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Clinical Features of Bronchogenic Carci- noma in Libya.

Akhtar, S.S., Haranath, K., Habbash, K.E., Salim, K., Haq, I.U. Alfateh University, Central Hospital Tripoli, Libya.

A retrospective study, first ever in Libya, was made of 124 patients seen in the Oncology Clinic with proven bronchogenic cancer. The median age at presentation was 52.2 years. The male to female ratio (14.5:1) was one of the highest in the world. Amongst males 86% were heavy smokers, 52% smoked for more than 20 years. The common- est symptoms were cough (63.7%), chest pain (37.9%) and haemoptysis (37.9%). Mean du- ration of symptoms was 4.8 months, being shortest in undifferentiated and small cell anaplastic (SCC) carcinomas.

Commonest clinicoradiological presen- tation was a mass lesion (78%). Right lung involvement was 53.2% whereas bronchosco- pically upper lobe was most frequently (48%) involved. The three major histolo- gical types accounted for 84.7% of the ca- ses, 45.7% epidermoid, 18% SCC and 21% adenocarcinoma. Commonest pressure symptoms (seen in 23 subjects) were superior vena caval (9) and Horner's (8) syndromes. Coincidental chronic bronchitis was seen in 33% patients.

Our patients presented late and only one case (0.86%) could be subjected to curative surgery.

Widespread Invasion into Pulmonary Circu- lation and Central Venous System. Mieno, T., Ishihara, T., Matsuoka, R., Kuratomi, U., Kobayashi, J., Okada, M., Aoki, S., Kira, S. Jichi Medical School, Tochigi, Japan.

Based on 148 autopsied cases with lung cancer, the invasion into pulmonary cir- culation and central venous system was analysed anatomically.

It was confirmed that invasion into pe- ricardium (42 cases, 29%) and superior vena cava or bilateral brachiocephalic veins (23 cases, 16%) were most frequent. However, simultaneous invasion into peri- cardium and superior vena cava, pericardi- um and inferior vena cava, and bilateral main pulmonary arteries were also noted in 8 cases (5%), 2 cases (1%) and 2 cases (1%) respectively.

The routes of spread of lung cancer into these mediastinal compartments were either direct invasion from the primary site of cancer, invasion from the metastatic medi- astinal lymph nodes or combination of both.

The evidence that simultaneous invasion into these intramediastinal structures by lung cancer can happen fairly frequently is not exceptional because these structu- res are located closely each other within

an unicompartment of the mediastinum, and

the opportunity to see these patients may in- crease in future because patients in far advan- ced stage may survive longer than presently

expected with introduction of the effective treatment. Therefore, it is quite necessary to pay attention even from clinical viewpoint to how far the mediastinum is involved by lung cancer.

A Computerized Dispaly of the Staging of Lung Cancer. Zeldin, R., Math, B. University of Toronto, Toronto, Canada.

Bronchogenic carcinoma is a leading cause of cancer deaths worldwide. Uniform nomenclature is necessary in describing various tumors and patterns of spread. The TNM classification (RNMC) achieves this goal but can be cumber- some and difficult to learn and recall. In or- der to teach and remember it concisely, effi- ciently and accuretely a computer program has been devised to better illustrate the details of the various tumors, characteristics of lymph node spread and possible routes of metastatic involvement.

Using computer-generated graphics and ani- mation techniques on a microcomputer the user is guided through the different tumors and staging patterns. One progresses through the stages at his own pace and may review features poorly understood repeatedly. As well the user may read the descriptions of the pictorial displays from the screen or listen as the com- puter, using speech synthesis techniques, "talks" to the user. At any time throughout the session one may request a printed version of the dis- play currently being viewed. Thus a useful summary of the TNMC is provided for permanent reference.

This method os presenting the TNMC offers the advantages of the written word, pictorial and animated display plus voice enhancement. The user is truly taught using a myriad of au- diovisual techniques that can be reviewed over and over. Only computer technology can provide this variety in presentation.

The Non-Metastatic Neuro-Muscular Disorders Associated with Carcinoma of the Lung. Gomm, S.A., Cumming, W.J.K., Barber, P.V., Thatcher, N. Manchester Lung Tumour Group, Wythenshawe Hospital, Manchester 23, U.K.

Among malignant neoplasms lung carcinoma has the highest incidence of non-metastatic neuro-muscular syndromes. (Cross & Wilkinson, Brain 88, 427, 1965). Their aetiology and pa- thogenesis remain largely unknown. They have been classified into four clinico-pathological groups: polymyopathy, "cachectic", (type I and II muscle Fibre atrophy)and "proximal" (type II and Fibre atrophy); myaesthenic syndrome: myositis (muscle necrosis) and endocrine myo- pathies (Henson & Urich, Cancer & the Nervous System, 406, 1982).

The clinical incidence of neuro-muscular

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disorder was estimated prospectively and correlated with muscle histology and with

lung tumour type in one hundred patients prior to treatment. Enzyme histochemistry was performed on fresh frozen muscle tis- sue obtained from the vastus lateralis under local anaesthetic by needle biopsy.

