CK-B concentrations in healthy adults (n = i00) were 0.53 + or - 0.22 ng/ml and ranged from 0.25 to 1.44 ng/ml, but they were sig- nificantly increased (> 1.5 ng/ml) in some patients with SCCL (26/42 cases, 62%), ADCL (7/36, 19%), ECCL (7/37, 19%), and large cell carcinoma of the lung (LCCL, 4/13, 31%). Serum CK-B was also enhanced in some patients with breast carcinoma and in a few cases in carcinomas of the stomach, colon and pancreas. Serum concentrations of CK-B were well correlated with those of gamma-enolase in patients with SCCL (r= 0.667, n=83, P<0.01) and LCCL (r=0.689, n=20, P<0.01), but poorly in patients with ADCL and ECCL. Since serum CK-B concentra- tions in patients with SCCL changed in pa- rallel with the clinical course during treatment, serum CK-B may also be a useful biomarker, as well as neuron-specific gam- ma-enolase, for monitoring the clinical course of patients with SCCL.

Cerebrospinal Fluid ACTH as a Marker of Central Nervous System Metastases from Small Cell Carcinoma of the Lung. Pedersen, A.G., Hamsen, M., Hummer, L., Rogowski, P. Department of Chemotherapy, The Finsen Institute, DK-2100 Copenhagen, Denmark. Cancer 56: 2456-2480, 1985.

Adrenocorticotrophic hormone (ACTH) concentrations were measured in the plasma and cerebrospinal fluid (CSF) of 107 conse- cutive patients with known or suspected central nervous system (CNS) metastases se- condary to small cell carcinoma of the lung. The combined results of computerized tomo- graphy scans, neurologic examination, and autopsy were used to determine the presence or absence of CNS metastases. On the basis of such an assessment, definitive conclu- sions were possible in 77 patients. CNS metastases were present in 52 cases and absent in 25. The median CSF ACTH level was 30 ng/ml in both groups. None of 5 pa- tients with very high CSF ACTH concentra- tions had elevated ACTH concentrations in plasma. Considering the 95th percentile of patients without CNS metastases as the upper limit of normal, 12 patients with metastases and 1 without had an elevated CSF ACTH value. Eleven patients with lep- tomeningeal carcinomatosis (MC) did not constitute a special subgroup in this re- spect. The median ratio of CSF ACTH and plasma ACTH was 1.0 in patients with CNS metastases and 0.4 in those without (P< 0.05). Ten patients with CNS metastases (i with MC) and 1 without exceeded the upper 95th percentile of the CSF/plasma (ACTH) ratio in patients without CNS meta- stases. The significance levels of these findings disappeared, however, when patients with signs of an elevated ACTH concentra-

tion in plasma were excluded. Patients

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with ectopic ACTH production into CSF do

not necessarily have ectopic ACTH produc- tion outside the CNS, despite the presence of extracerebral metastases. With the cri- teria employed in this study, an elevated level of CSF ACTH diagnosed too few patients for the authors to recommend its determina- tion as a single test in diagnosing CNS me- tastases or MC secondary to small cell car- cinoma of the lung.

Prognostic Value of Serum and Tissue CEA in Lung Cancer. Leonardo, E., Navone, R., Dogliotti, C., Oliaro, A. Universita di Torino, Instituto di Anatomia e Istologia Patologica, Catte- dra di Tecnica e Diagnostica Citopatologica, Torino, Italy. Minerva. Med. 76: 2111-211~, 1985.

Serum concentration of carcinoembryonic antigen (CEA) was determined in 53 lung cancer patients before and 1 month after surgery. Relationships between serum CEA levels after and before surgery and survi- val were demonstrated. Furthermore, histo- logical sections of the neoplastic surgical material were stained with anti human CEA antibody using an immunohistochemical method. The positivity of the neoplastic cells and of the macrophages was then analyzed and discussed.

The Role of Serum T~our Markers to Aid the Selection of Lung Cancer Patients for Sur- gery and the Assessment of Prognosis. Muller, T., Marshall, R.J., Cooper, E.H. et al. Unit for Cancer Research, Leeds Univer- sity, Leeds LS2 9NL, U.K. Eur. J. Cancer Clin. Oncol. 21: 1461-1466, 1985.

We have measured the following ten serum proteins in a sample of 290 patients pre- senting with possible lung cancer: carcino- embryonic antigen (CEA), alpha.-acid gly-

1 coprotein (AGP), C-reactive protein (CRP), ferritin (FER), prealbumin (PAB), third component of complement (C3), immunoglobin E (IgE), alpha2-pregnancy-associated gly- coprotein (PAGI, beta2microglobulin (beta2-m) and retinol binding protein (RBP). It is found that, with the exception of PAG, C3 and IgE, there are significant differences between protein concentrations in the sub- sequently diagnosed cancer and non-cancer patients. However, protein concentrations in the cancer patients who were suitable for surgery do not differ significantly from the concentrations in inoperable pa- tients. The prognostic significance of the proteins in the inoperable and operable cancer patients is also envisaged. In the operable group C3 appears to be useful, whilst AGP and RBP are prognostic indicators in the inoperable group.

