Lung cancer heterogeneity: Implications for clinical practice

Lung cancer heterogeneity: Implications for clinical practice

77 improved in almost all cases and the pts survived 91 days (mean). 3 pts survived over 6 months. These results show that malignant pericardial effu...

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improved in almost all cases and the pts survived 91 days (mean). 3 pts survived over 6 months. These results show that malignant pericardial effusion is controllable for their lives by temporary tube drainage. Subtype of Lung Adenocarcinoma. Prognosis and Radiographic Findings. Takaoka, K., Miyamoto, H., Ito, M., Araya, Y., Isobe, H., Dosaka, ~,, Inoue, S., Kawakami, Y. First Department of Medicine, Hokkaido University, Sapporo, Japan. Fifty four cases of adenocarcinoma of the lung were classified into six histologic features considering the cytologic subtypes of the tumor (based on origin of cells respectively), to examine the correlation between the subtypes, prognosis of patients and radiographic findings. We subtyped them as follows: (i) Bronchial surface epithelial cell type with no or scanty mucus (Non-goblet type), (2) Bronchial surface epithelial cell type with abundant mucus (Goblet type), (3) Bronchial gland cell type (Gland type), (4) Non-ciliated bronchiolar cell type (Clara type). Mixed cell type and type II alveolar epithelial cell type were not subjected to this study. Gland type which tends to metastasize to the lymph nodes and some of Clara type revealed a poor prognosis against non-goblet type or goblet type. Chest x-ray read as follows: Non-goblet type showed a roundish and dense shadow, contacting pleura. Goblet type showed a small and faint shadow with ill-defined margin. Gland type showed a dense and well-marginated shadow, occasionally accompanied by spicular formation, and in some cases showed a large mass of shadow. Clara type showed a slightly dense shadow with irregular shape and ill-defined margin, sometimes with indentation or spicular formation, and in some cases showed a large shadow. The histological features considering cytologic subtypes might be useful to estimate the prognosis of lung adenocar~ cinoma patients. Chest x-ray of each subtype seemed to present findings in proportion to the different subtype.

Lung Cancer Heterogeneity: Implications for Clinical Practice. Roggli, V.L., Vollmer, R.T., Greenberg, S.D., McGavran, M.H., Spjut, H.S., Yesner, R. Departments of Pathology, Baylor College of Medicine, Houston, TX., Duke University Medical Center, Durham, NC, and Yale University School of Medicine, New Haven, CT, U.S.A. The heterogeneity of carcinoma of the lung is well-recognized, but no previous attempts to quantitate this heterogeneity

in a blinded and randomized fashion have been reported. We collected i00 consecutive cases of lung carcinoma (including 35 autopsies and 65 surgical specimens) at Baylor College of Medicine, and examined the entire tumor or i0 blocks. Up ~o l0 additional blocks were submitted from metastases for the autopsied cases. The i001 slides were then randomized and examined by five pathologists in a blinded fashion; each slide was classified according to the histologic patterns present using the 1977 revised W.H.O. classification. W~en slides were classified according to the diagnosis of the majority (at least 3/5) of the panelists, only 34% of the cases were homogeneous. Another 21% showed minor (subtype) heterogeneity (e.g., mixtures of acinar and papillary adenocarcinoma). Forty-five percent of cases showed major heterogeneity; i.e., at least one slide from the case showed a different major histologic type than the remainder. Seven small cell carcinomas were homogeneous or showed only minor heterogeneity (i.e., mixtures of oat and intermediate patterns), while 8 cases showed mixtures of small cell and nonsmall cell patterns. The possible diagnostic and therapeutic implications of these findings are apparent, particularly as they apply to examination of small samples of tumor such as are obtained by endobronchial biopsy or fine needle aspiration. Twenty-six biopsies (including 16 bronchial) were positive for tumor preoperatively in our i00 cases, but the histologic diagnosis based on biopsy material was in agreement with the findings at surgical resection or at autopsy in only 12 (46%). The effect of heterogeneity on treatment outcome and survival is unknown but currently under investigation. Neurologic, Neuropsychologic and Head CY abnormalities in 2-10 Year Survivors of Small Cell Lung Cancer (SCLC). Johnson, B., Becker, B., Goff, W., Petronas, N., Krabel, M., McKenna, G., Ihde, D. NCI-Navy Med. and Rad. Oncol. Brs., Natl. Cancer Inst. and Naval Hosp., Bethesda, MD 20814, U.S.A. In order to assess neurologic function in long-term survivors of SCLC, 20 of our patients who were alive and free of cancer 2.4 - 10.6 years (median 6.2) from the start of therapy were evaluated. All received a neurologic history and exam, mental status exam, neuropsychologic testing, and review of serial head CT scans. Two patients were treated with therapeutic, 15 with prophylactic (PCl), and 3 without cranial irradiation. All patients but one are ambulatory and none are institutionalized. Eleven of 20 have returned to pre-therapy life styles. Sixteen (80%) had neurologic complaints, 14 (70%) had abnormal neurologic examinations, 12(60%) had abnormal mental status examinations, 13 (65%) had abnormal neurop~ychologic tests, and 15 (75%) had abnormal head CT scans. Compared to patients given low dose