Under the influence of weak unidirectiona l direct 
current (a few microamperes during 2-S weeks), hu· 
man breast fat develops in the anodic field solid "rods" 
of an epithelial type of cells. The rods arrange them­
selves lengthwise in the fibrous tissue in anodic groups 
surrounded by a sheet of circular fibres, containing 
fibroblast-like cells. Eventually the groups develop 
each a central lumen. These structures, which arc best 
developed close to the anode, have a" appearmrce wry 
much like mdogenously developed fibroadenosis in breast 
tissue. Close to the cathode, fat cells are simultaneously 
transformed into small "cells" with light cytoplasm 
8 Summary and a dark pOint-like nucleus (haematoxylin-eosin). They arrange themselves in cathodic groups around a 
central fibrous material. This material extends with 
radiating structures between the "cells" to a circular 
fibrous enclosure (without fibroblasts). The cathodic 
groups of cells arrange themselves as cathodic cores in 
the direction of the newly formed cathodic fibrous 
tissue. Some of these cores Jose their cells and leave a 
fibrous channel without cellular elements in its wall. Some cores gradually modify their cells and continue 
as anodic rods in the middle of the specimen. The light 
cathodic cells then gradually stain dark red-blue with 
hacmatOxylin ·cosin. Some cells in the cathodic field develop chamwl-like 
structures which have an appearance similar to emlogett· 
ous/y developed pathological vessels. The same type of cathodic channels, with an appear· 
ance of pathological vessels and anodic channels with 
fibrous walls containing fibroblast-like cells, could also 
be produced in normal, subcutaneous, human, ab· 
domina! fat specima. Further, in cathodic breast fat 
and abdominal fat, fibrous channels also develop with· 
out fibroblasts or cellular elements. When bidirectional current was passed over breast 
fat, thin anodic channels were produced. They con· 
tained fibroblast-like cells in their walls. The proposed existence of a fluctuating potemial aris· 
ing after injury to tissue is supported by in vitro experi· 
ments in which microcalcificatiom were produced in 
breast fat tissue. Fat removed from normal human 
breasts was expOsed to direct current (e.g., 25 cou­
lombs at 10 V). Anodic, intracellu lar, "bush-like" 
structures developed . They contained no calcium, but 
could be identified in microradiographs. At trus pOint 
the current over the tissue sample was reversed. Our· 
ing trus second phase, calcium precipitated in the bush· 
like matrix, which now bad the histologic appearance of 
spontaneously developed microcalc ifications in breast 
cancer. Fat itself is a relatively poor electric conductor. The 
electric current over small specimens of fat tissue is 
therefore, after a few hours, usually in the range of a 
few microamperes . The time of treatment was there­
fore extended over weeks. During such long time 
periods, the current seems to protect the specimen 
from bacteriological decompOs ition. Not only weak currents but also low energies of 
current are capable of modifying the structure of tis­
sue, when the forces are allowed to act over a long 
time. Thus, the weak electric pulses around pacemak· 
er devices and the intracardia c electrode can cause 
fibrous tissue to form, but only after relatively long 
periods of time. Such considerations may suppOrt the 
theory that metabolic pOlarization of tissues or organs 
should also be capable of producing substantial ionic 
transpOrtS over BCEC systems. Fibrotic tissues such as tissue membranes and organ capsules may be the re­
sult. The studies presented suggest also that pathologi­
cal conditions in which calcium precipitates in tissue, 
including healing of fractures by electric current 
(which has been attempted by previous researcher ), 
need investigation in terms of BCEC. The structural changes around carcinomas of the 
breast are remarkably similar to the structural changes 
around masses in the lung, despite the differences in 
basic morphology of the two organs. It has therefore 
been concluded that the biokinetic background for 
their development may essentially be the same. The 
central mechanism for such modifications of structure 
appears related to physicochemical polarization of tis­
sues within biologically closed electric circuits. Under the assumption that the BCEC systems repre­
sent a physiologic transport mechanism which influ­
ences normal functions , including healing, it seems 
reasonable to speculate that artificial activation of 
BCEC sysrems offers rhe possibilil)l of enhancing healing. Direct current used for therapeutic purposes (elec­
troc.hemical ITeatment) raises many possibilitie s either 
for separate treatments with direct current or for com­
binations with other techniques. Verified cancers occasionally heal sponuzneous/y, ac­
cording to well established reports in the literature. Several possible explanations have been advanced and 
also criticized. In addition to the commonly suspected 
immunologic or hormonal causes, it is suggested here 
that the mechanism of healing via the VICC system 
may be involved. It is assumed that cancers, which develop internal 
necrosis, bleeding or infection obtain a release of cata· 
bolic energy which will activate their VICC system. This represents the start of a process of healing, includ­
ing accumulation of leukocytes , production of fibrosis, 
microthromboses and other changes in the environ­
ment of the tumour. In favourable cases, such changes 
around the tumour may preclude its survival. More 
commonly, such changes should only slow the rate of 
neoplastic growth, because of insufficient release of en­
ergy for complete healing of all tumour tissue. An 
additional supply of energy to drive the VICC system 
is, however, possible over implanted electrodes con­
nected roan external electric source of power. The suggested mechanism of a narural, but rarely 
complete process of spontaneous healing of cancers 
and how this mechanism may be supported, formed 
the rationale for a series of electrochemical treatment s 
of cancer. A localized cancer may even offer rat.her favourable 
possibilities for therapy with direct current between 
implanted electrodes connected to an external source 
of DC power. After an earlier pilot study to introduce 
a self-driving i11jury reaction by local electrocoagulation 
of tumours, five patients with inoperable metastases in t.hc lung were treated with direct current. This type of 
treatment represents , during treatment s, an externally 
