NYSA TI Single-Page 4
the )nehostion of fl find- many ueh as invade Fig, 7. Roentgen film of the chest showing a
Abstract
Fig, 7. Roentgen film of the chest showing a homogeneous, semicircular density with smooth borders in the right ~mt and second interspaces, adjacent to the mediastinal structures. There is no other pare~chymal involvement.
Fields
- Named Organization
- American College of Chest Physicians
- American Journal of Physiology (scientific periodical)
- American Review of Respiratory Diseases (scientific periodical)
- Archives (National Archives and Records Administration)
- Brompton Hospital
- Bureau of the Census
- Charity Hospital (New Orleans)
- Chronic Disease Control
- City Hospital (California)
- Columbia University
- Committee on Interstate and Foreign Commerce
- *Department of Health, Education, and Welfare (HEW) (use United States Departmen (use @hew_dept)
- Doctors Hospital (Coral Gables)
- Food and Drug Administration (FDA)
- Lancet
- Memorial Hospital
- National Tuberculosis Association
- New York Academy of Medicine
- New York Medical College
- Singer
- Tobacco Institute (Industry Trade Association)The purpose of the Institute was to defeat legislation unfavorable to the industry, put a positive spin on the tobacco industry, bolster the industry's credibility with legislators and the public, and help maintain the controversy over "the primary issue" (the health issue).
- Named Person
- Basch, Van
- Beck, Irene
- Bernard, Claude
- Blanchard, Lea
- Collier, Fred
- Flint, Austin
- Forbes, John
- Horse, Royal
- Jackson, Chevalier (Research on incidents of lung cancer)
- Jenkins, William D. (CTR Asst. Secretary)Defense
- Jenner, William
- Johnson, Samuel
- Kloepfer, William J., Jr. (TI Public Affairs VP, c. 1988)Senior Vice President of Public Affairs Relations for the Tobacco Institute
- Lisa, James R.
- Passey, Richard Douglas (Professor, Dir. of Cancer Research, England Univ.)British cancer researcher, London's Chester Beatty Research Institute, 28 August 1888-1 September 1971
- Pike, M.C.
- Ros, Milton B.
- Rose, Milton B.
- Rosenblatt, Milton B.
- Stokes, William
- Teng, Peter
- Teng, Peter K.
- Trinidad, Salvador S.
- Turell, Robert
- Master ID
- TI09781644-3113
- TI09781644 DHEW Publication No. (NIH) 74-544 DEPARTMENT OF HEALTH, EDUCATION AND WELFARE Public Health Service
- TI09781828 Indermight
- TI09782012
- TI09782196
- TI09782380 f_or (a mm_ si_ _Ung a fall). t_m_ of t_ _vid_
- TI09782564 4- Reading an A_erican magazine recently, I cane across a state=ent about what is happening in
- TI09782932 0 I_f. B. Rosenblat'r
Related Documents:
Document Images
the
)nehos-
tion of
fl find-
" many
ueh as
invade
Fig, 7. Roentgen film of the chest showing a homogeneous, semicircular density with smooth
borders in the right ~mt and second interspaces, adjacent to the mediastinal structures. There
is no other pare~chymal involvement.
the bronchi, but the eli~ical implications
o~ this observation have ~ever been fully
appreciated. In 1940, Peary~ emphasized
that ma|i~nant involvemen~ o| the bren-
ehial mucosa was ~ot an absolu÷~e crit~ion
o.f primary origin and that its occurrence
in both primary and seeondary cancers
presented a potential source of dia~.ostic
error. King and Castleman,~ in 1943 in an
autopsy study of pulmonary metastases,
found that 18 per cent had invaded the
bronehL These pathological obsexvations
were reflected in surgical studies of solitary
pulmonary metastases which had been
erroneously dia~oeed prior to explorstory
thoracotomy as bronch~enic carcino~nas.
T109782748
558
F|g, 8, Roentgen film of the che~ showi~ a fairly homoge~eou~ deasi~y occupying the
major portion of the left upper lobe. The heart and meciia~ti~ai structures appear slightly
retracted to the left. There is no other pa~enehymal involvement.
Abbott~ reported 13 cases of endobronchia!
metastases imitating bronchoEenic carci-
noma. Seller/4 ia a eolleeted series of 62
eases of metastatic pulmonary carcinoma,
found bronchial involvement no~d in 17
(27 per cent) instances and estimated that
the true percentage was probaMy hetween
~5 and 40 per cent. In 10 {59 per cent} of
the 17 cases with bronchial involvement,
bronchial biopsy had been positive..
Metastatic tumors invading bronchi ac-
cessible to bronchoseopie visualization may
produce gro~ changes indisting'~able
from bronchogenic carcinoma.. Secondary
growths may projeo~ into the bronchial
lumen as polypoid masses, may produce
~enosis with s~cendary distal infection, or
may cause e.xte~nsive ulceration of the bron-
chial mucesa. Unless the bronchial biopsy
reveals histologic features characteristic of
I~RONCHOG~
.~.,.:-2
upper
a prima'.
may be
choseopi~
histolo~i~
are infall
lioma r~
Figure
the wall
T109782749
may
able
duce
~1~ or
ffon-
opsy
ic of
BitOK~IC CAmC~O~A
Fig. 9. Roentgen film of the che~t showing a large, homogeneous de~ity occupying the
upper lateral portion of the right upper lobe. There is no other parencbyma| involvement.
a primary malignancy elsewhere, an er-
roneous diagnosis el primary, lung eancex
may be made. The assumption that bron-
choscopic visualization of a tumor and
histolog~e confirmation of malignant tissue
are in£allible crit~eria of bronchogenic carci-
noma requires modification.
