Symptomatic pericardial effusion in lung cancer patients: The role of fluid cytology

268

ovarian cancer (n = 20). or epilepsy (n = 4) or in normal subjects(n = 9). In 4 of the patientswith paraneoplasticpseudoobstruction,antibodbound selectively to nuclei ies in highly diluted serum (I :4000- 1:8OOO) and cytoplasmof neuronalelementsin the gut. This novel autoantibody activity suggeststhat intestinalpseudoobstructionoccurring in patients with small-cell carcinoma may have an autoimmune basis. From a clinical standpoint,serologicaltestingoffers a simple means for determining which patients with gut dysmotility syndromes may have associatedsmall-cell carcinoma, therebyenabling earlier diagnosisand treatment ol the tumor.

Bronchial carcinoma associated with pulmonary osteoarthropathy (Marie Bamberger disease) Pankow W. Neumann KV, Wichert P. Zenrrwnfur Innere Medirin. MeditinischePoli~in~~, KIinikwnder Philipps-Universitaf,Ealdingersfraue. D-3550 Marbwg. Pneumologie 1990;44: 1306- 11. Hypertrophic pulmonaryosteoarthropatby(HPG) is characterizedby clubbed. or drumstick, fingers and a painful periostitisof the extremities, and occurs most frequently as paraneoplasia in association with bronchialcarcinoma. Much rarer are inflammatory pulmonarychanges such as lung abscesses.Curative treatment of the underlying disease will always also alleviate the pain in the extremities.This article reports on a case of a bronchial carcinoma masked by a pulmonary abscess. Despite the treatment of the abscessthe patient developed the typical patternof signsand symptomsol hypertmphicpulmonaryosteoarthropathy for the bronchial carcinoma which was identified only later and which had been masked by the abscess. Persistenceof hypertrophic pulmonaryosteoarthropathyincaseofasuccessfullytreatedpulmonary abscess should, therefore, always be regarded as a possible pointer towards an undetectedbronchial carcinoma.

DifTereotiaI diagnosis of lung tumor with positron emission tomography: A prospective study Kubota K, Matsurawa T, Fujiwara T, Ito M, Hatazawa I, Ishiwata K. et al. Departmenr ofRadiology and Nuclear Medicine, Research Inslirute forTubcrculosirandCancer,Tohoku

Universiry,l-1

Seiryo-cho.

Aoba-

J Nucl Med 1990;31:1927-32. To predict the nature of non-calcifying lung tumors, we performed a prospectivestudyof46 caseswith L-[methyl “Clmethionine (MET, 24 cases) and “F-fluorodeoxyglucose (FDG, 22 cases) using positron emission tomography (PET). Mean tumor/muscle radioactivity ratios are5.3i2.0(n= 14)formalignantand 1.9i0.9@= 10)forbenignwidt MET (p < O.OOl), and 4.4 f 2.2 (n = 12) and 1.5 f 0.3 (n = 10). respectively, with FDG (p < 0.001). The ratios indicate that malignant tumorshave higher metabolicdemand than benign lesions.Tumors less than I cm in diameter were difficult to accurately evaluate due to PET resolution. Compared to the diagnosis at pathology, the MET study showedasensitivityof9346 (13/14),aspeciticityof60%(6/10),andan accuracyof 79% (19/24). The FDG studyshowed83% (1002) 90% (9/ 10). 86% (19/22), respectively. No significant differences were observed between the two tracers. This study suggeststhat PET studies using either MET or FDG may be very useful for the differential diagnosisof lung tumors. ku. Send&

980.

The relative value of conventional staging procedures for developing prognostic models in extensive-stage small-cell lung cancer SheehanRG, BaJabanEP. Cox JV, Frenkel EP. Medical Service (I J J), Veterans Affairs Medico1 Center, 4500 S Luncosler Rd. Dal1a.s. 7X 75216. J Clin Oncol 1990,8:2@47-53. Publishedprognosticmodels for small-cell lung cancer (SCLC) have either combined limited- and extensive-stage patients or have not included standard anatomic staging information to assessthe relative value of the knowkdgc of specific sites and number of sites Of metastasesin predictingsurvival in extensive-stagedisease.We studied 136 extensive-stage patients in whom traditional staging procedures were performedand in whom other previouslydemonstratedsignificant pretreatment variables were determined. Using the Cox proportionat hazards model, when all data were included, three variables were significant: performance status (PS) (P = .OOOl), number of sites of metastases(P= .OOlO),andage(P= .0029). Aprognosticalgorithm Was

developed using these variables, which divided the patients into three distinct groups. When the anatomic staging data were omitted, the serum albumin (p = .0313) was the only variable in addition to PS (P = .0001)andage(P=.0061)thatwassignificant.Anal~mativealgorilhm using these three variables was nearly as predictive as tie original. Therefore, in extensive-stagepatients, reasonable pretreatment prognosticinformationcanbeobtained witboutusingdtenumberorspecitic sitesof metastasesas variablesonce the presenceof distant metastases has been demonstrated.

