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A prognostic model of recurrence and death in stage 1 nonsmall cell lung cancer utilizing presentation, histopathology, and oncoprotein expression
Abstracts/
Lung
Cancer
13 (1995)
81-104
Twenty a-dies including a total of 3500 resected patients revealed the, definite prognostic variables in the resectable patient group were ~~rformancc natus. SNEC. cate~ot~ of tumor size and location 0. and category of lymph &mvolv&& (N). Fourteen studies including a totalof5875~atientswithino~erableNSCLC. ineludedinchemather trials with or without mdiolhcrapy, revcalcd that solely pcrforrI&& status and stage WCP definite pmgnostic variables in this non-resectable patient group. Possible prediaors of long survival were low LDH, female gender, and high plasma albumin level, while weight loss, histology, and age were of minor importaea. A large pan of tbe variation in sorvival outlook remains tmcxplained, calling for tiutber studies on the prognoslic inlluence of biological fealures of tbe tumors.
analyzed using a high-resolution, automated image cytometer. These case; were divided a&ding to pathologic stage: stage I. 3 I; stage II. 3; stage 111. 19. and stage Iv, 7. For each nucleus 57 feelures were analyzed, and using a linear combination of lhree textore features describine the DNA distnbufion in the cell nucleus ITARL. ODMAX and FAREAL). aggressive canter cells belonging to Age III/IV could be identified The test discrimination ktwgn the Stages was achieved when the frequency of aggressive cancer cells was 48%; tbe currec, classification rate was 77% Usingthiscriterion. 22 of 27 patients (81%) who died of cancer within five years after surgery were correctly predicted. These resulti suggest that high-resolution cytometry may be of value in predicting the biologic behavior of adenocarcinoma cases, especially in stage VII
Binding capacities to blood-group antigen A, B md H, DNAand MST meuurrments, and survival in bronchial carcinoma Kavser K. Bovin NV. Penn F-Y. Zeilineer C. Cabins H-l. De~orrmenr of k’othotogy. Thmkbnik. Amotienshosse 5. D-69126 Hdidelbvg Radial Oncol 1994:28:282-6. The expresion of binding capacities related to blood-group antigens A. B. and H was asxssed glycohinochemically in para&n~mbedded samples fmm 149 lung carcmoma patients. In addition. measurements of integrated optical density (IOD) and syntactic stmnure analysis (MST) were performed. The material comprised potentially curative excised surgical specimens of 46 epidermond carcinomas. 42 adcmcarcinomas, 26 smell cell carcinomas, and 35 largecell anaplastic carcinomas In about 50% of the carcinomas bmdmg capacmes to BLOOD A, B. and H mold be demonstmted. No relabon 10 the tumor cell type was found. The measurements of IOD revealed a S-phaxrelated fraction of S-lS%of tumor cell nuclei and a remarkable fraction of tumor cell nuclei with an IOD > 5C. Patients’ survtval was strongly related to tbe numberofstem lines, S-phase related frxoon. percentage of tomor cells wilh a,, IOD > SC and expression of bmding sutes to BLOOD A and BLOOD H. The expression of binding sites lo bloodgroup antigens H was associated with decreased cellular heterogcneify is d&oos&d by tk percentage of tumor cell nuclei with abnormal IOD. The analysed prognosoc factors were found 10 be mdependcnt from cell type and tumor stage (TNM)
Anal metastasis from carcinoma of the lung: Report of a case Kawahara K. Akammc S. Takahashl T . Nakamura A. Kusano H. Nakagoc T e, al F,,.,r D<~or,,,nenr o/Su+?erv, .?.‘a,zfl.yok, I *,vux!v Schoo, ,2ledrcme. 7-1 Sn!.a,,wl<~ I-chom ?&wnkt 852 Surg Todada) 1994:24 1101-3 WC rcporl hcrein the cast ofa 75-jear-old man who dc\claped anal canal metastasu from squamous cell carcmoma of the lung Imt~all). he undcnvcnt a right mlddle and lower lobcc,omj combmcd ulth len atrial wall resectlo” under cardiopulmonary bypass He prcsenicd 3 months later wuh an anal polyp whnch had prolapsed and bled. for whnch he undcnven, a transanal pol>pcctom) H~s,olog,call>. the was classified as squamous cell carcnnoma and considered 10 bc a ~C,~,SWSISiron, ,he pr,maly lung cancer He 1s prcscn,l> ucll nllh no signs oi rcc~rrcnce 9 months af,cr his ~mt~al opcralaos To our knowlcdgc. thcrc has been no olhcr cast of anal me,astar,s from lung cancer ever rcponcd
