Malignancies in the lung and pleura mimicking benign processes
1
Abstracts/Lung Cancer 13 (1995) N-104 “WL~,“” of Thomcrc .%gely “nghnw rind ,riv,,m 1 H”\p,ml. 7.5 fiianc,r s1reer. Rosmn. dL.1 02//s Cancer RCS 1995.55 5 1-6 In order 10 constr~c, a ,,,ui,,\a,,atc model lo, prcd,c,,ng earl> ,CCU~~C”CCand cancer dath for pat,cnts i*ltrh r,agc f non-small cell lung cancer, 271 consecuwc pat~ntr (mem age. 63 f X yzarr, uho were diagnosed. trcatcd. and lollowcd at one ~nrututmn wx studred All patmts were clmcal stage I ulth hcnd and chcsuabdommal computed tomograms and radxxwchdc boric scans rrahout c\ rdcncc ol m~tastauc discar Pathological n~lcr~al after rc~ctmn uas re\wred to vcri@ hrstological rtagmg Follou-up docunwntcd the trmc and location of any rcc~rrcnc~. uas a mcdran 56 months I” duratmn. and was complclc m all arcs Data rccordcd rncludcd a8c. SC\. smokmg h,%ry. p;cscntmg ~mprams. pathological dcsn,pnon. and oncoprorc~n s,a,n,n~ for crbB-2 (HER-Z/ncu). ~51. and KId7 ,,rol,fcratmn pmtcm lmmunoh,stahcm~rtry of oncogcnc cxprcssmn &as pcrfcxn~cd an two separate archlvcd paratlin ,umor blocks lor each pa,,cnt. \\lth normal lung as control All anal,scs wcrc bhndcd and mcludcd Kaplan-Mcsr sutv~~al cstrmates with Co* proportmnal haards rcgrcssmn modchng Data. Including ~maunohrstochcm~stn. aerc complete lor all 271 pmcnls Actual 5.ycarsunwal uas 63%and acluarml IO-lea, suniral WAS58% ~I~III~C~III U~WXI~~C~~XIO~S(P a omrc~ri~ ~CCUI~~X~ andcarcrdcath wrc malt sex. the prcscncc ofnmptona. chest pan. type of cough. hemopt)sls. t~rwr we > 1 cnl dramctcr (T,). poor dUTcrcntmtmn. vascular imasron. crbB-2 cxprcwon. pS3 exprcsswn. and a hrghcr Kl-67 prohfcratmn mdc\ (>5”/.) An add,,,\e oncogene CXP~CSIO~ cuwc dcrnonstnted a 5-,a, IU~ 1val0r72% r0, I36 parents w,;hout p53 or crbB-2. S8”& for .I08 patlcnls who eXp,C& ather oncog~n~. and 38%for27 whoCsprCrsedboth(P< 0.001) Multt\anate mdcpcndent prcdlctors of early rcc~rrcnc~ and cancer death (P < 0 05) wcrc symptomat,c prcrntatmn. crbB-2 cxprcssmn. T, sire. \arular rnvas,o”. ~57 e\prcss,an. and poor ddTcrcntrat,on Ther da,a allo\red the creation of a multivariate model which quantltied tbc risk of recwrenoe and cancer death for patients with stage I non-small cell lung cancer This ma*,, based on complete data f m m 271 patients. represznts the largest analysis of its type in the literature and can form the basis for multi- institutional randomwed adiuvant trials for ‘high risk’ parents. Expmssion of Lewis-r&ted antigen and prognosis in stage I non-rmdl cell lung cancer 0gaw-d I, Sam A. lmue l-& K&de S. First Deporrmenr ofSwge!y School ofMedinne. Tokm Unrwrsiily. Bohseidoi. lsehoro. Konogmw 259-11 Ann Thorac surg 1995:59-412-5. lmmunohistochemical expression of Lewis(y). sialyl Lewsfxl. and sialyl Lms’ were examined in relation to blood vessel invasion and pmgnos~s in 133 patients with stage I non-small all lung cancer who hada curative resection f m m 198010 1991. Expression ofsialyl Lewis(x) in adenocarcinomas was higher than m squamous cell and large cell carcinomas. and Lewis(y) immunoreactivity was the highest among the th= antigens. The frequency ofblmd vessel mvasion was stgnilicantly hrgher m tumors with expression of Lewis@) or smlyl Lews antagen (sialyl Lewis(x) or sialyl Lewir’). however. Lms@) expression was even more sign&ant. The postoperat,ve survival was signilicantly shorter when tumors expressed both the Lewiz4y) and slalyl Laws antigen However, the survival of patients with either Lewis(y) or sialyl Lewis antigen expression was similar to that of patients whose tunwrs did m t express either the Lzws&) or sialyl Lewis antigens These results suggest that Lewis&) and sialyl Lewis antigen may be of prognostic ~aluc br metaslatic paential but have different functional roles in tumor cells Mdiindcs in