Figure 10 shows metastatic inva~on of
the wall of a bronchus with ulceration into
the lumen. The~normal bronchial structures
have been replaced by mali~ant tissue
except for a small ares where the columnar
epithelium is still intact. The malignant
cells are exfoliating into the bronchial
lumen. T~e primary lesion wa~ a carcinoma
of the adrenal.
Figure 11 shows ~omplete replacement
of the bronchial muco~a by metastatic in-
I
!
TI09782750
F~¢. I~o Metastatic ulceration of the b~onchial wall from a ca~inoma of the ~naL The
norm~ bro~hhl structures have been mpla~d by maH~ant cel~ yawing considerably in
size and shape. There are numerous m~Itinucleated gla~t celb p~st. The mallgn~g cel~
a~ exfoliatlag in~ the bmncMal lumen. A small am of columnar epiLhelium remai~ intact.
vasion from a carcinoma of the head of the
pancreas. The malignant tissue has formed
a thick layer encircling the bronchus and
extending down to the cartilage. The histo-
logical appearance of the bronchial
tastasis does not identify the primary site.
CYTOLOGIC FINDINGS
The diagnosis of primary lung cancer by
examination of the sputum has been
tempted for more than a century. The early
efforts were ba_sed on t.he finding of frag-
merits of malignant tissue in the sputum.
In the 1930's, staining technics were de-
veloped which facilitated cytological ex-
amination, but the procedure was limited
to research studies. In 1943, Papanicolaou
perfected a staining process which clearly
delineated exfotiated cells. The technic was
originally intended for gynecological in-
vestigation but soon became applicable to
the examination of sputum and bronchial
aspirates, .Accumulated experience has
demonstrated a high degree of accuracy in
Fit
from
layer
the iden
and the
cells is I
of the di
In case.,
cessible
p~tlve
been the
a definit
The i
aminatk
that the
T109782751
The
.b|y in
e sputum.
were de-
o~ical ex-
ae limited
panicol~,ou
,oh clearly
ethnic wns
topical in-
plie~ble t~
• bronchial
~ence h~
Lecuracy in
F3~. II. MMignaat replacement of the entire bronchial muco~ by metastatic invnsion
from ~ carcinoma of the pancreas. The proliferating tumor cells have formed a very thick
l~,yer which extsnds to the level of the carti|aZes. There is exfoEation ot the mn|ignant cells
into the bronchial h~mem
the identification of cancer cells in smears,
and the presence of mali~;nant epithdial
ca|is is ~enerai]y a~cep~ed as confirmation
of the diagnosis o~ bronchogenic carcinoma.
In cases in which the tumors are inac-
cessible to bronchoscopic visualization, the
positive cytologicM i~nd/ngs have often
sputum and bronchial aspirate is indica-
tive of cancer of the lung but does not
specify whether the cancer is primary or
secondary. In primary lun~ cancers
li~,,nant ceils may be desquamated which
have either a squamous or mucous secre~
ing appearance depending on the site of
been the only clinical means of establishing- origin. Metastatic cancers producing ul-
a definite diagnosis, cerafion of the bronchi may
exfoIiate ma-
The importance of the ~yto|o~ical ex- li~nant cells which simulate those
found in
amination m~kes it necessary to emphasise bronchogenic cancer~
Undifferentiated can-
that the ~resence of cancer cells in the cer cells from glandular tumors
often
562
TRINIDAD~ LL:.~-~ A.~D P.OSESBLAT~
C~
/~ig. 12. Sputum smears showing de.~uamated ci|iated columnar epithelial cel~s in variou~
stages of ¢legenerat,/on. (Cilioeytophthoria.) a: Coatra~ed epithelia! cell showing l~'knotlc
n~ele~s asd inehtsi~a bodies in the cytoplasm, b: Elongated epithelial cell _~howing eoatrscted
~tele~, k~s ~f eilig, amt svv~-al ~ell-defi~ed iaelu~0~ bedies in the eytop~. ¢: Ciliated
prese~ ia the ~. d: Contracted veil sb, o~v:mg chining of the nuclear ehromati~
~ith~ the m~r membcm~. There are a fe~ imrb.~oa bodes present in t~e .eytop~m.
feat
indistin
primar)
cus in
re.aria
bronchi
well as
and m,
d}fficult
The fin
or cel~
bmncl~
T109782753
natin
Fig. 13. SectioR of cervical lymph node showing malignant epithelial cells with ~quamous
features arTavged in clusters and shcet~.
have a squamoid appearance and may be
indistinguishable from those occurring in
primary lung cancer. The presence of mu-
cus in the desquamated cells has no dif-
ferential value because ~ is found in
bronchiologenic (alveolar cell) tumors as
well as in metastatic loci from glandular
tumors. Differentiation between primary
and mvtastatic ma~ignan~f is extremely
difficult on the bas/s of cytological studies.