Biological behaviour of lung carcinoids. A retrospective analysis of 71 patients Kern I. Rot, T . Rumr-Zupancr M, Sorli J, Gantar-Rot, U et al /ns,rtu,e for Respmmy D,seoses. 61204 Golnrk. fiadlol Oncol 1994,28:27681 A retrospecl~ve study of 7 t patients ,rea,ed for lung caranoids during the years 1973-1992 ~sprewnted. Besideclmical and pathological dam. an mquily was performed 10 establish the rates of recurrence of disease and survnal of the patients Lung carcinoids represented 0.6% of all lung carcinomas. There were 37 male and 34 female patienu with age mnee from I4 to 18 vears. and an average age 47 5 years at the time of st,r~ery. The highest incidence ofcarc,no& 08 pabents, 53%) appeared m the age group 4 t-60 years. In three patients (4%). assocmted clinical syndromes were documented one patlen, had typical carcmoid syndrome. while an two others Cushmg’s syndrome has developed The most mmmon lobeclomy was performed in 45 patients (63%) Six,ysix (93%) carcinolds were lccated centrally, and 5 were penphcral. Htstologically. 61 carcinoids (86%) were evaluated as typical. Two carcinoids (3%) were mmposal ofspindle cells. 2 had oncocytic areas. and stromal ossi,icatmn was found m 4 cases (6%). Out of 64 patuents, lymphnode me,asuses were found in only 3 cases (5%). and distant mctaslascs it, one patien, with a recorren, hunour. Nine paoents (I 3%) have Bed 5 (7%) because of atypical carcinolds and 4 because of other diseases. Tbe second primary maligMncy was detected in four pat~enll (5.6%). Fony-six out of 47 pat,ents (98%) have survived 5 years, 26/28 (93%) IO years. and l3/l8 (72%) have survived even I5 years. The prognosis was gocd in patients wxth typical carcmoids but much worse in those wilh atvoical -ino& nevertheless. even in ,he latter, the death cccurred la,cr than in other lung carcmomas
Use of high-resolution cytometry in predicting the biologic behavior of T I ndenocucinoma of the lung Ike& N. MacAulay C. Lam S, Gamer DM, Payne PW, Kate H et al. Cancer ,,mging Deporlmcn,, Bnrrsh Columbia Cancer Agency, 601 Wes, ,O,h Avenue. Voncouve,: BC “SZ ,L.J. Anal Quant Cytol mstol 1995:17,69-74. Touch preparations from 60 cases of Tl adenocarcinoma were
pol?p
CT image of compression of the left ventricle by a lung tumor Chudacek 2. Vejprnrcka 20, 31805 Plzen. Radio1 Diagn 1994;35:2091” Acachecticmalepatien,wasrcfened,o,heDe~ntofRadiology wth a workmg diagnosis of lung tumor. CT was performed with a Siemens Somatom ART. Slice thickness was 5 mm. CT confirmed a tumor at tbe right hilum and revealed pulmonary metasudses. Tumomus changes were also seen a, the vacheal biroration and the cranial aspect ofthe heat. Followingadministrationofcontrast. no enhancement was seen in the Idt atrium. Only the anterior lung veins were opacifed The density of the IeR atrium was inhomogenous. In our repon. a tumor in the left atrium was described. The patient went back 10 the Fakoltatskrankenbau PIzen and died one day after the CT examination Report 939192 of the post-mortem examination pcrformed at the Depmtment of Patholo& describes a carcinoma of the rigb, main stem bmnchos. There were lymph node me&stases as the tracheal b&nation and in the pamtracheal chain. The enlarged lymph nodes prerented as a tumor of 8 cm size. There was external compression ofthc lefl atrium by this tumor. No ,umor was found in the IeR atrium. Carcinosts p&icarti was found. Thecomnay attcries showal significant stenoses The imaging diagnosis was wmngbeause we did not consider external compression of the left atrium in the differential diagnosis Because of this mistake we did noi perform saandary remnstruct~ons m another plane or 3D &splay External compression of the lcfi venlr~cle ISa rare condition. Tothc bestofoor knowledge, no repxts refer to thisdiagnosis in the CT literature Unusual clinical manifestation of metastatic pulmonary carcinoma. A case report and miew of the literature Orabona P, D’Antonio A, De Rosa I, Boscaino A. Deporbnent of Pathology Faculty ofhledmne, Universrry ‘Federico II ‘, Naples. Arch Anat Cytol Pathol 1994;42:330-3. Wereponacaseofileal m~isfmmaclinicalfyNiden,bronchial carcinoma with an unusual sympomatology due to inteainal obsmxtion. Only 25 cases of ileal metas,asis have been previously reported in the literature in which the diagnosis was made due ,o the presence of abdominal symptoms related to intestinal perforation in 24 cases. We descnbc our atypical case W&I differential dmgnosis and renew of the b,era,ure.
