maintain a high index of suspicion in order to properly diagnose and treat this complication of lung cancer. Joseph. C. Koval, M.D., F.C.C.P,. Robert M. Curley,.
revealed almost
extensive totally
respiratory
failure
endobronchial tilation.
the
mens revealed well to 2,800 stmccessftmlly
lower
left
immediately
the carina brolnchi.
following
prolmpting
carcinoma. over
and
was instittmted.
delivered
fotmr
mechanical
yen-
biopsy
The
tumor
day’s;
the
pneumonia
therapy.
which
She
was
responded
again
qimickly
lower
lung
field.
Chest
x-ray
lower
lobe
the
that
climiiciamis
treating
these
especially’ in patients rhmring chemotherapy: Pii’ter
Brann
E. Postmus, L,unburg,
Hennie
M.D.;
MI).
and
,
C;, Russchen,
It!. 1).,
Univer.sity Groningen,
of a
hospital
Hospital
The
Netherlands
REFERENCES
in
Russchen Gil, Limburg AJ, Postmus PE. A pyrrhic victors’ in small cell lung cancer. Chest 1989; 95: 1331-32 2 AbeloffMD, Klastersky’J, Drings PD, Eagan lIT, Holsti L, Grecu FA, Mattson K, Postmus PE. Complications oftreatrnent of small cell carcinoma ofthe limng. Cancer Treat Rep 1983; 67:21-26 3 Sridhar KS, Barreras I, Saldana MJ, Manten II. Respiratory tract fisttmlae in recurrent aerodigestive cancers after chemotherapy Cancer 1988; 61:247-51 1
heard
showed
the
Cimrley
extimbated.
for ronchi
between
Esophagoscopy
and
was
cough.
examination
a fistula
bronchus.
Koval
responded
in the
prominent
lung markings in the right lower lobe. A barium contrast x-ray film of the esophagus (Fig 1)-shown in the right anterior oblique projection-demonstrated
with
Patients must be ass’are of this complication, (level(Iping infectiolns in the llasal lmmng parts
to intravenoims
to
1989 because of dysphagia and Her physical examination was remarkable
ttml)e indicated.’
agree
sped-
patient
and
admitted
celestin
ofa
\Ve
and
mechanical
The
ventilation
September,
right
and Acute
bronchoscopy
intubation
cCy
from
involving mainstem
was then begun using cisplatin and etop()side. 1989 the patient developed symptoms and signs lobe
antibiotic
and
radiotherapy small cell lung
weaned
Chemotherapy In August,
tumor
right
ensued
biolpsies, Emergent
right
endobronchial
occluding
esophagus
revealed
and
no
right
intraluminal
and the fistula could not be identified. The patient was with a percutaneotms gastrostomy tube for feeding and cytotox,ic therapy has been continued. Our patient differs from previously reported patients’2 in that she developed a bronchoesophageal fistimla while responding to) a tumor,
treated
combination
ofradiotherapy
and
chemotherapy’
that direct
extension
of SCLC
we postulate esophagus tumor
occurred
and
in response
to visualize
caused
a fistula
to combined
any
tumor
by a bulky
esophagus
that
modality
have
pressing
also
with
intol
shrinkage
therapy, stretching
and
with
necrosis
displacing
factor
A Diagnostic
the
imnable
wall
a contributing
Since
these
fistulae
are
are
almost
always
impossible
to prevent,
associated
and
with
fistula
morbidity’
pulmonary
C. Koval,
and
Mercy
and
Hospital
Taylor
Scranton,
Reprint
requests:
Dr
Kayo!,
S02jefferson
Ace,
Barreras
tract fistulae apy. Cancer
L,
in recurrent 1988;
aerodigestive
Manten
H.
cancers
after
in peripheral
bronchoscope
washing
addition
(,-()imld not patients
be
in
Respiratory
chemother-
61:247-51
cell
t(I
The are
patients
examples
without During this
described of a very
first
This metastases.
of chemotherapy;
a common
not
et al is the
in one
complication
workshop
was
by Russchen
majority’
in
IASLC
complication
induction
rare
radiotherapy, the
treated
by Koval and Cimrley- and Rtmsschen and
on small
reported. first
institution
the this
or
tumor.
