Bronchogenic Carcinoma

A Clinicopathologic Study of Fifty Autopsied Cases

¹ The Department of Surgery and Department of Pathology, Letterman General Hospital, San Francisco, California.

There was an increase in the percentage of bronchogenic carcinoma as proved at autopsy at Letterman General Hospital from 1.2 in the decade 1920-1929 to 2.7 in the period 1940 through 1948.

The average duration of the disease was 11.7 months. The average duration for the squamous cell type was 13.6 months, the small cell type, 5.6 months, and the adenocarcinoma type, 21.5 months.

The onset of cough later in life or change in an already established cough was the most frequent first symptom. Fever and leukocytosis were common in cases of all cell types.

Positive evidence of a pulmonary lesion was present in all cases in which roentgenograms were taken. In 68 per cent this was in the form of parenchymal opacity, and in 20 per cent, of pleural effusion.

Bronchoscopic examination was done late in the course of the disease in many cases and exploratory thoracotomy in only four. It is suggested that earlier diagnoses would result if lesions which had not changed for the better in three weeks' time were investigated by bronchoscopy and by cytologic examination of sputa by the Papanicolaou method. If bronchoscopic examination is not decisive, it is believed that early thoracotomy is indicated.

The average delay in diagnosis was found to be approximately 7.5 months from the onset of symptoms. The patient's delay accounted for 6 months and the physician's delay for 1.5 months.

The squamous cell type of bronchogenic carcinoma predominated in this series with 44 per cent; the small cell type was second with 40 per cent, the adenocarcinoma type was third with 16 per cent. In six of the cases, a mixture of the three primary types was found.

Seventy-eight per cent of the tumors arose centrally.

Gross and microscopic features of each of the three tumor types are presented.