PURPOSE: Metastatic cancer to the brain is a major problem for the patients with bronchogenic carcinoma, and most of these patients have a limited survival expectancy. To increase tumor control and/or to decrease late morbidity with possible shortening in over-all treatment period, multiple daily fraction technique for brain metastasis was performed. The author represented the results of accelerated fractionation radiotherapy in patients with brain metastases from non-small cell lung cancer. MATERIALS AND METHODS: Twenty-six patients with brain metastases from non-small cell lung cancer between 1991 and 1993 received brain radiotherapy with a total dose of 48 Gy, at 2 Gy per fraction, twice a day with a interfractional period of 6 hours, and delivered 5 days a week. The whole brain was treated to 40 Gy and boost dose escalated to 8 Gy for single metastatic lesion by reduced field. Twenty-four of the 26 patients completed the radiotherapy. Radiotherapy was interrupted in two patients suggesting progressive intracerebral disease. RESULTS: This radiotherapy regimen appears to be comparable to the conventional schema in relief from symptoms. Three of the 24 patients experienced nausea and or vomiting during the course of treatment because of acute irradiation toxicity. The author observed no excessive toxicity with escalating dose of irradiation. An increment in median survival, although not statistically significant (p>0.05), was noted with escalating doses(48 Gy) of accelerated fractionation (7 months) compared to conventional treatment(4.5 months). Median survival also increased in patients with brain solitary metastasis(9 months) compared to multiple extrathoracic sites(4 months), and in patients with good performance status(9 months versus 3.5 months), they were statistically significant(p<0.01). CONCLUSION: The increment in survival in patients with good prognostic factors such as controlled primary lesion, metastasis in brain only, and good performance status appeared encouraging. Based on these results, a multi-institutional prospective randomized trial should be initiated to compare the twice-a-day and one-a-day radiotherapy schemes on patients with brain metastasis with careful consideration for the patients' quality of life.
Brain* ; Carcinoma, Bronchogenic ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung* ; Nausea ; Neoplasm Metastasis* ; Quality of Life ; Radiotherapy ; Vomiting

The pulmonary giant cell carcinoma is classified as a variant of a large cell carcinoma and is diagnosed by the minimum component of 10% huge, pleomorphic and multinucleated giant tumor cell and emperipolesis of the neutrophils into the tumor cells. This tumor is characterized by local recurrences and early metastasis with extremely short patient survival. However, there are some reports that state that the survival time was extended by the operative resection and postoperative adjuvant chemotherapy and radiotherapy. A 46-year old male was admitted with complaint of hemoptysis for 2 months. Through chest X-ray and chest CT, a 5cm sized mass was found in the apical segment of the right upper lobe. During the preoperative evaluation, stenotic lesion in the left anterior descending coronary artery was found and treated by percutaneous transarterial coronary angioplasty. Four weeks later, right upper lobectomy was performed and the mass was proven to be a giant cell carcinoma. The patient received adjuvant chemotherapy and radiotherapy.
Angioplasty ; Carcinoma, Bronchogenic ; Carcinoma, Giant Cell* ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung ; Chemotherapy, Adjuvant ; Coronary Vessels ; Emperipolesis ; Giant Cells* ; Hemoptysis ; Humans ; Lung Neoplasms ; Male ; Middle Aged ; Neoplasm Metastasis ; Neutrophils ; Radiotherapy ; Recurrence ; Thorax ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the role of transbronchial needle aspiraion (TBNA) in the diagnosis of bronchogenic carcinoma with enlarged mediastinal and/or hilar lymph node.

METHODSPatients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported by WANG. All specimen was directly and instantly smeared for cytological examination.

RESULTSFrom June 2004 to May 2006, 77 such patients were examined: including 38 lung cancers, 35 lung benign diseases and 4 without definite diagnosis. All TBNA procedures were successfully carried out in 222/225 ( 98.7%). Positive TBNA rate was 81.6% (31/38) in patients who had been proven to suffer from bronchogenic carcinoma. The diagnosis of lung cancer was confirmed via TBNA only in 9 patients. A total of 63 lymph nodes in the 38 lung cancer patients were aspirated by TBNA with a positive rate of 65.1% (41/63). The sensitivity of TBNA was significantly correlated with pathology type, lymph node size and experience of the cytologist. Severe complications were rare except small amount of bleeding at the TBNA site (52/77, 67.5%).

CONCLUSIONTBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, yet it is not helpful in diagnosis of benign lung diseases.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; methods ; Bronchoscopy ; Carcinoma, Bronchogenic ; pathology ; Carcinoma, Non-Small-Cell Lung ; pathology ; Carcinoma, Small Cell ; pathology ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms ; pathology ; Lymph Nodes ; pathology ; Male ; Mediastinum ; Middle Aged ; Reproducibility of Results

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*

The syndrome of inappropriate ADH secretion is a disorder characterized by hyponatremia which results from water retention attributable to ADH release. The hallmark of SIADH is hyponatremia due to water retention, in the presence of urinary osmolality above plasma osmolality. The SIADH was initially described by Schwartz et al (1957). This syndrome, first recognized in patients with bronchogenic carcinoma, has now been observed in a variety of other illnesses. Recently, we encountered a 59 year-old female with small cell lung cancer, also she had SIADH. Thus, we present a case and review the literature on the subject.
Carcinoma, Bronchogenic ; Female ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Osmolar Concentration ; Plasma ; Small Cell Lung Carcinoma* ; Water

No abstract available.
Carcinoma, Bronchogenic*

PURPOSE: To evaluate the role of CT and CT features in the diagnosis of bronchogenic carcinomas not detected by plain radiography. MATERIALS AND METHODS: Eighteen patients [19 primary cancer lesions, M:F=16:2, aged 43 -75 (mean, 56.3)years] with lung cancer initially not detected by plain radiography were involved in this study. CT scanning was performed in all cases, and fibrobronchoscopy, and sputum cytology. each in 17. Lesions were divided into two groups: the central type, if on or proximal to the segmental bronchus, and the peripheral type, if distal to this. Plain radiographs were analysed for possible causes of occultness and for clinical characteristics including cell type, location, and size. We focused on the CT findings, comparing cases undetected by CT with those undetec6ted by bronchoscopy. RESULT: In the central type, the cause of occultness, as seen on plain radiographs, was small size, no secondary findings, or confusing shadow from hilar vessels. In the peripheral type, the cause was overlapping shadow due to normal structures of the chest, or combined diseases. Eight lesions were first detected by sputum cytology, 6 by bronchoscopy, and 5 by CT. Fourteen lesions were the central type (main bronchus 2, lobar bronchus 7, segmental bronchus 5), and five were peripheral. Central-type lesions were either squamous cell carcinoma (n =11), adenocarcinoma (n =1), small cell carcinoma (n =1), or large cell carcinoma (n =1). The peripheral type were either squamous cell carcinoma (n =2), adenocarcinoma (n =2), or large cell carcinoma (n =1). Size ranged from 0.2 to 4(mean, 2; central 1.7, peripheral 2.8) cm. Surgical resection was possible in 15 patients (16 cancers, including 13 at stage I). Only two were at a stage which rendered them unresectable. CT revealed 13 cancers, including all those which were peripheral. The findings were endobronchial nodule (n =4), bronchial wall thickening (n =1), perihilar mass (n =3), parenchymal mass (n =2), and subpleural mass (n =3). In six central-type cases [endobronchial mass (n =5), carcinoma in situ(n =1)], CT revealed no evidence of cancer. The mean size of these lesions was 1.1cm, and all were stage I. Bronchoscopy failed to detect five cases, including four peripheral cancers and one central. The mean size of these was 2.7 cm and all three adenocarcinomas were included in this group. In two of the five cases in which sputum cytology showed negative results, the existing condition was revealed by CT. CONCLUSION: For the detection of peripheral lung cancer, CT is better than bronchoscopy, though in cases of central lung cancer, in which CT plays a complementary role, bronchoscopy is better than complementary to bronchoscopy which is more excellent than CT in detecting central lung CT. In 68% of cases, CT revealed lung cancer which was not detected by plain radiography, and is therefore a suitable noninvasive screening method for the detection of this cancer.
Adenocarcinoma ; Bronchi ; Bronchoscopy ; Carcinoma, Bronchogenic* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis* ; Humans ; Lung ; Lung Neoplasms ; Mass Screening ; Radiography ; Sputum ; Thorax ; Tomography, X-Ray Computed

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