immunohistochemical staining using polyclonal antibodies to proGRP, chromogranin A, calcitonin, and monoclonal antibody to the neural cell adhesion molecule (NCC-Lu-243).

RESULTS

The serum proGRP levels were elevated in 140 SCLC patients (68.0%) and in 23 NSCLC patients (4.2%). Seven of these 23 NSCLC patients had serum proGRP levels > or = 100 pg/mL. They included two patients with renal dysfunction, one patient diagnosed cytologically with adenocarcinoma without undergoing precise pathologic examination, two patients diagnosed histologically with squamous cell carcinoma with foci of small cell elements, and two patients diagnosed with large cell neuroendocrine carcinoma and poorly differentiated adenocarcinoma, respectively, which showed neuroendocrine differentiation on immunohistologic analysis. The remaining 16 NSCLC patients had serum proGRP levels < 70 pg/mL.

CONCLUSIONS

Nearly all NSCLC patients had serum proGRP levels < 100 pg/mL. However, if an NSCLC patient presents with a proGRP level > or = 100 pg/mL, the clinicopathologic features must be examined with regard to the small cell component, neuroendocrine differentiation, and renal dysfunction.

Expression of CEA and trophoblastic cell markers by lung carcinoma in association with histological characteristics and serum marker levels

The study of tumour markers in lung cancer has focused mainly on serum-based analysis. The controversy about carcinoembryonic antigen (CEA), pregnancy specific glycoprotein 1 (SP1) and beta human chorionic gonadotropin (betahCG) production in lung carcinoma has been reported in several studies. The aims of this study were: to explore an expression of CEA, SP1 and betahCG in various histological types of lung carcinoma with respect to the grade of differentiation; and to define the relationship between tumour marker expression and serum marker concentration. Ninety two lung tumours (75 non-small cell carcinomas (NSCLC) and 17 small cell lung carcinomas (SCLC)) entered the study. Tumour marker expression was compared with the serum levels of CEA, SP1 and betahCG in 57 patients (pts) with NSCLC and four pts with SCLC. Positive immunostaining of CEA and SP1 was observed in 87% NSCLC, and betahCG was found in 24% NSCLC. In the SCLC group positive staining showed in 29% of tumours, SP1 in 51% and betahCG in 18%. Positive CEA expression ranged from 50-100% within the carcinomatous cell population (pcp) and was more characteristic for well and moderately differentiated adenocarcinomas. This finding was in contrast to squamous cell carcinomas, where the majority of tumours expressed CEA in 1-50% pcp. A significant negative correlation was noticed for adenocarcinoma between tumour expression and grade of histological differentiation for CEA (P < 0.001) and SP1 (P = 0.023). Results were not significant for squamous carcinoma. Significant differences of serum CEA concentration were noticed between adenocarcinoma and squamous carcinoma (P = 0.003). In addition, a statistically significant relation was found between serum CEA concentration and an early (I + II) and advanced (IIIa + IIIb + IV) stage of NSCLC (P = 0.031). A significant correlation was noticed when serum CEA and tumour CEA expression was compared for NSCLC (P < 0.001), and for serum betahCG and tumour betahCG (P = 0.019).

[Diagnostic procedure in patients with suspected lung cancer. Results of combined evaluation by thoracic surgery and pulmonary medicine specialists]

During the last 50 years, the 5-year survival of lung cancer patients has been unchanged at 5%. As the prognosis for patients with operable nonsmall cell lung cancer (NSCLC) is much better, the diagnostic examination of tumour suspicious lesions with secondary judgement of operability in NSCLC is an important subject. This study focuses on the diagnostic process. During the years 1991-1993, 467 consecutive patients with pulmonary tumour suspicious lesions were prospectively followed at the Department of Pulmonary Medicine and the Department of Thoracic Surgery, Bispebjerg Hospital. In 40% of the patients, the diagnostic delay was longer than 30 days. Fiberbronchoscopy and fine needle biopsy were the most important diagnostic tests with an accuracy of approx. 90% for both central and peripheral lesions. Benign lesions comprised 19% of all, while the prevalence of squamous cell carcinoma, adenocarcinoma, small-cell carcinoma and large-cell carcinoma was respectively 21%, 26%, 15% and 18% of the malignant infiltrates. Histological diagnosis was not achieved in 104 patients. Histological diagnosis was achieved in most patients, but the diagnostic process was slow. A faster diagnostic process is to be aimed for and can, hopefully, be achieved by accomplishing diagnostic standards as just proposed by the Danish Lung Cancer Group.

