Abstracts/Lung Cancer 12 (1995) 265-329

Diagnosis of mediastioal lymph node metastasis from primary lung caneeronMRim~ngnitbtheSTIRtechnique-Reevl)urtion ofuse- tidnewComparLwnwitbCT,conventionalMRIandMRIwiththeSTlR technique Fujimoto K, Meno S, Abe T, Edamitsu 0, Nishimura H, Hayabuchi N et al. Deporbnent ofRadio/ogv. Kwume University School ofMedicine. Kurume 830. Lung Cancer (Japan) 1994;34:91 l-22.

Sixty-one patients with primary lung cancer who had previously undergone CT and MR imaging (MRI) within two weeks before surgery were studied retrospectively. The accuracy of diagnosis of mediastinal lymph node metastasis W&P 80% on CT, 79% on conventional h@U (C-w, and 87% on conventional MRI with the STIR technique (STIR-MRI) according to our criteria. Nincty- one new patients with primary lung cancer were studied prospectively according to the same methods. The accuracy of diagnosis of mediastinal lymph node metastasis was 81% on CT, 81% on C-MRI, and 87% on STIR-MRI. AS the results of reevaluation using a prospective study corresponded to those of the retrospective study, it is suggested that STIR-MU is useful to diagnose mediastinal lymph node metastasis from lung cancer. Pathological findings of false positive cases were reactive lymphadcnopathy and those of false negative cases were micromctastases fmm adenocarcinomas. It seems to be diffwdt to distinguish reactive lymph adenopsthy from met&& lymphadmopnthy and to distinguish normal node from micrometastatic node, even though STIR-MIU is used. However, the accuracy of STIR-MRI was higher than CT and C-MRI, and the possibility of enhancement of diagnostic accuracy of lymph node metastasis fmm lung cancer is suggested by combining MR imaging with the STIR technique with CT.

Cliiopathological characteristics oftumor doubling time in primary llmgeancer Usuda K, Saito Y, Aikawa K, Sakurads A, Chen Y, Endo C et al. Department of Thoracic Surgery, Inst. ofDeveopmenUA~‘n~Canc~ Tohokx Universily, Sendai 980. Lung Cancer (Japan) 1994;34:875-81.

A total of 174 casts with primary lung cancer which were detected in local municipalities during a limited period were examined with regard to their distribution and the clinicopathological characteristics of tumor doubling time (DT). 1) A&r logarithmic conversion ofDT in lung cancer, a small skew (0.7204) and a small kurtosis (-0.0643) showed a normal distribution. DT was found to have a log-normal distribution. 2) The minimum DT was 30 days,and the maximum 1077 days in the present study. Arithmetic mean i standard deviation of DT was 163.7 f 177.5 days, and geometric mean was 113.3 days. 3) Mean DT in males

was significantly shorter than that in females, and that in cases with a smoking history was significantly shorter than that in cases without a smoking history. In cases with symptoms, DT was also significantly shorter than that in cases without symptoms. The mean DT in cases with adenocarcinoma was significantly longer than that in cases with squamous cell carcinoma, small cell carcinoma and large cell carcinoma. The mean DT in cases with Tl lung cancerwas significantly longer than that in cases with T2, T3, and T4 lung cancer, and that in cases with stage I lung cancer was significantly longer than that in cases with stage III lung center

The prognostic value of argyrophil oucleolar organizer regions (AgNORs) and fibmnectin antibody in stage I lung cancer Gomibuchi M, Kanno S, Masaki Y, Haraguchi S, Tanaka S, Shoji T et al. Department of Thoracic Surgery. Nippon Medical School, Tokyo. Lung Cancer (Japan) 1994;34:861-6.

We studied the usefulness of AgNORs and tibronmtin antibody (FN) to predict the survival in stage I lung cancer patients. A total of 72 lung cancer specimens were used: 36 cases (A group) which had no recurrence for more than tivc years aftcropcration and 36 cases(l3 gmup) which died from cancer recurrence within five years. Both groups consisted of 18 adenocarcinomas, 16 squamous cell carcinomas and two large cell carcinomas. Cases were divided into 3 groups and awarded point according to the number of AgNORs: cases with less than 3.0 (hvo points), those behveen 3.0 and 5.0 (one point) and those 5.0 or mire (zero points). The amount of FN was also classified into three groups: + + (2 points), + (1 point) and - (zero point). The survival time for each score for AgNORs, FN, and both together was studied. A group and B group were statistically compared using AgNORs scores, FN scores and total scores. The results were as follows: (1) Cases with a total score of zero had a shorter survival time than cases with I-

2 points (p = 0.025,0.0076). (2) AgNORs scores of the A group were higher than those of the B 8rO”p (p = 0.029). The same result was found for FN score (p = 0.022) end total score (p = 0.0057). (3) In adcnocarcinomas a total score of 2 had longer survival time than that of zero and A 8roup had higher total score than the B group. No statistical difference was found in squamous cell carcinomas. (4) All eight cases with a zero score were in the B group. Five cases out of 6 with II score of 3 were in the A group. From these results AgNORs and FN have some value for the prediction of the prognosis in stage I lung cancer patients.