35 patients had small cell (SCLC) and 65 non-small cell (NSCLC) tumours. Clini- cally 33 patients were myopathic: 18 of these were "cachectic" and 15 "proximal". In the NSCLC group a significantly higher proportion were cachectic (p < 0.05) and in the SCLC group a significantly higher proportion had proximal myopathy (p < 0.05).

99 patients had abnormal muscle histology, 66 were not myopathic clinically. 74 had type II fibre atrophy, 12 had type I and II fibre atrophy, 12 had muscle necrosis, and one had type I atrophy. These histo- chemical findings are at variance with the previous clinico-pathological classifi- cation indicating that the true incidence of neuromuscular disorders in lung carci- noma is very high and cannot be assessed on clinical criteria alone.

The Determination of Hyaluronic Acid in Pleural Fluids by a Simple HPLC Procedure. Hjerpe, A. Department of Pathology II, Ka- rolinska Institute, F42, Huddinge Univer- sity Hospital, S-141 86 Huddinge, Sweden.

To enhance the diagnosis of mesotheli- oma, a simple and sensitive HPLC procedure was optimized for the study of hyaluronic acid (HA) in pleural fluids. Twenty~l of a cell free supernatant was precipitated with 4 volumes of ethanol also containing sodium acatate. Following chondroitinase digestion more than 90% of the HA could be recovered as ~-disaccharides in the subsequent HPLC analysis, the HA derived

-disaccharides showing baseline separa- tion from those chondroitin derived.

This determination was performed on a consecutive material consisting of pleural fluids from 6 patients (20 samples) with known pleural mesothelioma and from 104 patients (154 samples) where this diagno- sis has not yet been established. Among these latter patients slightly increased HA concentrations could be associated with tissue destruction, but the HA derived uronic acid only rarely exceeded 30 ug/ml here. In 4 out of the 6 patients with meso- thelioma the HA concentration was conside- rably higher, the maximum values exceeding 800 ~g/ml. No further information was ob- tained by expressing the HA content as a proportion of the total glycosaminoglycan content.

The determination may therefore be of great help to establish this diagnosis, even though not all mesotheliomas seem to

produce HA. The method is so simple that

it may well be routin®usly used together with a cytological examination of sediment. The num- ber of cases detected during the observation

period is higher than expected, which may in- dicate that mesotheliomas often are misconcie- ved.

Natural Course of Untreated Lung Cancer at Stage I ~n Elderies. _ Mizukami-, Y., Kimula 2, y., Murai 3, y. 1. Re-

spiratory division, Toyama City Hospital, Toy- ama, Japan. 2. Pathology, University of Tsukuba, Ibaraki, Japan. 3. Respiratory division, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.

Natural course of lung cancer without anti- cancer treatment as surgery, radiotherapy and chemotherapy was studied in 34 autopsied el- deries, consisted with 21 adenocarcinoma, I0 epidermoid, 2 small cell and a large cell car- cinoma. The mean age was 80(70-97 y.o). All the cases were found out at stage I and follow- ed up only with general care for infection, nu- tritional state and diseases except for cancer.

Mean survival is 39 months and survival rate on a year, 2,3,4,5 years are 77,65,53,35,24% respectively. Mean survivals in T1 and T2 ca- ses are 48 and 39 months. Mean survivals in adeno- and epidermoid carcinoma are 45 and 34 months. Tumor doubling time was measured in 25 cases and over 200 days were 16 cases (64%). The growth rate correlates with survival period significantly. 19 (56%) cases died of cancer dissemination (cancer death), and 15(44%) cases died of complications. 6 (75%) of 8 five-year- survivors died of cancer since 7(88%) of 8 ca- ses died within a year with complications.

It is concluded that the considerable long survival of the lung cancer in the elderly is obtained even without anticancer therapy. Ca- ses of adenocarcinoma, of long doubling time and small size survive long. Successful general care is the most important factor for long survive.

Correlation of CTwith Fiberoptic Bronchosc0pic Findings Concerning Intrathoracic Lymph Node Metastasis from Lung Cancer. Matsushima, Y., Chung, FM, Takakura, H., Nahai, K., Amemiya, R., Oho, K., Hayata, Y., Hwang, LM. Department of Surgery, Tokyo Medical Colle- ge, Tokyo, Japan.

The role of CT in evaluation of intratho- racic lymph node metastasis in patients with lung cancer has been reported in the literature. However, a correlation of CT-detectable lymph node (LN) with fiberoptic bronchoscopic findings mainly external compression has not yet been reported. For this respect, we studied retro- spectively 70 resected lung cancer cases.

(Material and Method) from March 1983 to December 1984, 70 resected lung cancer cases in which CT scan had been done with a 2-second scanner GE9800 with contiguous 1 cm slices were studied. In all patients bronahofibersco-

py with an Olympus B6C was also performed. The