Sputum cytology in the management of patients with lung cancer.

Although more informative and precise diagnostic methods have become available, cytologic analysis of sputum is still considered the first step in evaluating bronchogenic carcinoma. We hypothesized that the cost of sputum examinations far outweighed their usefulness in actual patient management. To substantiate this, we retrospectively reviewed the charts of 190 patients with lung cancer who had sputum cytology done at Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas, during the period January 1981 to June 1982. Twenty-three percent of our patients had at least one sputum sample positive for malignant disease, but in only four patients (2%) was bronchoscopy or another procedure avoided by sputum analysis. In most patients with bronchogenic carcinoma diagnosed by sputum cytology, additional invasive diagnostic procedures are not avoided because they are often necessary to stage the disease process. These additional procedures, done for staging, also provide the histologic diagnosis in the majority of patients. Fiberoptic bronchoscopy most frequently provided the diagnosis regardless of positive sputum cytology in our patients, and there was no associated mortality or serious morbidity.

Aggressive diagnostic approach indicated in testicular sarcoidosis.

A twenty-nine-year-old black male presented with a testicular mass and hilar adenopathy. Histologic sections of the testis showed the 3 by 2 by 2-cm mass was an inflammatory granuloma due to sarcoidosis. The epididymides were involved bilaterally. The initial differential diagnosis included: sarcoidosis, testicular neoplasm, an infectious process, or a combination of the three. Biopsy of the testicle is recommended to confirm the diagnosis of sarcoidosis. We believe there are only 6 reported cases of clinically detected testicular sarcoidosis.

Mycobacterium simiae. Clinical features and follow-up of twenty-four patients.

The charts of twenty-four patients from whom Mycobacterium simiae was isolated from the sputum were reviewed and the patients seen in follow-up examination when possible. They were divided into 3 groups: 2 patients were felt to have had definite infection with M. simiae, 3 were felt to have had probable infection, and 19 showed no evidence of infection during follow-up for as long as 6 yr. All patients in the study had underlying pulmonary abnormalities. The results of PPD skin tests were negative in patients without evidence of tuberculosis. The patients without evidence of M. simiae infection were found to have had negative initial Acid Fast Bacillus smears, fewer sputum cultures positive for M. simiae, and lighter yields from cultures of M. simiae compared with those in the patients with M. simiae infection. We conclude that M. simiae is a nontuberculous mycobacterium capable of causing progressive granulomatous lung infection, but that it may also be identified as a causal isolate from the sputum of susceptible persons. Antituberculosis chemotherapy should not be employed in this latter group.