Bronchial Tumors Research Articles

Anaesthetic management of left main bronchial glomus tumour.

Glomus tumours involving bronchus are rare. Surgical resection is the treatment of choice for this tumour, with excellent prognosis. The nature and location of tumour pose a significant challenge for perioperative anaesthetic management. However, there is a paucity of case reports on anaesthetic risks involved in case of a bronchial glomus tumour. We present a case of glomus tumour involving left main stem bronchus, subjected to bronchial sleeve resection. The various anaesthetic implications of this tumour type and airway management with right double lumen tube are discussed.

Interventional endoscopy for tracheal and bronchial tumors

Interventional endoscopy for tracheal and bronchial tumors

気管支上皮内進展を来しポリープ様に認められた大細胞神経内分泌癌の1例

症例は80歳男性，現喫煙者．気管支喘息で加療中に呼吸困難，咳嗽を自覚した．胸部CTで右主気管支内腔に軟部陰影を認め，気管支鏡検査で右主気管支入口部に有茎性ポリープを認めた．Polypectomy標本の病理像から大細胞神経内分泌癌が考えられた．化学療法CBDCA＋VP-16を先行後，右上葉切除を行い，術後化学療法を施行した．中枢気管支発症の大細胞神経内分泌癌は極めて稀であり，発育機序も含め考察する．

Surgical interventions with tracheal bifurcation circular resection in bronchial cancer treatment

To evaluate results of circular resection and carina reconstruction in patients with bronchial cancer. Study included 82 patients with bronchial malignant tumors operated for the period from 1998 to 2014. Mean age was 56±1.1 years (range 24-75). There were 75 men and 7 women. Squamous cell carcinoma, adenocarcinoma, dimorphic cancer, carcinoid, adenocystic cancer, small cell cancer and clear cell renal cancer were observed in 66, 9, 1, 3, 1, 1 and 1 patients respectively. Stages IIB, IIIA, IIIB and IV were determined in 5 (6.2%), 45 (56.3%), 28 (35%) and 2 (2.5%) patients respectively. Tracheal carina resection was combined with right-sided pneumonectomy in 62 (75.6%) patients, left-sided pneumonectomy - in 5 (6.1%) cases, right upper lobectomy - in 10 (12.2%) cases. 3 patients underwent carina resection alone. Plasty with bronchopulmonary segment of right upper lobe was applied in 2 cases. Since 2002 primary bronhomyoplasty using m.latiss.dorsi, m.intercostalis and m.serr.anterior flaps has been used in 64 patients. Postoperative complications occurred in 31.7% (26) of patients. In-hospital mortality was 10.1%. Use of primary bronhomyoplasty and head adduction reduced broncho-pleural fistula incidence and mortality (p<0.05). Long-term results in T3-T4N0 tumors were significantly better compared with T3-4N1-2 tumors (5-year survival 41.2 vs. 16.8%, p<0,05). Results of resection with carina reconstruction may be improved using primary bronhomyoplasty and is associated with satisfactory long-term results in patients with N0-tumors.

Bronchial Foreign Body Alerting of a Bronchial Tumor: The Need of a Follow-Up Radiography.

Lung tumors are extremely rare in the pediatric population, comprising only 0.2% of all malignancies in children. Among them, mucoepidermoid carcinoma (MEC) is even rarer with a reported frequency of 0.1% to 0.2%. MEC is defined by the World Health Organization as a tumor characterized by a combination of mucus-secreting, squamous, and intermediate cell types. We describe the case of a 4-year-old girl who presented with a history of intermittent fever and nonproductive cough of 1-month duration after foreign body aspiration. The chest X-ray showed complete collapse of the left lung. After removal of the foreign body, the lung expanded well after. However, the control chest X-ray done after 5 days showed again complete collapse of the left lung. The biopsy specimen taken during bronchoscopy confirmed the diagnosis of low-grade MEC. Fluorescence in situ hybridization (FISH) confirmed the presence of MAML2 rearrangement. Complete surgical resection with preservation of lung parenchyma was performed. No adjuvant therapy was needed. Repeat bronchoscopy was performed 2 months after surgery and showed no recurrence of the tumor. In conclusion, a remote chest X-ray after removal of a foreign body is necessary to avoid missing a rare serious underlying disease such as MEC. According to the size and the location of the tumor, complete surgical removal is sufficient without additional treatment in case of low-grade tumor. The presence of MAML2 rearrangement confers a favorable outcome and may have long-term implications for the clinical management.

