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Synchronous triple malignant tumors of the lung. A case report of bronchial carcinoid, small cell carcinoma, and adenocarcinoma of the right lung
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stromal ossification is reported herein. The literature is reviewed for neoplasms that exhibit pulmonary ossification either by primary or metastatic lesions. To our knowledge, this case represents the first report of benign osseous stromal metaplasia in the primary lesion of a pulmonary adenocarcinoma. Synchronous Triple Malignant Tumors of the Lung. A Case Report of Bronchial Carcinoid, Small Cell Carcinoma, and Adenocarcinoma of the Right Lung. Jung-Legg, Y., McGowan, S.E., Sweeney, K.G. et al. Department of Pathology, Boston Veterans Administration Medical Center, Boston, MA 02130, U.S.A. Am. J. Clin. Pathol. 85: 96-101, 1986. The authors report a case in which a highly unusual, simultaneous occurrence of a peripheral small cell carcinoma and a central bronohial carcinoid in the right upper lobe and a peripheral adenocarcinoma in the right middle lobe was observed. This is the fourth case of triple lung cancer reported in the literature. The role of computerized tomography in disclosing multiple lung carcinomas and the significance of the concurrence of pulmonary small cell carcinoma and bronchial carcinoid are discussed.
Synchronous and Metachronous Lung Carcinomas Related to Malignant Primary Tumours at Other sites. Ciambellotti, E., Moro, G., Lanza, E. et al. USSL, n 47, Divisione di Radioterapia, Ospedale Civile, Biella, Italy. Minerva Med. 76: 1693-1897, 1985. A series of 19 cases are reported in which, with the exception of one case, two primary malignant tumours developed at different times, one of which in the lung. Some details of this occurrence are discussed in relation to similar findings in the international literature. The average interval between the two tumours was found to be 7.5 years. In eight cases, all male, the lung tumour arose in subjects who had already been subjected to radical treatment for a laryngeal tumour. A lung carcinoma appeared in four women who had been subjected to radiation therapy following mastectomy. This sequence of events was considered a coincidence and not radioinduced in view of the fact that a total of 1061 similarly treated patients were observed over the same period. Finally, it is suggested that certain histobiochemical factors induced by the lung tumour may somehow become pathogenically transformed to simulate a new primary malignant tumour.
6.
SURGERY
Surgery of Small Cell Lung Cancer.
~hields, T.W, Northwestern University Medical School, Chicago, IL, U.S.A. Chest 89: 264S-267S), 1986. The role of surgical resection in the management of patients with small cell lung cancer remains to be defined. Some data suggests the potential benefit of resection in the few patients with very limited disease (peripheral TINoT2N 0 lesions), and there are chemotherapy reglmens with 80-85% response rates in patients with more extensive but still localized disease. Interest has been reawakened in the role of adjuvant surgical resection in selected patients by 2 approaches: (1) in patients with peripheral T. or 1 T 2 lesions with negative mediastinal exploration, initial surgical resection followed by an adequate chemotherapeutic regimen and prophylactic cranial irradiation has resulted in an 80% disease-free survival at 30 months; (2) initial chemotherapy in patients with only localized disease is followed by resection in the responders. Approximately 30% of the responders have undergone exploratory thoracotomy after completion of the chemotherapy. Local irradiation, as well as prophylactic cranial irradiation, generally has been used postoperatively. Early pilot studies suggest benefit of this approach in patients found to have T 1 3N0 I disease but not in those with N~ dis~a~e.-Prospective, randomized, clinicaI trials by the Lung Cancer Study Group in North America and its counterparts in Europe are now being carried out in hopes of supplying definitive data relative to this multimodality therapy in small cell lung cancer. Unfortunately, no data are available to date. Selection of Patients With Non-Small Cell Lung Carcinoma for Surgical Resection. Rizk, N.W. Pulmonary Division, Palo Alto Medical Clinic, Palo Alto, CA 94301, U.S.A. West. J. Med. 143: 636-642, 1985. Cancer of the lung is rapidly increasing in incidence in both sexes and soon will overtake breast cancer as the most deadly cancer in women. Selection of patients with non-small-cell carcinoma for surgical resection is largely based on preoperative clinical staging, using the American Joint Committee on Cancer's TNM-based group staging protocol. Determining the presence or absence of mediastinal nodal metastasis is paramount and is currently best achieved by computed tomographic scanning of the chest and biopsy of enlarged nodes via mediastinoscopy. Certain types of stage III lesions, previously excluded from surgical treatment, are now recognized as operable. 'Carcinoma Surgery' in Bronchus Carcinoid: Yes or No? Juttner, F.-M., Pinter, M., Klepp, G. et al. Department Thoraxchirurgie, Chirurgische
stromal ossification is reported herein. The literature is reviewed for neoplasms that exhibit pulmonary ossification either by primary or metastatic lesions. To our knowledge, this case represents the first report of benign osseous stromal metaplasia in the primary lesion of a pulmonary adenocarcinoma. Synchronous Triple Malignant Tumors of the Lung. A Case Report of Bronchial Carcinoid, Small Cell Carcinoma, and Adenocarcinoma of the Right Lung. Jung-Legg, Y., McGowan, S.E., Sweeney, K.G. et al. Department of Pathology, Boston Veterans Administration Medical Center, Boston, MA 02130, U.S.A. Am. J. Clin. Pathol. 85: 96-101, 1986. The authors report a case in which a highly unusual, simultaneous occurrence of a peripheral small cell carcinoma and a central bronohial carcinoid in the right upper lobe and a peripheral adenocarcinoma in the right middle lobe was observed. This is the fourth case of triple lung cancer reported in the literature. The role of computerized tomography in disclosing multiple lung carcinomas and the significance of the concurrence of pulmonary small cell carcinoma and bronchial carcinoid are discussed.