the lung and pkura mimicking benign processes Cob TV Dewrrment ofPolho/orrv Maw ClintcSconsd~le. Scot&dole. AZ 85259 S&n Dia& Pathol i99Xi2:30-44 As pathologists. we are most concerned about wercalbng reactive changes in the lung as carcinoma and the fact that malignant prwxsses may be misinterpreted 8s knign processes in the lung IS less well rewgnized. This review wvem five such lesmns Welldifferentiated adenocarcinomas. especially bronchioloalvcolar carcinomas, are frequently undcrc8lk-d. particularly in small biopsy and cytology specimens. In swh cases. one must pay particular attention to the uniformity and monotony of the epithelium even tbougb it may be extremely well differentiated Spindk cell carcinomas may have neaosis end cavitatmn intersbtml growth and a rcac~lve tibrcblastic react on and thus be mistaken as organizing itiammatory processes. Careful attention to the atypical cytological features. prominent vascular invasion, and getting immunohistochcmical suppons helps in recognizing them. Lymph&d lesions of the lung present a number of prcbkmssmall lympkaytic IympbornasandHcd&in*sdiseaseareoften misinterpreted as inflammatory processa. lntra~ lymphomatosis in the lung may be misinterpreted as an interstitial pneumonia if one does not appreciate the atypical lymphoid cells with n the capillaries The desmoplastic variant of sarcomatous mesothclioma may be extremely diffcult to diagmx, bxause large pxticms of the tumor are composed of blandappearing fibrous tissue. A case of dcsmoplastic mesothelioma presenting predominantly as a nxdiastinal mass is discussed, and problems in differentral diagnosis are outlined. Angiosarcamas are rare tumors. but an appreciable percentage of them presentaspulmonary meurnasa which mayk interpre+edaspulmonary hemorrhage or organizing infarction. The clinical and radiographic pattern, uwally mimicking mete static dircase. and the fact that atypical spindlecellsacludesmallpllmonaryarlcricswithsunoundingalumlar hemorrhage are clues to the recognition of these lesions. Evaluation of MRl imaging using Helmholb coil for the hilus and tbe mediwtinum of the lung Matsui M, Matsumoto T , Fujita T . ltoh K, Nakaki K. Kuramltsu T et al Deporlmenl of Radiology, Yamoguchl Unrv. School ojiliedrcrne, Yamoguchr 753. Jpn J Clin Radio1 1995;40: I-8. Weevaluated High-Resolution MRJ images hy wing Hclmholtz cod compared with conventional MRJ images for the hilus and the media&urn of the lung Thetidy grcupwnssixvohmteersand Lwenty- seven patients (I 5 lung cancer, I I esaphagcal cancer and I medianinal tumor). MR imaging was perfomwd with a superwnductmg image, operating at l.ST, Our resull mdicates that High-Resolution MRI is significantly superior to conventional MRI for visibility of normal anatomic structures. lymph node enlargement and tumors. Rgh- Rmlution MRI maybe us&id fortheevaluation oftheertent ofdisease which is equivccal on other exammations circulating interleukin 6 concentrations in patients with lung e.neer Yamashrta J-I, Shimkusa T , Fujino N. Kiyama T. Kmuwak~ E. Ogawa M Deparlmenr of Surgery II, Fukuoka Unrversrry Medwzal School. Nonakumo 7-45-1. Johnon, Fukuoko B/J-O1 Oncol Rep 1995.2:215- 9 It has been suggested that a proponron of patrents wrth cancer have an ongmng acute phase response indicated by a raised C-rcact~ve praein (CRP) To examme whether an aate phaeprotcin response IL aswclated with circulating interleukm-6 (IL-61 wnczntrations ,n patients wth lung cancer, we measured serum levels of CRP and interieukin (IL)-5 in 176 patrents with lung cancer and 48 parents with other pulmonary dwases (28 d,Ifuse pulmonary mliltrates, I5 bemgn lung tumors. and 5 broncbal asthmas) Serum CRP was &tmable ( 2.5 mg/liter) in 57 4% of patients with lung cancer. 78.6%of patients wrth d&rsz pulmonary infiltrates. 