The clinical and radiographic findings of lung cancer have been well established many journals. Even if the radiographic findings of lung cancer show a typical pattern, the specific cell type of lung cancer sometimes needs to be determined prior to a pathological diagnosis. For example, the usual finding of a squamous cell carcinoma is similar to other cancer types such as an adenocarcinoma or a small cell carcinoma but with a lower incidence. Therefore, it should not be used to make a diagnosis of the cell type prior to a pathological diagnosis. Many unusual findings of lung cancer, so called atypical pattern have been reported, but atypical findings are widely accepted. The more important thing is not to diagnose a specific cell type of cancer but to differentiate it from other benign conditions such as tuberculosis, fungal infections or organizing pneumonia. This paper presents typical information of the cell type of lung cancer along with the atypical radiographic findings.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Incidence ; Lung Neoplasms* ; Lung* ; Pneumonia ; Radiography ; Tuberculosis

Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. Abdominal CT scan showed swelling of the pancreas with multiple masses. The patient was managed conservatively and pancreatitis subsided. This case indicates that metastasis induced acute pancreatitis can be a manifestation of lung cancer, especially in small cell carcinoma.
Carcinoma, Small Cell/secondary* ; Carcinoma, Small Cell/radiography ; Carcinoma, Small Cell/pathology ; Case Report ; Human ; Lung Neoplasms/radiography ; Lung Neoplasms/pathology* ; Male ; Middle Age ; Pancreatic Neoplasms/secondary* ; Pancreatitis/radiography ; Pancreatitis/pathology* ; Tomography, X-Ray Computed

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

BACKGROUND: The role of second-line chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) is known to be limited. Recently, ZD1839, the small molecule epidermal growth factor receptor-tyrosine kinase inhibitor, has been developed and has shown anti-tumor activity in patients with solid malignant tumors including lung cancer. We evaluated the response rate and toxicities of ZD1839 in patients with advanced NSCLC which has progressed after previous chemotherapy. PATIENTS AND METHODS: We examined 83 patients with advanced NSCLC treated with ZD1839 for more than 1 month in Korea Cancer Center Hospital during the period from January 2002 to September 2003. All the patients were enrolled in the international expanded access program (EAP) with ZD1839 by AstraZeneca. The administered dose of ZD1839 was 250 mg once daily. Chest radiography and laboratory tests were followed-up. We evaluated the response rate, median survival, and toxicity after treatment. RESULTS: Median age of the patients was 59 years (range 33-76). The most predominant cell type was adenocarcinoma and the most stage of the patients was IV. ECOG performance status was as follows; grade 0-1 in 10, grade 2 in 42, and grade 3 in 31 patients. Partial response was achieved in 12 patients (14.5%). Median overall survival was 9.2 (range 1.3-21.6+) months and median time to progression was 3.1 (range 1-21.2+) months. The most common adverse effect of ZD1839 was skin eruption which developed in 25 patients (25.8%). Significantly higher response rate and survival was found in patients with adenocarcinoma or good performance status. CONCLUSION: ZD1839 showed modest activity and tolerable toxicity in the treatment for patients with NSCLC which has progressed after previous chemotherapy.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Drug Therapy* ; Epidermal Growth Factor ; Humans ; Korea ; Lung Neoplasms ; Phosphotransferases ; Radiography ; Skin ; Small Cell Lung Carcinoma* ; Thorax

From January 1981 to December 1989, total 42 patients with atelectasis from lung cancer were treated with radiation therapy at the Department of Therapeutic Radiology in Kyung Hee University Hospital. The reexpansion of atelectasis after radiotherapy of the lung was evaluated retrospectively, utilizing treatment records and follow-up chest radiographs. Of the patients with non-small cell carcinoma of the lung, the response rate was 62% (21/34). Patient with small cell carcinoma showed a 75% (6/8) response rate. There appears to be some evidence of a relationship of total tumor dose versus response of atelectasis; radiation dose over 40 gy (1337 ret), had a favorable effect on the rate of response compared with that below 40 gy (1297 ret), 70% (21/30) and 50% (6/12), respectively (p<0.01). Total response rate (partial and complete responses) of all patients was 64% (27/42). Franction size was not contributed to the difference of response rates between small fraction (180~200 cgy) and large fraction (300 cgy), 53% (14/22) and 65% (13/20), respectively. The results of this study suggest that radiation therapy has a definite positive role in management of atelectasis caused by lung cancer, especially in inoperable non-small cell carcinoma.
Carcinoma, Small Cell ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Pulmonary Atelectasis* ; Radiation Oncology ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies

The classic presentation of small cell carcinoma is hilar or mediastinal lymph node metastases while the primary tumor remains an occult tumor. Grossly enlarged hilar and mediastinal lymph nodes can be frequently seen on the chest radiographs and CT scans. We report here on a case of small cell carcinoma that manifested as a unilateral bulky thoracic mass in a pregnant woman.
Carcinoma, Small Cell* ; Female ; Humans ; Lymph Nodes ; Mediastinum ; Neoplasm Metastasis ; Pregnant Women* ; Radiography, Thoracic ; Tomography, X-Ray Computed

