Elsevier

Diseases of the Chest

Volume 52, Issue 3, September 1967, Pages 329-337
Diseases of the Chest

Primary Carcinomatous Cavities of the Lung; Possible Role of Neoplastic Cell Autophagism

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On the basis of 19 clinical observations made by the author and his co-workers, the syndrome of clinically primary or pseudocystic peripheral pulmonary carcinomatous cavities is described. This syndrome is to be distinguished from the better-known syndrome of “pulmonary cancer abscess.” The differential diagnoses of cavitary tuberculosis of the lung and pulmonary abscess are discussed, since one of these clinical forms may easily be confused with the others.

Moreover, the pathogenesis of these cavities of peripheral epitheliomas of the lung is examined and a new pathogenic hypothesis is proposed, regarding the possibility of the role of a “neoplastic cell autophagism,” due to a particular enzymic system, secreted by epithelial cells, like that which sometimes occurs in cases of pulmonary metastasis of pancreatic carcinomas.

Finally, the attention of pneumophthisiologists is drawn to the necessity of bearing this particular syndrome in mind, especially in cases of doubtful diagnosis of tuberculosis, or of pulmonary abscesses of anomalous course, in subjects of rather advanced age admitted to the santatorium. It is mandatory to subject them to necessary bronchologic and laboratory examinations and tests prompty, in order to solve the diagnostic difficulty and resort to pulmonary resection when necessary.

Section snippets

CASE 1—G. P., aged 62 years.

In July, 1959, the patient had cough and bloodstreaked sputum and was admitted to a sanatorium. A tuberculous cavity of the lower left lobe was diagnosed. Sputum was negative. The cavity was the size of an apricot and showed an indistinct margin. No adenopathies were noted, and the remaining pulmonary parenchyma was normal (Fig. 1). The patient was treated with streptomycin and isoniazid for some months, without success. A tomograph taken on January 20, 1960 showed the same thin-walled cavity

CLINICAL AND PATHOLOGIC CONSIDERATIONS

From observation of our case records, of which two have been given in a concise form, the following can be concluded:

  • 1)

    The carcinomatous cavity is formed early, occupying nearly all the neoplastic mass. It increases in volume slowly but progressively and is resistant to medical therapy; the margins of the cavity remain relatively thin, a pseudocystic type.

  • 2)

    In spite of the steady tumor growth, the stage of dense neoformation is not reached, but what dominates the x-ray picture is always the

RESUMEN

Sobre la base de 19 observaciones clínicas del autor y sus colaboradores se describe el síndrome clínico de la cavitación carcinomatosa primaria o pseudo-quística periferica. Este síndrome no debe ser confundido con el mas conocido de abceso pulmonar canceroso. El diagnóstico diferencial con las cavernas tuberculosas y con el abceso pulmonar es expuesto, ya que estas distintas entidades anatomo-clínicas se prestan a confusión.

La patogénia de estas cavitaciones periféricas carcinomatosas es

ZUSAMMENFASSUNG

Beschreibung des Syndroms klinisch erkennbarer primärer oder pseudozystischer peripherer pulmonaler karzinomatöser Kavernen auf der Grundlage von 19 klinischen, vom Autor und seinen Mitarbeitern gemachten Beobachtungen. Dieses Syndrom muβ unterschieden werden von dem besser bekannten Syndrom des “pulmonalen Krebsabszesses” und die Differentialdiagnose einer kavernösen Lungentuberkulose und eines Lungenabszesses werden diskutiert, da jede dieser klinischen Erscheinungsformen leicht miteinander

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Presented at the IX International Congress on Diseases of the Chest, Copenhagen, August 2025, 1966.

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