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bed indicated that the tumor was actively secreting these two hormones, cytochemi- cal heterogeneity was seen in the tumor, in which two distinct populations of cells, one secreting ACTH and beta- endorphin and the other secreting CRH, were identified. This patient, thus, had an unusual syndrome of ectopic ACTH and ectopic CRH secretion.

Ectopic Adrenocorticotropin Syndrome Caused by Lung Cancer that Responded to Corticotropin-Releasing Hormone. Suda, T., Kondo, M., Totani, R. et al. Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical College, Tokyo 162, Japan. J. Clin. Endocrinol. Metab. 63: 1047-1051, 1986.

ACTH responses to corticotropin- releasing hormone (CRH) were studied in three patients with the ectopic ACTH syndrome caused by lung cancer. Plasma ACTH responded to synthetic CRH in two of three patients. Tumor tissues obtained from these two patients contained CRH and ACTH. In one patient, tumor ACTH secre- tion was stimulated by CRH in vitro. Tumor CRH was immunologically, chromatographically, and biologically similar to hypothalamic CRH. In addition, multiple forms of immunoreactive beta- endorphin were present in plasma and the tumor extracts. From these results, we conclude that some patients with the ec- topic ACTH syndrome have tumors that produce both ACTH and CRH and that CRH can stimulate ACTH secretion by such tumors. Other patients with the ectopic ACTH syndrome do not have ACTH responses to CRH. Therefore, procedures other than CRH testing are needed to differentiate with Cushing's syndrome due to ectopic ACTH/CRH production from those with Cushing's disease, since the latter also usually have ACTH responses to CRH.

Long-Term Survival After Brain Metastasis From Lung Cancer. Sarma, D.P., Weilbaecher, T.G. Department of Pathology, Veterans Administration Medical Center and Louisiana State University Medical School, New Orleans, LA, U.S.A. Cancer 58: 1366-1370, 1986.

A case is reported of prolonged sur- vival after lobectomy for large cell un- differentiated carcinoma of the lung and resection of metastatic carcinoma of the brain. The patient had survived ii years 5 months after lung resection and i0 years 4 months after excision of brain metastasis. A review of the reports of another 12 patients who survived 5 years or longer after craniotomy, shows that the surgical excision of a single metas- tatic lesion of the brain with or without postoperative irradiation offers the best hope for prolonged survival.

Lung Cancer Following Treatment for Lymphoma. Abernathy, D., Beltran, G., Stuckey, W.J. Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, U.S.A. Am. J. Med. 81: 215-218, 1986.

Six patients with lung carcinoma from a group of 206 treated for non-Hodgkin's lymphoma and 82 with Hodgkin's disease are described. Review of the literature shows that an increased risk of solid tumors following treatment for lymphoma has not been conclusively demonstrated. However, some series have reported a relative risk two to three times normal. A few investigators have suggested that there is an increased risk of carcinoma of the lung following treatment for lymphoma. The development of this tumor in six of 288 patients with lymphoma sug- gests that there may indeed be an association. Patients who have been treated for lymphoma should be observed for development of both hematologic and solid neoplasms. In particular, a patient who is a smoker should be investigated thoroughly for lung carcinoma if suspi- cious symptoms or new chest radiographic findings develop.

Sclerosing Adenosis in the Breast of a Man with Pulmonary Oat Cell Carcinoma: Report of a Case. Bigotti, G., Kasznica, J. Department of Pathology, Columbia Presbyterian Medical Center, New York, NY 10032, U.S.A. Hum. Pathol. 17: 861-863, 1986.

A case of sclerosing adenosis of the male breast is reported. This very unusual lesion was found at autopsy in a man with pulmonary oat cell carcinoma. In females, sclerosing adenosis is a well- characterized entity. In males, however, it does not normally occur because of the physiologic lack of lobular development. The possible pathomechanism of this le- sion is briefly discussed, with an em- phasis on presumed lobular stimulation by tumor-elaborated ectopic hormone.

Renal Metastases from Carcinoma of the Lung. Becker, W.E., Schellhammer, P.F. Depart- ment of Urology, Eastern Virginia Medical School, Norfolk, VA 23510, U.S.A. Br. J. Urol. 58: 494-498, 1986.

Five cases of clinically manifest solitary and bilateral renal lesions metastatic from the lung are presented. These cases are unusual in that renal metastases are usually silent lesions discovered at autopsy. Review of the autopsy data from this hospital iden- tified renal metastases in 19% of patients who died from carcinoma of the lung. This incidence parallels that of other series. A solid renal lesion which is identified in a patient with a history

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of pulmonary carcinoma should raise the suspicion of renal metastases, especially if computed tomography of the mass demonstrates relative homogeneity and minimal enhancement. More frequent use of the abdominal CT scan in staging patients with lung cancer will render metastatic carcinoma from lung to kidney a more frequent ante mortem diagnosis.

