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agnosis of clinically occult SVCO and should be considered in patients with up-

per chest masses, even in the absence of any physical signs of SVCO.

Superior Vena Caval Obstruction Syndrome in Small Cell Lung Cancer. Sculier, J.P., Evans, W.K., Feld, R. et al. Department of Medicine, University of Toronto, Toronto, Ont., Canada. Cancer 57: 847-851, 1986.

In a series of 643 patients with small cell lung cancer (SCLC), 55 patients (8.6%) had signs or symptoms of superior vena caval obstruction syndrome (SVCO). Rela- tively long intervals from the onset of the first symptoms of SVCO to the start of therapy were observed, and invasive diag- nostic procedures were safely performed in most patients. The pretreatment characte- ristics of patients with SVCO were not sig- nificantly different from those of patients without signs of the syndrome, and survi- val was similar in both groups. Patients with SVCO were usually treated first with induction chemotherapy, and prompt reso- lution of signs and symptoms occurred in the majority. Radiation was effective in controlling SVCO at relapse or after fai- lure of initial chemotherapy. It was con- cluded that SVCO in patients with SCLC should be treated initially with systemic chemotherapy, as for other presentations of this disease. The current data do not sup- port the commonly held view that SVCO in SCLC should be approached as an oncologic emergency.

Lung Abscess in Small Cell Carcinoma of the Lung During Chemotherapy and Cortico- steroids: An Analysis of 276 Consecutive Patients. Hansen, S.W., Aabo, K., Osterlind, K. De- partment of Oncology If, Finsen Institute, DK-2100 Copenhagen, Denmark. Eur. J. Respir. Dis. 68: 7-11, 1986.

Two hundred and seventy-six consecuti- ve patients with small cell carcinoma of the lung (SCCL) treated with combination chemotherapy and in 79 cases with 'high- dose' steroids (>40 mg of prednisone per day) were reviewed for the presence of lung abscess. This was diagnosed in 17 patients, in 4 (1.5%) at the time of their malignant diagnosis and 13 (4.9%) during chemotherapy. Five of 79 patients recei- ving 'high-dose' glucocorticoid therapy and 8 of 184 patients not receiving ste- roids developed lung abscess (no stati- stical difference, P > 0.05). 'High-dose' steroids do not facilitate the development of lung abscess. Eleven patients presen- ted with a lung abscess within a month of initiation of chemotherapy. Median sur- vival of these patients was 182 days and

not significantly different from a median

survival of 224 days (P > 0.05) observed in 31 compatible patients without lung ab- scess. Lung abscess per se in patients with SCCL should not prevent the use of inten- sive combination chemotherapy and 'high-dose' steroid therapy.

Acute Nonlymphocytic Leukemia, Preleukemia, and Solid T~,ors Following Intensive Chemo- therapy of Small Cell Carcinoma of the Lung. Pedersen-Bjergaard, J., Osterlind, K., Hansen, M. et al. Department of Hematology, The Finsen Institute, Rigshospitalet, DK- 2100 Copenhagen O, Denmark. Blood 66: 1393- 1397, 1985.

Six of 796 patients treated with inten- sive combination chemotherapy for small cell carcinoma of the lung developed overt acute nonlymphocytic leukemia (ANLL) (three pa- tients) or preleukemia with severe refrac- tory cytopenia and clonal cytogenetic ab- normalities in bone marrow cells (three pa- tients). The latent period to development of preleukemia or leukemia was less than two years in four of the six patients. The cumulative risk of preleukemia and leukemia according to a Kaplan-Meier estimate was 14.0% + or - 6.9% (mean + or - SE) four years after the start of treatment. The re- lative risk of overt ANLL was 77, since th:ree cases were obs~ed v 0.039 cases ex- pected based on the age-an~ sex-specific incidence of acute nonlymphocytic leukemia in the general Danish population. The risk of secondary solid tumors was not increased. The possible causes of the exceptionally early appearance and very high cumulative risk of leukemic complications found in the present study, as compared to previous ex- perience in other malignant diseases, is discussed, including the implications for future therapy of patients with small cell lung cancer.

Pulmonary Adenocarcinoma Metastatic to the Adrenal Gland Mimicking Normal Adrenal Cortical Epithelium on Fine Needle Aspira- tion. Mitchell, M.L., Ryan, F.P. Jr., Shermer, R.W. Department of Pathology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A. Acta Cytol. 29: 994-998, 1985.

Fine needle aspiration (FNA) of enlar- ged adrenal glands detected by computed tomography is a valuable method for extra- thoracic staging of pulmonary carcinomas. This paper presents ~he case of a middle- aged man with pulmonary adenocarcinoma me- tastatic to the adrenal glands, the FNA sample of which closely resembled normal adrenal cortical epithelium. Through review of the case and comparison with cytologic preparations from normal adrenal glands,

the aspiration cytologic features suggesting