46 1% of patients mth benign lung tumors. and 40 0% of parents with bmnchlalasthma Serum ILd wasdeteaablem all pabents by a hrghly sensmve enzyme-mununaassay. the concentratmn ranging from0 126to35.llSpglmI. AlthoughUlerewarnos~gn~f~tdiU~rcncc in serum ILd levels among the histologrc types of lung can~cr. the IL- 6 concentratmn was signifunlly hrgher in patients wth advanced cancers than m those with early ones Correlation anal~scs shoucd that there was no significant relationshap between the CRP and IL-6 mncenlrahons in the 176 patients wth lung cancer (r = 0 212. P = 0 1243). whde a highly srgmficant corrclalux~ between both levels was observed mtk28patwus w~thditTwpulmonary mtiltrates(r =O 783. P = 0 ooO5). These results indrcate that the scmrn level m pat~cntr wth lung cancer is closely assaaatcd wh the draw stage. but that a raxcd CRP c~“cc”tra,mn occurs mdcpcndcntly of crrculatlng IL-6 co”cen,ra,,o”s ,n pauents wnh lung cancer Multiple brushings with immediate Riu’s stain via flexible Sbreoptic bronchoscopy without tluomsdopic guidance in the diagnosis of peripheral pulmonary tumours Lee C-H, Wan8 C-H. Lm M-C, Tsao TCY. Lan R-S, Tsai Y-H et al Department OJ Thorocrc Medrcme, Chang Gung Memorial Hospad, 199 Tun-Hwa Norlh Rood, T&e,. Thorax 199550: 18-21. Bockgmund - Accurate dl;g”osas of peripheral pulmonary Iesslons
Transcript of Malignancies in the lung and pleura mimicking benign processes
Abstracts/Lung Cancer 13 (1995) N-104
“WL~,“” of Thomcrc .%gely “nghnw rind ,riv,,m 1 H”\p,ml. 7.5 fiianc,r s1reer. Rosmn. dL.1 02//s Cancer RCS 1995.55 5 1-6
In order 10 constr~c, a ,,,ui,,\a,,atc model lo, prcd,c,,ng earl> ,CCU~~C”CC and cancer dath for pat,cnts i*ltrh r,agc f non-small cell lung cancer, 271 consecuwc pat~ntr (mem age. 63 f X yzarr, uho were diagnosed. trcatcd. and lollowcd at one ~nrututmn wx studred All patmts were clmcal stage I ulth hcnd and chcsuabdommal computed tomograms and radxxwchdc boric scans rrahout c\ rdcncc ol m~tastauc discar Pathological n~lcr~al after rc~ctmn uas re\wred to vcri@ hrstological rtagmg Follou-up docunwntcd the trmc and location of any rcc~rrcnc~. uas a mcdran 56 months I” duratmn. and was complclc m all arcs Data rccordcd rncludcd a8c. SC\. smokmg h,%ry. p;cscntmg ~mprams. pathological dcsn,pnon. and oncoprorc~n s,a,n,n~ for crbB-2 (HER-Z/ncu). ~51. and KId7 ,,rol,fcratmn pmtcm lmmunoh,stahcm~rtry of oncogcnc cxprcssmn &as pcrfcxn~cd an two separate archlvcd paratlin ,umor blocks lor each pa,,cnt. \\lth normal lung as control All anal,scs wcrc bhndcd and mcludcd Kaplan-Mcsr sutv~~al cstrmates with Co* proportmnal haards rcgrcssmn modchng Data. Including ~maunohrstochcm~stn. aerc complete lor all 271 pmcnls Actual 5.ycarsunwal uas 63%and acluarml IO-lea, suniral WAS 58% ~I~III~C~III U~WXI~~C~~XIO~S(P a omrc~ri~ ~CCUI~~X~ andcarcrdcath wrc malt sex. the prcscncc ofnmptona. chest pan. type of cough. hemopt)sls. t~rwr we > 1 cnl dramctcr (T,). poor dUTcrcntmtmn. vascular imasron. crbB-2 cxprcwon. pS3 exprcsswn. and a hrghcr Kl-67 prohfcratmn mdc\ (>5”/.) An add,,,\e oncogene CXP~CSIO~ cuwc dcrnonstnted a 5-,a, IU~ 1val0r72% r0, I36 parents w,;hout p53 or crbB-2. S8”& for .I08 patlcnls who eXp,C& ather oncog~n~. and 38%for27 whoCsprCrsedboth(P< 0.001) Multt\anate mdcpcndent prcdlctors of early rcc~rrcnc~ and cancer death (P < 0 05) wcrc symptomat,c prcrntatmn. crbB-2 cxprcssmn. T , sire. \arular rnvas,o”. ~57 e\prcss,an. and poor ddTcrcntrat,on Ther da,a allo\red the creation of a multivariate model which quantltied tbc risk of recwrenoe and cancer death for patients with stage I non-small cell lung cancer This ma*,, based on complete data fmm 271 patients. represznts the largest analysis of its type in the literature and can form the basis for multi- institutional randomwed adiuvant trials for ‘high risk’ parents.