Small cell carcinoma of the uterine cervix with large cell neuroendocrine carcinoma component

A case of cervical small cell carcinoma (SCC) with large cell neuroendocrine carcinoma (LCNC) differentiation is presented. A 35-year-old Taiwanese woman was diagnosed as having stage IIB bulky SCC confirmed by cervical biopsy and underwent induction combination chemoradiotherapy followed by hysterectomy. The pathology of the cervical tumor after the initial treatment showed the residual tumor to be LCNC instead of SCC. Histochemistry, immunohistochemistry, and electron microscopy demonstrated presence of neuroendocrine differentiation on both the biopsy and the surgical specimens. Following surgical resection a course of adjuvant chemotherapy and a local radiation boost were added. Despite complete local control, she developed brain metastasis 8 months later and vertebral spread soon thereafter. The pathology of the brain tumor showed pure SCC. The patient died 19 months after diagnosis and 13 months after completion of treatment. This case suggests that SCC with LCNC component has a similar clinical course as a pure SCC.

Large cell carcinoma of the lung metastatic to nuchal muscle

Clinically apparent hematogenous skeletal muscle metastases from lung cancer are extremely rare. We present a 72-year-old man with a large cell lung carcinoma metastatic to nuchal muscle. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a well-defined mass in the left splenius capitis muscle. A percutaneous needle biopsy was performed to establish a diagnosis. Localized skeletal muscle swelling may rarely prove to be metastases in patients with lung cancer, but should be investigated in the case of muscle swelling.

Neural networks as a prognostic tool for patients with non-small cell carcinoma of the lung

Patients with non-small cell carcinoma of the lung (NSCLC) have a poor prognosis (64 and 41% survival rates in Stages I and II). It is currently not possible to predict which patients with Stage I or II NSCLC will survive the disease. Sixty-seven patients with NSCLC, including 49 patients with Stage I NSCLC and 18 with Stage II disease (11 with squamous cell carcinomas, 35 with adenocarcinomas, and 21 with large cell carcinomas) were treated with lobectomy and followed for a minimum of 5 years. The tumors were studied with DNA flow cytometry and quantitative immunocytochemical studies for proliferation cell nuclear antigen, p53 protein, and MIB-1. The data were analyzed with backpropagation neural networks, univariate analysis of variance, the Kaplan-Meier survival method, and Cox proportional hazards model. The dependent variables were "free of disease" and "recurrence or dead from disease." Twenty neural network models were trained, using all cases but one, after 1883 to 2000 training cycles. At 5 years, 30 patients were free of disease and 37 were dead or had recurrence. Proliferating cell nuclear antigen was the only statistically significant prognostic factor by univariate analysis of variance and Cox proportional hazards analysis. The S phase was statistically significant by univariate analysis of variance (P <.05). All of the 20 models classified the test cases correctly. Study with backpropagation neural networks using multiple prognostic features from patients with NSCLC suggests that this technology might be useful for prediction of survival. This preliminary study must be validated with data from a larger group of patients with NSCLC before its clinical adequacy is established.

[Systemic embolism in a renal transplant patient. Echocardiographic demonstration of bronchial carcinoma with intracardiac invasion]

A 45 year old female renal transplant patient was admitted for subacute ischaemia of a lower limb. Echocardiography was performed and showed the presence of bronchial carcinoma with intracardiac invasion. The tumour was confirmed by thoracic computerised tomography and by bronchoscopy. Histological investigation of bronchial biopsies and of the arterial embolism extracted at surgery showed large cell malignant disease. The tumour partially responded to chemotherapy and the patient survived for 5 months. Extension of a bronchial carcinoma to the left atrium is a classical complication in autopsy reports but rarely a source of systemic embolism. Echocardiographic diagnosis of this condition is very rare. The incidence of malignant diseases is higher in renal transplant patients than in the general population but this has not been verified for bronchial carcinoma. Echocardiography played an essential role in this case, detecting the tumour and its extension, indicating a poor prognosis and guiding treatment.