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Ten patients with biopsy-proved eosinophilic granuloma of the lung were followed for periods of as long as nine years. The disease occurs as an isolated lung lesion or in association with bone lesions. The roentgenographic pulmonary findings are either diffuse nodularity or a fine reticular pattern. Symptoms are few, and pneumothorax is frequent. Scalene node and liver biopsies are usually not fruitful, and the diagnosis must be made by open or needle lung biopsy. Consistently abnormal laboratory tests are impaired single-breath carbon monoxide diffusing capacity and elevation of the alpha 2 globulin protein fraction of serum. Treatment usually is not required; however, if deterioration occurs, the patient may benefit from corticosteroid therapy.

A patient with spontaneous chylothorax associated with a lymphogenous thymic cyst and multiple lymphangiomata of bone is reported and literature on the association of chylous effusion with mediastinal lymphangioma and lymphangiomata of bone reviewed. We offer further support for the concept that this syndrome represents a generalized abnormality of the lymphatic system.

A series of 348 patients undergoing operative intervention because of thyroid masses is reviewed. The incidence of primary malignancy among these patients is 16.4%. Male sex and the presence of cervical adenopathy significantly increase the probability of malignancy. The presence of multiple nodules or a functional nodule on radioiodine thyroid scan significantly reduces the probability of cancer. A rational approach to thyroid nodules is presented based on these findings and new modalities that have become available.

Three patients with “islet cell-carcinoid” tumors of the duodenum are reviewed. In each of these cases the presence of lymph node metastasis eventually prompted total gastrectomy as the course of treatment. The patient in case I is now clinically free of tumor five years after operation. In case II the patient's death occurred two years after surgery, and although tumor was found at operation, it was not related to his death. In case III the patient is alive and well five years after his surgical procedures.

Larsen, G. L., Armstrong, R. G., Stanford, W., and Cline, R. E. (1973).Thorax, 28, 641-643. Granular cell myoblastoma of the oesophagus. During evaluation of symptoms of oesophageal reflux in a 40-year-old man, a filling defect of the distal oesophagus was seen on the oesophagogram, and this was noted to be a submucosal mass at oesophagoscopy. He also had an oesophageal hiatus hernia. The lesion proved to be a granular cell myoblastoma, a rarity in the oesophagus, only 11 previous cases having been reported. Symptomatology evaluation and management of granular cell myoblastoma of the oesophagus are discussed. As with other submucosal lesions of the oesophagus, preoperative biopsy through an intact mucosa is to be avoided because of danger to the patient from haemorrhage or perforation and subsequent inflammatory reaction making surgical resection and microscopic diagnosis difficult.

Bilateral adjacent neurogenic tumors of the mediastinum were excised in a 20-year-old man through a single left thoracotomy. The presence of bilateral lesions was indicated by the discrepancy betweeen excised tumor and the mass on x-ray examination. Two distinct histologic patterns resulted in one mass representing a ganglioneuroma, and the second, a neurofibroma.

From 1958 to 1969, the cases of 144 patients with undiagnosed mediastinal masses were evaluated on the Thoracic Surgery Service of Wilford Hall USAF Medical Center. Of these patients, 72% were asymptomatic and their lesions were discovered on routine roentgenogram of the chest. This represents one of the largest asymptomatic series in the literature. It is believed that the relatively low surgical morbidity and mortality, as well as the early surgical detection of malignant diseases in this series, can justify the recommendation for early operative intervention in patients who have an asymptomatic mediastinal mass.