Small-Cell Lung Cancer ii Years After Ex- cision of a Cervical Lymph Node Metas- tasis of Identical Histology. Kuhn, M., Allemann, J., Cavalli, F. et al. Division de Pneumologie, Departement de Medecine Interne, CHUV, CH-1011 Lausanne, Switzerland. Schweiz. Med. Wochenschr. 116: 1264-1266, 1986.

Eleven years after surgical excision of a cervical lymph node metastasis of a small-cell carcinoma (without other treatment), lung cancer of identical his- tological character was diagnosed. Be- tween the two events there had been no suspicion of another primary tumor. The authors discuss possible explanations for this extraordinary clinical course, with special reference to the sarcoid-like reaction in the tissue surrounding the tumor and the panhypopituitarism diag- nosed nine years after excision of the lymph node metastasis.

Necropsy Evidence of Detection Bias in the Diagnosis of Lung Cancer. McFarlane, M.J., Feinstein, A.R., Wells, C.K. Department of Medicine, Yale Univer- sity School of Medicine, New Haven, CT, U.S.A. Arch. Intern. Med. 146:1695-1698 , 1986.

The correct diagnosis had not been made during life in 26% of 153 patients with lung cancer found in necropsies per- formed between 1971 and 1982. The likelihood of a correct antemortem diag- nosis showed distinctive gradients in relation to the patients' history and amount of cigarette smoking, symptomatic manifestions, and anatomic extensiveness of the cancers. However, cigarette smok- ing still exerted a diagnostic effect in patients with similar symptoms and similar degrees of anatomic spread. Furthermore, if a lesion was present, chest films were more likely to be radiologically interpreted as a cancer in smokers. The results suggest that smokers receive preferential consideration regarding the diagnosis of lung cancer. This detection bias can have adverse scientific consequences in depriving non- smokers of suitable therapy, in leading to falsely high estimates of the true magnitude of the smoking/lung cancer association, and in distracting etiologic attention from other agents that may cause lung cancer.

Estimating the Probability of Malignancy in Solitary Pulmonary Nodules. A Bayesian Approach.

Cummings, S.R., Lillington, G.A., Richard, R.J. Division of General Inter- nal Medicine, University of California, San Francisco, CA, U.S.A. Am. Rev. Respir. Dis. 134: 449-452, 1986.

Decisions about managing solitary pulmonary nodules often involve estimates of the likelihood that the nodule is malignant. We used Bayes' theorem to devise a simple scheme for estimating the likelihood that a solitary pulmonary nodule is malignant based on the diameter of the nodule, the patient's agen and history of cigarette smoking, and data on the overall prevalence of malignancy in solitary nodules. This method may improve the accuracy of estimating the likelihood of malignancy for individual patients with solitary pulmonary nodules.

Intratumoral Ethanol Injection for Malig- nant Tracheobronchial Lesions: A New Bronchofiberscopic Procedure. Fujisawa, T., Hongo, H., Yamaguchi, Y. et al. Department of Surgery, Chiba Univer- sity School of Medicine, Chiba 280, Japan. Endoscopy 18: 188-191, 1986.

We performed intratumoral ethanol in- jection via a flexible bronchofiberscope in 13 patients with malignant tracheobronchial lesions in order to evaluate its effects on airway dilatation and hemostasis. The results obtained are described below. Im- mediately after intratumoral injection of ethanol, bronchofiberscopic findings revealed that the tumor turned faintly white, there was a little regression of tumor, and a promising effect was demonstrated on patients with bleeding from tumors. The injected tumor turned necrotic within several days, and his- tological examination revealed no viable tumor cells in necrotic tissues. The his- tological anti-tumor effect of ethanol was also demonstrated in experiments with nude mice. This endoscopic treatment was very effective in polypoid tumor protrud- ing into the tracheobronchial lumen, but ineffective in the case of compressed stenosis or obstruction. In conclusion, intratumoral injection of ethanol is con- sidered to be a promising endoscopic treatment for malignant tracheobronchial lesions.

Bronchioloalveolar Carcinoma Presenting with Meningeal Carcinomatosis. Cytologic Diagnosis in Cerebrospinal Fluid. Csako, G, Chandra, P. Department of Pathology, George Washington University Hospital, Washington, DC 20037, U.S.A. Acta. Cytol. 30: 653-656, 1986.

The cytologic findings in a 35-year- old patient with bronchioloalveolar car- cinoma who initially presented with central nervous system involvement are reported. Following the cytologic diag- nosis of carcinomatous meningitis (metastatic adenocarcinoma), an open lung biopsy was performed, which confirmed the