Oat Cell Carcinoma
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DIXIE
J. ARONBERG,1
STUART
Manifesting S. SAGEL,
R. GILBERT
Three cases of oat cell carcinoma appearing as a bronchocele on the chest radiograph are described. A bronchocele as the major radlologic manifestation of oat cell carcinoma has not been emphasized previously. Such a bronchocele may be filled with neoplastic cells rather than only inspissated mucus. Needle aspiration biopsy was definitive in two of the cases when conventional diagnostic methods failed.
A bronchocele filled bronchus appearance
may
be caused
a dilated
bronchocele
may
also
result
from
segmental
Case
experienced
history
of a productive
(fig.
or
filled
with both oat cell
neoplasm in an enlarged smaller hilar lymph nodes
2C)
weakness.
a mass density
defined
a well
Chest
radiography
near the left hilum.
circumscribed
2A and
Tomography
elliptical
with a bronchocele,
history
(figs left
perihilar
and left hilar lymph
node
Case 3 A 71-year-old man with a heavy smoking history had a productive cough and weight loss. Chest radiography (figs. 3A and 3B) demonstrated ovoid shadows adjacent to the left hilum.
Tomography
in the left posterior
defined a bilobulated density consistent with a bronchocele. bronchoscopy and washings lobe with
mass showed oat cell combined chemotherapy
oblique
projection
(fig.
3C)
radiating into the left upper lobe, Sputum analysis and fiberoptic were negative. Cytologic speci-
mens from a needle aspiration
biopsy
of the lobulated
left upper
carcinoma. The patient was treated and radiation therapy.
Discussion
The three cases described have in common the appearance on chest radiographs of lesions consistent with bronchocele formation Theoretically bronchoceles might be expected to occur in association with oat cell .
carcinoma frequently
since involves
festation
has
hensive
articles
cough
Received July 19, 1978; accepted after revision October 9, 1978. , All authors: Mallinckrodt Institute of Radiology, Washington University 63110. Address reprint requeststo 0. J. Aronberg. 132:23-25, January 1979 American Roentgen Ray Society
bronchus
Metastatic in several
enlargement. The major bronchi were patent. Sputum analysis and fiberoptic bronchoscopy and washings were negative. Bronchography demonstrated narrowing of the superior segment of the lingular bronchus, but brushings from the area were negative. Cytologic specimens from an aspiration needle biopsy of the bronchocele were positive for oat cell carcinoma. The patient was referred for radiation therapy.
These bronchial
cases
,
this type of the proximal
not
been
bronchogenic bronchi.
demonstrated
carcinoma Yet
in recent
this manicompre-
[5, 6].
emphasize
neoplasm
may
that not
bronchoceles
have
caused
a proximal
by
obstructing
mass within the reach of a fiberoptic bronchoscope. Histologic examination of the bronchocele in the first case revealed the unexpected finding of oat cell carcinoma mixed with mucus. Prior to this case, we had not used needle aspiration in the evaluation of a broncho-
major airways, and washings were negative. Bronchography (fig. iB) demonstrated nonfilling of the superior segmental bronchus of the lingula, corresponding to the region of bronchocele formation. Cytologic specimens from concomitant
© 1 979
G. LEVITT
man with a 100 pack per year smoking
mass, consistent
and night sweats. Chest radiography (fig. 1A) revealed oval densities in the left mid-lung field, suggestive of bronchocele formation, and an enlarged ductus lymph node. Sputum cytologies were negative. Fiberoptic bronchoscopy showed patent
AJR
segmental
marked
2B) revealed
Reports
man had a 4-week
superior
A 66-year-old
by ab-
1
A 54-year-old
ROBERT
Case 2
subsegmental bronchial occlusion caused by congenital atresia or inflammatory stricture. Although rare, bronchial neoplasm may be the underlying etiology of a bronchocele [2, 4]. In association with malignancy, a mucocele has been understood as a dilated mucus-filled bronchus distal to an obstructing mass. On the basis of the following cases, this concept should be enlarged to include tumor impaction within a bronchus. Recent reviews of oat cell carcinoma [5, 6] have not described a bronchocele as an initial radiographic feature. This report demonstrates that a bronchocele may be the sole finding or part of the tumor complex seen on radiographs in oat cell carcinoma. During the past 3 years, we have studied three such cases. During this same time period, two cases of bronchoceles associated with bronchogenic carcinoma of the squamous cell type were seen. In addition, we point out that such a bronchocele may be filled with neoplastic cells rather than only inspissated mucus, and that needle aspiration biopsy [7] can achieve a diagnosis when standard techniques (sputum analysis, fiberoptic bronchoscopy) fail. Case
AND
carcinoma and mucus. ductus lymph node and was also found.
