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Should curative surgery be attempted in patients with cancer of the main stem bronchus?

Among tumors of the lung, main stem bronchial cancer offers a particularly unfavorable prognosis, probably because of its rapid extension to the segmental bronchi, trachea, and extrapulmonary structures. However, analysis of data gathered by the End Results Group indicates that survival among those patients with main stem bronchial cancer whose tumor was resected was virtually the same as that of patients with resectable lung cancer of other sites. From these data it is impossible to assess what role, if any, the resection itself played, and a randomized trial would be necessary to determine whether resection improves the probability of patient survival. On the other hand, it is not now advisable to deny resection to patients with operable main stem bronchial tumors (except oat cell tumors) on the basis of the available nonexperimental evidence alone.

Adenocarcinoma↗

Acinic cell tumor of the bronchus.

A bronchogenic tumor was removed from a 12-year-old girl. Histology showed a clear cell lesion with electron microscope features compatible with serous acinic cell origin.

Bronchial Neoplasms↗

A stratified randomized study of intradermal BCG in patients with carcinoma of the bronchus: prolongation of quality but not length of life in inoperable patients.

This paper reports the results of a stratified, randomized trial of monthly intradermal injections of Glaxo BCG in addition to conventional therapy (surgery, radiotherapy or no treatment) in a consecutive series of 75 men with confirmed bronchial carcinoma. BCG treatment did not significantly prolong survival but had consistenly more effect in prolonging the period in good general condition and in "acceptable" clinical condition. These were significantly prolonged among the BCG patients (all histopathologies) treated with a full course of radiotherapy (p = 0.01, p = 0.005) and among the 43 patients with squamous carcinoma after adjustment for treatment and general prognostic factors (ratio of observed to expected deaths (O/E) for BCG 0.65, P = 0.025). There was a tendency for BCG patients with oat cell carcinoma to survive less well than controls (O/E for BCG 1.40 not significant). Within comparable groups of patients with squamous carcinoma the delay in decline of general condition was accompanied by reduced weight loss.

Aged↗

Computerized axial tomography in the pretreatment assessment of small-cell carcinoma of the bronchus.

Computerized axial tomographic scans (CAT scans) of thorax and abdomen were used as part of the initial staging procedure of 50 consecutive patients with small-cell bronchogenic carcinoma (SCBC). The aims were to define the extent of the primary tumor and metastatic spread, and to compare the information obtained from CAT scans with conventional staging procedures. With CAT scanning, spread of the primary tumor was found to be far more extensive than originally believed when defined by conventional assessment. Of 35 patients conventionally staged as localized T1 or T2 tumors, 27 (77%) had their stage increased to extensive T3 disease. similarly, subcarinal lymph nodes were found in one patient when conventional methods were used (2%), but 16 patients (32%) were found when CAT scan was used. Unsuspected adrenal metastases were found in eight patients (16%) and retrocrural nodes in four patients (8%). Thirty-seven patients (74%) were found to have Stage III tumors when conventional staging was used; 47 patients (94%) were found to be Stage III following CAT scanning, demonstrating that, within the thorax, localized tumors are very uncommon. CAT scanning demonstrates the degree of intrathoracic spread very clearly, and has a valuable role in the initial investigation of patients with SCBC if the planned treatment includes radiotherapy.

Adrenal Gland Neoplasms↗

Carcinoma of the bronchus with unsuspected microscopic resection-line involvement.

In a series of 560 pulmonary resections for bronchial carcinoma, unsuspected microscopic tumor was present at the bronchial resection margin in 26 patients (4.5%). Adjuvant chemotherapy or radiotherapy was given in two patients. In follow-up times ranging from 1 to 72 months (mean, 22 months), 58% of patients were alive and free of recurrent disease. Twelve patients underwent periodic surveillance bronchoscopy in an attempt to identify early local recurrence. Eighty-three percent of these patients were alive and disease-free in follow-up times from 4 to 72 months (mean, 29.7 months). Only one choscopies. It was concluded that microscopic residual resection-line tumor does not preclude prolonged survival and that no benefit from surveillance bronchoscopy could be demonstrated in this small patient sample.

