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histological examination of the resected lobe showed there was an adenocarcinoma ari- sen in intralobar bronchopulmonary seque- stration. In the second case, on the con- trary, the sequestration was occasionally found during the operation and the histo- logical diagnosis was malignant fibroistio- citoma. The analysis of these cases, besi- des being a simple report, gives rise to some considerations and pathogenetic hypo- theses.

The Bronchial Innervation and It's Pre- servation in Resective - Bronchial Tree. Morrone, G.F., Bordini, R., Fiacchi, M., Sette, P. Chirurgia Toracica Universit~ di Bologna, Italia.

Conservative tracheo-bronchial surgery is often accompanied with complications due to vascular and/or nervous interrup- tion. The troubles include mostly healing defects and secretion accumulation if the distal tracheo-broncopulmonary tract. Often there is also present an angioparalytic pulmonary edema. The phenomena are most- ly due to the interruption of the nervous fibers, especially vagal, directed to the distal respiratory tree. In order to pre- serve these fibers it is necessary to re- cognize their origin and distribution. From here, the necessity of a critical revision of anatomical data was executed on twenty adult corpses. The data found was adapted to the surgical field with improvement of the postoperative course. In fact the preservation of the vagus nerve produces a notable improvement of the postoperative course of conservative tracheobronchial surgery.

Variation Type of Tracheal TLunor (From the Point of Findings and Treatment). Takakura, H., Amemiya, R., Matsushima, Y., Chung, F.M., Koshiishi, Y., Taira, O., Hayashi, T., Oho, K., Hayata, Y. Depart- ment of Surgery, Tokyo Medical College Hospital.

We have experienced 14 tracheal tumors (4 adenoid cystic carcinoma, 4 squamous cell ca, i small cell ca, 2 mixed tumor, 1 hamartoma, 1 leiomyoma, and 1 schwannoma) from 1980 until the end of January 1985. Endoscopic findings were classified into three groups.

i) Submucosal type (e.g. adenoidcystic ca, leiomyoma, schwannoma, hamartoma etc)

2) Replacement type (e.g., sq cell ca ect)

3) Protrusion type (e.g., mixed type etc).

Protrusion type tumor might be able to be treated in the some way as a benign lesion, in these cases treatment by Nd-YAG

laser vaporization might be sufficient.

In the case of replacement type tumor, some kind of surgical treatment and ad-

juvant therapy could be required. In the sub-

mucosal type tumor group it was sometimes dif~ ficult to discriminate between benign and ma- lignant tumors and it is necessary to make a definitive histological diagnosis before treat- ment. Particularly in the case of adenoid cy- stic carcinoma the tumor invasion is sometimes present at quite a distance from the location of visually recognizable pathological changes, thus tracheal prosthesis should be prepared for operation. The endoscopic findings of se- veral types of tracheal lesion are reviewed treatment approaches are introduced based on endoscopic and roentgenologic findings.

Malignant Pleural Mesothelioma: A Continuing Diagnostic Problem.

This rare malignant neoplasm is frequently unrecognized clinically and pathologically. The first symptom is chest pain. Initial chest x-rays reveal a small or moderate amount of effusion fluid which often is not diagnostic. Chest pain becomes progressively more severe and persistent and the fluid becomes blood tinged or bloody. It is often diagnosed as po- sitive for malignant cells suggestive of meta- static adenocarcinoma. If all of the chest fluid is removed x-rays or CAT scan reveals a mass, nodularity or pleural thickening. If the fluid removed i~ not properly processed or is not diagnostic or if an inadequate biopsy is performed, the diagnosis may still be un- certain, With small samples, cytology and light microscopy may not yield a definitive diagno- sis. Additional work-up is therefore performed and when no primary tumor is detected in other organs, the patient is generally referred to a medical center.

Since 1956, more than 140 confirmed cases of mesothelioma have been reviewed. Pleural fluids, needle aspirations, open thoracotomy biopsies and pneumonectomy specimens were clas- sified as epithelial (50%), sarcomatous (10%), mixed (30%) and fibrous (10%). They were exa- mined by cytologic technique, histologic pre- parations including special histochemical stains and electron microscopy (EM).

The common symptoms, clinical findings, epi- demiologic data, histologic patterns and con- tributions of immunohistochemical stains and EM to the diagnosis will be discussed.

Endobronchial ~tastases of Non-Pulmonary Origin Diagnosed at Fiberoptic Bronchoscopy. Barber, P.V., Sutcliffe, N., Brear, S.G., Chetty, N. Wythenshawe Hospital, Manchester, U.K.

Metastases to the bronchial tree are un- common and most reports are of individual cases or small series. We have reviewed the clinical and pathological features of 22 patients with endobronchial metastases identified out of a total of 5060 endoscopic examinations over a

six year period. 15 patients were female and 7 male with a