normal or excessive mucus production, such as cystic fibrosis or bronchial asthma. In the latter condition, an allergic reaction to aspergillosis may be responsible for the excess mucus formation. Mucoid impaction is a term often used for bronchocele formation in which no anatomic obstruction is present. A
JOST,
brushing of this area under fluoroscopic control disclosed malignant cells (specific cell type could not be characterized). After a negative mediastinoscopy, thoracotomy with a left pneumonectomy was performed. The pathologic specimen showed
or bronchial mucocele is a dilated mucuswhich has a characteristic radiographic [1-3]. Bronchoceles
as a Bronchocele
cele,
School
23
assuming
of Medicine,
that
any
etiologic
510 South Kingshighway
obstructing
Boulevard,
neoplasm
St. Louis, Missouri
0361-803X/79/1321
-0023
$0.00
ARONBERG
Downloaded from www.ajronline.org by 190.5.158.129 on 11/14/15 from IP address 190.5.158.129. Copyright ARRS. For personal use only; all rights reserved
24
AJR:132,
ET AL.
January
1979
Fig. 1.-A, Oval densities in left mid lung field and enlarged ductus lymph node (arrow). B, Nonfilling of superior segment of lingular bronchus.
Fig. 2.-A, Left hilar mass with poorly defined consistent with bronchocele, adjacent to left hilar
density in mid adenopathy.
lung
would be too small to successfully biopsy. As cases 2 and 3 illustrate, needle aspiration biopsy may confirm neoplasm to be the cause of an observed bronchocele when standard diagnostic methods fail. We have used needle aspiration biopsy to establish a diagnosis in another
instance
(other than revealing. A specific be determined other
this
oat
bronchocele
when
due
other
to
B, Same hilar mass. C, Left
pected plated resection
prove
malignant thoracotomy of an
futile
were
frequently
carcinoma biopsy,
cannot
[6, 7]. Ascertaining
be
the
distinguished
cell
type
by
of a sus-
lung
field.
Fingerlike
density,
to a contemimportant, as almost always
[8].
REFERENCES
not
usually can even though
mid
pulmonary lesion prior may be extremely oat cell carcinoma will
malignancy
methods
1 . Lemire
diagnosis of oat cell by needle aspiration
cell types
method
of
cell)
field (arrow).
G: Bronchocele and blocked 110:687-693, 1970 AG, Forrest JV, Sagel SS: Roentgenographic recogof bronchoceles. South Med J 69: 1556-1558, 1976 LB, Gmelich JT, Liebow AA, Greenspan RH: The P, Trepanier
bronchiectasis.
2. Levitt nition 3. Talner
A, Hebert
AJR
Downloaded from www.ajronline.org by 190.5.158.129 on 11/14/15 from IP address 190.5.158.129. Copyright ARRS. For personal use only; all rights reserved
AJR:132,
January
OAT
1979
CELL
CARCINOMA
AS
BRONCHOCELE
25
L Fig. 3.-A, Hilar
Ovoid densities
adenopathy
syndrome
tion
with
of
anterior
bronchial
of the lung.
AJR
in left perihilar lobulated
mucocele
110:675-686,
region.
density
and
B, Hilar mass associated
extending
to lung
regional
hyperinfla-
periphery,
1970
4. Rees DO, Ruttley MST: The bronchocele in bronchial neoplasm. C!in Radio! 21:62-67, 1970 5. Byrd RB, Miller WE, Carr DT, Payne WS, Woolner LB: The roentgenographic appearance of small cell carcinoma of the bronchus. Mayo C!in Proc 43:337-341, 1968 6. Sinner WN, Sandstedt B: Small-cell carcinoma of the lung.
with oblong suggesting
density
in anterior
segment
of right
upper
lobe
(arrows).
C.
bronchocele.
Cytological,
roentgenologic,
secutive
series diagnosed
Radiology
1 21 : 269-274
7. Sagel SS, Forrest
and clinical
findings
by fine needle ,
in a con-
aspiration
biopsy.