Congenital tracheoesophageal fittula associated with carcinoma of the lung in an adult CampbeJlJP,SalisburyBG. JOOOLakeviewRd. Clearwaler. FL.34616. Ann Thorac Surg 1990$0:978-9. A rare case of adult congenilal H-type tracheoesophagealfistula was diagnosed. Subsequently, at operation, large cell, undifferentiated carcinoma of the right middle lobe with extensionto the right lobe and adherence to tbe diaphragm was documented.The diagnosis, surgical intervention, and 4-year follow-up are presented.

of non-small cell lung cancers with a monoclonal antibody, KtXGJ, which recognizes a human milk fat globule antigen OncolDienhart DG. Schmelter RF, Lear JL et al. Division ofMedical ogy. University of Colorado Cancer Center, 4200 Earl 9th Avenue. Denver, CO 80262. Cancer Res 1990;50:7068-76. To determine the role of lung cancer tumor imaging with monoclonal antibodies directed against high molecular weight human milk fat globuleantigens,weadministered i.v. “‘In-KC4G3 to24 patientswith advanced non-small cell lung cancer. One mg of 1’11n-KC-4G3 was mixedwith0,9,49,99,or499 mgof unlabeledKC4G3andinfusedi.v. over 1 to 5 h. The mean “lit-r-KC4G3 radiochemicalpurity was >97% and the resultantimmunoreactivityaveraged 62%. Successfulimaging of cancer sites was accomplishedin 92% of 24 patients,and 57% of 91 total lesions were visualized. Successful localization of tumor sites related to size (P < 0.001). with 81% of lesions b3.0 cm in diameter, 50% of lesions 1.5 to 3 cm. and 6% of lesions cl.5 cm successfully imaging, and to location (P < 0.05). with 69% of pulmonary lesions, 80% of soft tissue lesions, and only 32% of bone metastasesbeing visualized. Nonspecific reticula-endothelial uptake of radioactivity was a major problem. Approximately 35% of “‘In was chelated to serum transferrin by 24 and 48 h after infusion. The mean t(l)(6) for plasma radioisotope and immunoreactive KC4G3 was 29 and 27 h. respectively. There was no correlation between total infused antibody dose and imaging successor between total dose and effect on “‘In and KC-4G3 kinetics. Circulating free KC-I antigen was measurablein all but one patient before study. Tumor biopsy following infusion could demonstrateantibody presence but not saturableantigen binding. We conclude that (a) “‘ln-KC4G3 demonstratessuccessfultumor localization in non-smallcell lung cancersbearinggenerally high expression of its antigen and (b) further investigations to diminish nonspecific radioactivity for imaging and utilization of high dose radio-labeled antibody for therapeutic intent are warranted. Imaging

Symptomatic pericardial effusion in lung cancer patients: The role of ftuid cytology Edoute. Y. Malberger E, Kuten A, Moxovitcz M, Ben-Haim SA. Deparrmenl

of Internal

Medicine

C. Ran&am

Medical

Center,

Haifa

35254. J Surg Gncol 1990:45:121-3. During Ihe years 1975- 1988, twenty lung cancer patientswilh symptomatic pericardial effusion were treated conservativelyat our center. Echocardiography demonstrated small pericardial effusion in 2 patients, medium size effusion in 3 patients and large amount of fluid in 15 patients. Fifteen patientsdeveloped cardiac tamponade;in duee of these patients, this was the presenting manifestation of lung cancer. Pericardiocentesisresultedin prompt, thoughtemporary, symptomatic relief in all patients.Fluid cytology demonstratedsuspectedmalignant cells in 2 patientsand malignantcells in 13 patients.Basedon cytology, me diagnosisof adenocarcinomawas establishedin six patients, small cell carcinoma in three patients, and epidermoid carcinoma in one

269

All patients were dead within

patient. diagnosis

of pericardial

is concluded

effusion:

that pericardial

rapid tumor progression immediate

9 months

17 died within

effusion

from

the time

of

less than 3 months. It

in lung cancer is indicative

and short survival.

