Small cell anaplastic carcinoma of the lung. A review of growth characteristics and implications for chemotherapy.

Small cell anaplastic lung cancer is increasingly considered to be potentially curable. The opinion that this tumor is a rapidly proliferating one has not been substantiated by kinetic studies, and for this reason late relapse may occur in complete remitters. Differential rates of response/relapse in different tumor sites may be explained on the basis of heterogeneity in tumor kinetics.

Skeletal manifestations in cutaneous T-cell lymphomas.

The clinical course of three patients with cutaneous T-cell lymphoma (CTCL) in whom skeletal disease developed is presented and the literature on skeletal involvement in these disorders is reviewed. Three separate types of skeletal manifestations occurred: (1) osteolytic lesions, (2) osteoblastic lesions, and (3) diffuse osteoporosis. Hypercalcemia was present in two cases. Tumor cells from two patients in short-term culture secreted osteoclast-activating factor(s). Both of these patients had pathologic evidence of osteoclast activation in bone sections. Thus, the tumor cells in certain patients with CTCL may derive from a monoclonal proliferation of a T-cell subset capable of producing humoral bone-resorbing factor(s) similar to those demonstrated in cultures of mitogen- and antigen-activated normal lymphocytes. Since skeletal lesions are unusual, it would follow that other T-cell subsets account for pathologic cell proliferation in most patients with CTCL.

Anaesthetic complications of mediastinal masses and superior vena caval obstruction.

Two patients with mediastinal tumour and superior vena caval obstruction who, after general anaesthesia, experienced respiratory difficulties requiring intubation or reintubation are presented. Possible aetiological mechanisms are discussed in relation to these cases.

Marijuana smoking and carcinoma of the tongue. Is there an association?

There is considerable theoretical evidence that marijuana should be carcinogenic. However, most reviews have found no direct evidence of chronic marijuana smoking causing lung cancer. Some recent reports implicate marijuana smoking as a cause of cancer of the upper aerodigestive tract, though most of the subjects were exposed to other, possibly confounding, etiologic factors, namely tobacco and alcohol. We report two cases of squamous cell carcinoma of the tongue in men who chronically smoked marijuana but had no other risk factors. The totality of cases may point to a predilection of marijuana smoke for carcinogenesis in the upper aerodigestive tract. This correlates with nonmalignant effects and may be related to a different method of smoking marijuana compared with tobacco.

Bone marrow necrosis diagnosed during life: clinical and laboratory features of extensive involvement.

Bone marrow necrosis occurred in two patients with non-Hodgkin's lymphoma. One had a four-year history of lymphoma for which he received combination chemotherapy. Severe bone pain, abdominal pain and fever occurred during the terminal part of his illness. The other patient presented initially with symptoms of bone pain and lymphadenopathy. At bone marrow examinations, both had anatomically extensive bone marrow necrosis with associated evidence of involvement by lymphoma. The previously recognized clinical features of bone marrow necrosis and its complications occurred in one or both of these illustrative cases, with the exception that bone tenderness was absent in both. Attempts were made to correlate the technetium-99m sulphur colloid scans with sites of disease as determined by the bone marrow examinations.

Growth rates of small cell bronchogenic carcinomas.

In reviewing a series of 144 patients with small cell bronchogenic carcinoma, 12 were found to have serially measurable roentgenographic lesions prior to therapy. Although caliper-based measurements and a silhouette cutout method gave comparable sets of tumor doubling time data, inter-observer variability was less with the silhouette cutout method. Tumor doubling times in small cell bronchogenic carcinoma ranged between 25 and 160 days, with a median of 77 days, a log mean of 81 days, and an arithmetic mean of 91 days. There was no apparent relation between tumor doubling time and tumor location, histologic subtype, response to therapy, or patient survival. The data indicate that small cell bronchogenic carcinoma of the lung is a relatively slowly growing tumor. Assuming that late subclinical disease exhibits growth characteristics that are similar to those seen in the clinical stages of growth, it can be estimated that residual body tumor burdens of 1 X 10(6) cells may be followed by tumor recurrence times of 2 years or longer; the likelihood of "cure" should not be entertained in patients with disease-free intervals shorter than 4-5 years.