341

of patients wth biopsy or autopsy proven neoplasm, the sensitiwty

varying according to the type and growth pattern of the tumour (93 46 in

bronchioloalveolar carcinoma). BAL can prove useful also in the

diagnosis of pulmonary involvement in lymphoproliferative disorders,

particularly when the immunologic evaluation of surface markers is

performed. We conclude that in the appropriate setting BAL represents

a useful tool for studymg patients with lung cancer.

Bronchoalveolar lavage in the assessment of primary and m&static lung cancer Rennard SI. Pulmonary and Crit Care Med Se, Department of Internal Medirin Univ of Nebraska Medical Centr. 6RI South 42nd Street,

Omaha, NE 68198- 2465. Respiration 1992;59:Suppl 1:41-3.

Bronchoalveolar lavage (BAL) can provide diagnostic information in

cases of primary and me&static disease to the lung. Diagnostic material

can be obtained in about 50% of primary lung cancers, with more

accuracy m bronchoalveolar cell carcinoma and adenocarcinoma than in

squamouscellcarcinoma. Tbediagnostic yieldforcytologicexammation

IS comparable to that of other widely used endoscopic techniques such

as transbronchial biopsy. Technical considerations for the performance

of BAL for the diagnosis of cancer remain incompletely defined. These

Include: 1) methods to assure lavage of the appropriate segment, 2) the

type of cytologic preparation and stain used, 3) conditions such as viral

Infections and anti-nwplastic chemotherapy, which can Induce changes

m anway epithelial cells very difficult to distinguish from malignancy,

4) the optimum technique for the performance of lavage. Lavage may

be limited in staging patients with pnmary lung cancer, but may be

useful in staging metastatlc lung cancer. In selected clinical situations,

BAL wdl be an important tool for the physician caring for patients in

whom malignancy of the lung IS suspected.

DNA analysis of malignant effusion% Comparison with cytologic diagnosis and uwcinoemhryonic antigen content Pinto MM. Depamtent of Pathology, Bridgeport Hospital, 267 Grant

Street, Bridgeport, CT06616 Anal Quad Cytol Histol 1992; 14:222-

6.

Twenty-three consecutive malignant effusions from 19 patients

submitted forcytologicexamination wereanalyzed forcarcinoembryonic

antigen (CEA) content and for DNA analysis by flow cytometry. The

study was undertaken to determine if the addition of DNA analysis

would improve the sensitivity of cytologic diagnosis and CEA assay.

CEA examination was performed on Papanicolaou-stained smears and

hematoxylin-and-eosin-stained cell blocks. Final diagnoses were

correlated with histologic examination (four patients), clinical and

radiologic studies, and follow-up. The malignant effusions in 19

patients were secondary to carcinoma of the breast (5), lung (S), ovary

(I), endometrium (l), mutinous carcinoma of the colon (l), unknown

pnmary (l), extraovarian papillary carcinoma (I), mesothelioma (2)

and large cell lymphoma (2). The sensitivity of cytologic diagnosis was

100% and specificity 100%. DNA aneuploidy, defined as the presence

of two separate peaks in the histogram, was present in 7 of 23 fluids

(sensitivity, 30%). Four fluids had insufficient cells for analysis, and

onehistogramshoweddebris(followingchemotherapy). DNAaneuploidy

was detected in effusions secondary to carcinoma of the breast (4), lung

(1) and lymphoma (2). Using 5 ng/mL as the cutoff, the sensitivity of CEA was 68%. DNA analysis of cells in malignant effusions is less

sensitive than cytologtc diagnosis, and CEA assay and isnot recommended

for routine use in the diagnosis of malignant effusions.

Trends in the association of Lamhert-Eaton myasthenic syndrome with carcinoma Gutmann L, Phillips LH, II Gutmann L. Department of Neurology,

Llniv. of Virginia Health Sri. Center, Box 394, Charlottesville, VA

22908. Neurology 1992;42:848-50.

The Lamb&-Eaton myasthenic syndrome (LEMS) is often associated

with carcinoma. The exact number of patients with tumor has been

reported to be as high as 70%. Recent clinical experience suggests that

theactual number ofpatients with tumor may be substantially lower. We

combined data from the clinical experience of the neuromuscular

services at West Virginia University and the Universrty of Virgima to

determine the rate of occurrence of cancer in this disorder. We Identified

28 patients with LEMS. and 14 had cancer. There IS a dlstmct trend for

a lower tumor frequency over the past decade, which suggests that the

clinical manifestations of the disease may be changmg.

Bronchogenic carcinoma in patients with pulmonary histiocytosis X Sadoun D, Vaylet F, Valeyre D, Natali F, Gorges R, Allard P et al.

Service de Pr Battesti, Hopital Avicenne, 83009 Bobigny. Chest

1992;101:1610-3.

Five cases of bronchogenic carcinoma were observed among 93

patients with pulmonary histiocytosis X (Hx). Mean age at the time of

diagnosis of Hx was 42 years; on the average, cancer occurred 10.5

years later. All patients were. smokers and continued to smoke heavily

at the time of diagnosis of cancer. Comparison of the five cases

associatmg Hx and lung carcinoma with a group of 88 control patients

suffering from Hx alone suggested that smoking played the predominant

role in the pathogenesis of cancer. In fact, among the four patients with

Hx and carcinoma older than 45 years, tobacco consumption was

significantly greater (64.7 k 37 pack-year, mean f SD) than that of tht:

15 control patients of the same age with only Hx (40.8 k 11.6,

p<O.Ol). In light ofthis good correlation, thediagnosisof Hx strongly

advocates stopping tobacco smoking and long-term medical follow-up.

Plasmapheresis and antineoplastic treatment in CNS paraneoplastic syndromes with antineuronal autoantibodies Graus F, Vega F, Delattre JY, Bonavenhtra I, Rene R, Arbaiza D et al.

Depattment of Neurology, Hospital Clinic i Provincial, Villarroel J 70.

08036 Barcelona. Neurology 1992;42:536-40.

We retrospectively evaluated the effect of plasmapheresls (PE) m

seven patients with paraneoplastic encephalomyelitis (PEM), small-cell

lung carcinoma, and anti-Hu antibodies, and four patrents with

paraneoplastic cerebellardegeneration (PCD), ovarian or breast cancer,

and anti-Y0 antibodies. In addition to PE, patients received prednisone

(nine), cyclophosphamide (eight), or treatment of the tumor (five). All

butone patient wereseverely disabled by the time PEbegan. Theclinical

outcomewascompared with that offivepatients(PEM, four; PCD, one)

who only had treatment of the tumor. Only one of these five pattents had

a severe neurologic deficit at the onset of the antineoplastic treatment.

No patient improved. Two patients treated with PE and antineoplastlc

therapy and three who only received treatment of the tumor remained

stable for at least 6 months. Four of the five patients with a stable course

started the treatment when the neurologic deficit was not severe. We

conclude that the efficacy of PE with other immunosuppressive theraples

in the stabilization of the neurologic deficit is uncertain.