Fluid cytology

of

provides an

and accurate means of diagnosis.

Elevatedserum levelsofsolubleintcrleukin-Zreceptorsin smallcell lung carcinoma Yamaguchi K, Nishimura Y, Kiyokawa T. Blood Transfusion Service, Kumamoto Universiry Medtcal School, Honjo I-i-1, Kumamoto 860. J LabClin

Med

1990;116:457-61.

The presence of the soluble form of the interleuktn-2

immune reactivity in bronchogenic carcinoma and its relation to Syear survival rate Watanabe Y. Shim& J. HashiLume Y et al. Deporrmenr ofSurgery. Kanazawo Universiry School of Medicine, 13-I Takaramachi. KoMIIIW~920. J Surg Oncol 1990;45: 103.9. We performed parameters

a prospective

of the immune

patients with bronchogenic ined

before

starting

response

were

the 5year

Parameters

Delayed

natural killer

prcduction

with

carcinoma.

treatment.

lymphoblastogenesis, 2 (IL-2)

study on the correlation

survival

rate m

were mitially

hypersensitivity

(NK)

employed

of various

cell activity,

exam-

skin

tests.

and interleukin-

to assess immune

competence.

Each reaction was classified

into four or five grades in accordance

intensity;

rate of the patients showing

the 5-year survival

the immune before

response was calculated.

treatment

and tJre survival

lymphoblastogenesis. poorer correlations, 2 production

A correlation

and noexactcorrelation

and the immune

each grade of

between

response

rate was most clearly

The skin tests and the NK

with

noted

cell activity

for

showed

ZR)

was evaluated

carcinoma

(SCLC)

(nonl-SCLC)by sIL-2R

in the serum of 21 patients and 37 patients with non-small

and after therapy.

cell lung

cell lung carcinoma

in patients with SCLC

The mean Serum level of sIL-2R

both during and after therapy.

in patients

small

meansofanenzyme-linkedimmunosorbentassay.The

level was measured serially

SCLC

receptors (sIL-

with

with

SCLC

both during

m patients

with

The mean serum level of sIL-2R

was 3.8 times

higher

than that of 47 healthy

controls and was I.9 times higher than in 37 patients with non-SCLC. Six patients with SCLC

had very high levels of sIL-2R.

ranging

five to52 timcsthemcanlevelobservedmnormalcontrols. in the pleural

from

Tumorcells

fluid of the patient with highest levels were positive

with

monoclonalantibodies~IL-2R(CD25).NKH-I.OKDR,andOKT9.A longitudinal

study in this patient

tumor activily

and sIL-2R

patients responding secrete sIL-2R

showed

a good correlation

levels. Also. the sIL-2R

between

levels decreased in

to therapy. These results suggest that some SCLCs

and that the serial measurements

levels can be used as a nonmvasive

of the serum sIL-2R

tumor marker

in thts disease.

was noted between the IL-

response.

Surgery Echocardiography in the initial assessmentof patients with small cell lung cancer Mackintosh IF, Hawson CAT, Sorensen C. 121 Wictim Terrace, Brisbane 4ooO. Cancer J 1990;3:248-5 I. ‘The value of pm-treatment echocardiography has been assessed m 82 patients with small cell lung cancer (SCLC) tion between ographic

1985 and 1988. Thirty-six

abnormalities

been recognized abnormality (26%).

and 23 (28%)

at the initial was a strong

pericardial

effusion

obstruction

and pleural

normalities

included

and the clinical

(8 patients).

left ventricular

had urgent

cant left ventricular

or valvular

regtmen

given lo the 4 palients (including large pericardial otoxicity ography

effusions

because of potential

had abnormal

pretreatment

is a useful mvestigation

Kumura

CA125

level is a good prognostic

Y, Fujii

T. Hamamoto

perfusion.

The planned reduction

(I3

pa-

was

was not

problems

with

indicator

The serum CA125

level was determmed

assay method

CA125

levels were observed in 37.8%

cancer, m 30.0% with

small

in patients

cell cancer.