Serum Copper and Zinc Levels in Lung Cancer Patients.

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Altavilla, G., Adamo, V., Alafaci, E. et al.

Universita di Messina, Istituto di Clinica Oncologica e di Ricerca sui Tumori, Messina, Italy. Minerva. Med. 76: 2117-2120, 1985.

Serum copper levels (SCL) and serum zinc levels (SZL) were measured in two groups of lung cancer patients divided according to disease extension. SCL was higher, SZL was lower and the SCL/SZL ratio was raised to a greater extent in patients extensively affected by the disease. It is confirmed that SCL, SZL and the SCL/SZL ratio play an important role in indicating the stage of lung cancer development. Plumbers are consi- stent with previous reports. Elevated risks for stomach cancer among carpenters and ma- chinists may reflect exposure to dusts, abrasives, and cutting oils.

Imune Reactivity to Thomsen-Friedenreich Antigen in Patients with Lung Cancer Detect- ed by Superoxide Assay Leukocyte Adherence Inhibition Test. Ichinose, y., Yagawa, K., Kaku, M. et al. Department of Chest Surgery, Kyushu Cancer Center, Fukuoka 815, Japan. Cancer Res. 45: 4473-4477, 1985.

The immune reactivity to partially purified Thomsen-Friedenreich antigen was investigated in patients with lung cancer. The modified method of original leukocyte adherence inhibition test, termed super- oxide assay-leukocyte adherence inhibition test, was used to detect the reactivity. The coded peripheral mononuclear cells from 34 of 50 (68%) patients with lung cancer showed a positive response to the antigen whereas in only 3 of 19 (16%) patients with benign pulmonary disease was there a reac- tion to the antigen. The same experiments were performed using the 3 m KCI extract of lung tumors as an antigen. In this case in 39 of 50 (78%) patients with lung cancer but in only 4 of 24 (17%) with benign pulmo- nary disease and in none of the breast cancer patients (0 of 17) was there a reaction to the antigen. These results strongly suggest that patients with lung cancer are sensitized to both Thomsen-Friedenreich antigen and tumor-associated antigens expressed in can- cer cells of lung tissue origin.

Cardiac Metastasis from Adenocarcinoma of the Lung. Echocardiographic-Pathologic Correlation.

weg, I.L., Mehra, S., Azueta, V., Rosner, F. Department of Medicine, Queens Hospital Center Affiliation of Long Island Jewish- Hillside Medical Center, Jamaica, NY 11432, U.S.A. Am. J. Med. 80: 108-112, 1986.

Metastatic cancer to the heart is dif- ficult to diagnose ante-mortem. This report describes a patient with adenocarcinoma of the lung who presented with cardiac manife- stations mimicking coronary artery disease.

Two-dimensional echocardiography demonstra- ted massive cardiac infiltration with tumor, correlating with subsequent autopsy findings, which were also remarkable for endocardial implants and coronary artery emboli without myocardial infarction. Use of two-dimen- sional echocardiography may detect intra- cardiac tumor at an earlier stage.

Giant Cell Carcinoma of the Lung. Clinical and Roentgenographic Manifestations. Shin, M.S., Jackson, L.K., Shelton, R.W. Jr., Greene, R.E. Department of Diagnostic Radiology, University of Alabama, Birming- ham, AL 35233, U.S.A. Chest 89: 366-369, 1986.

Giant cell carcinoma of the lung is an unusual form of pulmonary malignancy that follows an extremely aggressive clinical course. We report the clinical and roent- genographic manifestations of 14 patients with pathologically proven giant cell car- cinoma of the lung, and compare our data to other reports in the literature. Our patients often presented with or developed constitutional or nonthoracic symptoms. This neoplasm was characterized by early evidence of wide-spread metastases. However, extension of tumor to the chest wall was not as frequent in our series as has been previously described. The survival from the time of diagnosis was extremely short. Any hope of successful treatment of this neo- plasm depends on prompt, early diagnosis. PulmonMry giant cell carcinoma should be included in the differential diagnosis of large, round or oval, sharply outlined peripheral lung masses.

Possible Risk of Invasive Pulmonary Asper- gillosis With MarijuanaUse during Chemo- therpay for Small Cell Lung Cancer. sutton, s., Lum, B.L., Torti, P.M. Depart- ment of Pharmacy, Veterans Administration Medical Center, Palo Alto, CA 94304, U.S.A. Drug. Intell. Clin. Pharm. 20: 289-291, 1986.

Bacterial and fungal contaminants have been identified in marijuana samples and thus are a potential risk factor in the im- munocompromised patient using it as an antiemetic. We describe the development of an invasive pulmonary aspergillosis in a patient using illicitly obtained marijuana as an antiemetic during combination anti- tumor therapy for small cell lung cancer. Although this patient had multiple risk factors implicated in the developmmnt of invasive pulmonary aspergillosis, the in- fectious potential of inhaled marijuana must be recognized. Further study of this potential health risk is needed.

Sensory Neuronopathy and Small Cell Lung Cancer. Antineuronal Antibody tha t a l so Reacts with the Tumor.