Clinicopathologic features of small cell lung cancer presenting as a sdiwpulmoorry- Yamaji Y, Yamadori I, Fujita T, Fujita J, T&ham J, Ma& M et al. First Dept. of IntemolMedicine, KagawaMedicalSchwl. Kagawa 761-07. LungCancer(Jspan) 1994;34:853-9.

Although we, small cell lung cancer(SCLC) presenting as a solitary pulmonary nodule (SPN-SCLC) without lymph node involvement, has interesting clinical and biological features. In this study our objectives are to elucidate whether SPN- SCLC is an independent entity and differs clinically or pathologically from usual forms of SCLC. We reviewed the clinical and pathological feahmzs of 80 patients treated at Kagswa Medical School Hospital behveen 1983 and 1992 on a diagnosis of SCLC. The features of SPN-SCLC were wmpered with those of non-SPN- SCLC or of the peripherally originated, but locally advanced, subgroup in non- SPN-SCLC. Ten SPN-SCLC patients (9 male and 1 female) were identified among the 80 SCLC patients. In terms of histological subclassification, oat cell type was diagnosed in 3 and intermediate cell type in 7. Good chemotherapeutic response was observed among SIX SPN-SCLC patients who received induction chemotherapy (one CR and 5 PR). However, 4 out of the 6 SPN-SCLC patients relapsed at the primaty sites. Surgical operation was performed in 6 (3 surgery alone, 1 neoadjuvant surgery and 2 acjuvant surgery) and additional radiation therapy after induction chemotherapy in one among 10 SPN-SCLC patients. Although, the SPN-SCLC patients had a longer survival time than non-SPN- SCLC patients, we could not find any differences in pathological and biological characteristics behveen SPN-SCLC and non-SPN-SCLC. Since it was difficult to curatively treat SPN-SCLC patients by chemotherapy alone, additional surgery combined with chemotherapy for the SPN-SCLC patients may be feasible for cure in such cases.

Features and significance of nonbacterial thmmbotic endocarditis in patients with lung cancer Tamura A, Matsubara 0, Komatsu H, Mohri M, Katayama T. Deporbnent o/ Pathology Faculry of Medicine, Tohyo Medic&Dental Uniwrsiry. Bunhyu-h, Tokyo. Lung Cancer (Japan) 1994,34:843-52.

To examine feahu-es and signiticancc of nonbacterial thrombotic endocarditis (NBTE) in patients with lung cancer, WC clinicopthologically reviewed 142 autopsicd patients with lung cancer. Eleven (7.7%) of the patients had NBTE. Incidence of NBTE was 13% (E/62 cases) in adcnocarcinoma and 8.6% (3135 cases) in squamous cell carcinoma. None of the patients with small cell carcinoma (34 cases) had NBTE. Eleven of the 142 patients had pathologically proved disseminated intravascular coagulation (DIG), and 4 of the 1 I patients (36%) also had NBTE. There was significant correlation behvccn DIC and NBTE (p < 0.01). Seven of the 11 patients with NBTE had systemic thromboembolism mostly accompanied by infarction. Organs with thrombocmbolism were as follows: spleen (7 cases), brain (5 cases), kidneya (4 cases), heart (3 cases), and mcsentcry (2 cases). Multiple, hemorrhagic cerebral infarction (4 cases) was fatal. Myocardial infarction and peritonitis caused by mesenteric arterial embolization also contributed to death. The present study revealed that NBTE occasionally occured in patients with lung cancer and that systemic thromboembolism due to NBTE affected prognosis of the patients. The authors stress that clinicians should keep in mind the features and significance of NBTE in tr&b,g patients with lung cancer.

Anatomic basi8 of lymphatic spread of lung carcinoma to the media- stinum: Anatomo-clinical correlations Riquet M, h4anac’h D, Dupont P, Dujon A, Hidden G, Debesse B. Service de Chirwgie Thocacique, HopitalLaennec. 42, NC de Sewes, F-75007Paris. Surg Radio1 Anat 1994,16:229-38.

