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Computed tomography for staging of lung cancer: A critical assessment
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tastasis resulting in extrahepatic biliary obstruction, and seven had diffuse hepatic metastases without extrahepatic obstruction. All patients with pancreatic masses had complete (or nearly complete) resolution of jaundice and abdominal pain within 3 weeks of starting chemotherapy. Patients with extensive liver metastases usually remained icteric in spite of intensive treatment. Three patients with pancreatiu metastases survived more than 12 months after the institution of therapy. No patient presenting with jaundice caused solely by hepatic metastases survived beyond 8 month. Small-cell lung cancer can present with jaundice due to diffuse hepatic parenchymal involvement, which is associated with a poor prognosis, or as a result of extrahepatic biliary obstruction, which has potential for rapid palliation and prolonged survival. C o ~ u t e d Tomography for Staging of Lung Cancer: A Critical Assessment. Jegge, P., Ayer, G., Voegeli, E. Rontgeninstitut des Kontonsspitals Luzern, CH-6004, Luzern, Switzerland. Schweiz. Med. Wochenschr. 115: 297-301, 1985. The planning of treatment in patients with non-oat cell carcinoma of the lung requires an extensive diagnostic work-up. As far as TN-staging is concerned, the role of CT is controversial. On the basis of 25 operated and histologically proven cases of non-oat cell cancer of the lung, the results of both CT and conventional radiography are critically evaluated. In the present study CT is found to be more sensitive but not more specific than conventional radiography in detecting pleural invasion and regional, especially mediastinal, lymph node metastases. These results are in accordance with those of others. Since both modalities follow the same diagnostic criteria (lymph node size, contact to pleura), and increase in sensitivity is initimately related to a corresponding loss of specificity. The relatively high sensitivity of CT on the one hand, and the relatively high specificity of conventional radiography on the other hand, suggest the following procedure: if conventional radiography is definitely positive, additional CT can be omitted. If CT proves negative as well, the presence of mediastinal metastases of pleural invastion is very unlikely. Positive findings on CT, however, need histologic verification. Acute Leukemia Secondary to Lung Cancer. Case Report and Review of the Literature. De Gramont, A., Rioux, E~, Fortin, P., Shields, C. Department of Oncology, Hopital de l'Enfant-Jesus, Quebec Ville, Quebec, Canada. Oncology 42: 107-111, 1985.
A case of acute myelomonocytic leukemia following cytotoxic therapy for an oat cell carcinoma of the lung in a 48-year-old man is reported. This case is characterized by a long phase of increasing macrocytosis during cyclophosphamide maintenance therapy. 15 other cases of secondary leukemia to lung cancer from the literature are reviewed. All patients received alkylating agents. Most patients showed peripheral blood changes more than 3 months before the onset of acute leukemia. All leukemia cases, except one, were nonlymphocytic with a high frequency of erythroleukemia. The development of acute leukemia seems to be linked with an unexpected good response to chemotherapy in advanced or poor histologic prognosis cancers. With therapeutic improvement in lung cancer, secondary leukemia could become a major hazard as in other cancers successfully treated with cytotoxic agents. Broncho-Pulmonary Carcinoma Diagnosed as a Result of Cerebral Metastase, Excluding Oat Cell Carcinoma. A Surgeon's View. Boumghar, M. Service de Chirurgie A, CHUV, CH-1011 Lausanne, Switzerland. Schweiz. Med. Wochenschr. 115: 403-407, 1985. Within the last 20 years, 16 patients have undergone surgery for solitary intracerebral tumours revealing asymptomatic bronchopulmonary cancer for which they all underwent subsequent operations without operative mortality or morbidity. One patient who was operated , upon at the age of 39 is still alive without recurrence ii years after removal of an intracranial metastasis, and 9 years after successful lobectomy for a mixed bronchopulmonary carcinoma (adenocarcinoma and a squamous cell carcinoma). This patient received no adjuvant treatment. The other 15 patients had survivals varying from 2 to 18 months. The treatment of bronchial carcinoma and its metastases is a complex problem, in particular as regards the indication for surgery, which for most patients is the Dnly means of improving survival and, in exceptional cases, securing prolonged remission. Bronchial Carcinoid T~nours. A Clinicopathologic Study of 82 Cases. Bertelsen, S., Aasted, A., Lund, C., et al. Department of Thoracic Surgery, Bispebjerg Hospital, Copenhagen, Denmark. Scand. J. Thorac Cardiovasc. Surg. 19: 105-111, 1985. A clinical and "blind" histologic review of 82 cases of bronchial carcinoid tumous is presented. The malignant potential of the tumours was only partly predictable from their histologic appearance. Histologically 65 of the tumours were typical benign carcinoids. Regional metastases were found at operation in two of these patients. Fatal carcinoid syndrome with regional and distant metastases appeared in two patients about 1 and 3 years postoperatively.