A prognostic model of recurrence and death in stage I nonsmall cell lung cancer utilizing presentation, histopathology, and oncoprotein expression Harpole DH Jr. Hcrndon JE II, Wolfe WC. lglchan JD. Marks JR
Abstracts/Lung “WL~,“” of Thomcrc .%gely “nghnw rind ,riv,,m 1 H”\p,ml. fiianc,r s1reer. Rosmn. dL.1 02//s Cancer RCS 1995.55 5 1-6
Cancer 13 (1995) N-104 7.5
In order 10 constr~c, a ,,,ui,,\a,,atc model lo, prcd,c,,ng earl> ,CCU~~C”CCand cancer dath for pat,cnts i*ltrh r,agc f non-small cell cancer, 271 consecuwc pat~ntr (mem age. 63 f X yzarr, uho were diagnosed. trcatcd. and lollowcd at one ~nrututmn wx studred All patmts were clmcal stage I ulth hcnd and chcsuabdommal computed tomograms and radxxwchdc boric scans rrahout c\ rdcncc ol m~tastauc discar Pathological n~lcr~al after rc~ctmn uas re\wred to vcri@ hrstological rtagmg Follou-up docunwntcd the trmc and location of any rcc~rrcnc~. uas a mcdran 56 months I” duratmn. and was complclc m all arcs Data rccordcd rncludcd a8c. SC\. smokmg h,%ry. p;cscntmg ~mprams. pathological dcsn,pnon. and oncoprorc~n s,a,n,n~ for crbB-2 (HER-Z/ncu). ~51. and KId7 ,,rol,fcratmn pmtcm lmmunoh,stahcm~rtry of oncogcnc cxprcssmn &as pcrfcxn~cd an two separate archlvcd paratlin ,umor blocks lor each pa,,cnt. \\lth normal lung as control All anal,scs wcrc bhndcd and mcludcd Kaplan-Mcsr sutv~~al cstrmates with Co* proportmnal haards rcgrcssmn modchng Data. Including ~maunohrstochcm~stn. aerc complete lor all 271 pmcnls Actual 5.ycarsunwal uas 63%and acluarml IO-lea, suniral lung
WAS58% ~I~III~C~III U~WXI~~C~~XIO~S(P
a omrc~ri~
~CCUI~~X~
andcarcrdcath wrc malt sex. the prcscncc ofnmptona. chest pan. type of cough. hemopt)sls. t~rwr we > 1 cnl dramctcr (T,). poor dUTcrcntmtmn. vascular imasron. crbB-2 cxprcwon. pS3 exprcsswn. and a hrghcr Kl-67 prohfcratmn mdc\ (>5”/.) An add,,,\e oncogene CXP~CSIO~ cuwc dcrnonstnted a 5-,a, IU~ 1val0r72% r0, I36 parents w,;hout p53 or crbB-2. S8”& for .I08 patlcnls who eXp,C& ather oncog~n~. and 38%for27 whoCsprCrsedboth(P< 0.001) Multt\anate mdcpcndent prcdlctors of early rcc~rrcnc~ and cancer death (P < 0 05) wcrc symptomat,c prcrntatmn. crbB-2 cxprcssmn. T , sire. \arular rnvas,o”. ~57 e\prcss,an. and poor ddTcrcntrat,on Ther da,a allo\red the creation of a multivariate model which quantltied tbc risk of recwrenoe and cancer death for patients with stage I non-small cell lung cancer This ma*,, based on complete data fmm 271 patients. represznts the largest analysis of its type in the literature and can form the basis for multi- institutional randomwed adiuvant trials for ‘high risk’ parents.
Expmssion of Lewis-r&ted antigen non-rmdl cell lung cancer 0gaw-d I, Sam A. lmue l-& K&de S. First ofMedinne.
Tokm
Unrwrsiily.
Bohseidoi.
and prognosis Deporrmenr lsehoro.
ofSwge!y Konogmw
in stage I School 259-11
Ann Thorac surg 1995:59-412-5. lmmunohistochemical expression of Lewis(y). sialyl Lewsfxl. and sialyl Lms’ were examined in relation to blood vessel invasion and pmgnos~s in 133 patients with stage I non-small all lung cancer who hada curative resection fmm 198010 1991. Expression ofsialyl Lewis(x) in adenocarcinomas was higher than m squamous cell and large cell carcinomas. and Lewis(y) immunoreactivity was the highest among the th= antigens. The frequency ofblmd vessel mvasion was stgnilicantly hrgher m tumors with expression of Lewis@) or smlyl Lews antagen (sialyl Lewis(x) or sialyl Lewir’). however. Lms@) expression was even more sign&ant. The postoperat,ve survival was signilicantly shorter when tumors expressed both the Lewiz4y) and slalyl Laws antigen However, the survival of patients with either Lewis(y) or sialyl Lewis antigen expression was similar to that of patients whose tunwrs did mt express either the Lzws&) or sialyl Lewis antigens These results suggest that Lewis&) and sialyl Lewis antigen may be of prognostic ~aluc br metaslatic paential but have different functional roles in tumor cells
Mdiindcs in the lung and pkura mimicking benign processes Cob TV Dewrrment ofPolho/orrv Maw ClintcSconsd~le. Scot&dole. AZ 85259 S&n Dia& Pathol i99Xi2:30-44 As pathologists. we are most concerned about wercalbng reactive changes in the lung as carcinoma and the fact that malignant prwxsses may be misinterpreted 8s knign processes in the lung IS less well rewgnized. This review wvem five such lesmns Welldifferentiated adenocarcinomas. especially bronchioloalvcolar carcinomas, are frequently undcrc8lk-d. particularly in small biopsy and cytology specimens. In swh cases. one must pay particular attention to the uniformity and monotony of the epithelium even tbougb it may be extremely well differentiated Spindk cell carcinomas may have neaosis end cavitatmn intersbtml growth and a rcac~lve tibrcblastic react on and thus be mistaken as organizing itiammatory processes. Careful
attention to the atypical cytological features. prominent vascular invasion, and getting immunohistochcmical suppons helps in recognizing them. Lymph&d lesions of the lung present a number of prcbkmssmall lympkaytic IympbornasandHcd&in*sdiseaseareoften misinterpreted as inflammatory processa. lntra~ lymphomatosis in the lung may be misinterpreted as an interstitial pneumonia if one does not appreciate the atypical lymphoid cells with n the capillaries The desmoplastic variant of sarcomatous mesothclioma may be extremely diffcult to diagmx, bxause large pxticms of the tumor are composed of blandappearing fibrous tissue. A case of dcsmoplastic mesothelioma presenting predominantly as a nxdiastinal mass is discussed, and problems in differentral diagnosis are outlined. Angiosarcamas are rare tumors. but an appreciable percentage of them presentaspulmonary meurnasa which mayk interpre+edaspulmonary hemorrhage or organizing infarction. The clinical and radiographic pattern, uwally mimicking mete static dircase. and the fact that atypical spindlecellsacludesmallpllmonaryarlcricswithsunoundingalumlar hemorrhage are clues to the recognition of these lesions.
