Metastatic tumors of the lung.

From a clinician’s viewpoint, carcinomatous pulmonary metastases are still discouraging entities. With the remarkable strides in producing regressive changes of metastatic breast and prostatic carcinoma with hormonal therapy, and the ever widening vista of therapeutic results with artificial radioactive substances, it behooves all of us to re-examine our fundamental knowledge of pulmonary metastases. All too often we become pessimistic about carcinoma and especially about metastases, not realizing that we must be soundly prepared in our diagnostic approach to these conditions for the time when we will have sounder therapeutic aids to handle these overwhelming conditions. It is almost heresy to say today that results may be anticipated in pulmonary metastases. Yet, all of us recall that only a short time ago subacute bacterial endocarditis, pneumococcal meningitis, congenital cardiac disorders, pulmonary carcinoma and a horde of other fatal diseases were considered incurable. Now these are being treated with astonishing success in all centers of the world. Can we then dismiss pulmonary metastases with hittel foresight? Or shall we examine closely the etiologies, avenues of transmission, clinical and roentgen manifestations of pulmonary metastases and then cautiously approach and await potential strokes of repair? The question frequently arises, how often do primary lesions of the various organs metastasize to the lung? In an extensive review of over 1300 cases, Turner and Jaffe5hist the incidence of lung metastases as in Table 1. Thus it may be said that the relative frequency of metastases to the hung from malignancies of all organs is approximately 25 per cent. In more simple terms, if a patient has a malignancy there is one chance out of four that he or she will have pulmonary metastases. Further, using rough percentage figures, all neuromuscular, skeletal, glandular, and hemopoietlc primary malIgnancies metastasize 50 per cent of the time. All urinary tract, male and female genital organs, gastrointestinal, and respiratory tract