Imaging and staging of lung cancer.
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Carcinoma, Bronchogenic↗
Biomedical subjects
H I Libshitz
Publications and source records attributed to H I Libshitz.
Massive osteolysis of the right clavicle developing after radiation therapy.
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Accidental Falls↗
Thymic lesions. Experience with computed tomography in 24 patients.
The value of computed tomography in the treatment of 24 patients with thymic lesions was analyzed. These included 21 patients with thymomas, and one each with thymic carcinoid, thymic lymphoma, and thymic cyst. Twelve patients were seen before therapy and 12 after treatment elsewhere. Computed tomography gave additional information in 14 of 24 cases and management was altered in two. The presence or absence of invasion of adjacent structures was predicted in 16 of 17 patients in whom computed tomographic-surgical correlation was available.
Adult↗
The postlobectomy chest: anatomic considerations.
The authors present a systematic review of the changes that occur in pulmonary and extrapulmonary anatomy as the result of lobar collapse or resection. Differences in the changes produced by lobectomy and lobar collapse are noted.
Humans↗
Pulmonary metastatic disease: radiologic-surgical correlation.
Radiologic-surgical correlative studies were performed for new pulmonary parenchymal nodules in 100 lungs of 84 patients with previously treated extrathoracic malignancies. Ten patients with radiographically typical bronchogenic carcinomas were excluded from analysis. Of 237 nodules resected, 173 (73%) were identified with computed tomography (CT) and 64 (27%) were not. Two hundred seven (87%) were of metastatic origin, 21 (9%) were benign, and nine (4%) were bronchogenic carcinomas. Of those nodules seen with CT and not with radiography of the chest, 84% were of metastatic origin. Between patients with carcinoma and those with sarcoma or melanoma, there was little difference in the percentage of nodules found with CT. More resected nodules were metastases in the sarcoma-melanoma group (93%) than in the carcinoma group (77%). New bronchogenic carcinomas and benign lesions were more common in the carcinoma group. Chest radiography disclosed all nodules resected in 44% of cases, whereas CT disclosed 78%. Of 65 nodules detected as solitary nodules with chest radiography, only 35 (54%) proved to be truly solitary, whereas 35 of 44 (80%) detected with CT were truly solitary.
Carcinoma, Bronchogenic↗
CT of interpectoral lymph nodes.
The presence of lymph nodes between the pectoralis major and minor muscles (Rotter's nodes) has been noted in the anatomic and surgical literature. We analyzed the appearance of the interpectoral space and nodes on chest CT scans of 25 patients without known chest wall abnormalities or causes for lymphadenopathy. In some of these cases small structures were detected in the interpectoral fat that could be either vessels or nodes. In addition we studied chest CT scans in six patients with interpectoral adenopathy due to metastases from breast cancer. The nodes were oval soft-tissue densities ranging from 1.5 X 1 cm to 3.5 X 3 cm in diameter.
Breast Neoplasms↗
Urachal carcinoma: evaluation with computed tomography.
The computed tomographic (CT) findings in 7 patients with urachal carcinoma were reviewed. Computed tomography was useful in establishing an initial diagnosis, determining the tumor extent, and visualizing tumor recurrence. The embryology, histology, and clinical course of urachal carcinoma are reviewed.
Abdominal Neoplasms↗
Patterns of mediastinal metastases in bronchogenic carcinoma.
The location and frequency of metastases to the lymph nodes were documented in a review of 200 patients with bronchogenic carcinoma who underwent pulmonary resection and total lymph node resection. No nodal metastases were found in 120 patients (60 percent). Metastases were present in only lobar or hilar nodes (or both) in 32 patients (16 percent), and 34 (17 percent) had metastases in mediastinal nodes as well as in lobar or hilar nodes. Only mediastinal nodal metastases were found in 14 patients (7 percent). Previously described lymphatic pathways can explain the presence of metastases in mediastinal nodes alone. Unexplained findings were the higher prevalence of mediastinal nodal metastases in adenocarcinoma vs squamous cell carcinoma and a much higher frequency of mediastinal metastases without lobar or hilar involvement (or both) in patients with adenocarcinoma compared to those with squamous cell carcinoma.
Adenocarcinoma↗
Primary central nervous system lymphoma: CT and pathologic correlation.