One of the patients with re-
tastasis resulting in extrahepatic biliary obstruction, and seven had diffuse hepatic metastases without extrahepatic obstruction. All patients with pancreatic masses had complete (or nearly complete) resolution of jaundice and abdominal pain within 3 weeks of starting chemotherapy. Patients with extensive liver metastases usually remained icteric in spite of intensive treatment. Three patients with pancreatiu metastases survived more than 12 months after the institution of therapy. No patient presenting with jaundice caused solely by hepatic metastases survived beyond 8 month. Small-cell lung cancer can present with jaundice due to diffuse hepatic parenchymal involvement, which is associated with a poor prognosis, or as a result of extrahepatic biliary obstruction, which has potential for rapid palliation and prolonged survival. C o ~ u t e d Tomography for Staging of Lung Cancer: A Critical Assessment. Jegge, P., Ayer, G., Voegeli, E. Rontgeninstitut des Kontonsspitals Luzern, CH-6004, Luzern, Switzerland. Schweiz. Med. Wochenschr. 115: 297-301, 1985. The planning of treatment in patients with non-oat cell carcinoma of the lung requires an extensive diagnostic work-up. As far as TN-staging is concerned, the role of CT is controversial. On the basis of 25 operated and histologically proven cases of non-oat cell cancer of the lung, the results of both CT and conventional radiography are critically evaluated. In the present study CT is found to be more sensitive but not more specific than conventional radiography in detecting pleural invasion and regional, especially mediastinal, lymph node metastases. These results are in accordance with those of others. Since both modalities follow the same diagnostic criteria (lymph node size, contact to pleura), and increase in sensitivity is initimately related to a corresponding loss of specificity. The relatively high sensitivity of CT on the one hand, and the relatively high specificity of conventional radiography on the other hand, suggest the following procedure: if conventional radiography is definitely positive, additional CT can be omitted. If CT proves negative as well, the presence of mediastinal metastases of pleural invastion is very unlikely. Positive findings on CT, however, need histologic verification. Acute Leukemia Secondary to Lung Cancer. Case Report and Review of the Literature. De Gramont, A., Rioux, E~, Fortin, P., Shields, C. Department of Oncology, Hopital de l'Enfant-Jesus, Quebec Ville, Quebec, Canada. Oncology 42: 107-111, 1985.
A case of acute myelomonocytic leukemia following cytotoxic therapy for an oat cell carcinoma of the lung in a 48-year-old man is reported. This case is characterized by a long phase of increasing macrocytosis during cyclophosphamide maintenance therapy. 15 other cases of secondary leukemia to lung cancer from the literature are reviewed. All patients received alkylating agents. Most patients showed peripheral blood changes more than 3 months before the onset of acute leukemia. All leukemia cases, except one, were nonlymphocytic with a high frequency of erythroleukemia. The development of acute leukemia seems to be linked with an unexpected good response to chemotherapy in advanced or poor histologic prognosis cancers. With therapeutic improvement in lung cancer, secondary leukemia could become a major hazard as in other cancers successfully treated with cytotoxic agents. Broncho-Pulmonary Carcinoma Diagnosed as a Result of Cerebral Metastase, Excluding Oat Cell Carcinoma. A Surgeon's View. Boumghar, M. Service de Chirurgie A, CHUV, CH-1011 Lausanne, Switzerland. Schweiz. Med. Wochenschr. 115: 403-407, 1985. Within the last 20 years, 16 patients have undergone surgery for solitary intracerebral tumours revealing asymptomatic bronchopulmonary cancer for which they all underwent subsequent operations without operative mortality or morbidity. One patient who was operated , upon at the age of 39 is still alive without recurrence ii years after removal of an intracranial metastasis, and 9 years after successful lobectomy for a mixed bronchopulmonary carcinoma (adenocarcinoma and a squamous cell carcinoma). This patient received no adjuvant treatment. The other 15 patients had survivals varying from 2 to 18 months. The treatment of bronchial carcinoma and its metastases is a complex problem, in particular as regards the indication for surgery, which for most patients is the Dnly means of improving survival and, in exceptional cases, securing prolonged remission. Bronchial Carcinoid T~nours. A Clinicopathologic Study of 82 Cases. Bertelsen, S., Aasted, A., Lund, C., et al. Department of Thoracic Surgery, Bispebjerg Hospital, Copenhagen, Denmark. Scand. J. Thorac Cardiovasc. Surg. 19: 105-111, 1985. A clinical and "blind" histologic review of 82 cases of bronchial carcinoid tumous is presented. The malignant potential of the tumours was only partly predictable from their histologic appearance. Histologically 65 of the tumours were typical benign carcinoids. Regional metastases were found at operation in two of these patients. Fatal carcinoid syndrome with regional and distant metastases appeared in two patients about 1 and 3 years postoperatively.
One of the patients with re-