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carcinoma are described.

Detection of Occult Cardiac Invasion by Two Dimentional Echocardiography in Patients with Bronchial Carcinoma. corris, P.A., Kertes, P.J., Jennings, K. et al. Regional Cardiotheracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, U.K. Thorax 41: 138-141, 1986.

Cardiac invasion by bronchial carcinoma may prevent successful resection but may be undetected before operation. In a retrospec- tive analysis of i00 consecutive thoracoto- mies nine patients had unsuspected cardiac invasion by tumour. A prospective study of preoperative two dimensional echocardio- graphy was therefore undertaken in patients with bronchial carcinoma who had no clinical evidence of cardiac tumour. Comparison with anatomical findings was possible in 65 patients in whom an echocardiogram of suit- able quality had been obtained. There was one false negative among 55 negative echo- cardiograms and three false positives among l0 positive echocardiograms; non-malignant pericardial disease accounted for the echo- cardiographic finding in one of the latter. The predictive value of a negative test was 98%, and the predictive value of a positive test was highest (80%) if the echo- cardiogram suggested atrial invasion.

Frequency of Distribution According to Hi- stological Types of Lung Cancer in the Tra- cheobronchial Tree. Celikoglu, S.I., Aykan, T.B., Karayel, T. et al. Pneumology Department of Internal Medicine, Medical Faculty of Istanbul Uni- versity, Istanbul, Turkey. Respiration 49: 152-156, 1986.

The incidence of the location within the bronchi related to the cell types was inve- stigated with the flexible fiberoptic bron- choscope in 355 cases of lung carcinoma. In 5 patients carcinoma was situated only in the trachea. In the other 350 cases the cell types other than adenocarcinoma were found to show different locations following their cell type. Epidermoid carcinoma was found more frequently in the two upper lo- bes (p < 0.001), while small cell carcinomas showed predilection for the main bronchus on the right side, and the upper lobe in the left (p < 0.001). No difference could be found between the upper, lower lobes and main bronchi for adenocarcinoma. It was also observed that large cell carcinomas were situated more often in the right upper lobe. The most important finding in this investi- gation was that, apart from adenocarcinomas, the other types were located mainly in the upper lobes, and much less frequently in the lower lobes, The predilection of localiza- tion of epidermoid and small cell carcino-

mas in the upper lobes suggests a possible relationship to tobacco smoke inhalation as these regions have been shown to be more affected by the smoke.

Radiographic Differences Between two Sub- types of Bronchioalveolar Carcinoma. Schraufnagel, D.E., Peloquin, A., Pare, J. A.P., Wang, N.-S. Montreal Chest Hospital Centre, Montreal, Quebec, Canada. J. Can. Assoc. Radiol. 36: 244-247, 1985.

Bronchioalveolar carcinoma has two light- microscopic, morphologic types, the alveolar type which has cuboidal cells resembling Type II pneumocytes, and the bronchiolar type in which these cells are of the tall columnar variety. To determine if these two different cellular patterns are associated with different clinical or radiologic patterns of disease, we compared the anthro- pometric, demographic and past medical histo- ry, the presenting symptoms, signs, radio- graphic changes and survival of patients with these two diseases. Clinical records, chest radiographs and pathologic specimens were reviewed by individuals blinded to the hypothesis. Of 30 patients reviewed, we found only one purely alveolar pattern, one predominantly alveolar, 13 mixed, 12 predominantly bronchiolar, and three purely bronchiolar. For analysis we combined the alveolar and the mixed groups and compared them to the purely and predominantly bron- chiolar groups. Anthropometric and histo- rical data were similar. The radiographs were different; the most striking differen- ce was the presence of air bronchograms only in the bronchiolar group (p < 0.001). Of those who had previous chest films, 80% in the alveolar-mixed group were abnormal, whereas none of those in the bronchiolar group were (p = 0.02). All the initial films in the bronchiolar group had a lesion with definable borders, whereas only two- thirds of the mixed alveolar group did (p = 0.02). Some of the radiographic changes of bronchioalveolar carcinoma depend on the histologic subtype.

Carcinoma of the Lung with Osseous Stromal Metaplasia. McLendon, R.E., Roggli, V.L., Foster, W.L. Jr., Becsey, D. Department of Pathology, Duke University Medical Center, Durham, NC 27710, U.S.A. Arch. Pathol. Lab. Med. 109: 1051-1053, 1985.

Calcification has long been a determi- nant of the radiologic distinction of a benign pulmonary mass. However, rare examp- les of calcification without ossification in pulmonary adenocarcinoma and ossification in the bronchial carcinoid have led some in- vestigators to warn against this approach. A case of pulmonary adenocarcinoma with

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stromal ossification is reported herein. The literature is reviewed for neoplasms that exhibit pulmonary ossification either by

primary or metastatic lesions. To our know- ledge, this case represents the first report of benign osseous stromal metaplasia in the primary lesion of a pulmonary adenocarcino- ma.

