95

of pulmonary carcinoma should raise the suspicion of renal metastases, especially if computed tomography of the mass demonstrates relative homogeneity and minimal enhancement. More frequent use of the abdominal CT scan in staging patients with lung cancer will render metastatic carcinoma from lung to kidney a more frequent ante mortem diagnosis.

Small-Cell Lung Cancer ii Years After Ex- cision of a Cervical Lymph Node Metas- tasis of Identical Histology. Kuhn, M., Allemann, J., Cavalli, F. et al. Division de Pneumologie, Departement de Medecine Interne, CHUV, CH-1011 Lausanne, Switzerland. Schweiz. Med. Wochenschr. 116: 1264-1266, 1986.

Eleven years after surgical excision of a cervical lymph node metastasis of a small-cell carcinoma (without other treatment), lung cancer of identical his- tological character was diagnosed. Be- tween the two events there had been no suspicion of another primary tumor. The authors discuss possible explanations for this extraordinary clinical course, with special reference to the sarcoid-like reaction in the tissue surrounding the tumor and the panhypopituitarism diag- nosed nine years after excision of the lymph node metastasis.

Necropsy Evidence of Detection Bias in the Diagnosis of Lung Cancer. McFarlane, M.J., Feinstein, A.R., Wells, C.K. Department of Medicine, Yale Univer- sity School of Medicine, New Haven, CT, U.S.A. Arch. Intern. Med. 146:1695-1698 , 1986.

The correct diagnosis had not been made during life in 26% of 153 patients with lung cancer found in necropsies per- formed between 1971 and 1982. The likelihood of a correct antemortem diag- nosis showed distinctive gradients in relation to the patients' history and amount of cigarette smoking, symptomatic manifestions, and anatomic extensiveness of the cancers. However, cigarette smok- ing still exerted a diagnostic effect in patients with similar symptoms and similar degrees of anatomic spread. Furthermore, if a lesion was present, chest films were more likely to be radiologically interpreted as a cancer in smokers. The results suggest that smokers receive preferential consideration regarding the diagnosis of lung cancer. This detection bias can have adverse scientific consequences in depriving non- smokers of suitable therapy, in leading to falsely high estimates of the true magnitude of the smoking/lung cancer association, and in distracting etiologic attention from other agents that may cause lung cancer.

Estimating the Probability of Malignancy in Solitary Pulmonary Nodules. A Bayesian Approach.

Cummings, S.R., Lillington, G.A., Richard, R.J. Division of General Inter- nal Medicine, University of California, San Francisco, CA, U.S.A. Am. Rev. Respir. Dis. 134: 449-452, 1986.

Decisions about managing solitary pulmonary nodules often involve estimates of the likelihood that the nodule is malignant. We used Bayes' theorem to devise a simple scheme for estimating the likelihood that a solitary pulmonary nodule is malignant based on the diameter of the nodule, the patient's agen and history of cigarette smoking, and data on the overall prevalence of malignancy in solitary nodules. This method may improve the accuracy of estimating the likelihood of malignancy for individual patients with solitary pulmonary nodules.

Intratumoral Ethanol Injection for Malig- nant Tracheobronchial Lesions: A New Bronchofiberscopic Procedure. Fujisawa, T., Hongo, H., Yamaguchi, Y. et al. Department of Surgery, Chiba Univer- sity School of Medicine, Chiba 280, Japan. Endoscopy 18: 188-191, 1986.

We performed intratumoral ethanol in- jection via a flexible bronchofiberscope in 13 patients with malignant tracheobronchial lesions in order to evaluate its effects on airway dilatation and hemostasis. The results obtained are described below. Im- mediately after intratumoral injection of ethanol, bronchofiberscopic findings revealed that the tumor turned faintly white, there was a little regression of tumor, and a promising effect was demonstrated on patients with bleeding from tumors. The injected tumor turned necrotic within several days, and his- tological examination revealed no viable tumor cells in necrotic tissues. The his- tological anti-tumor effect of ethanol was also demonstrated in experiments with nude mice. This endoscopic treatment was very effective in polypoid tumor protrud- ing into the tracheobronchial lumen, but ineffective in the case of compressed stenosis or obstruction. In conclusion, intratumoral injection of ethanol is con- sidered to be a promising endoscopic treatment for malignant tracheobronchial lesions.

Bronchioloalveolar Carcinoma Presenting with Meningeal Carcinomatosis. Cytologic Diagnosis in Cerebrospinal Fluid. Csako, G, Chandra, P. Department of Pathology, George Washington University Hospital, Washington, DC 20037, U.S.A. Acta. Cytol. 30: 653-656, 1986.

The cytologic findings in a 35-year- old patient with bronchioloalveolar car- cinoma who initially presented with central nervous system involvement are reported. Following the cytologic diag- nosis of carcinomatous meningitis (metastatic adenocarcinoma), an open lung biopsy was performed, which confirmed the