195

There were 37 malignant and 44 benign lesions; 72 were found in the ribs and nine m the sternum, of which five were malignant and four benign. Bemgn tomoors of the ribs outnumbered malignant ones by a

ratio of 5:4. The distinction between benign and malignant lesions is difficult clinically and radiologically unless cortical destruction and soft tissue swelling arc present. The pathological differentiation is also not possible in all cases. All the patients with benign tumours were treated by exciston with no rccurrcnces or deaths. The overall 5-year survival for primary malignant chest wall tamours was 43% and lo-year survival was 27%. These were the results of radical en bloc exwions. Based on our cxpericnces we belicvc that all tumours of the bony chest wall should bc considered potentially malignant and wide excision should be performed, not only to prowdc adequate tissue for diagnosis but also to allow the best chance of curt m malignant lesions.

A case of asynchronous triple primary malignant tumors of blad-

der, stomach and lung Harima M, Yasumoto R, Kawashlma H, Asakawa M, Kishimoto T, Mackawa M. Deparmen~ of Urology, Medical School, Osaka City Ilniversiry, Osaka Jpn J Ural 1990;81:630-3.

An asynchronous case of triple prlrnary malignant tumors of bladder, stomach and lung was reported. The patient was treated by total cystectomy and ileal condtut plasty for a bladder tumor in 1978 and subtotal gastrectomy and Billroth- plasty for a gastric cancer in 1984. In 1987, a lung cancer was found and the biopsy revealed a small cell carcinoma. Though combined chemotherapy was done, he died from the lung cancer 2 years later. Fulfilling the Warren and Gate’s criteria, this case may be said to bc an asynchronous case of triple primary cancers.

Shunt between right subclavian vein and the left heart in superior

vena cava obstruction due to lung cancer

Taki J, Bunko H, Tonami N, Hisada K. Depar~menr ofNuclear Medi- cine, School of Medicine, Kanazawa University, Kanazawa 920. Clin Nucl Med 1990;15:251-3.

A case in which there was a shunt between systemic veins and the left heart in superior vena cava syndrome due to lung cancer is reported.

Superior vena cava syndrome developed one and a half years after right upper lobectomy with combined resection of thoraclc wall. Radionu- elide vcnography from the right antecubaal vein showed immediate visuahzation of the left ventricle and aorta, before the right atrtum and right ventricle were seen. In the superior vena cava syndrome due to a malignant tumor, thisrarcpathwayas wellasusualcollaterals shouldbe considered.

Usefulness of computed tomography guided percutaneous fine needle

aspiration lung biopsy

Choi GJ, Kim TH, Lee KS, Park JK, Lee BK, Lee CK. Deparrmenr of ln~ernal Medicine, School of Medicine, Kyungpook National Unrver- my, Taegu. Tuberc Respir Dis 3989:36:328-32.

Computed tomography (CT)-guided fine needle aspiration biopsies were done in 62 patiencj with abnormal mass-like densities on routine chest films. When CT-guided necdlc aspiratron we&d no diagnostic findings in these pattents, additional histopathological examinations of specimens obtained by open thoracotomy, lymph node biopsy and/or transbronchial lung biopsy were carried out for definitive diagnosis. The overall diagnostic rate of CT-guided needle aspiration was 80.6%: higher in neoplastic discascs (83%) and lower in infecuous diseases (63%). The diagnostic rate was more satisfactory in patients with lesions in or adjacent to the mediasunum, and also in the middle lung fields. The CT-guided biopsy was complicated by 3 casts of pneumot- horax, all of which had lesions m posterior portions of right lower lobes and necessitated chest tube insertion for treatment. Nevertheless. our study reconfirms that the procedure is a relatively safe, simple and sausfactory diagnostic tool m patlcnts with mass-like lesions withm the thorax.