Evaluation of MRl imaging using Helmholb coil for the hilus and tbe mediwtinum of the lung Matsui M, Matsumoto T , Fujita T . ltoh K, Nakaki K. Kuramltsu T et al Deporlmenl Yamoguchr
of Radiology,
Yamoguchl
Unrv.
School
ojiliedrcrne,
753. Jpn J Clin Radio1 1995;40: I-8. Weevaluated High-Resolution MRJ images hy wing Hclmholtz cod compared with conventional MRJ images for the hilus and the media&urn of the lung Thetidy grcupwnssixvohmteersand Lwentyseven patients (I 5 lung cancer, I I esaphagcal cancer and I medianinal tumor). MR imaging was perfomwd with a superwnductmg image, operating at l.ST, Our resull mdicates that High-Resolution MRI is significantly superior to conventional MRI for visibility of normal anatomic structures. lymph node enlargement and tumors. RghRmlution MRI maybe us&id fortheevaluation oftheertent ofdisease which is equivccal on other exammations
circulating interleukin 6 concentrations in patients with lung e.neer Yamashrta J-I, Shimkusa T , Fujino N. Kiyama T . Kmuwak~ E. Ogawa M Deparlmenr of Surgery Nonakumo 7-45-1. Johnon,
II, Fukuoka Unrversrry Medwzal School. Fukuoko B/J-O1 Oncol Rep 1995.2:215-
9 It has been suggested that a proponron of patrents wrth cancer have an ongmng acute phase response indicated by a raised C-rcact~ve praein (CRP) To examme whether an aate phaeprotcin response IL aswclated with circulating interleukm-6 (IL-61 wnczntrations ,n patients wth lung cancer, we measured serum levels of CRP and interieukin (IL)-5 in 176 patrents with lung cancer and 48 parents with other pulmonary dwases (28 d,Ifuse pulmonary mliltrates, I5 bemgn lung tumors. and 5 broncbal asthmas) Serum CRP was &tmable ( 2.5 mg/liter) in 57 4% of patients with lung cancer. 78.6%of patients wrth d&rsz pulmonary infiltrates. 46 1% of patients mth benign lung tumors. and 40 0% of parents with bmnchlalasthma Serum ILd wasdeteaablem all pabents by a hrghly sensmve enzyme-mununaassay. the concentratmn ranging from0 126to35.llSpglmI. AlthoughUlerewarnos~gn~f~tdiU~rcncc in serum ILd levels among the histologrc types of lung can~cr. the IL6 concentratmn was signifunlly hrgher in patients wth advanced cancers than m those with early ones Correlation anal~scs shoucd that there was no significant relationshap between the CRP and IL-6 mncenlrahons in the 176 patients wth lung cancer (r = 0 212. P = 0 1243). whde a highly srgmficant corrclalux~ between both levels was observed mtk28patwus w~thditTwpulmonary mtiltrates(r =O 783. P = 0 ooO5). These results indrcate that the scmrn level m pat~cntr wth lung cancer is closely assaaatcd wh the draw stage. but that a raxcd CRP c~“cc”tra,mn occurs mdcpcndcntly of crrculatlng IL-6 co”cen,ra,,o”s ,n pauents wnh lung cancer
Multiple brushings with immediate Riu’s stain via flexible Sbreoptic bronchoscopy without tluomsdopic guidance in the diagnosis of peripheral pulmonary tumours Lee C-H, Wan8 C-H. Lm M-C, Tsao TCY. Lan R-S, Tsai Y-H et al Department 199 Tun-Hwa Bockgmund
OJ Thorocrc Medrcme, Norlh Rood, T&e,.
