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In this study, the performance of artificial neural network (NN) in diagnosis of solitary pulmonary nodule (SPN) on HRCT images was evaluated. One hundred and forty-five cases of SPN, including 86 cases of pulmonary carcinoma, 18 cases of tuberculoma, 29 cases of inflammatory nodule and 12 cases of benign tumor, were collected, which were all confirmed by pathology or biopsy and over-two-year clinical treatment. Five clinical parameters and 10 radiological characteristics were observed and quantified for qualitative characteristics. About 70 percent of all cases (up to 103 cases) were selected randomly to form training samples set, on which BP neural network and Logistic regression model were built. The total consistent rate 98.6% of BP NN was greater than that of Logistic model, which is 88.3% (P=0.0007). Areas under ROC curve were 0.997+/- 0.004 and 0.959+/-0.016 respectively, and the difference between the two was significant statistically (P=0.009). NN showed high performance in diagnosis of SPN on HRCT images. It was worthy of further study.

Aspergillosis is an uncommon complication of pulmonary carcinoma. A 60-year-old female was performed right lower lobectomy because of adenocarcinoma with pseudocavities. The diagnosis was bronchiolo-alveolar adenocarcinoma, and there was aspergilloma in one of the cysts in the tumor. Cavitation or cystic change in bronchiolo-alveolar adenocarcinoma is rare because of nondestructive growth pattern with an adequate blood supply in this histologic type. Additionally, bronchiolo-alveolar adenocarcinoma associated with pulmonary aspergilloma is rare.

A patient with a remitting non-microcytic pulmonary carcinoma was subjected to Doppler-echocardiography. The detection of a pericardial effusion with compression of the pulmonary artery due to an extrinsic mass indicated that the disease was progressing. The Doppler technique was used to evaluate the degree of arterial stenosis by determining the pressure gradient caused by it (49 mmHg) and to calculate the right ventricle pressure (75 mmHg). Tumor infiltration of mediastinal structures was posteriorly confirmed by computed tomography.

A panel of five monoclonal antibodies to surface antigens of small-cell pulmonary carcinoma was used for immunodiagnosis of metastases to the bone marrowin vitro in patients with small-cell carcinoma of the lungs. Standard cytomorphological diagnosis revealed metastases to the bone marrow in 6 out of 58 patients (10.3%). Using monoclonal antibodies, positive cells were detected in 12 (20.6%) patients, the tumor nature of the positive cells being undoubted in 7 preparations (12.6%). Five out of 6 cytologically positive cases were confirmed.

Study of the expression of type IV collagen by Lewis pulmonary carcinoma cells (PLMG-T, PLMG-M1, PLMG-M2) showed that these cells produce type IV collagen. The expression of type IV collagen in PLMG-T and PLMG-M2 cells approximately 2-fold surpassed that in PLMG-M1 cells. The number of active cells (synthesizing type IV collagen) in PLMG-M1 culture was 1.6 and 2.2 times lower than in PLMG-M2 and PLMG-T cultures, respectively. It was found that cell culture medium modulated expression of type IV collagen and this effect was mediated via cell receptors.

The size of the primary tumor and number of metastases to the lungs in mice with Lewis pulmonary carcinoma treated with doxorubicin were, respectively, 3 and 2.2 times less than in the control. Injection of doxorubicin and heparin led to an 8-fold reduction of the tumor. The number of animals with detected metastases to the lungs and the mean number of metastases per animal were decreased. Supplementation of doxorubicin therapy with a complex of drugs correcting platelet aggregation and the antithrombogenic properties of the vascular wall resulted in a reduction of the number of metastases on the lung surface in comparison with the control and with the animals treated with doxorubicin alone.

A fructan named CoPS3 was isolated from Cyathula officinalis Kuan. The structure of CoPS3 was determined by methylation, by the reductive-cleavage method combined with GC-MS analysis, and both 1D and 2D 1H and 13C NMR spectroscopy. These results show that CoPS3 is a graminans-type fructan that is comprised of a beta-D-fructofuranosyl backbone having residues linked (2-->1)- and (2-->6) with branches and an alpha-D-glucopyranose residue on the nonreducing end of the fructan chain. Each branch is terminated by a beta-D-Fruf residue. Bioassay showed that it could inhibit growth of Lewis pulmonary carcinoma implanted in mice.

This article compares the presence of solid particles in lung parenchyma samples collected from accident victims and in bronchoalveolar lavage fluid taken from patients diagnosed with pulmonary carcinoma. Analysis by electron microscopy showed differences in particle size between the two groups, which could be attributable both to differences in original particle size and to their solubility in the biological environment.

Arbidol, a new antiviral drug, is found to suppress metastases of Lewis' pulmonary carcinoma for various methods of transplantation. The effects of arbidol are compatible with those of the standard interferon inductor poly-I-poly-C.

Intuition would suggest that any additional mass caused by carcinoma in the lungs should change the overall eigen system of the thorax in resonance. To confirm this the authors undertook measurements on several carcinoma patients to ascertain whether this is indeed the case. They present two cases in which one can observe this suspected behaviour without the problems of associated fluid or other conditions masking the effect one wishes to study. The authors have noted that usually only directly above the carcinoma site does any significant difference appear in the spectral response thus suggesting that carcinomas may generate an acoustical shadow. However, the authors conclude that further research is required before this can be used in any clinical sense.

Pulmonary adenocarcinoma, which accounts for 35.3% of pulmonary carcinoma, causes brain metastases up to 28% in clinical setting (1, 2). Leptomeningeal carcinomatosis occurs in approximately 0.7% of lung cancer patients (3). The patterns for spread of secondary temporal bone malignancies could be summarized as: isolated metastasis, diffuse metastatic leptomeningeal carcinomatosis, and direct extension. In this study, a case of metastatic tumor of the internal auditory canal from leptomeningeal carcinomatosis of pulmonary adenocarcinoma will be reported.

A transplantable rat pulmonary carcinoma line (IP) in F344 rats is a useful animal model for humoral hypercalcemia of malignancy (HHM). The present study analyzed the degree of HHM by implanting IP into F344 female rats aged 6, 20 or 45 weeks. IP-bearing females developed elevated plasma parathyroid hormone-related protein levels, hypercalcemia and increased osteoclastic activity as well as calcification in various organs. The severity of such HHM differed depending on age; particularly, calcification showed age-dependent reduction. HHM development in IP-bearing females may be influenced by age-related factors.

The synchronous development of malignant mesothelioma and pulmonary carcinoma is extremely rare. In this case, an 83-year-old woman, without evidence of past asbestos exposure, developed malignant pleural mesothelioma and pulmonary adenocarcinoma. She was discovered to have a lung lesion on an unrelated preoperative chest X-ray. Clinical evaluation suggested primary bronchogenic malignancy. She had a forty pack-year smoking history, but quit twenty years previously. At surgery, she had nodularity of the pleura. Pathology revealed adenocarcinoma of the lung and suspected malignant mesothelioma of the pleura. Malignant mesothelioma was confirmed histologically at a second surgery.

Cryptococcosis presenting as an intrabronchial mass is not a recognized cause of complete lung collapse. This case report illustrates this extremely rare manifestation of pulmonary cryptococcosis, which mimicked primary pulmonary carcinoma clinically, radiologically and bronchoscopically.

A 61-year-old woman, who had undergone total right pneumonectomy 22 months before due to lung cancer (adenosquamous cell carcinoma) was admitted for macroscopic hematuria. Abdominal CT showed two renal tumors in the right kidney. Right radical nephrectomy was performed, because no imaging study showed any other metastasis. Pathological examination revealed adenosquamous cell carcinoma, which was the same pathology as the lung cancer had been. She died of the left lung metastasis 24 months after right radical nephrectomy. Her prognosis was thought to have been prolonged by the operation of right radical nephrectomy.

Metastatic tumors to the jaws and oral tissues are rarely encountered, accounting for less than 1% of all malignant tumors affecting the mouth. Although, metastasis to the mandible from a pulmonary carcinoma is extremely rare, when it does occur it mimics more common pathoses such as odontogenic cysts, osteomyelitis, space infections making its diagnosis even more challenging. Metastasis should be taken into account especially in patients with chronic history of smoking and sudden onset of paresthesia. The rarity of such cases has also resulted in there being no definitive consensus on managing them.

Purpose: β-human chorionic gonadotropin (β-hCG) expressing pulmonary carcinoma is very rare, and little is known about this entity. The aim of this study was to find the characteristic clinicopathologic features of β-hCG expressing pulmonary carcinoma. Materials and Methods: Of all 2790 lobectomy specimens of lung excised between January 2006 and December 2010, only six cases of β-hCG expressing pulmonary carcinoma were identified retrospectively. The cases were classified according to the WHO classification, and clinicopathologic features were investigated. Results: The patients consisted of 4 males and 2 females, and the median age was 64 years. Half of the patients presented with blood tinged sputum or hemoptysis. The median tumor diameter was 4.2 cm. All but one case showed prominent area of hemorrhage and necrosis. All six cases were pleomorphic carcinoma, composed of various types of non-small cell carcinomatous component and giant cell component. All cases showed significant area of β-hCG positivity, and β-hCG was usually expressed in the pleomorphic giant cells. Conclusion: In pulmonary carcinoma with pleomorphic giant cells, is necessary to check

연구배경 : 고립성 폐결절에서 연령, 흡연력, 과거 암 발생력 등의 임상적 특징과 크기, 석회화, 성장속도, 전산화단층촬영 소견 등의 방사선학적 특징이 악성결절과 양성결절의 감별점으로 제시되고 있다. 하지만 알려진 대부분의 감별점은 전산화단층촬영이 광범위하게 보급되기 이전의 자료 그리고 폐암이 현재와 같이 높은 발생률을 보이기 이전의 자료를 토대로 한 것이다. 또한 이를 토대로 한 진단적 접근이 결핵종이 상대적으로 많은 국내에서도 마찬가지로 적용될 수 있을 지에 대해서는 잘 알려져 있지 않다. 악성결절과 양성결절의 감별점으로 제시되는 여러 임상적, 방사선학적 특징과 경피적 흡인세침검사, 외과적 절제술 등 여러 진단방법의 임상적 의의를 재평가하고자 하였다. 방법 : 1994년 1월부터 1995년 2월까지 서울대학교병원에 입원한 고립성 폐결절 환자 113명중 결절의 원인이 확인된 94명을 대상으로 후향적 연구를 시행하였다. 결과 : (1) 113례중 94례에서 원인질환이 확인되었다. 악성결절이 60례였고 이중 기관지암종이 49례였으며 선암이 30례로 기관지암종의 대부분을 차지하였다. (2) 악성결절을 가진 환자의 평균연령( $58.1{\pm}10.0$ 세)이 양성결절을 가진 환자( $49.7{\pm}12.0$ 세)에 비해 높았으며(p=0.0004), 연령증가에 따라 악성결절이 차지하는 비율이 직선적으로 증가하였다. (3) 흡연력은 양성결절을 가진 환자( $13.0{\pm}17.6$ 갑년)과 악성결절을 가진 환자( $18.5{\pm}25.1$ 갑년)에서 유의한 차이가 없었다(p=0.2108). (4) 과거력상 암발생력이 있었던 10례중 9례가 악성결절이었으며, 이중 5례는 이전의 암과는 무관하게 새로이 발생한 원발성 폐암이었다. (5)결절의 평균크기는 양성결절( $3.01{\pm}1.20cm$ )과 악성결절( $2.98{\pm}0.97cm$ )에서 유의한 차이가 없었다(p=0.8937). (6) 용적배가시간을 구할 수 있었던 22례중 용적배가시간이 400일이상인 결절 9례중 악성결절이 6례였다. (7) 흉부 전산화단층촬영상 분엽성 또는 침상형 변연, 공기기관지음영, 결절과 흉막사이의 선상음영, 림프절 증대 등을 보이는 경우 악성결절을 보다 더 시사할 수 있었다. 결절 내부의 석회화, 내부 저음영, 결절내부 공동의 벽두께가 균일한 경우, 경계가 잘 지어진 변연, 결절주위 폐실질의 위성병소 등은 양성결절을 시사할 수 있었다. (8) 경피적 흡인세침검사를 통하여 양성결절의 57.6%(19/33)와 악성결절의 81.0%(47/58)를 진단하였다. 양성결절 2례와 악성결절 1례에서 풍요한 진단적 뒤바뀜이 있었다. (9) 수술전 진단이 되지 않은 상태에서 외과적 절제술을 시행한 26례중 11례(42.3%)가 악성결절이었다. 외과적 절제술을 시행한 전체 61례중 악성결절은 46례(75.4%)였다. 결론: 연령이 높을수록, 과거력상 암발생력이 있는 경우, 흉부전산화단층촬영상 분엽성 또는 침상형 변인, 공기기관지음영, 결절과 흉막사이의 선상음영, 림프절 증대 등을 보이는 경우 악성결절을 보다 더 시사할 수 있을 것으로 보인다. 하지만 현재까지 고립성 폐결절에서 악성결절과 양성결절을 감별할 수 있는 지표로 여겨졌던 흡연여부나 흡연량, 결절의 크기, 용적배가시간 등은 악성결절과 양성결절의 감별에 도움이 되지 않았다. 국내에서도 원발성 폐암의 빈도가 급속히 증가하고 있는 현실을 고려할 때 원발성 폐암의 치유 가능한 병기를 반영하는 고립성 폐결절이 발견된 환자에서 외과적 절제술을 포함한 보다 적극적인 진단적 접근이 필요할 것으로 보인다. 【Background : The solitary pulmonary nodule(SPN) presents a diagnostic dilemma to the physician and the patient. Many clinical characteristics(i.e. age, smoking history, prior history of malignancy) and radiological characteristics( i.e. size, calcification, growth rate, several findings of computed tomography) have been proposed to help to determine whether the SPN was benign or malignant. However, most of these diagnostic guidelines are based on the data collected before computed tomography(CT) has been introduced and lung cancer was not as common as these days. Moreover, it is not well established whether these guidelines from western populations could be applicable to Korean patients. Methods : We had a retrospective analysis of the case records and radiographic findings in 114 patients presenting with SPN from Jan. 1994 to Feb. 1995 in Seoul National University Hospital, a tertiary referral hospital. Results : We observed the following results ; (1) Out of 113 SPNs, the etiology was documented in 94 SP IS. There were 34 benign SP s and 60 malignant SPNs. Among which, 49 SPNs were primary lung cancers and the most common hi stologic type was adenocarcinoma. (2) The average age of patients with benign and malignant SPNs was $49.7{\pm}12.0$ and $58.1{\pm}10.0$ years, respectively( p=0.0004), and the malignant SPNs had a striking linear propensity to increase with age. (3) No significant difference in the hi story of smoking was noted between the patients with benign SPNs( $13.0{\pm}17.6$ pack- year) and those with malignant SPNs( $18.6{\pm}25.1$ pack-year) (p=0.2108). (4) 9 out of 10 patients with prior history of malignancy had malignant SPNs. 5 were new primary lung cancers with no relation to prior malignancy. (5) The average size of benign SPNs( $3.01{\pm}1.20cm$ ) and malignant SPNs( $2.98{\pm}0.97cm$ ) was not significantly different(p=0.8937). (6) The volume doubling time could be calculated in 22 SPNs. 9 SPNs had the volume doubling time longer than 400 days. Out of these, 6 were malignant SPNs. (7) The CT findings suggesting malignancy included the lobulated or spiculated border, air- bronchogram, pleural tail, and lymphadenopathy. In contrast, calcification, central low attenuation, cavity with even thickness, well-marginated border, and peri nodular micronodules were more suggestive for benign nodule. (8) The diagnostic yield of percutaneous needle aspiration and biopsy was 57.6%(19/33) of benign SPNs and 81.0%(47/58) of malignant SPNs. The diagnostic value of sputum analysis and bronchoscopic evaluations were relatively very low. (9) 42.3%(11/26) of SPNs of undetermined etiology preoperatively turned out to be malignant after surgical resection. Overall, 75.4%(46/61) of surgically resected SPNs were malignant. Conclusions : We conclude that the likelihood of malignant SPN correlates the age of patient, prior history of malignancy, some CT findings including lobulated or spiculated border, air-bronchogram, pleural tail and lymphadenopathy. However, the history of smoking, the size of the nodule, and the volume doubling time are not helpful to determent whether the SPN is benign or malignant, which have been regarded as valuable clinical parameters previously. We suggest that aggressive diagnostic approach including surgical resection is necessary in patient with SPNs.】

To the Editor. —As a pipe smoker who rarely smokes in company, I take some umbrage at Dr Tuteur's rather opinionated reply in the Question and Answers section of a recent issue ofJAMA.1A simple "no hard data exist" would have answered the question more truthfully. To state that "pipe smokers' risk of death due to pulmonary carcinoma is intermediate between those of never smokers and cigarette smokers" stretches the definition of intermediate (which is defined as "lying or being in the middle place or degree," according toWebster's). As Tuteur knows, the risk of pulmonary carcinoma in pipe smokers is much closer to the never smokers and far from the cigarette smokers. Though the degree of inhalation is undoubtedly important, it is unlikely that "all types of tobacco smoke (regardless of source)" are equally dangerous. For reasons not yet elucidated, cigarette smoke is much the greater

A case report of a malignant hamartoma of the lung observed in a 36-year-old housewife was presented. The hamartoma was non-chondromatous (fibromyomatous), located beneath the pleura of the left upper lobe. The malignant lesion corresponded to anaplastic carcinoma of the lung. A review of the literatures on the malignant hamartoma of the lung revealed rare incidences of the tumor, but hamartoma and hamartomatous lesions of the lung should be regarded as one of the histopathological backgrounds where pulmonary carcinoma may arise. ACTA PATH. JAP. 27: 541–546, 1977.

Over a 6 year period, three cases of pulmonary carcinoma in young men with severe bullous lung disease were seen at Washington University Medical Center. The patients did not have a long cigarette-smoking exposure. It would seem that patients with severe bullous lung disease are at a higher risk for the development of pulmonary neoplasm than the general population. Physicians should be aware of this association to expedite diagnosis and therapy.

The Grimelius silver nitrate stain has enabled us to demonstrate the presence of tumor cells with argyrophil granules (argyrophil cells) in small cell carcinoma of the lung. Of the 22 tumors, 11 showed varying numbers of argyrophil cells. The occurrence of the cells differed in frequency among the subtypes of small cell carcinoma. The fusiform cell type showed the cells more frequently than the other types. Both tumors with numerous argyrophil cells belonged to the fusiform cell type. The number of positive cells seen under the light microscope did not correlate with the number of cells containing neurosecretory granules under the electron microscope, nor with the amount of either ACTH or serotonin in the tumor extracts. The demonstration of these cells in a pulmonary carcinoma may be of help in making correct histological diagnosis.

At scanning electron microscopy of cells from the lymph of the thoracic duct, collected by cannulation of patients with malignant tumours of different types, lymphocytes and red blood cells were found, but few malignant cells. The latter came from patients with pulmonary carcinoma and mammary carcinoma with lung metastases. Various abnormal shapes of the red blood cells were observed, possibly due to extrinsic factors such as administered drugs of abnormal metabolites from the malignant disease. The lymphocytes had no consistent pathologic shape, but appeared to act as immunologic, active cells against the malignant cells in the thoracic lymph.

The repeated finding of malignant or suspicious cells in the sputum of an apparently normal person must not be ignored. Immediate and intensive attempts should be made to localize the carcinoma. Sometimes, in the presence of a central tumour an early diagnosis can be made radiologically. With peripheral tumours and early diagnosis is more likely. The most successful method for the early localisation of an occult bronchial carcinoma is fibre optic bronchoscopy, with selective bronchial aspiration. Consistent finding of malignant cells in the secretions from a lobar bronchus, provided contamination can be excluded, justifies surgery such as a lobectomy. Delay in instituting treatment while waiting for radiological or bronchoscopic confirmation reduces the chance of successful surgery because of the possibility of metastases or the development of cardiological or respiratory complications.

The degree of retention of arsenic trioxide (As 2 O 3 ) and calcium arsenate in rat lung after intratracheal instillation was investigated. Calcium arsenate was retained for a long period (about 50% recovered after 7 days), while AS 2 O 3 disappeared at a much faster rate (2% recovered after 24 h). The association between retention rate of these carcinogens and the subsequent induction of pulmonary carcinoma should be considered.

胸膜陥入を認める原発性肺癌17例につき, そのX線像, 肺血流シンチグラムなどの所見につき検討した. 鮮鋭な線・索状影, 胸膜側のテント状陰影または葉間胸膜の陥入像により, 17例中15例で胸膜陥入を診断しえ, 気管支造影で腫瘤周囲における気管支の末梢性集簇, X線像または肺動脈造影像で肺動脈肢の集簇傾向が認められ, 肺血流シンチグラムでは11例で腫瘤の大きさに比し広範囲の血流障害を認めた. 肺血流シンチグラムの所見と胸膜陥入像を含むX線像との関連につき検討し考察を加えた.

The prognosis of patients subjected to operation for a solitary cerebral metastasis from a pulmonary carcinoma is unfavourable. The prognosis of a solitary cerebral metastasis from a mammary carcinoma that is removed appears to be better: a prolongation of life of acceptable duration and quality is frequently achieved.