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Four Cases of Lung Cancer with Metastasis to the Stomach

Hidehiko Ohtsuka, Minehiko Yamada, Susumu Shimizu, Takanori Akizawa, Michiaki Narushima, Kazumasa Tanaka, Hajime Suzuki, Eisei Noguchi

Department of Respiratory Internal Medicine, Showa University, Fujigaoka Hospital

Gastric metastasis from primary lung cancer is rare(l-5%) and autopsical diag- nosis of this disorder has been established in a few reports. Clinically apparent gas- tric metastasis from lung cancer are ex- tremely rare.

We experienced a case with spitting blood and three cases with appetite-loss and epigastralgia, then gastroscopic findings showed submucosal tumor with "bull's eye sign" in our cases. Gastroscopic biopsy showed gastric metastasis from lung cancer identical to the bronchoscopic biopsy. These four cases were dead, and mean sur- vival time after symptoms appered were about 2-3 months. When gastric metastasis were found, the metastasis to multiple organs had occured already in our cases. Gastric metastasis from primary lung cancer is rare, but is seemed to occur at terminal state.

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Cytological Diagnosis and DNA Content Analysis in Lung Cancer T. Mizumoto, H. Kusagawa, T. Shimono, S.

Namikawa, M. Rusagawa (Dept. of Thorac. Surg. Mie Univ., Tsu, Japan)

Diagnostic methods were performed in 186 patients who surgically treated under a diagnosis of primary lung cancer at our department during the past 4 years. Cancer was diagnosed cytologically using sputum specimens obtained by brushing or washing via bronchoscopy in 6i' patients (36.0%) or by a combination of diagnosis and bronchoscopic biopsy or percutaneous biopsy in 91 (48.9%). The definitive diagnostic rate in all patients was 84.9%. A false-positive diagnosis was made in 2.0% of cases. To increase the definitive diagnostic rate, nuclear DNA content was measured by flowcytometry using cell materials from patients diagnosed cytologically and compared with the amount of nuclear DNA in their surgical specimens. Measurement of cell materials was possible in all cases, and the DNA ploidy pattern determined by this method agreed with the results in surgical specimens in 26 of 30 cases examined. Objective and detailed diagnosis can be expected by combining morphological diagnosis with measurement of nuclear DNA content, which reflects biological cell behavior.

Adenosquamous Carcinoma of the Lung: Clinical Characteristics and Prognosis.

K. Kunishima, M. Suyama, K. Karasawa, M. Kuwahara and Y. Ariyoshi. Aichi Cancer Center Hospital, Nagoya, Japan.

During 25 years between 1965 and 1989, 4% (32/837) of patients (pts.) with surgica- lly resected primary lung cancer had adeno- squamous carcinomas. The clinical features of these pts. were compared with thoses 431 pts. with adenocarcinoma and 320 pts. with squamous cell carcinoma.

The ratio (1.5:1) of male and female pts. with adenosquamous carcinoma was identical to that with adenocarcinoma, whereas the ratio of squamous cell carcinoma was 9:l. As for the comparison of clinical stage 25% of cases with adenosquamous carci- noma were included in stage I, whereas 58% and 48% of each adenocarcinoma and squamous cell carcinoma cases, respectively, were in stage I. Few pts. with adenosquamous carci- noma in stage I was noted. The percentage of positive cases with preoperative serum CEA level 05.0 ng/ml) were 64% in adenosquamous carcinoma, 39% in adenocarcinoma and 28% in squamous cell carcinoma. The 5-year survival rate of adenosquamous carcinoma was 18%, which was significantly poor comparing with that of adenocarcinoma (42%) and squamous cell carcinoma (44%).

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Letwan, Univ. Hospital Pellenberg Eelgium.

Evaluation of locoregional operability in lung cancer patients includes adequate histology of mediastinal lymph nodes obtained either by mediastinoscopy or endoscopic procedurca. Transbroncltial puncture during fiberoptic bronchoscopy has the disadvantage of rather low yield and the danger of false positive results through contamination by bronchial elements. We used a 22 mm long 17 Gauge needle for transbmnchial subcarinal biopsy through a rigid bronchoscope. In the years 1989-1990, eighty-three patients, selected by the presence of subcminal mediastinal nodes on CT- scan, were examined. Adequate specimens were obtained in 69 patients (83%), of which 54 (65%) were of histological quality, and 15 (18%) had cytology of definite lymph node origin (i.e. preponderance of lymphoid elements and absence of bronchial cells). Fourty-two of these 69 specimens showed malignancy, and 27 did not. All patients with negative puncture and operated on had subcarinal nodes free of tumour. The procedure was more likely to be positive in non-squamous turnout’s (P 0.004). ‘B-T4 turnouts (P 0.03), and patients with blunted carina or subcarinal bulging (P 0.004). Complication were rare and mild minor bleeding in two, fever with negative blocd cultures in one, and small pneumothorax in two patients requiring no treatment. We conclude that in lung cancer patients, selected by CT scan, transcarinal biopsy through the rigid bronchoscope is a safe and reliable alternative to more invasive surgical mediastinal staging.