Synchronous and Metachronous Lung Carcinomas Related to Malignant Primary Tumours at Other sites. Ciambellotti, E., Moro, G., Lanza, E. et al. USSL, n 47, Divisione di Radioterapia, Ospedale Civile, Biella, Italy. Minerva Med. 76: 1693-1897, 1985. A series of 19 cases are reported in which, with the exception of one case, two primary malignant tumours developed at different times, one of which in the lung. Some details of this occurrence are discussed in relation to similar findings in the international literature. The average interval between the two tumours was found to be 7.5 years. In eight cases, all male, the lung tumour arose in subjects who had already been subjected to radical treatment for a laryngeal tumour. A lung carcinoma appeared in four women who had been subjected to radiation therapy following mastectomy. This sequence of events was considered a coincidence and not radioinduced in view of the fact that a total of 1061 similarly treated patients were observed over the same period. Finally, it is suggested that certain histobiochemical factors induced by the lung tumour may somehow become pathogenically transformed to simulate a new primary malignant tumour.
6.
SURGERY
Surgery of Small Cell Lung Cancer.
~hields, T.W, Northwestern University Medical School, Chicago, IL, U.S.A. Chest 89: 264S-267S), 1986. The role of surgical resection in the management of patients with small cell lung cancer remains to be defined. Some data suggests the potential benefit of resection in the few patients with very limited disease (peripheral TINoT2N 0 lesions), and there are chemotherapy reglmens with 80-85% response rates in patients with more extensive but still localized disease. Interest has been reawakened in the role of adjuvant surgical resection in selected patients by 2 approaches: (1) in patients with peripheral T. or 1 T 2 lesions with negative mediastinal exploration, initial surgical resection followed by an adequate chemotherapeutic regimen and prophylactic cranial irradiation has resulted in an 80% disease-free survival at 30 months; (2) initial chemotherapy in patients with only localized disease is followed by resection in the responders. Approximately 30% of the responders have undergone exploratory thoracotomy after completion of the chemotherapy. Local irradiation, as well as prophylactic cranial irradiation, generally has been used postoperatively. Early pilot studies suggest benefit of this approach in patients found to have T 1 3N0 I disease but not in those with N~ dis~a~e.-Prospective, randomized, clinicaI trials by the Lung Cancer Study Group in North America and its counterparts in Europe are now being carried out in hopes of supplying definitive data relative to this multimodality therapy in small cell lung cancer. Unfortunately, no data are available to date. Selection of Patients With Non-Small Cell Lung Carcinoma for Surgical Resection. Rizk, N.W. Pulmonary Division, Palo Alto Medical Clinic, Palo Alto, CA 94301, U.S.A. West. J. Med. 143: 636-642, 1985. Cancer of the lung is rapidly increasing in incidence in both sexes and soon will overtake breast cancer as the most deadly cancer in women. Selection of patients with non-small-cell carcinoma for surgical resection is largely based on preoperative clinical staging, using the American Joint Committee on Cancer's TNM-based group staging protocol. Determining the presence or absence of mediastinal nodal metastasis is paramount and is currently best achieved by computed tomographic scanning of the chest and biopsy of enlarged nodes via mediastinoscopy. Certain types of stage III lesions, previously excluded from surgical treatment, are now recognized as operable. 'Carcinoma Surgery' in Bronchus Carcinoid: Yes or No? Juttner, F.-M., Pinter, M., Klepp, G. et al. Department Thoraxchirurgie, Chirurgische