Correlation of the anatomic and surgical features in 360 cadavers and in 260 patients opcratcd for bronchial carcinoma reveals that the lymphatics of the lung

292 Abstracts/Lung Cancer I2 (1995) 265-329

reach the ipsilateral mediastinum, sometimes directly and sometimes by sites which do not correspond to the anatomic site of the injection or of the pulmonary lesion. This implies the need for systematic eradication ofall the lymph nodes of the ipsilateral mediastinum during surgery for bmnchial carcinoma. In cases of tomoral lesions (IQ), the prognosis is better when only one site is involved, whether the nodal disease is microscopic, uni- or multiglandular, with or without rupho’e ofthe capsule and whatever treatment is carried out, even when resection stems macroscopic-ally complete to the surgeon. This is explicable in the light of the anatomic stody, which shows that the lymph node chain is a functional entity which channels the lymph into the systemic circulation, either at the venous confluence of the neck or into the thoracic duct in the mediastinum. When only a sir&chain isatTected,thcn isagreaterthan IO%chancethat aystemicmetastascs are ah’Cady present, 90% wheo N2 affects 2 chains, while in N3 cases (lymph pkpsage to Contralateral chains) the incidence reaches virtually 100%. However, macroscopieally satisfactory excision allows management of the local pmblom, and involvement of the mcdiastinal nodes, even with capsular rupture, cannot be considered BS a contraindication in the absence of clinically detectable systemic metastescs.

Prognostic importance of humaa papilloma virus typing in squamous cell papilloma oftbe bronchus: Comparisoa ofia situ hybridization and the polymer= chain reaction Popper HH, El-Shabrawi Y, Wockel W, Hofler G, Kennn L, Juttncr-Smollc FM. Insti~te ofPafhology. Unk of GrazSchool ofMedicine, Auenbmggerplars 25. A- 8036 Grr. Hum Path01 1994;25:1191-7.

Thirtyanc solitary bronchial squamous cell papillomas (SCPs) with variable degrees of dysplasia, one combined with larynx papilloma and small cell carcinoma in the contralateral lung, and I2 papillomas combined with invasive squamous eelI carcinomas (SCCs) were investigated for the presence of human papilloma virus (HPV) DNA by in situ hybridization (ISH) and the polymcrase chain reaction @‘CR). Benign SCPs showed an association with HPV type 1 I and rarely with type 6, whereas type 16 or 18, sometimes in combination with type 3 t/33/35, was found in SCPs associated with SCCs. In one patient HPV type l8- and 31/33/35-positive benign SCP preceded the recurrence of HPV IS-positive SCP (this time combined with carcinoma) by 2 years. Patients with SCP exhibiting HPV I6 or 18 positivity are at high risk for the development of SCC. Virus typing seems to be a better prognostic indicator than grading of dysplasia or age relationship. Virus typing by the PCR is more sensitive compared with ISH, but positive cells cannot be determined; ISH is less sensitive than the PCR but permits a definite designation of the cell types that have integrated HPV sequences into their DNA. Our data suggest that HPV typing should be performed in every bronchial SCP.

Myastbenk(Eato+Lambert)syndmmeassociatedwithpuhomuy~ eell owroeaducrine carcinoma Demirer T, Ravits J, Aboulatia D. Section o/Hemaro/ogv/onco/om l&ginia Mason Medical Center: PO Box 900, SeartIe, WA 98Ill. South Med J 1994;87: 1186-9.

A 66-year-old woman presented clinical findings of Eaton-Lambert (myasthcnic) syndrome (ELS). Fifteen months later, large-cell pulmonary carcinoma was detected. At?er systemic chemotherapy and radiotherapy, the tumor regressed and ncurologic function improved. Although ELS is usually associated with pulmonary small-cell carcinoma, a minority of tumors are of squamous or glandular differentiation. We believe this is the first case report of ELS associated with Iarge~ll ncumendocrine carcinoma in the English language literature, and it illustrates the importance of an aggressive approach to diagnosis and treatment.

CT demonstratioa Orcakif~atioa in carcioomaof the lung Grewal RG, Austin JHM. PHC of North Weslem Pennsyhunia, 1720 Holland 9. Erie. PA 16503. J Comput Assisted Tomogr 1994;18:867-71.