CT findings of 15 patients with histologically proven primary central nervous system (CNS) lymphoma were reviewed with pathologic correlation in order to evaluate variable CT patterns. There were a total of 32 lesions. Of the 15 patients studied, seven had acquired immunodeficiency syndrome (AIDS), all diagnosed within the past 3 years. The CT observations of eight non-AIDS patients were consistent with findings reported previously. Most of the lymphomatous lesions were either hyper- or isodense, round or oval masses with homogeneous contrast enhancement and variable surrounding edema. Pathologic examination showed tightly packed preserved lymphoma cells without necrosis. In AIDS patients, rim or ring enhancement of lymphoma, indistinguishable from brain abscess, was frequently seen. Histologic examination consistently showed extensive tumor necrosis with preservation of viable tumor cells at the periphery. A third and infrequent CT pattern was multiple infiltrative nonnodular solid enhancement with extensive edema. Pathologic correlation showed infiltrating viable tumor cells without necrosis. The rim- or ring-enhancing brain lesion seen in AIDS patients can either be an abscess or a primary lymphoma; proper tissue collection is essential for correct diagnosis and appropriate treatment.
Acquired Immunodeficiency Syndrome↗
Superior vena caval syndrome in primary mediastinal germ cell tumors.
Upon examination, nine of 45 patients (20%) with primary mediastinal germ cell tumors were found to have superior vena caval syndrome. All patients were men (average age, 27). Superior vena caval syndrome was found with all mediastinal germ cell tumor cell types except mature teratoma. Primary mediastinal germ cell tumors should be strongly considered in the diagnosis of young men with a mediastinal mass and superior vena caval syndrome.
Adolescent↗
Complications of colonic interposition.
The roentgenographic and surgical experience with 44 patients treated with colon interpositions was examined. Forty-two of these patients had carcinoma of the esophagus. Staged therapy consisted of mediastinal irradiation, colonic interposition, and total esophagectomy. The more common complications related to luminal patency and conduit integrity. A total of 29.5% developed anastomotic narrowing due to postoperative edema. Anastomotic leaks arose only at the proximal anastomosis and had an incidence rate of 31.8%. Thirty-four percent had fistulous tracts originating in the reconstructed upper gastrointestinal tract. In eighty percent of the patients with leaks or fistulae, their defects healed spontaneously or with simple drainage. Strictures were encountered in 59.1%, and there were 5 instances of colonic graft ischemia. The mortality directly related to surgery was 6.8%. Ischemia, particularly at the cervical anastomosis, is probably the most common cause of complications. Radiographic evaluation is recommended using a single contrast barium examination unless gross extravasation is expected.
Adenocarcinoma↗
Appearance of the intact lymphomatous stomach following radiotherapy and chemotherapy.
Gastric lymphoma can be treated effectively by a combination of chemotherapy and radiotherapy of the intact stomach; this often eliminates the need for gastrectomy. This article presents 21 patients with gastric lymphoma and compares the radiographic appearance of the intact stomach before and after treatment. There was a variable decrease in lymphomatous involvement of the stomach during the first several months after radiotherapy alone or in combination with chemotherapy. Gastric atrophy with diminished distensibility and constrictive changes was observed, but most remarkable was the appearance of linitis plastica.
Adult↗
Critical evaluation of the gallium-67 scan for surgical patients with lung cancer.
Seventy-five patients with lung cancer underwent a gallium scan and thoracotomy with total mediastinal nodal dissection. Evaluation of mediastinal lymph nodes by means of the gallium scan showed a sensitivity of 23 percent (3/13), a specificity of 82 percent (31/38), an accuracy of 67 percent (34/51), a positive predictive valve of 30 percent (3/10), and a negative predictive value of 76 percent (31/41) in those patients whose primary tumors demonstrated uptake of radioactive gallium. The low sensitivity was due to an inability to detect microscopic disease in mediastinal lymph nodes. The specificity was decreased by gallium-67 uptake in enlarged inflamed nodes that contained no metastases. These results do not support the use of the gallium scan in the selection of patients with lung cancer for thoracotomy.
Adenocarcinoma↗
Roentgenographic evaluation of mediastinal nodes for preoperative assessment in lung cancer.
Evaluation of mediastinal nodal metastases is a critical step in the assessment of potential surgical candidates with lung cancer. Mediastinal tomography (TOMO) and chest computerized tomography (CT) visualize the mediastinal nodes more clearly than a chest roentgenogram (CXR). A prospective study was undertaken to determine the clinical value of these three tests for mediastinal staging in 102 surgical patients with lung cancer. All patients underwent thoracotomy and mediastinal nodal dissection. The roentgenographic findings were compared with the histologic evaluation of paratracheal, tracheobronchial angle, aortic window, subcarinal, and inferior pulmonary ligament nodes. TOMO, and especially CT, correctly predicted the size and location of mediastinal nodes; however, the overall accuracies were CXR (74 percent), TOMO (74 percent), CT (61 percent). These results demonstrated that the improvement in mediastinal imaging is counteracted by the fact that enlarged nodes need not contain metastases and normal-appearing small nodes may harbor microscopic disease. Computed tomography and TOMO had little clinical impact on the assessment of mediastinal nodes in potential surgical candidates with lung cancer.