Bilobectomy in non-small cell lung carcinoma: an analysis of indications and outcome with a review of the literature

Background: The gold standard of treatment for non-small cell lung cancer (NSCLC) is anatomic pulmonary resection. Wider resection methods may be preferred due to the size or anatomic location of the tumor. One method of choice is bilobectomy due of the anatomy of the right lung. Materials and Methods: This study retrospectively analyzed 93 patients who were diagnosed with NSCLC and had bilobectomy, complete resection, and mediastinal lymph node dissection at our center between January 2005 and April 2013. Results: Forty-seven patients underwent superior bilobectomy (sBL), and 46 patients underwent inferior bilobectomy (iBL). Bilobectomy was performed due to fissure invasion in 51 (58.1%) patients, internal or external bronchial tumor invasion in 31 (33.3%) patients, external bronchial lymph node invasion in six (6.4%) patients, and vascular invasion in two (2.2%) patients. The bronchial invasion-based indications were significantly higher in the iBL group compared to the fissure invasion-based indications in the sBL group (P < 0.001). Conclusions: Bilobectomy leads to a substantial amount of parenchymal loss in the right lung, but it is a procedure that should be performed under the necessary conditions. It is obvious that performing bilobectomy under proper indications would result in good outcomes for lung cancer patients.

Argon-laser ablation is a new method of airways recanalization for tumoral stenosis

To develop the new method of laser recanalization of airways for tumoral stenosis. It is proposed to conduct laser effect in the gas environment that does not support combustion (argon). Also the device for these AIM: is suggested. The method is called argon-laser ablation (ALA). A comparison of ALA and conventional high-energy laser exposure (LPD) was performed. ALA and LPD were used in 46 patients and 17 patients with non-small cell lung cancer. The duration of endobronchial operations and incidence of complications were significantly higher in group 2. The incidence of complete remission was significantly higher in group 1. Endobronchial argon-laser ablation of tracheal and bronchial tumors removes exophytic tumoral component in more favorable conditions compared with conventional high-energy laser exposure. Also it significantly increases an efficiency and reduces the frequency of complications.

Biopsy testing in an inoperable, non-small cell lung cancer population-a retrospective, real-life study in Sweden.

Correct diagnosis and staging are required for optimal treatment choice in lung cancer patients. This retrospective, patient medical records study investigated the clinical practice of lung cancer biopsy procedures and testing in Sweden. Consecutive patients with a recorded inoperable, malignant tumour of bronchus and lung were retrospectively identified at geographically widespread pulmonology clinics (NCT01139619). Data, including diagnostic sampling methodology [bronchoscopy, biopsy by pulmonologist and computed tomography (CT)-guided biopsy], were collected for patients diagnosed between 1 June 2009-31 May 2010, and analysed using descriptive statistics. A study-predefined algorithm, including six criteria on tumour localization and size, forced expiratory volume in one second (FEV1), blood saturation and risk of bleeding theoretically categorizing patient suitability for CT-guided biopsy, was used. In total, 132 patients (mean age 68 years, 48% women, 61% adenocarcinoma, 86% current/ former smokers, 96% performance status ≤2, mean FEV1 volume ≥2 L) were included. The majority were examined by >1 diagnostic procedure (29% by CT-guided biopsy). Median overall time from first hospital contact to established diagnosis was 12.0 days (10.0 and 28.0 days for bronchoscopy and CT-guided biopsy, respectively). No major differences in lung function, age, performance status or predefined algorithm criteria were noted for patients examined by CT-guided biopsy versus bronchoscopy or biopsy. Complications were reported for 11 patients, including pneumothorax in six patients. Histopathology was used most frequently to diagnose and subtype (70%), although 66% of patients examined solely by bronchoscopy were diagnosed by cytology. For 26.5% of patients, epidermal growth factor receptor (EGFR) mutation testing was recorded. No limitations regarding patient suitability or methodological complications were noted in this real-life, observational study. The CT-guided biopsy is a relatively safe and well-established method, and may need to be utilized further to fulfil current and future demands for faster diagnosis and high quality tissue as new tumour markers and targeted therapies become available.

Single-port thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction.

We describe herein a case of single-port thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction. A 66-year-old male patient had a right main bronchial tumor longer than 12 months, who had been received endobronchial cryosurgery twice before. However, the tumor relapsed quickly. Then the patient transferred to our department. He was underwent a single-port complete thoracoscopic right main bronchial tumor sleeve resection and secondary carinal reconstruction. He recovered smoothly, without any perioperative complications. On the 5th postoperative day (POD), he was discharged in good condition.