ltmng cancer
in a series
developed
with
chemosensitive cell
Actually,
patient
who
et al
imu 1981,2
patient
of over
described 500
and
and
two
because
of patients,
centrally
Regarding
believe
it is not
patients
with small
the
justified cell
small located
low
cell with
incidence
to routinely lung
cancer.
lung
of fistula perform
Neither
cancer
mediastinal
is, lymph
in
revealed
malignant washing
remaining
14 patients, or
the
esophagosco)y’
is preventive
placement
40 percent.
was
reached
cells was
imu
eight in
in four
obtained
with
of
the
small
contrast,
it is interesting
patterns
were
positive
iy- this
and
coworkersM
while In the
reached
by complementary sensitivity,
with
post-bromichoscopy the
diagnosis
of malignancy analysis
sensitivity
significantly’
the
sputum,
specimens,
BAL
of 53
with
percent.
increases
diagnostic
imse of bronchial
washing
(p>O.05). of
three
patients,
methld.
patients
neoplastic
and two)
CHEST
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cell
not
find
diagnosis.
In
did with
By’ contrast,
radiologic lesions had similar to those reported found
we
to histologic
of four
BAL analysis,
diagnostic
LIatients with nodular test. Our results are Baglimi
on
percent),
in relation
that
specimens
percent).
overall
number
positivities
six small
of BAL (40
combined
sputum
of involvement.
adenocarcinomas, (26
of
not
the
a 80
patients
patients an
with
exceeding
12 patients
and
by- analysis
45 years
a peripherically-located
diagnostic
washings
was
analysis
was
The
all three procedtmres (Ibtains The addition of BAL does
exclusively
we
in
lesion Twenty-six
pattern
The
positive
surgery:
Since
in BAL
1 1
the diagnosis
by
exclusively
sensitivity’
showed
of
increased
of 30 patients
index
infiltrative
histology.
use ofhronchial
was
an
was
endobronchial
age
in
yield
bronchoscope.
mean
carcinomas,
mixed
l)ronchial
differences
node
formatiomi,
had
diagnostic
in a group
a Karnofsky’s
26 patients
four
with
women,
the
35 percent
sputtmm the
the
sensitivity through
and
ifthe
the
All had
The
report’
to determine
four
had epidermoid
Because
dimring
chemotherapy. is remarkable
and
analysed
be visualized
in one
post-bronchoscopy
75 years.
in Hodgkin’s
have
carcinoma.
cannot
through
lymphomam2
involvement
BAL cytologic analysis carcinoma in whom
plims post-bronchoscopy’
patients
complicati(In
and
Radiologically, or mass
combined
Editor:
tried
visimalized men
of 36
percent.
victory’
lung
were
range
PA 18510
(If
primary
that
specimens
lung
workers
lung
60 percent
study#{176}We have
llrOnchiaj
Few
lesions been
cytologic
in primary’ lung
fungoides. in peripheral
has
techniques To the
Neoplasmas
lavage)
imseful
of parenchymal
mycosis
achieved
Eleven
MJ,
diagnosis and
(bronchoalveolar
diagnostically
sensitivity
node
Saldana
for Lung
Location
of BAL
found
diagnostic
with
Pennsylvania
1 Russchen GH, Limburg AJ, Postmtms, PE. A pyrrhic small cell lung cancer. Chest 1989; 95: 1331-32 KS,
in the
by- the
REFERENCES
2 Sridhar
and
the
Hospital,
Scranton,
been
another
of Medicine,
Moses
has
disease’
M.D., F.C.C.P, M. Curley, DO,
Robert
a Peripheral
The analysis
infections
Department
Technique
the
for
resulting from aspiration of esophageal contents, the clinician mimst maintain a high index of suspicion in order to properly diagnose and treat this complication of lung cancer. Joseph
in Bronchoalveolar
To the Editor:
formation.
mortality
Cytologic Diagnosis Lavage Specimens
of the
we were
Esophageal
on,
been
Althoimgh
the lung
from
formed
by esophagoscopy.
timmor
may
for SCLC.
infiltrative
them
of
only
positive
five
of 26
a positive by
diagnostic Sineway et al.#{176}
imi nine
I 98 I 2 I AUGUST,
of
1990
1 1
BAL
513