Humans↗
Stages IE and IIE non-Hodgkin's lymphomas of the stomach. Comparison of treatment modalities.
Seventy-nine patients with Stages IE and IIE non-Hodgkin's lymphomas of the stomach were treated between 1953 and 1980. The histopathologic classification was as follows: diffuse large cell, 61 (of which 23 were immunoblastic sarcomas [plasmacytoid]); diffuse well-differentiated lymphocytic, 6; diffuse mixed, 1; undifferentiated non-Burkitt's, 1; nodular, 9; and unclassifiable, 1. Thirty-five patients had Stage IE disease and 44 had Stage IIE. Treatment modalities included surgery, radiotherapy, chemotherapy, and combinations thereof. Sixty-six patients had a laparotomy for diagnosis and/or management. Of these, only 42 had a gastrectomy. The stomach was considered to be unresectable in the other 24 patients. There were 5 postoperative deaths among 31 patients who had a laparotomy or gastrectomy at our institution. The overall 5-year actuarial survival was 56%; the disease-free survival was 54%. For patients with Stage IE disease the survival was 76%, and for those with Stage IIE, 42%. Promising results were obtained in 13 patients who were treated on a multimodality program consisting of four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus bleomycin (Bleo), which was alternated with involved field radiotherapy. All 13 patients had no evidence of disease as of this report. Only one patient had a relapse (Waldeyer's ring), and he was salvaged with radiotherapy. Six of these 13 were diagnosed by endoscopic biopsy and did not have a laparotomy, 3 were found to have unresectable disease at laparotomy, and 4 had a resection. Biopsy with the flexible fiberscope and treatment with CHOP-Bleo and radiotherapy can avoid the morbidity and mortality of gastrectomy.
Adult↗
Prophylactic diazepam in prevention of contrast media-associated seizures in glioma patients undergoing cerebral computed tomography.
Five milligrams of intravenous diazepam given prior to contrast media injection statistically significantly reduced the incidence of contrast media-associated seizures from 16% to 2% in a prospective, randomized series of glioma patients. Factors related to increased risk of contrast media-associated seizures are (1) prior seizure history due to glioma and/or prior contrast media and (2) prior or concurrent brain antineoplastic therapy. Factors not related to an increased risk of contrast media-associated seizures are (1) contrast media dosage, (2) type or grade of glioma, and (3) computerized tomographic appearance of the glioma. Theories regarding the etiology of contrast media-associated seizures are discussed.
Adolescent↗
Cerebral radiation necrosis following treatment of extracranial malignancies.
Nine patients with cerebral radiation necrosis following radiation therapy for extracranial neoplasms were seen at MD Anderson Hospital between 1956 and 1982. The diagnosis was confirmed at autopsy in one case, by surgical intervention in six cases, and strongly suspected based upon CT scan findings and radiation records in two cases. The world literature is reviewed, and diagnostic criteria using the CT scan and radiation doses presented.
Aged↗
Osseous metastases of breast cancer. Clinical, biochemical, radiographic, and scintigraphic evaluation of response to therapy.
Serial bone scans and radiographs were assessed in 50 patients with breast cancer metastatic to bone treated with combination chemotherapy. In 34 patients evaluable nonosseous metastases were present in addition to bone lesions. Clinical and biochemical changes also were assessed serially, independent of skeletal disease. Pretherapy bone scans were more sensitive but less specific than radiographs for detection of osseous metastasis. Response to therapy in nonosseous metastasis correlated well with radiographic improvement of bone lesions (91%), but less well with changes in bone scans (57%). There was concordance between clinical and radiographic findings, suggesting progression of metastatic disease, in 81% of patients and between scan and clinical findings in 72% of them. Changes in carcinoembryonic antigen levels closely reflected clinical and radiographic changes. Serial bone radiographs are the most useful method of determining response to therapy in breast cancer metastatic to bone. The addition of scintigraphs and carcinoembryonic antigen measurements results in a highly sensitive and accurate method of response evaluation.
Adult↗