Unraveling the intrafamilial correlations and heritability of tumor types in MEN1: a Groupe d'étude des Tumeurs Endocrines study.

MEN1, which is secondary to the mutation of the MEN1 gene, is a rare autosomal-dominant disease that predisposes mutation carriers to endocrine tumors. Most studies demonstrated the absence of direct genotype-phenotype correlations. The existence of a higher risk of death in the Groupe d'étude des Tumeurs Endocrines-cohort associated with a mutation in the JunD interacting domain suggests heterogeneity across families in disease expressivity. This study aims to assess the existence of modifying genetic factors by estimating the intrafamilial correlations and heritability of the six main tumor types in MEN1. The study included 797 patients from 265 kindred and studied seven phenotypic criteria: parathyroid and pancreatic neuroendocrine tumors (NETs) and pituitary, adrenal, bronchial, and thymic (thNET) tumors and the presence of metastasis. Intrafamilial correlations and heritability estimates were calculated from family tree data using specific validated statistical analysis software. Intrafamilial correlations were significant and decreased along parental degrees distance for pituitary, adrenal and thNETs. The heritability of these three tumor types was consistently strong and significant with 64% (s.e.m.=0.13; P<0.001) for pituitary tumor, 65% (s.e.m.=0.21; P<0.001) for adrenal tumors, and 97% (s.e.m.=0.41; P=0.006) for thNETs. The present study shows the existence of modifying genetic factors for thymus, adrenal, and pituitary MEN1 tumor types. The identification of at-risk subgroups of individuals within cohorts is the first step toward personalization of care. Next generation sequencing on this subset of tumors will help identify the molecular basis of MEN1 variable genetic expressivity.

Diagnostic Value of Multidetector CT and Its Multiplanar Reformation, Volume Rendering and Virtual Bronchoscopy Postprocessing Techniques for Primary Trachea and Main Bronchus Tumors.

PurposeTo evaluate the diagnostic value of multidetector CT (MDCT) and its multiplanar reformation (MPR), volume rendering (VR) and virtual bronchoscopy (VB) postprocessing techniques for primary trachea and main bronchus tumors.MethodsDetection results of 31 primary trachea and main bronchus tumors with MDCT and its MPR, VR and VB postprocessing techniques, were analyzed retrospectively with regard to tumor locations, tumor morphologies, extramural invasions of tumors, longitudinal involvements of tumors, morphologies and extents of luminal stenoses, distances between main bronchus tumors and trachea carinae, and internal features of tumors. The detection results were compared with that of surgery and pathology.ResultsDetection results with MDCT and its MPR, VR and VB were consistent with that of surgery and pathology, included tumor locations (tracheae, n = 19; right main bronchi, n = 6; left main bronchi, n = 6), tumor morphologies (endoluminal nodes with narrow bases, n = 2; endoluminal nodes with wide bases, n = 13; both intraluminal and extraluminal masses, n = 16), extramural invasions of tumors (brokethrough only serous membrane, n = 1; 4.0 mm—56.0 mm, n = 14; no clear border with right atelectasis, n = 1), longitudinal involvements of tumors (3.0 mm, n = 1; 5.0 mm—68.0 mm, n = 29; whole right main bronchus wall and trachea carina, n = 1), morphologies of luminal stenoses (irregular, n = 26; circular, n = 3; eccentric, n = 1; conical, n = 1) and extents (mild, n = 5; moderate, n = 7; severe, n = 19), distances between main bronchus tumors and trachea carinae (16.0 mm, n = 1; invaded trachea carina, n = 1; >20.0 mm, n = 10), and internal features of tumors (fairly homogeneous densities with rather obvious enhancements, n = 26; homogeneous density with obvious enhancement, n = 1; homogeneous density without obvious enhancement, n = 1; not enough homogeneous density with obvious enhancement, n = 1; punctate calcification with obvious enhancement, n = 1; low density without obvious enhancement, n = 1).ConclusionMDCT and its MPR, VR and VB images have respective advantages and disadvantages. Their combination could complement to each other to accurately detect locations, natures (benignancy, malignancy or low malignancy), and quantities (extramural invasions, longitudinal involvements, extents of luminal stenoses, distances between main bronchus tumors and trachea carinae) of primary trachea and main bronchus tumors with crucial information for surgical treatment, are highly useful diagnostic methods for primary trachea and main bronchus tumors.