Chang
Gung
Memorial
Thorax 199550: 18-21. - Accurate dl;g”osas of peripheral pulmonary
Hospad,
Iesslons
Lung
Cancer
13 (1995)
81-104
Twenty a-dies including a total of 3500 resected patients revealed the, definite prognostic variables in the resectable patient group were ~~rformancc natus. SNEC. cate~ot~ of tumor size and location 0. and category of lymph &mvolv&& (N). Fourteen studies including a totalof5875~atientswithino~erableNSCLC. ineludedinchemather trials with or without mdiolhcrapy, revcalcd that solely pcrforrI&& status and stage WCP definite pmgnostic variables in this non-resectable patient group. Possible prediaors of long survival were low LDH, female gender, and high plasma albumin level, while weight loss, histology, and age were of minor importaea. A large pan of tbe variation in sorvival outlook remains tmcxplained, calling for tiutber studies on the prognoslic inlluence of biological fealures of tbe tumors.
analyzed using a high-resolution, automated image cytometer. These case; were divided a&ding to pathologic stage: stage I. 3 I; stage II. 3; stage 111. 19. and stage Iv, 7. For each nucleus 57 feelures were analyzed, and using a linear combination of lhree textore features describine the DNA distnbufion in the cell nucleus ITARL. ODMAX and FAREAL). aggressive canter cells belonging to Age III/IV could be identified The test discrimination ktwgn the Stages was achieved when the frequency of aggressive cancer cells was 48%; tbe currec, classification rate was 77% Usingthiscriterion. 22 of 27 patients (81%) who died of cancer within five years after surgery were correctly predicted. These resulti suggest that high-resolution cytometry may be of value in predicting the biologic behavior of adenocarcinoma cases, especially in stage VII
Binding capacities to blood-group antigen A, B md H, DNAand MST meuurrments, and survival in bronchial carcinoma Kavser K. Bovin NV. Penn F-Y. Zeilineer C. Cabins H-l. De~orrmenr of k’othotogy. Thmkbnik. Amotienshosse 5. D-69126 Hdidelbvg Radial Oncol 1994:28:282-6. The expresion of binding capacities related to blood-group antigens A. B. and H was asxssed glycohinochemically in para&n~mbedded samples fmm 149 lung carcmoma patients. In addition. measurements of integrated optical density (IOD) and syntactic stmnure analysis (MST) were performed. The material comprised potentially curative excised surgical specimens of 46 epidermond carcinomas. 42 adcmcarcinomas, 26 smell cell carcinomas, and 35 largecell anaplastic carcinomas In about 50% of the carcinomas bmdmg capacmes to BLOOD A, B. and H mold be demonstmted. No relabon 10 the tumor cell type was found. The measurements of IOD revealed a S-phaxrelated fraction of S-lS%of tumor cell nuclei and a remarkable fraction of tumor cell nuclei with an IOD > 5C. Patients’ survtval was strongly related to tbe numberofstem lines, S-phase related frxoon. percentage of tomor cells wilh a,, IOD > SC and expression of bmding sutes to BLOOD A and BLOOD H. The expression of binding sites lo bloodgroup antigens H was associated with decreased cellular heterogcneify is d&oos&d by tk percentage of tumor cell nuclei with abnormal IOD. The analysed prognosoc factors were found 10 be mdependcnt from cell type and tumor stage (TNM)
Anal metastasis from carcinoma of the lung: Report of a case Kawahara K. Akammc S. Takahashl T . Nakamura A. Kusano H. Nakagoc T e, al F,,.,r D<~or,,,nenr o/Su+?erv, .?.‘a,zfl.yok, I *,vux!v Schoo, ,2ledrcme. 7-1 Sn!.a,,wl<~ I-chom ?&wnkt 852 Surg Todada) 1994:24 1101-3 WC rcporl hcrein the cast ofa 75-jear-old man who dc\claped anal canal metastasu from squamous cell carcmoma of the lung Imt~all). he undcnvcnt a right mlddle and lower lobcc,omj combmcd ulth len atrial wall resectlo” under cardiopulmonary bypass He prcsenicd 3 months later wuh an anal polyp whnch had prolapsed and bled. for whnch he undcnven, a transanal pol>pcctom) H~s,olog,call>. the was classified as squamous cell carcnnoma and considered 10 bc a ~C,~,SWSISiron, ,he pr,maly lung cancer He 1s prcscn,l> ucll nllh no signs oi rcc~rrcnce 9 months af,cr his ~mt~al opcralaos To our knowlcdgc. thcrc has been no olhcr cast of anal me,astar,s from lung cancer ever rcponcd