Synchronous Triple Malignant Tumors of the Lung. A Case Report of Bronchial Carcinoid, Small Cell Carcinoma, and Adenocarcinoma of the Right Lung. Jung-Legg, Y., McGowan, S.E., Sweeney, K.G. et al. Department of Pathology, Boston Ve- terans Administration Medical Center, Boston, MA 02130, U.S.A. Am. J. Clin. Pathol. 85: 96-101, 1986.

The authors report a case in which a highly unusual, simultaneous occurrence of a peripheral small cell carcinoma and a central bronohial carcinoid in the right upper lobe and a peripheral adenocarcinoma in the right middle lobe was observed. This is the fourth case of triple lung cancer reported in the literature. The role of com- puterized tomography in disclosing multiple lung carcinomas and the significance of the concurrence of pulmonary small cell carci- noma and bronchial carcinoid are discussed.

Synchronous and Metachronous Lung Carcinomas Related to Malignant Primary Tumours at Other sites. Ciambellotti, E., Moro, G., Lanza, E. et al. USSL, n 47, Divisione di Radioterapia, Os- pedale Civile, Biella, Italy. Minerva Med. 76: 1693-1897, 1985.

A series of 19 cases are reported in which, with the exception of one case, two primary malignant tumours developed at dif- ferent times, one of which in the lung. Some details of this occurrence are discussed in relation to similar findings in the in- ternational literature. The average inter- val between the two tumours was found to be 7.5 years. In eight cases, all male, the lung tumour arose in subjects who had alrea- dy been subjected to radical treatment for a laryngeal tumour. A lung carcinoma appear- ed in four women who had been subjected to radiation therapy following mastectomy. This sequence of events was considered a coincidence and not radioinduced in view of the fact that a total of 1061 similarly treated patients were observed over the same period. Finally, it is suggested that cer- tain histobiochemical factors induced by the lung tumour may somehow become patho- genically transformed to simulate a new pri- mary malignant tumour.

6. SURGERY

Surgery of Small Cell Lung Cancer.

~hields, T.W, Northwestern University Medi- cal School, Chicago, IL, U.S.A. Chest 89: 264S-267S), 1986.

The role of surgical resection in the management of patients with small cell lung cancer remains to be defined. Some data sug- gests the potential benefit of resection in the few patients with very limited disease

(peripheral TINoT2N 0 lesions), and there are chemotherapy reglmens with 80-85% response rates in patients with more extensive but still localized disease. Interest has been reawakened in the role of adjuvant surgical resection in selected patients by 2 approach- es: (1) in patients with peripheral T. or

1 T 2 lesions with negative mediastinal explo- ration, initial surgical resection followed by an adequate chemotherapeutic regimen and prophylactic cranial irradiation has result- ed in an 80% disease-free survival at 30 months; (2) initial chemotherapy in patients with only localized disease is followed by resection in the responders. Approximately 30% of the responders have undergone explo- ratory thoracotomy after completion of the chemotherapy. Local irradiation, as well as prophylactic cranial irradiation, generally has been used postoperatively. Early pilot studies suggest benefit of this approach in

patients found to have T 1 3N0 I disease but not in those with N~ dis~a~e.-Prospective, randomized, clinicaI trials by the Lung Cancer Study Group in North America and its counterparts in Europe are now being carried out in hopes of supplying definitive data relative to this multimodality therapy in small cell lung cancer. Unfortunately, no data are available to date.

Selection of Patients With Non-Small Cell Lung Carcinoma for Surgical Resection. Rizk, N.W. Pulmonary Division, Palo Alto Medical Clinic, Palo Alto, CA 94301, U.S.A. West. J. Med. 143: 636-642, 1985.

Cancer of the lung is rapidly increasing in incidence in both sexes and soon will overtake breast cancer as the most deadly cancer in women. Selection of patients with non-small-cell carcinoma for surgical re- section is largely based on preoperative clinical staging, using the American Joint Committee on Cancer's TNM-based group staging protocol. Determining the presence or ab- sence of mediastinal nodal metastasis is paramount and is currently best achieved by computed tomographic scanning of the chest and biopsy of enlarged nodes via mediasti- noscopy. Certain types of stage III lesions, previously excluded from surgical treatment, are now recognized as operable.

'Carcinoma Surgery' in Bronchus Carcinoid: Yes or No? Juttner, F.-M., Pinter, M., Klepp, G. et al.

Department Thoraxchirurgie, Chirurgische