High-Grade Neuroendocrine Carcinoma with Bronchial Intraepithelial Tumor Spread: Possibly a New Histologic Feature of Large-Cell Neuroendocrine Carcinoma

During surgical resection of a peripherally located high-grade neuroendocrine carcinoma (HGNEC), we unexpectedly discovered prominent bronchial intraepithelial tumor spread up to the surgical end of the bronchus. Because bronchial intraepithelial tumor spread of peripherally located HGNEC has been rarely reported, we conducted a retrospective analysis at our hospital. We histologically reviewed surgically resected HGNEC cases to assess bronchial intraepithelial spread of tumor cells. HGNECs with bronchial intraepithelial tumor spread were further studied by immunohistochemistry for neuroendocrine markers, and their clinicopathological characteristics were evaluated. Of 1778 cases of surgically resected lung cancer in our hospital, 47 cases of HGNEC were evaluated. Bronchial intraepithelial tumor spread was observed in nine cases (19.1%); eight of these cases were large-cell neuroendocrine carcinoma (LCNEC) or small-cell lung carcinoma with an LCNEC component. Moreover, bronchial intraepithelial tumor spread was continuous from the primary tumor to the resected end of the bronchus in four cases, and all these cases had an LCNEC component. Furthermore, HGNEC with bronchial intraepithelial tumor spread was associated with a higher recurrence rate than no bronchial intraepithelial tumor spread. The results of this study suggest that bronchial intraepithelial tumor spread is commonly observed in cases of peripherally located HGNEC and may be a unique form of tumor invasion, especially tumors with LCNEC morphology. Therefore, surgeons and pathologists should be cognizant of bronchial intraepithelial tumor spread in peripherally located HGNEC, as well as its potential role as an indicator of HGNEC aggressiveness.

Conventional and Nuclear Medicine Imaging in Ectopic Cushing's Syndrome: A Systematic Review.

Ectopic Cushing's Syndrome (ECS) can be a diagnostic challenge with the hormonal source difficult to find. This study analyzes the accuracy of imaging studies in ECS localization. Systematic review of medical literature for ECS case series providing individual patient data on at least one conventional imaging technique (computed tomography [CT]/magnetic resonance imaging) and one of the following: 111In-pentetreotide (OCT), 131I/123I-metaiodobenzylguanidine, 18Ffluoro-2-deoxyglucose-positron emission tomography (FDG-PET), 18F-fluorodopa-PET (F-DOPA-PET), 68Ga- DOTATATE-PET/CT or 68Ga-DOTATOC-PET/CT scan (68Gallium-SSTR-PET/CT). The analysis comprised 231 patients (females, 50.2%; age, 42.617 y). Overall, 52.4%(121/231) had "overt" ECS,18.6% had "occult" ECS, and 29% had "covert" ECS. Tumors were located in the lung (55.3%), mediastinum-thymus (7.9%), pancreas (8.5%), adrenal glands (6.4%), gastrointestinal tract (5.4%), thyroid (3.7%), and other sites (12.8%), and primary tumors were mostly bronchial neuroendocrine tumors (NETs) (54.8%), pancreatic NETs (8%), mediastinum-thymus NETs (6.9%), gastrointestinal NETs (5.3%), pheochromocytoma (6.4%), neuroblastoma (3.2%), and medullary thyroid carcinoma (3.2%). Tumors were localized byCTin66.2%(137/207), magnetic resonance imaging in 51.5% (53/103), OCT in 48.9% (84/172), FDG-PET in 51.7% (46/89), F-DOPAPET in 57.1% (12/21), 131/123I-metaiodobenzylguanidine in 30.8% (4/13), and 68Gallium-SSTRPET/CT in 81.8% (18/22) of cases. Molecular imaging discovered 79.1% (53/67) of tumors unidentified by conventional radiology, with OCT the most commonly used, revealing the tumor in 64%, followed by FDG-PET in 59.4%. F-DOPA-PET was used in only seven covert cases (sensitivity, 85.7%). Notably, 68Gallium-SSTR-PET/CT had 100% sensitivity among covert cases. Nuclear medicine improves the sensitivity of conventional radiology when tumor site identification is problematic. OCT offers a good availability/reliability ratio, and FDG-PET was proven useful. 68Gallium-SSTR-PET/CT use was infrequent, despite offering the highest sensitivity.

