In the unusual manifestation of right upper lobe collapse confusing with mediastinal or parenchymal mass, both alteration of the pulmonary vessels and shifting pattern of the collapsed lobe to the periphery on supine positionare the key to the diagnosis of it rather than mediastinal or parenchymal mass. The mechanisms of these unusual manifestation s are obscure, however lobar torsion and gravity factor are considered to be a main process. Authors have experienced 2 cases of unusual manifestations of right upper lobe collapse due to bronchogenic carcinomaduring resent 2 years in Kyung Hee University hospital, and prsent radiologic findings.
Carcinoma, Bronchogenic ; Diagnosis ; Gravitation

We reviewed the computed tomography (CT) of 32 patients with upper lobe collapse to assess the significance of small atypically redistributed pleural effusion (ARPE) in distinguishing the bronchogenic carcinoma (BC) form tuberculosis (TB). Upper lobe collapse was caused by BC in 21 and by TB in 11 of the 32 patients. Small ARPE was Present in 14 of 21 patients with BC and two of the 11 patients with TB, Among 16 patients with small ARPE, CT showd mediastinal invasion in 11 (69%) patients and mediastinal lymphadenopathyn 6 (38%). Our results suggest that small ARPE associated with upper lobe collapse can be used a an auxiliary sign in the differential diagnosis between BC and TB.
Carcinoma, Bronchogenic* ; Diagnosis, Differential ; Humans ; Pleural Effusion* ; Tuberculosis ; Tuberculosis, Pulmonary*

To evaluate the role of sputum and bronchial washing for the diagnosis of lung carcinoma, we studied the sensitivity of both cytologic techniques using the biopsy confirmed cases from 228 patients. Among them, 123 cases were squamous cell carcinomas, 42 cases were adenocarcinomas, 48 cases were small cell carcinomas, one case was large cell carcinoma, and 14 cases were other types of carcinoma including poorly differentiated carcinomas. Three hundreds and ninety two sputa and 173 sputa were obtained in the pre- and post- bronchoscopic periods. Bronchial washing had been taken once in each patient. The overall sensitivity of the sputum cytology was 0.52 and that of the bronchial washing 0.63, while it increased to 0.83 when a combination of both techniques. Squamous cell carcinomas were diagnosed to the great extent in which sensitivities were 0.59 and 0.74, in sputum and bronchial washing, respectively. The post-bronchoscopic sputa showed higher sensitivity (0.44) than pre-bronchoscopic sputa (0.30). The sensitivity of sputa increased from 0.34 to 0.49 when three samples were examined compared to the single examination. The accuracy of cell typing was 94.0% in sputa and 93.8% in bronchial washing. Repeated sputum examination including post- bronchoscopic sputa is warranted to improve sensitivity and a complementary role of both cytologic techniques can be postulated by these data.
Adenocarcinoma ; Biopsy* ; Carcinoma, Bronchogenic* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Lung ; Sputum*

BACKGROUND: The purpose of this study was to evaluate the usefulness of the pleural fluid carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) tumor markers as complementary tools for the diagnosis of malignant pleural effusions. PATIENTS AND METHODS: The levels of pleural and serum CEA and CYFRA 21-1 were prospectively assayed in 222 patients with pleural effusions (150 benign effusions, 57 bronchogenic carcinomas and 15 metastatic carcinomas). RESULTS: The levels of pleural fluid CEA and CYFRA 21-1 in the malignant effusions were significantly higher than those in the benign effusions. With a specificity of 95%, the cut off values for the CEA and CYFRA 21-1 in pleural effusions were 5 and 89 ng/ml, respectively. The diagnostic sensitivities of the pleural fluid CEA and CYFRA 21-1 in malignant effusions were 72 and 54%, respectively, whereas using a combination of the two, the sensitivity increased to 87% (p<0.05). CONCLUSIONS : These findings suggest that a combination of the pleural fluid CEA and CYFRA 21-1 in pleural effusions can be useful in the diagnosis of malignant pleural effusions.
Carcinoembryonic Antigen ; Carcinoma, Bronchogenic ; Diagnosis ; Humans ; Keratins ; Pleural Effusion ; Pleural Effusion, Malignant* ; Prospective Studies ; Biomarkers, Tumor

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.
Aged ; Biopsy ; Bronchi ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Humans ; Lung ; Male ; Neoplasm Metastasis* ; Prostate ; Prostatic Neoplasms

PURPOSE: Transbronchial needle aspiration (TBNA) has been used for the diagnosis and staging of bronchogenic carcinoma through the flexible bronchoscope. The aim of this study was to investigate the diagnostic role of TBNA for bronchogenic carcinoma. MATERIALS AND METHODS: TBNA was performed in 34 patients with suspected bron- chogenic carcinoma. We analyzed diagnostic rate of TBNA m 28 patients who were ulti- mately diagnosed as bronchogenic carcinoma. RESULTS: In 12 of 28 patients, TBNA was performed for endobronchial lesions with a type of infiltration, nodular infiltration or compression. The diagnostic rate was 75%. Addition of TBNA to bronchial washing, brush, and biopsy increased the diagnostic rate from 58% to 80%. In 16 patients with peripheral tumor and mediastinal lymphadenopathy, TBNA was performed for mediastinal lymph nodes. The diagnostic rate was 62.5%, and was positively correlated with the size of lymph nodes. There was no significant complications related to TBNA. CONCLUSION: TBNA was a safe and effective procedure for the diagnosis of bronchogenic carcinoma in selected patients.
Biopsy ; Bronchoscopes ; Carcinoma, Bronchogenic* ; Diagnosis* ; Humans ; Lung Neoplasms ; Lymph Nodes ; Lymphatic Diseases ; Needles*