Expmssion of Lewis-r&ted antigen and prognosis in stage I non-rmdl cell lung cancer 0gaw-d I, Sam A. lmue l-& K&de S. First Deporrmenr ofSwge!y School
ofMedinne. Tokm Unrwrsiily. Bohseidoi. lsehoro. Konogmw 259-11
Ann Thorac surg 1995:59-412-5. lmmunohistochemical expression of Lewis(y). sialyl Lewsfxl. and
sialyl Lms’ were examined in relation to blood vessel invasion and pmgnos~s in 133 patients with stage I non-small all lung cancer who hada curative resection fmm 198010 1991. Expression ofsialyl Lewis(x) in adenocarcinomas was higher than m squamous cell and large cell carcinomas. and Lewis(y) immunoreactivity was the highest among the th= antigens. The frequency ofblmd vessel mvasion was stgnilicantly hrgher m tumors with expression of Lewis@) or smlyl Lews antagen (sialyl Lewis(x) or sialyl Lewir’). however. Lms@) expression was even more sign&ant. The postoperat,ve survival was signilicantly shorter when tumors expressed both the Lewiz4y) and slalyl Laws antigen However, the survival of patients with either Lewis(y) or sialyl Lewis antigen expression was similar to that of patients whose tunwrs did mt express either the Lzws&) or sialyl Lewis antigens These results suggest that Lewis&) and sialyl Lewis antigen may be of prognostic ~aluc br metaslatic paential but have different functional roles in tumor cells
Mdiindcs in the lung and pkura mimicking benign processes Cob TV Dewrrment ofPolho/orrv Maw ClintcSconsd~le. Scot&dole.
AZ 85259 S&n Dia& Pathol i99Xi2:30-44 As pathologists. we are most concerned about wercalbng reactive
changes in the lung as carcinoma and the fact that malignant prwxsses may be misinterpreted 8s knign processes in the lung IS less well rewgnized. This review wvem five such lesmns Welldifferentiated adenocarcinomas. especially bronchioloalvcolar carcinomas, are frequently undcrc8lk-d. particularly in small biopsy and cytology specimens. In swh cases. one must pay particular attention to the uniformity and monotony of the epithelium even tbougb it may be extremely well differentiated Spindk cell carcinomas may have neaosis end cavitatmn intersbtml growth and a rcac~lve tibrcblastic react on and thus be mistaken as organizing itiammatory processes. Careful
attention to the atypical cytological features. prominent vascular invasion, and getting immunohistochcmical suppons helps in recognizing them. Lymph&d lesions of the lung present a number of prcbkmssmall lympkaytic IympbornasandHcd&in*sdiseaseareoften misinterpreted as inflammatory processa. lntra~ lymphomatosis in the lung may be misinterpreted as an interstitial pneumonia if one does not appreciate the atypical lymphoid cells with n the capillaries The desmoplastic variant of sarcomatous mesothclioma may be extremely diffcult to diagmx, bxause large pxticms of the tumor are composed of blandappearing fibrous tissue. A case of dcsmoplastic mesothelioma presenting predominantly as a nxdiastinal mass is discussed, and problems in differentral diagnosis are outlined. Angiosarcamas are rare tumors. but an appreciable percentage of them presentaspulmonary meurnasa which mayk interpre+edaspulmonary hemorrhage or organizing infarction. The clinical and radiographic pattern, uwally mimicking mete static dircase. and the fact that atypical spindlecellsacludesmallpllmonaryarlcricswithsunoundingalumlar hemorrhage are clues to the recognition of these lesions.