Biological behaviour of lung carcinoids. A retrospective analysis of 71 patients Kern I. Rot, T . Rumr-Zupancr M, Sorli J, Gantar-Rot, U et al /ns,rtu,e for Respmmy D,seoses. 61204 Golnrk. fiadlol Oncol 1994,28:27681 A retrospecl~ve study of 7 t patients ,rea,ed for lung caranoids during the years 1973-1992 ~sprewnted. Besideclmical and pathological dam. an mquily was performed 10 establish the rates of recurrence of disease and survnal of the patients Lung carcinoids represented 0.6% of all lung carcinomas. There were 37 male and 34 female patienu with age mnee from I4 to 18 vears. and an average age 47 5 years at the time of st,r~ery. The highest incidence ofcarc,no& 08 pabents, 53%) appeared m the age group 4 t-60 years. In three patients (4%). assocmted clinical syndromes were documented one patlen, had typical carcmoid syndrome. while an two others Cushmg’s syndrome has developed The most mmmon lobeclomy was performed in 45 patients (63%) Six,ysix (93%) carcinolds were lccated centrally, and 5 were penphcral. Htstologically. 61 carcinoids (86%) were evaluated as typical. Two carcinoids (3%) were mmposal ofspindle cells. 2 had oncocytic areas. and stromal ossi,icatmn was found m 4 cases (6%). Out of 64 patuents, lymphnode me,asuses were found in only 3 cases (5%). and distant mctaslascs it, one patien, with a recorren, hunour. Nine paoents (I 3%) have Bed 5 (7%) because of atypical carcinolds and 4 because of other diseases. Tbe second primary maligMncy was detected in four pat~enll (5.6%). Fony-six out of 47 pat,ents (98%) have survived 5 years, 26/28 (93%) IO years. and l3/l8 (72%) have survived even I5 years. The prognosis was gocd in patients wxth typical carcmoids but much worse in those wilh atvoical -ino& nevertheless. even in ,he latter, the death cccurred la,cr than in other lung carcmomas
Use of high-resolution cytometry in predicting the biologic behavior of T I ndenocucinoma of the lung Ike& N. MacAulay C. Lam S, Gamer DM, Payne PW, Kate H et al. Cancer ,,mging Deporlmcn,, Bnrrsh Columbia Cancer Agency, 601 Wes, ,O,h Avenue. Voncouve,: BC “SZ ,L.J. Anal Quant Cytol mstol 1995:17,69-74. Touch preparations from 60 cases of Tl adenocarcinoma were
pol?p
CT image of compression of the left ventricle by a lung tumor Chudacek 2. Vejprnrcka 20, 31805 Plzen. Radio1 Diagn 1994;35:2091” Acachecticmalepatien,wasrcfened,o,heDe~ntofRadiology wth a workmg diagnosis of lung tumor. CT was performed with a Siemens Somatom ART. Slice thickness was 5 mm. CT confirmed a tumor at tbe right hilum and revealed pulmonary metasudses. Tumomus changes were also seen a, the vacheal biroration and the cranial aspect ofthe heat. Followingadministrationofcontrast. no enhancement was seen in the Idt atrium. Only the anterior lung veins were opacifed The density of the IeR atrium was inhomogenous. In our repon. a tumor in the left atrium was described. The patient went back 10 the Fakoltatskrankenbau PIzen and died one day after the CT examination Report 939192 of the post-mortem examination pcrformed at the Depmtment of Patholo& describes a carcinoma of the rigb, main stem bmnchos. There were lymph node me&stases as the tracheal b&nation and in the pamtracheal chain. The enlarged lymph nodes prerented as a tumor of 8 cm size. There was external compression ofthc lefl atrium by this tumor. No ,umor was found in the IeR atrium. Carcinosts p&icarti was found. Thecomnay attcries showal significant stenoses The imaging diagnosis was wmngbeause we did not consider external compression of the left atrium in the differential diagnosis Because of this mistake we did noi perform saandary remnstruct~ons m another plane or 3D &splay External compression of the lcfi venlr~cle ISa rare condition. Tothc bestofoor knowledge, no repxts refer to thisdiagnosis in the CT literature Unusual clinical manifestation of metastatic pulmonary carcinoma. A case report and miew of the literature Orabona P, D’Antonio A, De Rosa I, Boscaino A. Deporbnent of Pathology Faculty ofhledmne, Universrry ‘Federico II ‘, Naples. Arch Anat Cytol Pathol 1994;42:330-3. Wereponacaseofileal m~isfmmaclinicalfyNiden,bronchial carcinoma with an unusual sympomatology due to inteainal obsmxtion. Only 25 cases of ileal metas,asis have been previously reported in the literature in which the diagnosis was made due ,o the presence of abdominal symptoms related to intestinal perforation in 24 cases. We descnbc our atypical case W&I differential dmgnosis and renew of the b,era,ure.
