Chest
Volume 101, Issue 6, June 1992, Pages 1610-1613
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Clinical Investigations
Bronchogenic Carcinoma in Patients with Pulmonary Histiocytosis X

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Five cases of bronchogenic carcinoma were observed among 93 patients with pulmonary histiocytosis X (Hx). Mean age at the time of diagnosis of Hx was 42 years; on the average, cancer occurred 10.5 years later. All patients were smokers and continued to smoke heavily at the time of diagnosis of cancer. Comparison of the five cases associating Hx and lung carcinoma with a group of 88 control patients suffering from Hx alone suggested that smoking played the predominant role in the pathogenesis of cancer. In fact, among the four patients with Hx and carcinoma older than 45 years, tobacco consumption was significantly greater (64.7 ± 37 pack-year, mean ± SD) than that of the 15 control patients of the same age with only Hx (40.8 ± 11.6, p<0.01). In light of this good correlation, the diagnosis of Hx strongly advocates stopping tobacco smoking and long-term medical follow-up.

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Patients with Bronchogenic Carcinoma (Table 1)

The mean age of our patients at the time of diagnosis of Hx was 42 years. Histiocytosis X was diagnosed either by open lung biopsy (four cases) or bone biopsy (one case). The chest roentgenogram was always abnormal, showing various associations of reticulation, cysts, and nodules, according to the classification of Basset et al.3 Bronchogenic carcinoma occurred 10.5 years on the average (range, 5 to 20 years) after the discovery of Hx. The type of carcinoma varied: squamous cell (patients 1 and

Discussion

Among the 93 cases of pulmonary Hx diagnosed, we observed the development of lung carcinoma in five patients after a mean Hx duration of 10.5 years. The annual bronchogenic carcinoma risk of 1,040/ 100,000 appears exceptionally high, lending support to the notion that patients with pulmonary Hx have a high risk of developing lung carcinoma. Moreover, since many of our patients were younger than 40 years old at the time of the last consultation, the observed rate of bronchogenic carcinoma

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    Manuscript received October 17, 1990; revision accepted September 16, 1991.

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