Sex-associated differences in presentation and survival in patients

with lung cancer

Ferguson MK, Skosey C, Hoffman PC, Golomb HM. Deparrmnr of Surgery The Universuy of Chicago, SR41 S Maryland, Chicago, IL

60637. I Clin Oncol 1990;8:1402-7. A retrospectwe study of478 men and 294 women wth primary lung

cancer was conducted to characterize sex-associated diffcrcnces in their prescntarion and survival. At the time of diagnosis, women were younger than men (mean age, 57.4 f 10.4 v 60.2 f 9.9 years, respec- tively; P = .0007). Men were more likely to be current or previous smokers(94% v 84%; P< .005),and in patients wrth a positive smoking history, cigarette consumption was greater in men (52.2 v 40.2 pack years; P = .OOQl). The proportlon of adenocarcinomas compared with squamous cancers was high in women (45% v 23%). while these cell types were equally rcprcscnted in mtn. The majority of patients in both sex groups had regionally advanced or metastatic disease at dtagnosis. Survival was rclatcd to age, stage at presentation and ccl1 type. In addition, sex was found to be an independent prognosuc factor for survival. Women with tumors of all cell types hved longer than their male counterparts (P < 0.001). and survival by stage rn patlen& with nonsmall-cell cancers was grcatcr for women than 11 was for men. These data demonstrate that important sex-associated dd”ferences exist in presentation and survival from lung cancer. Such differences should bc considered when plannmg and analyrmg clinical trials.

Anti-neuronal antibodies in paraneoplastic neurological disorders

with small-cell long carcinoma

Mall JWB, Henzcn-Logmans SC, Vecht ChJ. Deparfmenf of Neurol- ogy. Dr Daniel den Hoed Cancer Cent. P.O. Box 5201, 300R AE Romrdam. Clin Ncurol Neurosurg 1990;92:223-8.

Auto-anttbodics of the neuronal anti-nuclear antibody (anti-Ha) type were found in serum of three patients suspected of a paraneoplasttc syndrome of the central nervous system. In all three a small cell carcinoma of the lung was detected. The scra showed bright sfainmg of ncuronal nuclei sparing tbc nucleolus. In two patients the antibody was of the IgG class (titers 1: 1600 and 1:4000). In one patient only an IgM class antibody was present (titer 1: lo(X)). The presence of the am-Ha antibody strongly supporLz a diagnosis of a parancoplastlc ncurologtcal syndrome asswatcd with small cell carcinoma of the lung.

Three cases of pneumothorax due to lung cancer

Takagl 0, Akiyama H, Kubo H, Tohda Y, Yamasakt K, Nakajima S. Fourth Depar~mem of ln~ernal Medicine, Kmki Universrry School of Medicine, Osaka. Jpn J Thorac Dis 1990:28:330-S.

Spontaneous pneumothorax due to primary lung cancers are increas- ingly reported as of lung cancer incidence increased. We experienced one hmgcancercase wth pneumothorax as a primary symptom and two who dewloped pneumothorax after chcmothcrapy, among 238 cases Of

prmwy lung cancer. In the litcraturc, 76 casts of pneumothorax due to primary lung cancers arc dcscnbed. The mechanism of pneumothorax IS discussed.

Prognosis at presentation of small cell carcinoma of the lung

Allan SG, Stcwan ME, Love S, Cornblect MA, Smyth JF. Leonard RCF. ImperraiCancer Research Fund Medral O,KdO~y Unu, Unwer-

sily Deparrmm of Clinicoi Oncology, Wesrern General Ilospml,

Edmburxh El14 2XU. Ear J Cancer 1990;26:703-5. Prognostic factors in 411 patients with small ccl1 lung carcinoma

have been rctrospcctively analysul. Unwariatc analysis of continuous variables showed that prognosis was worst wrth deteriorating perform- ancc status, extensive diseasc, positive bone scan, increasing age, elcvatcd total white ccl1 count, alkalme phosphatasc, lactate dehydro- genasc, and decreased scram chlorldc and albumin. Low serum sodwm was less clearly associated wth poor survival. Cox multwwate regrcs- sion showed that performance status. disease cxtcm, age and raised lactate dehydrogcnasc and white cell count were mdepcndent prognos- lit factors. When disease cxtcnt was cxcludcd from analysis, perform- ance stxus, age, total white cell count, lowered serum chloride and raised lactate dehydrogcnase were sigmficant mdcpcndcnt prognostic variables.

Clinical and serologic markers of stage and prognosis in small cell

lung cancer. A multivariate analysis Gronowitz JS, Bergstrom R, Nou E et al. Deparrmenr of Smi.rfics, Uppsala Unwersify. Uppsala. Cancer 1990;66:722-32.