Although exophytic endobronchial lesions can readily be diagnosed by routine forceps biopsy through the fiberoptic bronchoscope, submucosal or peribronchial tumor can be difficult to diagnose. So we evaluated the diagnostic utility of transbronchial needle aspiration (TBNA) through the fiberoptic bronchoscope in patients presenting with endoscopic abnormalities suggestive of submucosal or peribronchial tumor. PATIENTS AND METHODS: Retrospective review of 120 lung cancer patients who were found to have the lesions suggestive of peribronchial and submucosal tumor during fiberoptic bronchoscopy was performed from Jan. 1994 to Dec. 2002 at Severance Hospital, Yonsei University College of Medicine. METHODS: Forcep biopsy was positive in 63 cases (52.5%) and TBNA in 91 (75.8%), which was significantly better than forcep biopsy (p=0.001). The combination of forceps biopsy and TBNA was positive in 106 cases (88.3%), which was significantly better than forceps biopsy alone (p=0.0001). The difference of TBNA yield according to cell type or bronchoscopic appearance of lesion was not significant, but it showed the relatively better result in small cell carcinoma. CONCLUSIONS: We concluded that TBNA significantly increase the yield over forcep biopsy alone in the detection of submucosal or peribronchial bronchogenic carcinoma.
Biopsy ; Bronchoscopes ; Bronchoscopy ; Carcinoma, Bronchogenic* ; Carcinoma, Small Cell ; Diagnosis* ; Humans ; Lung Neoplasms ; Needles* ; Retrospective Studies ; Surgical Instruments

The Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of neuromuscular transmission that is frequently associated with malignancy, particulary small cell carcinoma of the lung. To our knowledge, there was no report of LEMS in Korean listeratures and this might be the first case in this country. The patient is a 55 year old man with muscle weakness and fatigability of proximal lower limbs for 2 months. Bronchogenic carcinoma is confirmed radiologically and pathologically. The electrophysiological studies suppert the clinical diagnosis of LEMS with (1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, (2) significant decremental response at low rates of stimulation and (3) marked incremental response at high rates of stimulation.
Carcinoma, Bronchogenic ; Carcinoma, Small Cell ; Diagnosis ; Humans ; Lambert-Eaton Myasthenic Syndrome* ; Lower Extremity ; Lung ; Middle Aged ; Muscle Weakness

Metastatic tumors to the eye are probably the most common type of intraocular malignancies. The choroid is the most common site of involvement. Though the iris is a less common site of uveal involvement, metastases to the iris may occur and may produce a variety of clinical findings. The most common metastatic tumor to the eye is breast tumor and lung tumor is second, whereas the prompt most common metastatic tumor to the iris is lung tumor and breast tumor is second. The iris lesion may be the first presentation of the cancer and should make a search for the primary tumor. The diagnosis of metastatic tumor to the iris can be established by cytologic examination of aqueous. Local irradiation can spare the patient an enucleation and can preserve the eye for the generally few months of life that remain. Although the prognosis for vision is usually good, the prognosis for life is poor. The authors describe a 37 year old male patient having a metastasis from oat cell carcinoma of the lung to iris, which begins to respond to chemotherapy.
Adult ; Breast Neoplasms ; Carcinoma, Bronchogenic* ; Carcinoma, Small Cell ; Choroid ; Diagnosis ; Drug Therapy* ; Humans ; Iris* ; Lung ; Male ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Lung cancer-associated hypercalcemia is one of the most disabling and life-threatening paraneoplastic desorders. Humoral hypercalcemia is responsible for most lung cancer-associated hypercalcemia. Patients with hypercalcemia are usually in the advenced atage with obvious bulky tumor and carry a poor prognosis. MATERIALS AND METHODS: Total 29 patients satisfied the following criteria: histologically proven primary lung cancer, corrected calcium level> or =10.5 mg/dL, and symptons which could possibly be attributed to hypercalcemia. In this retrospective study, we evalluated the various clinical aspects of hypercalcemia, in relation to cancer stage, histologic cell type, mass size, bone metastasis, performance status, and other possible characteristics RESULTS: Total 29 lung cancer patients with hypercalcemia were studied, and most of them had squamous cell carcinoma in their histologic finding. The incidence of hypercalcemia was significantly higher between 50 and 69 years of age, and in the advancement of cancer stage. Although serum calcium level showed positive correlation with mass size, performance statusm and bone ore frequent in the patients with higher serum calcium level. There were no differences in effectiveness among therapeutic regimens. Hypercalcemia was more frequently in the later stage of disease than during the initial diagnosis of lung cancer. Most of the patients died within 1 month after development of hypercalcemia. CONCLUSION: We concluded that hypercalcemia in lung cancer is related to extremely poor prognosis, and may be one of the causes of drath and should be treated aggressively to prevent sudden deterioration or death.
Calcium ; Carcinoma, Bronchogenic* ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Hypercalcemia* ; Incidence ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies