221

with MC at sutopsy, CK-BB was, with the

above cut-off point, elevated in six pa- tients with a false negative cytology. Of the 73 patients examined for beta-2-m, 18 had MC, 30 had parenchymatous meta- stases only, and 25 patients had no CNS metastases. The CSF concentrations in the three groups were not significantly dif- ferent. The median concentrations in the groups were 133 nmol/L, 125 nmol/L, and 107 nmol/L, respectively. The ratios be- tween beta-2-m in CSF and plasma were also not significantly different between the three groups. Thus, the data on CK- BB are promising, and further studies are warranted to see if the usefulness of CM-BB can be more firmly established. By contrast, beta-2-m has no role as a marker of CNS disease secondary to SCLC.

Carcinoembryonic Antigen: A Useful Prog- nostic Marker in Small-Cell Lung Cancer. Sculier, J.P., Feld, R., Evans, W.K. et al. The Ontario Cancer Institute, 500 Sherbourne St., Toronto M4X IK9, Canada. J. Clin. Oncol. 3: 1349-1354, 1985.

Plasma carcinoembyonic antigen (CEA) was determined in 180 patients with small-cell lung cancer (SCLC) before treat- ment. An abnormal level (> or = 6 ng/ml) was found in 34% of patients tested. Pa- tients with extensive disease (39/83) had a significantly higher frequency of abnormal CEA (p = .001) than those with limited disease (22/97). There was a strong correlation between obtaining an objective response - particularly a com- plete response (p = .00003) - and the absence of an elevated CEA. Patients with an abnormal CEA also had a shorter survival time (P = .0007) and the difference re- mained statistically significant after logrank adjustment for extent of disease and ECOG (Eastern Cooperative Oncology Group) performance status. There was also a negative correlation between survival time and the quantitative level of CEA. In this series, only the group of patients with normal initial CEA levels included all survivors beyond 2.5 years. We conclude that CEA is a useful progno- stic factor in SCLC.

Seln~n Creatine Kinase BB Isoenzyme as a Diagnostic Aid in Occult Small Cell Lung Cancer. Kurtz, K.J., Nielsen, R.D. University of Nevada School of Medicine, Division of General Internal Medicine, Department of Medicine, Reno, NV 89520, U.S.A. Cancer

56: 562-566, 1985. Four patients with metastatic small

cell carcinoma of the lung who had ini- tial chest x-rays that did not reveal

the cancer showed striking elevations

of serum creatine kinase BB isoenzyme, which sug-

gested the diagnosis and directed the subsequent evaluation. Creatine kinase BB isoenzyme elevation with widespread small cell carcinoma of the lung is probably more common than currently recognized, and is a useful diagnostic indicator for extensive stage small cell lung cancer, even in the absence of central nervous system metastases.

Pleural Lavage After Pulmonary Resection for Bron- chogenic Carcinoma. Eagan, R.T., Bernatz, P.E., Spencer-Payne, W. et al. Mayo Clinic and MayG Foundation, Rochester, MN 55905, U.S.A.J. Thorac. Cardiovasc. Surg. 88: 1000-1003, 1984.

A cytologic examination of pleural fluid was performed on a pleural lavage specimen collected

at the completion of operation after pulmonary re- section in 135 of 599 patients undergoing curative

pulmonary resection for a non-small cell carcinoma of the lung between 1977 and 1982. The cytologic results of lavage was positive for malignant cells in 12 of the 135 patients (8.9%). The incidence of positive results was correlated with lymph node status (N2 > N1 > NO), cell type (adenocarcinoma > other non-small cell lung cancers), stage (III > II > I), and visceral pleural status (invaded > not invaded). No positive cytologic results were noted in 39 patients having a diagnostic excisional pulmonary biopsy prior to more definite resection. The disease has recurred in nine of the 12 patients with positive cytologic results (only two in the ipsilateral pleural space), and eight have died. The prognostic role of pleural lavage cytology

needs more study.

Acute Pancreatitis in Association with Small Cell Lung Carcinoma: Potential Pitfall in Diagnosis and N~nagement. Allan, S.G., Bundred, N., Eremin, O., Leonard, R. C.F. University Department of Clinical Oncology, Western General Hospital, Edinburgh EH4 2XU, U.K. Postgrad. Med. J. 61: 643-644, 1985.

Tumour metastases to the pancreas are a rare but recognized causes of acute pancreatitis, there is a 24-40% incidence of pancreatic involvement from small cell lung cancer in autopsy series but only a very few cases of tumour-induced acute pancreatitis have been described. Chemotherapy has been advocated as the primary therapy in patients with known oat cell/carcinoma who develop acute pancreatitis. We describe 2 patients with acute haemorrhagic pancreatitis in association with dis- seminated small cell carcinoma but without evidence of tumour invasion in the gland and with gall sto- nes present in the gall bladder. Chemotherapy would have been inappropriate therapy for these patients.

Systemic Scleroderma and Small Cell Carcinoma of the Lung. Sarma, D.P., Weilbaecher, T.G. Department of Patho- logy, VA Medical Center, New Orleans, LA, U.S.A. J. Surg. Oncol. 29: 28-30, 1985.

A 64-year-old man diagnosed to have systemic

scleroderma for 1 year developed small-cell carci-