Bronchi↗

Nucleolar organizer regions in precancerous and cancerous lesions of the bronchus.

Using a silver staining technique, nucleolar organizer region-associated proteins (Ag-NOR) were studied in paraffin sections of five specimens of normal bronchial epithelium, eight of atypical squamous metaplasia, five of carcinoma in situ, and seven of microinvasive squamous cell carcinoma. The mean number of Ag-NOR in the nucleus were normal epithelium 1.2 +/- 0.1 (mean +/- SD), atypical squamous metaplasia (borderline lesion) 2.2 +/- 0.5, carcinoma in situ 3.8 +/- 0.6, and microinvasive squamous cell carcinoma 4.8 +/- 1.1. There was a highly significant difference between the Ag-NOR numbers in the atypical squamous metaplasia and those in the carcinoma in situ (P less than 0.01). The Ag-NOR staining is a useful technique for the differential diagnosis of difficult borderline lesions in the bronchial epithelium.

Bronchial Neoplasms↗

Microcephaly, jejunal atresia, aberrant right bronchus, ocular anomalies, and XY sex reversal.

We present a patient with microcephaly, jejunal atresia, aberrant right tracheobronchial tree, mild left blepharoptosis, and corectopia (irregular pupil), left sectoral iris stromal hypoplasia and peripheral anterior synechia, and 46,XY sex reversal. Testosterone and dihydrotestosterone (DHT) levels were within normal limits for a male infant at 3 weeks of age. Gonadectomy at age 18 months revealed immature testis tissue and no evidence of Müllerian structures. PCR amplification of the androgen receptor (AR) gene and flanking genomic regions revealed no evidence for deletion. Array-comparative genomic hybridization (array-CGH) for assessment of gene dosage in other regions of the genome was normal. This patient represents a multiple anomaly disorder similar to intestinal atresia-ocular anomalies-microcephaly syndrome (MIM#243605) but incorporating 46,XY sex reversal with testicular tissue, demonstrating a defect in the sexual differentiation pathway.

Abnormalities, Multiple↗

Cell kinetics of lamina propria fibroblasts in normal adult hamster bronchus.

Forty-nine 12-week-old male Syrian golden hamsters (Mesocricetus auratus), weighting 108 to 128 g, were injected i.p. with [3H]-thymidine (3HTdR 2 microCi/g body wt). Animals were divided into 7 weight-matched groups and were killed at 1 hour (day zero) and 1, 2, 3, 4, 7, and 14 days after thymidine injection. Lungs were fixed by vascular perfusion of 4% formalin/1% glutaraldehyde in 0.2 M cacodylate buffer at pH 7.4, cut at 2 microns, dipped in Kodak NTB3 or NTB2 nuclear emulsion, exposed for 2 weeks, developed and stained. In each airway cross-section, total epithelial and fibroblast counts and labeled cell count were estimated. A cell was considered labeled when 3 or more silver grains appeared on its nucleus. The background grain count was less than 1 grain per nucleus. Mean epithelial and fibroblast cell density in a 100 microns segment were respectively 14.8 +/- 0.1 and 6.6 +/- 0.1 cells (the second number is one standard error of the mean). One hour after labeling, their respective labeling indices (L.I.) were 0.13 +/- 0.02 and 1.24 +/- 0.1. On day 1, their L.I. doubled and then returned to the initial value. One hour after labeling, epithelial and fibroblast mean grain counts did not differ significantly. They were respectively 20.6 + 1, and 15.8 +/- 2. Because grain count intensity is closely related to DNA synthetic time, it seems plausible that epithelial and fibroblast synthetic times do not differ much. Cell turnover and cell cycle times were estimated from grain count dilution curves.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