PURPOSE: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. MATHOD AND MATERIALS: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinDma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years(range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range of 2 to 150 days (median 40 days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose(ED) model, ED=D.N-0.377.T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. RESULT: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic charges consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced charge between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy. No correlation was seen between incidence of radiation pneumonitis and age or sex. CONCOUSIONS: The occurrence cf radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.
Appointments and Schedules ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Drug Therapy ; Female ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Male ; Particle Accelerators ; Pneumonectomy ; Radiation Pneumonitis ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies ; Thorax

A major obstacles to evaluation of newly-developed treatment strategy for human lung cancer has been the lack of appropriate experimental animal models. We describe a new experimental model of orthotopically-developed non-small cell lung cancer in nude rat, involving inoculation of tumor cell suspension by thoracotomy. Over 40 direct implantation to the periphery of the lung has been performed to date, each requiring less than 1 hour for completion. This model has been used to perform a series of experiments to investigate whether the rat lung and surrounding structures trapped tumor cells with 2 different non-small cell lung cancer cell lines(NCI-H460 and NCI-H1299). Every animal showed development of tumor masses, which were loculated at the periphery of the lung paren- chyma and identified also by radiography. After 3 weeks of the inoculation, tumor develop ment at the mediastinal strutures were identified. The life expectancies of the victims were different between the cell lines, but were approximately 5 weeks when NCI-H460 cell line was used. This new orthotopic lung cancer model may be facilitate future studies of the new therapeutics of localized non-small cell lung cancer .
Animals* ; Carcinoma, Non-Small-Cell Lung* ; Cell Line ; Humans ; Life Expectancy ; Lung ; Lung Neoplasms ; Models, Animal* ; Models, Theoretical ; Radiography ; Rats ; Rats, Nude* ; Thoracotomy

PURPOSE: To determine the ultrasonographic findings and assess the usefulness of ultrasound (US)-guided biopsy of central lung tumors in patients with obstructive pneumonitis. MATERIALS AND METHODS: Fourteen patients with central lung tumors causing obstructive pneumonitis, as seen on chest radiographs and chest CT scans, were examined between January 1997 and January 2000. In no patient conclusive histologic diagnosis obtained by means of bronchoscopic biopsy or sputum cytology. Eleven patients were men and three were women, and their ages ranged from 45 to 83 (mean, 64) years. For all examinations, real-time, linear-array, convex US units with a 3.75- and a 5.0-MHz transducer were used. The images obtained were analyzed for evidence of consolidation or atelectasis in the lung, demonstrable tumors, and tumor size and echogenicity. For US-guided percutaneous transthoracic biopsy, 19.5G automatic biopsy devices, were employed. RESULTS: Lung consolidation due to a wedge-shaped, homogeneous, hypoechoic lesion was revealed by sonographic fluid bronchograms, air bronchograms, air alveolograms, and visualization of intraparenchymal pulmonary vessels, which showed appropriate motion with respiration. The tumor presumed to be causing obstruction was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Pleural effusion was observed in one case. The cytologic findings indicated the presence of squamous cell carcinoma (n=4), adenocarcinoma (n=4), small cell carcinoma (n=3), non-small cell carcinoma (n=2) and large cell carcinoma (n=1). The success rate was 100%, and there were no complications. CONCLUSION: In patients with central lung tumors causing obstructive pneumonitis, chest ultrasonography and US-guided biopsy are useful adjunctive diagnostic modalities and techniques.
Adenocarcinoma ; Biopsy* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Humans ; Lung* ; Male ; Pleural Effusion ; Pneumonia ; Pulmonary Atelectasis ; Radiography, Thoracic ; Respiration ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Transducers ; Ultrasonography

We report a case of small cell carcinoma of extrahepatic bile duct presenting with jaundice and hemobilia. A 59-year-old woman was admitted due to right upper quadrant pain and jaundice. An abdominal computed tomography revealed a 2 cm sized mass in the extrahepatic bile duct. Endoscopic retrograde cholangiopancreatography revealed bloody discharge coming out of the papillary orifice in endoscopic view and a dilated extrahepatic bile duct with multiple irregular filling defects in cholangiogram. A coronal T2-weighted image revealed a hyperintense mass at extrahepatic bile duct. Laparotomy was performed, and pathologic examination of resected specimen showed tumor cells having round to oval nuclei with coarsely granular chromatin and scanty cytoplasm, which were immunoreactive for synaptophysin and chromogranin A, compatible with the diagnosis of small cell carcinoma. The small cell carcinoma of bile duct, despite its rarity, should be considered in differential diagnosis of the causes for obstructive jaundice and hemobilia.
Bile Duct Neoplasms/*diagnosis/pathology/radiography ; Bile Ducts, Extrahepatic/*pathology/radiography ; Carcinoma, Small Cell/*diagnosis/pathology/radiography ; Cholangiopancreatography, Endoscopic Retrograde ; Chromogranin A/metabolism ; Female ; Hemobilia/complications/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Synaptophysin/metabolism ; Tomography, X-Ray Computed