Evaluation of MRl imaging using Helmholb coil for the hilus and tbe mediwtinum of the lung Matsui M, Matsumoto T , Fujita T . ltoh K, Nakaki K. Kuramltsu T et al Deporlmenl of Radiology, Yamoguchl Unrv. School ojiliedrcrne,
Yamoguchr 753. Jpn J Clin Radio1 1995;40: I-8. Weevaluated High-Resolution MRJ images hy wing Hclmholtz cod
compared with conventional MRJ images for the hilus and the media&urn of the lung Thetidy grcupwnssixvohmteersand Lwenty- seven patients (I 5 lung cancer, I I esaphagcal cancer and I medianinal tumor). MR imaging was perfomwd with a superwnductmg image, operating at l.ST, Our resull mdicates that High-Resolution MRI is significantly superior to conventional MRI for visibility of normal anatomic structures. lymph node enlargement and tumors. Rgh- Rmlution MRI maybe us&id fortheevaluation oftheertent ofdisease which is equivccal on other exammations
circulating interleukin 6 concentrations in patients with lung e.neer Yamashrta J-I, Shimkusa T , Fujino N. Kiyama T . Kmuwak~ E. Ogawa M Deparlmenr of Surgery II, Fukuoka Unrversrry Medwzal School.
Nonakumo 7-45-1. Johnon, Fukuoko B/J-O1 Oncol Rep 1995.2:215- 9
It has been suggested that a proponron of patrents wrth cancer have an ongmng acute phase response indicated by a raised C-rcact~ve praein (CRP) To examme whether an aate phaeprotcin response IL aswclated with circulating interleukm-6 (IL-61 wnczntrations ,n patients wth lung cancer, we measured serum levels of CRP and interieukin (IL)-5 in 176 patrents with lung cancer and 48 parents with other pulmonary dwases (28 d,Ifuse pulmonary mliltrates, I5 bemgn lung tumors. and 5 broncbal asthmas) Serum CRP was &tmable ( 2.5 mg/liter) in 57 4% of patients with lung cancer. 78.6%of patients wrth d&rsz pulmonary infiltrates. 46 1% of patients mth benign lung tumors. and 40 0% of parents with bmnchlalasthma Serum ILd wasdeteaablem all pabents by a hrghly sensmve enzyme-mununaassay. the concentratmn ranging from0 126to35.llSpglmI. AlthoughUlerewarnos~gn~f~tdiU~rcncc in serum ILd levels among the histologrc types of lung can~cr. the IL- 6 concentratmn was signifunlly hrgher in patients wth advanced cancers than m those with early ones Correlation anal~scs shoucd that there was no significant relationshap between the CRP and IL-6 mncenlrahons in the 176 patients wth lung cancer (r = 0 212. P = 0 1243). whde a highly srgmficant corrclalux~ between both levels was observed mtk28patwus w~thditTwpulmonary mtiltrates(r =O 783. P = 0 ooO5). These results indrcate that the scmrn level m pat~cntr wth lung cancer is closely assaaatcd wh the draw stage. but that a raxcd CRP c~“cc”tra,mn occurs mdcpcndcntly of crrculatlng IL-6 co”cen,ra,,o”s ,n pauents wnh lung cancer
Multiple brushings with immediate Riu’s stain via flexible
Sbreoptic bronchoscopy without tluomsdopic guidance in the diagnosis of peripheral pulmonary tumours Lee C-H, Wan8 C-H. Lm M-C, Tsao TCY. Lan R-S, Tsai Y-H et al Department OJ Thorocrc Medrcme, Chang Gung Memorial Hospad,
199 Tun-Hwa Norlh Rood, T&e,. Thorax 199550: 18-21. Bockgmund - Accurate dl;g”osas of peripheral pulmonary Iesslons
