Abstracts/Lung Cancer 14 (1996) 149-179 163

six cases. Metastases were presumed because of an increase in the size of axillary lymph nodes compared with prior studies in six patients and enlarged axillary lymph nodes associated with biopsy-proven ipsilateral supraclavicular lymph node metastasis in tive patients. Results. Four of 10 right-sided lung cancers had ipsilateral and six had contralateral axillary lymph node me&stases. Six of seven left-sided cancers had ipsilateral and one had contralateral axillary lymph node metastases. Patients with ipsilateral lymph node disease hadchest wall involvement and/or supraclavicular and mediastinal lymph node me&stases. All seven patients with contralateral axillary lymph node me&stases had supraclavicularand/ormediastinal lymphnodemetastases. Conclusion. Bronchogenic carcinoma may involve ipsilateral axillary lymph nodes via either chest wall invasion or retrograde spread from supraclavicular lymph nodes, Contralateral axillary lymph node involvement requires involvement of contralateral mediastinal and supraclavicular lymph nodes with retrograde spread to the axillary lymph nodes.

Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer Degner LF, Sloan JA. Research Center, St. Bon$ace GeneraI Hospital, 351 Tache Avenue, Winnipeg, Man. RZH2A6. I Pain Symptom Manage 1995;10:423-3 1.

Levelsofsymptom distressare mostottenmeasuredinaclinicaltrial context rather than in general ambulatory populations. The purpose of this paper is to report levels of symptom distress in such a population, and to describe the factors associated with this distress. Over a 6-month period, aconsecutivesampleof434newlydiagnosedpatients, including 82 patientswith hug cancer, weretested with the symptom distress scale at two tertiary oncology clinics serving the population ofone Canadian prairie province. While levels of symptom distress in this population were generally low, the most problematic symptoms for patients were fatigueandinsomnia. with40%and30% havingmoderate orhighscores onthese symptoms,respectively. Patientswithadvanceddiseasereported more distress than those with early stage disease; women reported more distress than men; older patients had less distress than younger patients; distress was highest in lung cancer patients and lowest in men with genitourinary cancers. Consistent with the findings of four previous studies, the single measure of symptom distress was a significant predictor of survival in lung cancer patients, with the exception ofthree patients who had substantial post-thoracotomy symptoms.

Squamous cell carcinoma of the lung with high CT number, but without calcification Kotani I, Honda A, Eto T, Nagashima Y, Suzuki H, Nakajima N et al. DepartmentofRespiratory Medicine. Shtuoka General Hospital, 4-2 7- 1. Kitaondo. Shizuoka 420. Jpn J Thorac Dis 1995;33:873-7.

Squamous cell carcinomaofthe lung was diagnosed in a&t-year-old man. Chest roentgenographic and tomographic examinations did not show areas ofhigh-density in the tumor, but chest CT scan showed dif- fuse, scattered, high-density nodules in the tumor. Histologic exam- ination did not show calcification, and calcium staining (Kossamethod) was negative. Examination ofthe thin-slice CT, the sot? X-ray film, and the resected slice ofthe lung indicated that the high-density nodules seen in the tumor on the chest CT scan corresponded to markedly fibrotic lesions with severe anthracosis. This case shows that high-density areas on a CT scan may reflect non-calcified lesions.

Acaseoflargecellcarcinomaofthelungarisingfromtheinner surface of a pulmonary bulla and complicated by hematoma Sakamaki F, Nakano M, Urano T, Mori M, Yamaguchi K, Kanazawa M. Department o/Medicine. School of Medicine, Keio Universily. Tokyo. Jpn J Thorac Dis 1995;33:906-IO.

A 64-year-old man with a history of smoking was admitted to our hospital, because he was noted to have a solitary mass lesion at the apex of the right lung on a chest roentgenogram. Eight months before admission, he had come to our hospital because ofhemoptysis. At that time,however,noabnormalshadowwasseenonhischestroentgenogram, except for multiple bullae at both apexes. Based on chest CT findings on admission, the tumor appeared to be a hematoma growing inside the bulla. The resected tumor was found to contain a large amount of coagulated blood in the hula. Histopathological examination ofthe bulla revealed a proliferation of large atypical cells from the inner surface of the bulla toward the inner space. Thus, the diagnosis was large cell carcinoma within the wall of the pulmonary bulla, the inside of which was filled with hematoma. We believe that the bematoma in the bulla allowed us to make an early diagnosis, and thus to succeed in curing the patient.

Proliferation markers MIB-I and PCNAin pulmonary neuro- endocrine tumors DurhamJR,NakhlehRE,SwansonPE,FischerJR,ZarboRJ. Department ofPathology. Henry Ford Hospital, 2799 W. GrandBoulevard. Detroit. MI 48202. Appl lmmunohistochem 1995;3: 174-83.

We examined cell proliferation in 40 pulmonary neuroendocrine tumors (I 7 typical carcinoid tumors [TC], 7 atypical carcinoid tumors [ATC], 5 large cell neuroendocrine carcinomas [LCNEC] and I 1 small cell carcinomas [SCC], using the monoclonal antibody MIB- 1 detecting the Ki-67 antigen and anti-proliferating cell nuclear antigen (PCNA) as immunochemical markers of cell proliferation, to seek correlation with tumor type, mitotic index, stage, and disease outcome. MIB- I and anti- PCNA immunostaining was performed on formalin-fixed, paraftin- embeddedtissue. MeanMlB-I and PCNAproliferationindiceswere4.4 andl1.6%forTC.l4.1and23.7%forATC,35.9and72.0%forLCNEC, and 36.2 and 54.6% for SCC. With both MIB-1 and anti-PCNA proliferation indices, there were statistically significant differences between TC or ATC and LCNEC or SCC, but not between TC and ATC or LCNEC and SCC. Correlation of proliferation index and mitotic index was strong for anti-PCNA (r = 0.82), but weaker for MIB- 1 (r = 0.58). The MIB-I index correlated with stage @ < 0.0003). dif- ferentiating stages I-III from stage IV. The PCNA index weakly correlated with stage @ < 0.36), differentiating between stages I and III. A high MIB-1 index strongly correlated with a poor outcome (p ( 0.0001). but a low MIB-I index was not predictive of a uniformly favorable outcome (2 cases of TC with a low MIB- I index had a poor outcome). Analysis by Cox proportional hazards regression model showed that traditional histologic classification was the best predictor of outcome. We conclude that MIB-I and anti-PCNA proliferation indices correlate with tumor type, mitotic index, stage, and disease outcome, but proliferation markers do not add prognostic information beyond that provided by traditional histologic tumor classification and staging of pulmonary neuroendocrine tumors.

Surgery

Are bilobectomies acceptable procedures? Massard G, Dabbagh A, Dumont P. Kessler R, Roeslin N, Wihlm J-M et al. Department of Thorocic Surgety, University Hospital, 1 Place de I’Hopitol. F-67091 Strasbourg. Ann Thorac Surg 1995;60:640-5.

Background: Controversy about operative morbidity and oncologic value of bilobectomy has led to a review ofour experience over the past 12 years Methods: The charts of 112 patients (100 men and 12 women with ameanage of63 years) were reviewed foroperative mortality and morbidity and long-term survival. Survival of patients with stage I or