Most

normal

with

limits.

and 4). an increased factor (P-z 0.01). with the survival

with

of lung parenchyma

was expressed as

i.e. the predicted postoperative

function of the lung, was calculated. functional

of the predicted lung function

high correlation perfusion

(VC and FEF,)

coefficients

scintigraphy

IO

of the total

and the expected decrease in VC and FEV,, lung capacity

with

The

the re-

6 months after surgery showed

for both VC and FEV,.

Semiquantitative

of the lung helps to determine therapy

of

the extent

of

lung cancer and is espy-

fluid

cially important

in patients with a high operative

risk.

immunoradi-

Unfortunately. judged

of those

of choice for non-small

one quarter

concerned treatment

with

to the chest that is unresectable. for cure by surgical

have stage

the presentation.

are and

25% of patients with bronchogenic

who have the potential of these patients

carcinoma

disease at the time of diagnosis,

have a lesion confined

These figures leave approximately majority

cell lung cancer is surgery.

about half of patients with bronchogenic

to have distant metastatic

carcinoma

serum

squamous cell serum

Surgical approach to non-small cell lung cancer stage I and II KJingmanRR. DeMccstcr TB. Department of Surgery, University of Southern California Medical Center. 1200 North State Street. Las Angeles. CA 90033. Hematol Chico1 Clin North Am 1990;4:1079-91. The treatment

M, ho A.

and in 60.0% increased

as a fraction

I and

diagnostic

therapy.

The

II disease. This article evaluation,

is

and surgical

of this subgroup of patients.

CA125

3 or 4. Patients with pleural effusions or ascites

showed high serum CA125 shorter in patients

patients

of perfusion

comparison estimated

scan

Echocardi-

lung cancer. Increased of patients with

forced expira-

The perfusion

cardi-

in lung cancer

by aone-step

percent of total perfusion,

(VC),

were semiquantitatcd

in the individual

of patients with

N, Katoaka

of those with adenocarcinoma

levels were in stages

withm

with

distribution

to predict

i.e. the functional

lung imaging.

surgery possible

Depa~menr ofRadmlogy, Ehime Universiry School ofMedicine, Shitsukmva, Shigenobu-thou, Onsen-gun. Ehime 791-02. Br J Cancer 1’990;62:676-8. ometric

and perfusion

with

tamponade)

treatment-related

K. Miyagawa

vital capacity

the relative

SCLC.

Serum

prcoprative

were studied

surgery,

determine

doxorubicin

work-up

employing

carcinoma

resectional

cardiac ab-

caused us to

echocardiograms.

in the Initial

thoracic

into I2 regions of interest which

and cis-platinum

Three of live patients who developed

bronchogenic

was divided

in I9 patients with signifi-

those with incipient

operability,

with after

vena caval

3 patients with incipient

dysfunction;

function

(FEV,)

of a

hypertmphy

findings

28 patients lung

tory volume

dysfunction

pericardioccntesis:

from the chemotherapy

in 21 patients

left ventricular

In particular,

had not

the presence

of superior

In 23 patients the echocardiographic

tamponade

loading.

effusion

Non tumour-related

(7 patients),

approach.

which

The most frequent

between

features

involvement.

signiticant

change our treatment cardiac

assessment.

association

tients). valvularabnormalities

to one instituhad echocardi-

had abnormalities

clmical

was tbc presence of a pcricardial

There

eliminated

presenting

patients (44%)

Estimation of risk of surgery of lung cancer by means of quantitative perfusion scintigraphy Mende T, Orlick M, Fischbcck 0. Neef H. Abteilung Nuklearmedizin, Klinikmd PoliklinikficrRodiologie,Marts-Ltuher-Uniwrsitat, Vosstmsse I. O-llalle 4020. Nuklearmedizin 1990;29:274-7.

levels. The survival

increased

serum CA125

time was significantly levels than in those

Among patients with advanceddisease (stages 3 Serum CA125

The existence

level was again a poor prognostic

of a pleural

time, We conclude

effusion

that CA125

disease extent and serum levels correlate

did not correlate

is a good indicator

to the length of survival.

of

Long-term results of operation for non-small cell lung cancer in the elderly Ishida T, Yokoyama H, Kaneko S, Sugio K, Sugimachi K. Depwfment ofdurgeryll. FacultyofMedicine, Kyushu University, 3-1-I Maidashi, Higashi-ku. Fukuoka 812. Ann Thorac Surg 1990:50:919-22. We surgically

treated

I85 patients

wuh non-small

who were 70 years old or older. The operative

cell lung cancer

mortality

rate was 3%