270

stromal ossification is reported herein. The literature is reviewed for neoplasms that exhibit pulmonary ossification either by

primary or metastatic lesions. To our know- ledge, this case represents the first report of benign osseous stromal metaplasia in the primary lesion of a pulmonary adenocarcino- ma.

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 Ve- terans 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 com- puterized tomography in disclosing multiple lung carcinomas and the significance of the concurrence of pulmonary small cell carci- noma 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, Os- pedale 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 dif- ferent times, one of which in the lung. Some details of this occurrence are discussed in relation to similar findings in the in- ternational literature. The average inter- val between the two tumours was found to be 7.5 years. In eight cases, all male, the lung tumour arose in subjects who had alrea- dy been subjected to radical treatment for a laryngeal tumour. A lung carcinoma appear- ed 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 cer- tain histobiochemical factors induced by the lung tumour may somehow become patho- genically transformed to simulate a new pri- mary malignant tumour.

6. SURGERY

Surgery of Small Cell Lung Cancer.

~hields, T.W, Northwestern University Medi- cal 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 sug- gests 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 approach- es: (1) in patients with peripheral T. or

1 T 2 lesions with negative mediastinal explo- ration, initial surgical resection followed by an adequate chemotherapeutic regimen and prophylactic cranial irradiation has result- ed 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 explo- ratory 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 re- section is largely based on preoperative clinical staging, using the American Joint Committee on Cancer's TNM-based group staging protocol. Determining the presence or ab- sence of mediastinal nodal metastasis is paramount and is currently best achieved by computed tomographic scanning of the chest and biopsy of enlarged nodes via mediasti- noscopy. 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

271

Universit~ts-Klinik, A-8036 Graz, Austria.

Prax. Klin. Pneumol. 39: 846, 1985.

During 1971 to 1983 the authors opera- ted on 28 carcinoid patients in accordance with the criteria of carcinoma surgery. The 5-year survival ra~e was 95%, operation mor- tality 0%. In view of the fact that the tumour status cannot be predicted in indi- vidual cases of bronchus carcinoid, and also

because of the high rate of incidence of irreversible poststenotic changes we believe that procedures aiming at preserving the parenchyma are feasible only for very spe- cific indications.

Wedge Resection a s a n Alternative Procedure for Peripheral Bronchogenic Carcinoma in Poor-Risk Patients. Errett, L.E., Wilson, J., Chiu, R.C.-J., Munro, D.D. The Montreal Chest Hospital, Montreal, Que., Canada. J. Thorac. Cardio- vasc. Surg. 90: 656-661, 1985.

Although lobectomy is the procedure of preference forpatients with peripheral,

clinical Stage I bronchogenic carcinomas, wedge resection of the tumor may be a sa- tisfactory alternative in poor-risk patients. Between 1965 and 1982, 197 patients with peripheral bronchogenic carcinomas were operated upon. Clinical staging was esta- blished by radiography, bronchoscopy, and mediastinoscopy. Ninety-seven patients underwent lobectomies and I00 had wedge re-- sections. The decision to perform the wedge

resection was made preoperatively in the

majority of cases based on the assessment of operative risks. Compared to lobectomy patients, these who had wedge resections were older (70.3 + or - 0.5 versus 64.9 + or - 0.5 years, p < 0.001) and had a lower 1 second forced expiratory volume (1.56 +

or - 0.03 versus 1.94 + or - .

Segmental Pulmonary Resection for Cancer. Stair, J.M., Womble, J., Schaefer, R.F., Read, R.C. Department of Surgery, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, U.S.A. Am. J. Surg. 150:

659-664, 1985. Segmental pulmonary resection was em-

ployed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the

curative group with disease staged TINoM0, 9 patients in the limited group with resl- dual thoracic disease, 8 patients in the palliative group with severe chronic ob-

structive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant

palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survi-

val rates (64% after an average of 16 months)

~n the curative group were not as good as had been anticipated because small peWiphe- ral, asymptomatic, and predominantly scar

adenocarcinoma spread systemically more than similar bronchoqenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5% was low. Seg- mentectomy was well tolerated, even in patients with compromised pulmonary function.

Local Recurrence of Resectahle Non~Dat Cell Carcinoma of the Lung. A Warning Against Conservative Treatment for N0 and N1 disea- se. lascone, C., DeMeester, T.R., Albertucci, M.

et al. Creighton University School of Medi- cine, Department of Surgery, St. Joseph Hospital, Omaha, NE 68131, U.S.A. Cancer

57: 471-476, 1986. Ninety-five patients with non-oat cell

lung cancer underwent resection of all ap-

parent disease and were followed for a mini- mum of 36 months. Incidence of recurrence was 34% in 47 patients with NO disease, 65% in 32 patients with NI disease, and 81.3%

in 16 patients with N2 disease (P < 0.02 and P < 0.005, respectively). Seventy-five percent of the recurrences with NO disease

were local, compared with 28.6% with N1 disease (P < 0.01) and 15.6% with N2 disea- se (P < 0.005). Presumably some of the pa- tients with NO disease could have been cured by eradication of local disease with a pneu- monectomy. Patients with N1 disease had a greater rate of local recurrence when treat- ed with lobectomy compared with pneumonec- tomy, and as with NO patients, some could have been cured by eradication of local dis- ease with the more extensive procedure. Pa- tients with N2 disease were more apt to have distant before local recurrence, which obviates the benefits of a more extensive resection. The incidence of distal recur- rence was statistically great@r in NI than in NO disease (P < 0.001) and similar be- tween NI and N2 disease. It was concluded that, when NO and NI disease is present, a more extensive procedure should be con- sidered, even though it appears that all disease would be removed by a conservative

resection.

Incidence, Cause and Survival Time of Ex- ploratoryThoracotomy in Bronchial Carci- noma Selected via Mediastinoscopy. Greschuchna, D. Ruhrlandklinik, D-4300 Essen 16, Germany. Prax. Klin. Pneumol. 39:

821-822, 1985. Between 1962 and 1980, we terminated in

1448 thoracotomies for bronchial carcinoma, and with the routine use of mediastinoscopy, the surgical procedure prematurely in the sense of an exploratory thoracotomy. In only

4.3% routine preoperative mediastinoscopy