Endoscopic treatment of primary benign central airway tumors: Results from a large consecutive case series and decision making flow chart to address bronchoscopic excision

BackgroundBenign tracheo-bronchial neoplasms are rare, but potentially dangerous conditions with life threatening consequences. Tumor removal should be pursued by methods minimizing the procedural stress. The role of endoscopic treatment, as an alternative to open surgery, remains controversial. Objectivesreport the twelve-years endoscopic experience in Rome, Italy. Fifty-seven benign tracheo-bronchial tumors were diagnosed and 130 tracheo-bronchial resections by rigid bronchoscopy performed. Methodswe identified histotypes associated with higher recurrence rate and assessed their relationship with gender, age and tracheo-bronchial location. We provided data on safety and complications and suggested a decision making flow chart to address the patients to endoscopic resection. Resultscomplete eradication after a single procedure without recurrence at 2 years was obtained in 63.1% of cases (36/57). Need of a second intervention within few months but no further recurrence at follow up was seen in a further 8.8% (5/57). Histotypes associated with recurrence were papillomas and inflammatory polyp. Seven patients (12.3%) were addressed to surgery because of multiple recurrence. Ten patients (17.5%) were lost at follow up. In case of recurrence, the bronchial biopsy was always repeated and no malignant transformation was observed. No major complications, pneumothorax or pneumomediastinum occurred. Conclusionsendoscopic treatment of benign tracheo bronchial tumors is safe and effective, provided that the procedure is carefully and systematically planned. The rate of eradication is satisfactory and the incidence of complications negligible. This will encourage this approach as first line treatment especially in patients, frequently elderly people, having increased surgical risk due to concomitant respiratory failure or major comorbidities.

Abstract 2302: Analysis of the role of CADM1 in suppression of lung cancer using Cadm1-deficient mice

Abstract Lung cancer is the leading cause of cancer deaths, and non-small-cell lung cancer (NSCLC) is the most prevalent form of lung cancer. The tumor suppressor gene CADM1/TSLC1 was originally identified in NSCLC. CADM1 encodes an immunoglobulin superfamily cell adhesion molecule. CADM1 is inactivated by deletion and/or promoter methylation of the gene in 40-60% of NSCLC, especially in their advanced stages. Previously we generated conventional Cadm1-deficient mice and found that around 40% of Cadm1-deficient mice spontaneously developed lung adenoma and adenocarcinoma by 15 months of age. To assess the precise role of CADM1 in suppression of lung tumorigenesis, we crossed Cadm1-deficient mice to conditional K-ras-mutant mice, well-established mouse models of lung cancer. The K-ras-mutant mice are shown to develop multiple lung adenocarcinomas by 25 weeks after administration of adenovirus expressing Cre recombinase followed by the activation of oncogenic K-ras. We then analyzed the development of lung tumors in K-ras-mutant (K) mice and K-ras-mutant Cadm1-deficient (KC) mice. Loss of Cadm1 results in enlargement of the size of alveolar tumors (adenomas or adenocarcinomas) as well as higher tumor grades. The most malignant histology of vascular or pleural invasion was only detected in tumors from KC mice. On the other hand, the size of the bronchial tumors was larger in K mice than in KC mice. Immunohistochemical analysis of bronchial marker SOX2 showed that adenomas or adenocarcinomas expressing SOX2 were larger in KC mice, indicating that loss of Cadm1 enhanced the rapid growth of alveolar tumors and thereby impaired the growth of bronchial tumors originated from the common stem cells, bronchio-alveolar stem cells (BASCs). Furthermore, tumors from K mice showed frequent loss of CADM1 expression and the tumors with low expression of CADM1 exhibited more malignant histological features. These results suggest that loss of Cadm1 promotes the malignant progression of alveolar tumor. Citation Format: Takeshi Ito, Masayoshi Nagata, Taketo Kawai, Mika Sakurai-Yageta, Akihiko Ito, Akiteru Goto, Daisuke Matsubara, Yoshinori Murakami. Analysis of the role of CADM1 in suppression of lung cancer using Cadm1-deficient mice. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2302. doi:10.1158/1538-7445.AM2015-2302

Localisation secondaire atypique au « sein » des cancers bronchiques

In the context of bronchial cancers, the most frequent sites for metastases to occur are the lung, bone, brain, liver and adrenal glands. However, metastasis to other sites does additionally occur and this might be influenced by the biological characteristics of the tumour. We report the case of a 54-year-old woman with a primary bronchial adenocarcinoma with an EML4-ALK translocation. During her treatment with crizotinib, the patient developed a lesion in her right breast. The initial pathological diagnosis was of an invasive ductal adenocarcinoma of the breast. However, an additional immuno-histochemical analysis revealed it to be a metastasis from her bronchial tumour. This case is an illustration that, in the context of a lung cancer with ALK rearrangement, synchronous or secondary lesions must be interpreted with caution. Specific biological analysis -ALK immunohistochemistry or FISH- must be performed to confirm a primary or metastatic origin for these lesions.