1976
lung biopsy edited by Potchen EJ, Philadelphia, Saunders, 1976, p 22-69 8. Scannell JG: The problem of oat cell carcinoma. N EngI J techniques,
Med
JV: Fluoroscopically
in Special Procedures
282:98-99,
1970
assisted
in Chest
Radiology,
Downloaded from www.ajronline.org by 190.5.158.129 on 11/14/15 from IP address 190.5.158.129. Copyright ARRS. For personal use only; all rights reserved
DIXIE
J. ARONBERG,1
STUART
Manifesting S. SAGEL,
R. GILBERT
Three cases of oat cell carcinoma appearing as a bronchocele on the chest radiograph are described. A bronchocele as the major radlologic manifestation of oat cell carcinoma has not been emphasized previously. Such a bronchocele may be filled with neoplastic cells rather than only inspissated mucus. Needle aspiration biopsy was definitive in two of the cases when conventional diagnostic methods failed.
A bronchocele filled bronchus appearance
may
be caused
a dilated
bronchocele
may
also
result
from
segmental
Case
experienced
history
of a productive
(fig.
or
filled
with both oat cell
neoplasm in an enlarged smaller hilar lymph nodes
2C)
weakness.
a mass density
defined
a well
Chest
radiography
near the left hilum.
circumscribed
2A and
Tomography
elliptical
with a bronchocele,
history
(figs left
perihilar
and left hilar lymph
node
Case 3 A 71-year-old man with a heavy smoking history had a productive cough and weight loss. Chest radiography (figs. 3A and 3B) demonstrated ovoid shadows adjacent to the left hilum.
Tomography
in the left posterior
defined a bilobulated density consistent with a bronchocele. bronchoscopy and washings lobe with
mass showed oat cell combined chemotherapy
oblique
projection
(fig.
3C)
radiating into the left upper lobe, Sputum analysis and fiberoptic were negative. Cytologic speci-
mens from a needle aspiration
biopsy
of the lobulated
left upper
carcinoma. The patient was treated and radiation therapy.
Discussion
The three cases described have in common the appearance on chest radiographs of lesions consistent with bronchocele formation Theoretically bronchoceles might be expected to occur in association with oat cell .
carcinoma frequently
since involves
festation
has
hensive
articles
cough
Received July 19, 1978; accepted after revision October 9, 1978. , All authors: Mallinckrodt Institute of Radiology, Washington University 63110. Address reprint requeststo 0. J. Aronberg. 132:23-25, January 1979 American Roentgen Ray Society
bronchus
Metastatic in several
enlargement. The major bronchi were patent. Sputum analysis and fiberoptic bronchoscopy and washings were negative. Bronchography demonstrated narrowing of the superior segment of the lingular bronchus, but brushings from the area were negative. Cytologic specimens from an aspiration needle biopsy of the bronchocele were positive for oat cell carcinoma. The patient was referred for radiation therapy.
These bronchial
cases
,
this type of the proximal
not
been
bronchogenic bronchi.
demonstrated
carcinoma Yet
in recent
this manicompre-
[5, 6].
emphasize
neoplasm
may
that not
bronchoceles
have
caused
a proximal
by
obstructing
mass within the reach of a fiberoptic bronchoscope. Histologic examination of the bronchocele in the first case revealed the unexpected finding of oat cell carcinoma mixed with mucus. Prior to this case, we had not used needle aspiration in the evaluation of a broncho-
major airways, and washings were negative. Bronchography (fig. iB) demonstrated nonfilling of the superior segmental bronchus of the lingula, corresponding to the region of bronchocele formation. Cytologic specimens from concomitant
© 1 979
G. LEVITT
man with a 100 pack per year smoking
mass, consistent
and night sweats. Chest radiography (fig. 1A) revealed oval densities in the left mid-lung field, suggestive of bronchocele formation, and an enlarged ductus lymph node. Sputum cytologies were negative. Fiberoptic bronchoscopy showed patent
AJR
segmental
marked
2B) revealed
Reports
man had a 4-week
superior
A 66-year-old
by ab-
1
A 54-year-old
ROBERT
Case 2
subsegmental bronchial occlusion caused by congenital atresia or inflammatory stricture. Although rare, bronchial neoplasm may be the underlying etiology of a bronchocele [2, 4]. In association with malignancy, a mucocele has been understood as a dilated mucus-filled bronchus distal to an obstructing mass. On the basis of the following cases, this concept should be enlarged to include tumor impaction within a bronchus. Recent reviews of oat cell carcinoma [5, 6] have not described a bronchocele as an initial radiographic feature. This report demonstrates that a bronchocele may be the sole finding or part of the tumor complex seen on radiographs in oat cell carcinoma. During the past 3 years, we have studied three such cases. During this same time period, two cases of bronchoceles associated with bronchogenic carcinoma of the squamous cell type were seen. In addition, we point out that such a bronchocele may be filled with neoplastic cells rather than only inspissated mucus, and that needle aspiration biopsy [7] can achieve a diagnosis when standard techniques (sputum analysis, fiberoptic bronchoscopy) fail. Case
AND
carcinoma and mucus. ductus lymph node and was also found.