Tb~ finding of keratini~ed squamous cells
or cells in pearl formation would sugges~
bronehogenie origin i[ tumors arising from
squamous tissue can be excluded.
Cytological examination of the sputum
in bronchogenic carcinoma cases often
shows bronchial epithelial cells in various
stages of degeneration. Papanicolaou~s
found these epithelial changes, de~signated
as eilioeytophthoria, in other pulmonary
conditions, but he was impressed with the
frequent occurrence in lung cancer. The
degenerative changes in the ciliated colum-
nar cells are fairly specific (figure 12),
occurring in three main types: (I) pykno-
sis, characterized by condensation of the
nuclear chromatin network; (2) clumping,
in which the chromatin is redistributed
TI09782754
~4
Fig. 14~ Section from the p~ncmas showi~z mMignant cpithe|ial ca|Is arranged ~n typical
ductal pattern. (~ame case as shown in figure 13.)
is a common occurrence in bmnchogenic
caxcinoma but may also r~sult from meta-
static invasion of the bronchial mucosa.
The finding of ciliocytophthoria forms has
no sig~dficance in differentiation between
primary and secondary cancer of the lung.
LYMPH NODE BIOPSY
The diagnosis of bronchogenic carcinoma
has often been established on the basis of
histological findings in a metastatic Lymph
node. Biopsy of nodes from the cervical,
axillary, or other accessible areas fre-
quently provide the only source of patho-
i~to clusters or a ring-|ike arrangement
near the nuclear membrane; and (3) tufts,
consisting of ~tlular fr~gmen~ ~u~ning
cilia and anuclea~d cy~plasm. Rosen-
blatt et aZ.,~ ~ing Papa~eolaou's ~h~o,
confirmed the high in,dance of ci~iocy~-
ph~o~a in viral infec~o~ ~d bmncho-
~c c~cinoma, but ~ a~ f~d it ~
occur in ~ per c~t of the ~ of me~
s~c puimonary caner. The pre~ce o~
ciliocytophthoria forms in ~e sputum is
~di~ve of ~ e~elio~pic
~sul~ng in ~e d~ua~tion of ~mn~
ep]~elium. ~oHa~ of ~e~al
Fig. 3
of norm,
' d~agnostic
tza~ndicate~
peribronchi
for diagno~
procedure:
eases in wl
mor preclu
c/sed lymp
of tissue fo~
In the r
structure o
T109782755
:pical
~chogenic
~nl
orm~ has
betwee~
as lung.
:areinoma
.~ basis of
tic lymph
cervical,
of
Fig. 15. Section from cervical lymph node ia ca~e of lymphosarcoma showing replacement
of normal structures by malignant small round cells resembling the histologica! features of
oat-cell carcinoma.
logical confirmation in cases where other
diagnostic measures are negative or con-
traindicated. Excision of paratracheal,
peribronchial, or subcarinal lymph nodes
for diagnostic purposes is also a common
procedure in explorat~ thorsootomy. In
cases in which extensive spread of the
moz precludes definitive surgery, ~e ex-
cised lymph node may be the only source
of tissue for histological study.
In the majority of h~stanees the
s~ructure of the exc'~_,d metastatic lymph
node resembles that of the primary tumor
readily assuring identification. It has also
been found, however, that lymph node
metastases may exhibit p~eomorphic fea-
tures which are a source of diagnostic error.
Metastatic nodes from ductal or glandular
~umors, such as carcinomas of the pan-
cress, may show histological findings com-
patible with the diagnosis of sqtmmous
carcinoma.
Figure 13 shows a resected cervical node
in which the normal architecture has been
T1097827,56
566
arranged i~ ~heets.
completely replaced by clusters ol malig-
nant epitheliaI cells resembling squamous
cells.
Figure 14 shows the primary tremor in
t~e pancreas with an entirely different
cellular structure. The hyperchromatic ma-
lignant cells are arranged in a ~ypi~al
ducta| pattern and there is no similarity
to the metastasis in lymph nodes. The diag-
nosis in the case prior to autopsy had been
bro~ehogenic carcinoma based on clinical
rand roentgen finding~ apparently confirmed
by lymph node biopsy.
The similarities in appearance beLween
the cat, cell type of bronchogenie carcinoma
and lymphosarcoma have been responsible
for considerable confusion in the diagnosis
of both conditions, In the latter decades o.f
the nineteenth century and early decades
of the twentieth century, the oat-cell car-
cinom~ had been considered a form of
sarcoma. Barnard~ in 1926 established the
bronchial origin of the oat-cell tumors but
diagnostic errors continued to be made.
Figure 15 shows an excised cervical
lymph node in which the normal structure
is replaced by malii~nant, small round cells
with hyper~hromatic nuclei. The diag-
had
roem
petit
inva
T!
may
in bi
Tl)e
i~ li~t
T109782757