Bronchial neuroendocrine neoplasms: A Surveillance Epidemiology and End Results (SEER) database review of demographics and survival in 187,991 cases.

4097 Background: Bronchial neuroendocrine neoplasms (NENs) are a biologically heterogeneous group of malignancies whose differences are incompletely understood. We aimed to study the demographics and survival of patients with these neoplasms by reviewing the SEER database. Methods: We identified 945,331 cases in the SEER database with malignancies of the lung and extracted 187,991 bronchial NENs to examine patient characteristics & clinical outcomes by histology and stage. Results: By histology and grade, there were 130,092 cases of small cell carcinoma, 44,520 cases of large cell carcinoma, 3,349 cases of neuroendocrine carcinoma (grade 3/4), 9,135 cases of typical bronchial carcinoid (grade 1), and 895 cases of atypical bronchial carcinoid (grade 2). The ethnic predilection was Caucasian (87%, with 9% black and 4% other). Overall there were more cases in men (55% of the entire cohort), but women accounted for 66% of the carcinoid cases. Mean age at diagnosis for all NENs was 66, with typical carcinoids ...

Bronchial neuroendocrine neoplasms: A Surveillance Epidemiology and End Results (SEER) database review of treatment outcomes.

4098 Background: Bronchial neuroendocrine tumors (NENs) are a biologically heterogeneous group of malignancies with varied approaches to treatment. We queried the SEER database about outcomes of surgery and radiation. Methods: We identified 945331 cases in the SEER database with malignancies of the lung and extracted 187991 bronchial NENs – 130092 cases of small cell carcinoma, 44520 cases of large cell carcinoma, 3349 cases of neuroendocrine carcinoma (grades 3/4 [G3/4]), 9135 cases of typical bronchial carcinoid (grade 1 [G1]), and 895 cases of atypical bronchial carcinoid (grade 2 [G2]) – to examine clinical outcomes by treatment modality, including radiation in 82157 cases and surgery in 21352. Results: Surgical intervention on the primary NEN became less frequent as SEER stage become more extensive; operations were performed in 56.0% of cases of localized disease, 19.9% of regional disease, and 4.5% of distant disease. Proportionately more surgery was performed on lower-grade histologies (e.g. 84% of...

Anesthesiology in interventional pneumology- endoscopic interventions: part 1

Less invasive bronchoscopic techniques for lung-volume-reduction have almost replaced surgical resections. Tracheobronchial obstructions and - to a certain degree - even bronchial tumors can be treated bronchoscopically. However all these procedures show specific risks anesthesiologists have to consider.

Lambert-Eaton myasthenia

The myasthenic syndromes are a group of disorders in which neuromuscular transmission is impaired at the motor endplate. Many of the myasthenic syndromes are congenital, but Lambert-Eaton myasthenic syndrome, which was one of the fi rst of these syndromes to be described, is associated with a tumour, mostly small-cell carcinoma of the lung, in 50–60% of patients. In 1951, severe muscle weakness was seen in a patient with bronchial neoplasm who was admitted to St Thomas’s Hospital, London, UK; this weakness disappeared almost immediately after removal of the tumour, suggesting that such neoplasms might give rise to a peripheral neuropathy. When a 47-year-old man complaining of progressive muscle weakness that fi rst aff ected his legs but later aff ected his arms and head was admitted to the same hospital 2 years later, further investigations were warranted. Upon examination, he was found to have small-cell lung carcinoma, and administration of thiopentone sodium and succinylcholine prior to biopsy led to prolonged apnoea. In the presence of normal cholinesterase activity, this was suggestive of a change in the response of the motor endplate to depolarising drugs, and investigations showed that the response at the motor endplate to tubocurarine, decamethonium, and succinylcholine was similar to that seen in myasthenia gravis. At the meeting of the American Physiological Society in 1956, Lambert, Eaton, and Rooke presented the cases of six patients with defective neuromuscular transmission that was associated with malignant neoplasms. In these patients, many of the clinical and electrophysiological features were reported to be diff erent from those seen in myasthenia gravis. A year later, Lambert and Eaton reported the electrophysiological features of the myasthenic syndrome, leading to the eponym.