normal or excessive mucus production, such as cystic fibrosis or bronchial asthma. In the latter condition, an allergic reaction to aspergillosis may be responsible for the excess mucus formation. Mucoid impaction is a term often used for bronchocele formation in which no anatomic obstruction is present. A
JOST,
brushing of this area under fluoroscopic control disclosed malignant cells (specific cell type could not be characterized). After a negative mediastinoscopy, thoracotomy with a left pneumonectomy was performed. The pathologic specimen showed
or bronchial mucocele is a dilated mucuswhich has a characteristic radiographic [1-3]. Bronchoceles
as a Bronchocele
cele,
School
23
assuming
of Medicine,
that
any
etiologic
510 South Kingshighway
obstructing
Boulevard,
neoplasm
St. Louis, Missouri
0361-803X/79/1321
-0023
$0.00
ARONBERG
Downloaded from www.ajronline.org by 190.5.158.129 on 11/14/15 from IP address 190.5.158.129. Copyright ARRS. For personal use only; all rights reserved
24
AJR:132,
ET AL.
January
1979
Fig. 1.-A, Oval densities in left mid lung field and enlarged ductus lymph node (arrow). B, Nonfilling of superior segment of lingular bronchus.
Fig. 2.-A, Left hilar mass with poorly defined consistent with bronchocele, adjacent to left hilar
density in mid adenopathy.
lung
would be too small to successfully biopsy. As cases 2 and 3 illustrate, needle aspiration biopsy may confirm neoplasm to be the cause of an observed bronchocele when standard diagnostic methods fail. We have used needle aspiration biopsy to establish a diagnosis in another
instance
(other than revealing. A specific be determined other
this
oat
bronchocele
when
due
other
to
B, Same hilar mass. C, Left
pected plated resection
prove
malignant thoracotomy of an
futile
were
frequently
carcinoma biopsy,
cannot
[6, 7]. Ascertaining
be
the
distinguished
cell
type
by
of a sus-
lung
field.
Fingerlike
density,
to a contemimportant, as almost always
[8].
REFERENCES
not
usually can even though
mid
pulmonary lesion prior may be extremely oat cell carcinoma will
malignancy
methods
1 . Lemire
diagnosis of oat cell by needle aspiration
cell types
method
of
cell)
field (arrow).
G: Bronchocele and blocked 110:687-693, 1970 AG, Forrest JV, Sagel SS: Roentgenographic recogof bronchoceles. South Med J 69: 1556-1558, 1976 LB, Gmelich JT, Liebow AA, Greenspan RH: The P, Trepanier
bronchiectasis.
2. Levitt nition 3. Talner
A, Hebert
AJR
Downloaded from www.ajronline.org by 190.5.158.129 on 11/14/15 from IP address 190.5.158.129. Copyright ARRS. For personal use only; all rights reserved
AJR:132,
January
OAT
1979
CELL
CARCINOMA
AS
BRONCHOCELE
25
L Fig. 3.-A, Hilar
Ovoid densities
adenopathy
syndrome
tion
with
of
anterior
bronchial
of the lung.
AJR
in left perihilar lobulated
mucocele
110:675-686,
region.
density
and
B, Hilar mass associated
extending
to lung
regional
hyperinfla-
periphery,
1970
4. Rees DO, Ruttley MST: The bronchocele in bronchial neoplasm. C!in Radio! 21:62-67, 1970 5. Byrd RB, Miller WE, Carr DT, Payne WS, Woolner LB: The roentgenographic appearance of small cell carcinoma of the bronchus. Mayo C!in Proc 43:337-341, 1968 6. Sinner WN, Sandstedt B: Small-cell carcinoma of the lung.
with oblong suggesting
density
in anterior
segment
of right
upper
lobe
(arrows).
C.
bronchocele.
Cytological,
roentgenologic,
secutive
series diagnosed
Radiology
1 21 : 269-274
7. Sagel SS, Forrest
and clinical
findings
by fine needle ,
in a con-
aspiration
biopsy.
1976
lung biopsy edited by Potchen EJ, Philadelphia, Saunders, 1976, p 22-69 8. Scannell JG: The problem of oat cell carcinoma. N EngI J techniques,
Med
JV: Fluoroscopically
in Special Procedures
282:98-99,
1970
assisted
in Chest
Radiology,