Objective: Our goal was to assess the diagnostic significance of calcification in carcinoma of the lung, as seen on CT. Materials and Methods: We prospectively identified 500 consecutive patients with the provisional clinical diagnosis of lung cancer, who underwent CT examination of the chest from 1987 to 1991. Fifty-three (10.6%) of the 500 CT examinations revealed intratomorrd calcification. When these 53 patients were reviewed retrospectively in 1992. CT examinations were available for 39, each with microscopic proof of

primary carcinoma of the lung. Tumors were assessed for histologic subtype, size, and lccdtion and compared with a control group of the last 1 I5 noncalcified. proven, primary carcinomas of the lung in the series. Intrammoral calcification seen on chest CT was assessed for location, extent. and pattern. Results: The calcitied tumors tended to be large (6.2 i 3.0 cm, mean diameter f SD) compared with the noncalcified tumors (4.4 * 2.3 cm) (p = 0.0001). The calcified tumors were central in 28 (72%) and peripheral in II (28%) patients. The noncalcified tumors were central in 52 (45%) and peripheral in 63 (55%) patients (p = 0.007). PunCtate patter!! of calcification correlated marginally with small cell carcinoma (p = 0.07). Histologic subtype showed no correlation with intratumoral location Or extent of calcification. Conclusions Calcification is identified in 10% of lung cancer, does not predict histologic subtype, and tends to occur in large, central tumors.

Lung emleer WitIt skla metaataslr Teraahima T, Kanazawa M. Dept ofMedicine, Keio Universiry SchoolofMedicine, 35 Shinonomachi, Shinjuh-Ku, To@o 160. Chest 1994;106:1448-50.

We describe findings in 34 cases of lung cancer with skin mctastases. In 24 men and 10 women. ages ranged from 32 to 85 years (mean, 61 years). In five, a skin lesion was the tirst manifestation of the underlying cancer, in another four, it was found coincidentally with detection of the lung mass. Pathologic findings included adcnocarcinoma in I8 patients, large*ell carcinoma in 9, squamous cell carcinoma in 5, and small-cell carcinoma in 2. Among 87 patients with largc+ell carcinoma, 9 (10.3 percent) developed cutaneous metastases. A review of 510 autopsies of primary lung cancer at Kcio University from 1958 to 1992 showed 25 cases with skin mctastaaes (4.9 percent), adenocaminoma in 13 cases, large-cell carcinoma in 6, squamous cell carcinoma in 4, and small- cell carcinoma in 2. Skin mctastases were proven in 15.4 percent of autopsy cases of large-cell carcinoma of the lung. Mean survival time fmm diagnosis of lung cancer was 10.3 months and that from diagnosis of skin metastasis was 4.9 months. The prognosis for patients having lung cancer with skin metastasis is thus very poor. In the review of 34 patients and 25 autopsies of lung cancer with skin metastasis, we conclude that the incidence of cutaneous metastasis is high for large-cell carcinoma and low for squamous and small-cell carcinoma.

‘he value of combioed assay of serum lung caocer associated anti-gens 3C,Ag and WI&A& Bai X-F, Deporbnmr of Respiraroty Disease. Xinqioo Hospilal, 3rd Military Medical College, Chongqing. Chin J Clin Oncol 1994%1:752-6.

Using the method of EA-ELISA immunobinding inhibition test, the McAbs 3C, and WLA-2C, against antigens 3CsAg and WLA-Ag, were detected in sera of 102 lung cancer (LC) patients, 96 normal adults and 76 lung benign diseases patients. It was found that the sensitivity, specificity and accuracy for 3C$g in the diagnosis of LC were 64.7% (66/102), 93.0% and 82.5% while for WLA-Ag, they were 50.0% (49198). 95.1% and 73.1% respcctivcly. WLA-Ag, seemed to be a complement to 3C$g in LC.diagnosis, and combined assay of 3C@g and WLA-Ag, could increase the positive rate to 75%. It was also found that serum 3Ckg would be of great importance in the surveillance of tumor burden changes in viva and in the survcillancc post-operatively. Serum WLA-Ag, changes after operation could be of some importance as well.

Diffuse infiltrating pulmonary neoplasm with an analysis of 43 cp9e.s Zheng J-X. Deparbnenl ofPulmonaryMedicine, Wongshon Hospital, Shanghai Medico/ University. Shanghai. Chin J Clin Oncol 1994;21:728-30.

Forty-three cases of pulmonary neoplasm with diffuac infiltrative signs on radiography were reported and the clinical featores, diagnosis and treatment of this disease were discussed. It is concluded that (1) scrutinized physical examination is able to detect symptomless pulmonary neoplasm early, (2) TBLB is the most useful diagnostic means, and (3) patients with diffuse interstitial lung disease must be followed-up closely and repeated examination of TBLB enable early diagnosis of malignant disease.

A suspected case of TONlMO small cell carcinoma of the lung Nakamura K. Isobe T, Okusaki K, Niitani K, Murakami I. Yoshida Y et al. Second Depl. of Inlemal Medicine, Hiroshima Universiy School of Med., Kaeumi 1-2-3, Hiroshima 734. Jpn J Thorac Dis 1994;32:814-8.

A 5 I -year-old man was admitted to our hospital with a chief complaint of CO@. His chest X-my and CT scan revealed enlargement of a let7 hilar lymph