A prognostic model of recurrence and death in stage I nonsmall cell lung cancer utilizing presentation, histopathology, and oncoprotein expression Harpole DH Jr. Hcrndon JE II, Wolfe WC. lglchan JD. Marks JR
Abstracts/Lung “WL~,“” of Thomcrc .%gely “nghnw rind ,riv,,m 1 H”\p,ml. fiianc,r s1reer. Rosmn. dL.1 02//s Cancer RCS 1995.55 5 1-6
Cancer 13 (1995) N-104 7.5
In order 10 constr~c, a ,,,ui,,\a,,atc model lo, prcd,c,,ng earl> ,CCU~~C”CCand cancer dath for pat,cnts i*ltrh r,agc f non-small cell cancer, 271 consecuwc pat~ntr (mem age. 63 f X yzarr, uho were diagnosed. trcatcd. and lollowcd at one ~nrututmn wx studred All patmts were clmcal stage I ulth hcnd and chcsuabdommal computed tomograms and radxxwchdc boric scans rrahout c\ rdcncc ol m~tastauc discar Pathological n~lcr~al after rc~ctmn uas re\wred to vcri@ hrstological rtagmg Follou-up docunwntcd the trmc and location of any rcc~rrcnc~. uas a mcdran 56 months I” duratmn. and was complclc m all arcs Data rccordcd rncludcd a8c. SC\. smokmg h,%ry. p;cscntmg ~mprams. pathological dcsn,pnon. and oncoprorc~n s,a,n,n~ for crbB-2 (HER-Z/ncu). ~51. and KId7 ,,rol,fcratmn pmtcm lmmunoh,stahcm~rtry of oncogcnc cxprcssmn &as pcrfcxn~cd an two separate archlvcd paratlin ,umor blocks lor each pa,,cnt. \\lth normal lung as control All anal,scs wcrc bhndcd and mcludcd Kaplan-Mcsr sutv~~al cstrmates with Co* proportmnal haards rcgrcssmn modchng Data. Including ~maunohrstochcm~stn. aerc complete lor all 271 pmcnls Actual 5.ycarsunwal uas 63%and acluarml IO-lea, suniral lung
WAS58% ~I~III~C~III U~WXI~~C~~XIO~S(P
a omrc~ri~
~CCUI~~X~
andcarcrdcath wrc malt sex. the prcscncc ofnmptona. chest pan. type of cough. hemopt)sls. t~rwr we > 1 cnl dramctcr (T,). poor dUTcrcntmtmn. vascular imasron. crbB-2 cxprcwon. pS3 exprcsswn. and a hrghcr Kl-67 prohfcratmn mdc\ (>5”/.) An add,,,\e oncogene CXP~CSIO~ cuwc dcrnonstnted a 5-,a, IU~ 1val0r72% r0, I36 parents w,;hout p53 or crbB-2. S8”& for .I08 patlcnls who eXp,C& ather oncog~n~. and 38%for27 whoCsprCrsedboth(P< 0.001) Multt\anate mdcpcndent prcdlctors of early rcc~rrcnc~ and cancer death (P < 0 05) wcrc symptomat,c prcrntatmn. crbB-2 cxprcssmn. T , sire. \arular rnvas,o”. ~57 e\prcss,an. and poor ddTcrcntrat,on Ther da,a allo\red the creation of a multivariate model which quantltied tbc risk of recwrenoe and cancer death for patients with stage I non-small cell lung cancer This ma*,, based on complete data fmm 271 patients. represznts the largest analysis of its type in the literature and can form the basis for multi- institutional randomwed adiuvant trials for ‘high risk’ parents.
Expmssion of Lewis-r&ted antigen non-rmdl cell lung cancer 0gaw-d I, Sam A. lmue l-& K&de S. First ofMedinne.
Tokm
Unrwrsiily.
Bohseidoi.
and prognosis Deporrmenr lsehoro.
ofSwge!y Konogmw
in stage I School 259-11
Ann Thorac surg 1995:59-412-5. lmmunohistochemical expression of Lewis(y). sialyl Lewsfxl. and sialyl Lms’ were examined in relation to blood vessel invasion and pmgnos~s in 133 patients with stage I non-small all lung cancer who hada curative resection fmm 198010 1991. Expression ofsialyl Lewis(x) in adenocarcinomas was higher than m squamous cell and large cell carcinomas. and Lewis(y) immunoreactivity was the highest among the th= antigens. The frequency ofblmd vessel mvasion was stgnilicantly hrgher m tumors with expression of Lewis@) or smlyl Lews antagen (sialyl Lewis(x) or sialyl Lewir’). however. Lms@) expression was even more sign&ant. The postoperat,ve survival was signilicantly shorter when tumors expressed both the Lewiz4y) and slalyl Laws antigen However, the survival of patients with either Lewis(y) or sialyl Lewis antigen expression was similar to that of patients whose tunwrs did mt express either the Lzws&) or sialyl Lewis antigens These results suggest that Lewis&) and sialyl Lewis antigen may be of prognostic ~aluc br metaslatic paential but have different functional roles in tumor cells
Mdiindcs in the lung and pkura mimicking benign processes Cob TV Dewrrment ofPolho/orrv Maw ClintcSconsd~le. Scot&dole. AZ 85259 S&n Dia& Pathol i99Xi2:30-44 As pathologists. we are most concerned about wercalbng reactive changes in the lung as carcinoma and the fact that malignant prwxsses may be misinterpreted 8s knign processes in the lung IS less well rewgnized. This review wvem five such lesmns Welldifferentiated adenocarcinomas. especially bronchioloalvcolar carcinomas, are frequently undcrc8lk-d. particularly in small biopsy and cytology specimens. In swh cases. one must pay particular attention to the uniformity and monotony of the epithelium even tbougb it may be extremely well differentiated Spindk cell carcinomas may have neaosis end cavitatmn intersbtml growth and a rcac~lve tibrcblastic react on and thus be mistaken as organizing itiammatory processes. Careful
attention to the atypical cytological features. prominent vascular invasion, and getting immunohistochcmical suppons helps in recognizing them. Lymph&d lesions of the lung present a number of prcbkmssmall lympkaytic IympbornasandHcd&in*sdiseaseareoften misinterpreted as inflammatory processa. lntra~ lymphomatosis in the lung may be misinterpreted as an interstitial pneumonia if one does not appreciate the atypical lymphoid cells with n the capillaries The desmoplastic variant of sarcomatous mesothclioma may be extremely diffcult to diagmx, bxause large pxticms of the tumor are composed of blandappearing fibrous tissue. A case of dcsmoplastic mesothelioma presenting predominantly as a nxdiastinal mass is discussed, and problems in differentral diagnosis are outlined. Angiosarcamas are rare tumors. but an appreciable percentage of them presentaspulmonary meurnasa which mayk interpre+edaspulmonary hemorrhage or organizing infarction. The clinical and radiographic pattern, uwally mimicking mete static dircase. and the fact that atypical spindlecellsacludesmallpllmonaryarlcricswithsunoundingalumlar hemorrhage are clues to the recognition of these lesions.
Evaluation of MRl imaging using Helmholb coil for the hilus and tbe mediwtinum of the lung Matsui M, Matsumoto T , Fujita T . ltoh K, Nakaki K. Kuramltsu T et al Deporlmenl Yamoguchr
of Radiology,
Yamoguchl
Unrv.
School
ojiliedrcrne,
753. Jpn J Clin Radio1 1995;40: I-8. Weevaluated High-Resolution MRJ images hy wing Hclmholtz cod compared with conventional MRJ images for the hilus and the media&urn of the lung Thetidy grcupwnssixvohmteersand Lwentyseven patients (I 5 lung cancer, I I esaphagcal cancer and I medianinal tumor). MR imaging was perfomwd with a superwnductmg image, operating at l.ST, Our resull mdicates that High-Resolution MRI is significantly superior to conventional MRI for visibility of normal anatomic structures. lymph node enlargement and tumors. RghRmlution MRI maybe us&id fortheevaluation oftheertent ofdisease which is equivccal on other exammations
circulating interleukin 6 concentrations in patients with lung e.neer Yamashrta J-I, Shimkusa T , Fujino N. Kiyama T . Kmuwak~ E. Ogawa M Deparlmenr of Surgery Nonakumo 7-45-1. Johnon,
II, Fukuoka Unrversrry Medwzal School. Fukuoko B/J-O1 Oncol Rep 1995.2:215-
9 It has been suggested that a proponron of patrents wrth cancer have an ongmng acute phase response indicated by a raised C-rcact~ve praein (CRP) To examme whether an aate phaeprotcin response IL aswclated with circulating interleukm-6 (IL-61 wnczntrations ,n patients wth lung cancer, we measured serum levels of CRP and interieukin (IL)-5 in 176 patrents with lung cancer and 48 parents with other pulmonary dwases (28 d,Ifuse pulmonary mliltrates, I5 bemgn lung tumors. and 5 broncbal asthmas) Serum CRP was &tmable ( 2.5 mg/liter) in 57 4% of patients with lung cancer. 78.6%of patients wrth d&rsz pulmonary infiltrates. 46 1% of patients mth benign lung tumors. and 40 0% of parents with bmnchlalasthma Serum ILd wasdeteaablem all pabents by a hrghly sensmve enzyme-mununaassay. the concentratmn ranging from0 126to35.llSpglmI. AlthoughUlerewarnos~gn~f~tdiU~rcncc in serum ILd levels among the histologrc types of lung can~cr. the IL6 concentratmn was signifunlly hrgher in patients wth advanced cancers than m those with early ones Correlation anal~scs shoucd that there was no significant relationshap between the CRP and IL-6 mncenlrahons in the 176 patients wth lung cancer (r = 0 212. P = 0 1243). whde a highly srgmficant corrclalux~ between both levels was observed mtk28patwus w~thditTwpulmonary mtiltrates(r =O 783. P = 0 ooO5). These results indrcate that the scmrn level m pat~cntr wth lung cancer is closely assaaatcd wh the draw stage. but that a raxcd CRP c~“cc”tra,mn occurs mdcpcndcntly of crrculatlng IL-6 co”cen,ra,,o”s ,n pauents wnh lung cancer
Multiple brushings with immediate Riu’s stain via flexible Sbreoptic bronchoscopy without tluomsdopic guidance in the diagnosis of peripheral pulmonary tumours Lee C-H, Wan8 C-H. Lm M-C, Tsao TCY. Lan R-S, Tsai Y-H et al Department 199 Tun-Hwa Bockgmund
OJ Thorocrc Medrcme, Norlh Rood, T&e,.
Chang
Gung
Memorial
Thorax 199550: 18-21. - Accurate dl;g”osas of peripheral pulmonary
Hospad,
Iesslons