driven system. It offers the advantage that any magni­
tude of energy can be applied to activate the biologic 
circuits. The drawback is, however, that we sti11 do 
not know enough about the mode of application to 
optimize the technique. As soon as the current is 
interrupted, a self-driving system will start in the tis­
sues. The direcrion of current will now reverse, com­
pared to the applied current. The tissues will take over 
the initiated process of healing. Eltctrochemical treatments have now been further 
modilicd and applied in a trial series of 26 cancers in 
20 patients. The study shows that some peripheral 
nonopcrable lung tumours can be treated successfully 
in patients with poor cardiorespiratory or general con­
dition. The tumour electrode is made anodic because 
cancer cells are generally considered to carry a surplus 
of fixed electronegative surface charges. In this way 
the tumour cells are kept attracted to the anode during 
treatment. After treatment , 13 of the tumours gradually disap­
peared or decreased in size, usually during the first 
three or four months. One of these tumours later 
increased in size. Thirteen patients have died, five 
from multiple metastases, four from brain metastases, 
one each from bronchopneumonia, abuse of alcohol, 
myocardial infarction , and suicide. The treatments 
have been free of mortality. Complications (e.g., 
pneumothorax ) have been minor. Electrochemical treatment of tumours offers a new 
and promising therapeutic possibility . The technique 
of treatmenr, including the electronic equipment and 
elecuodes, is, however, still far from optimized. Treatment of tumours with direct current might also 
be supplemented by chemotherapeutic compounds 
provided with a suitable charge. Experiments were 
performed which suggest that such a medium, after 
injec1ion into the blood stream, might then beeome 
attracted electrophoretically to the tumour during ap­
plication of direct current. The treatment with direct current produces around 
tumours radiograph ically visible structural changes of 
an appearance which can not be distinguished from 
spomaneously developed corona structures. These 
changes include "A" and "B" zones, radiadn,g fibrous 
struclUres, arches and arcades, and narrowing and 
circular displacement of vessels. The fomfation of ttcw '1-vtssels in healing of injury is 
still not well understood. Newly formed pathological 
vessels are often found inside and around malignant 
fumours. In vitro experiments on fat tissue have 
shown that application of direct current through an 
excised specimen is able to transform the tissue into 
primirive channels. It is anticipated, on the basis of 
these observations , that a spontaneous flow of current 
Summary 9 over a BCEC system is likely to be a main factor in the 
development of tissue channels. Future research may 
disclose the role of an activated VICC system for the 
formation of new vessels. As knowledge of BCEC mechanisms increases, oth­
er closed circuit therapeutic measures may become 
possible, e.g., healing of wounds, fractures and infec­
tions. The inconsistent results of previous attempts to 
improve healing of fractures by electric current is, in 
the opinion of the author, dependent on lack of know­
ledge about how the treatments should be coordinated 
with the physiologic mechanisms. A large number of chemicals, physical and biologic 
factors are capable of induci"g ca,.cer. They all seem to 
have the capability, direct or indirect, of polarizing 
tissue. A unidirectional activation of BCEC systems by 
weak currems over a long time will change the internal and 
external cmvircmmem of cells. Surviving, modifzed cells 
still capable of multiplying may therr possibly produce 
neoplastic tissue. It is suggested that activated BCEC 
systems, under certain circumstances , represent a commmr 
factor in carcinogenesis. An acceptance of the principle of BCEC systems leads 
logically to a number of imeresting cotuequenc:es. The last 
chapter of this book discusses some of these conse­
quences. Thus, it will be seen that poorly understood 
events or even rather obscure phenomena such as 
acupuncture and oral galvanism may be explained on 
the basis of BCEC systems. An important function of BCEC systems, not pre­
viously mentioned, must now be touched upon. Closed circuit electric transport s are always associated 
with the creation of magnetic fields around L>ach cir­
cuit. Such electromagnetic systems can be influenced 
10 Summary by external electromag netic fields, by the principle of 
superimposition. A flow of current in a BCEC system 
will consequently produce electromagnetic fields. Moreover , an external magnetic field moving in rela­
tion to BCEC circuits will produce a flow of current in 
the BCEC channels. The BCEC system then ca11 be seen 
to act as a recepwr for extmuJl electromagnetic forces. Such forces, both man-made and natural, are pans of 
our normal surroundings and within certain limits 
evidently well tolerated. A continuous separation of 
electric charges takes place in the atmosphere . When 
these collections of charges (ionars) move by winds, 
strong electromagnetic fields are created. Before thun­
derstorms , during certain winds such as the Fohn 
winds in Central Europe, and sometimes even during 
ordinary changes of weather, many organisms includ­
ing human beings react in various ways. Headaches, 
hemicrania , epileptic fits, joint pains, increase in traf­
fic accidents and the like are reported. From a physical 
standpoint the moving electromagnetic external fields 
must induce transport of current in the channels of 
BCEC systems. When these currents exceed physio­
logic tolerance, the organism will react. Such phenom­
ena are most easily explained as a disturbance of ho­
meostasis. An ordinary Faraday's cage will not protect 
against such interferences . The energy of activation of 
BCEC systems is tied 10 the moving magnetic fields. Their high power of penetration would probably re­
quire a chamber of steel with perhaps one inch thick 
walls for protection. It is the hope of the author that the reader will proceed 
to read the followi11g chapters, because this summary coll­
tains ma11y shortcuts and simpliftcatimu. n. 
Radiographic detectability 
of corona structures 
Clinical radiologic research based on large numbers of 
examinations is hampered by the fact that the quality 
of routine radiographs varies widely. This fact in turn 
may limit various aspects of a study. Not only do 
technique s of image production vary, but also inter­
pretation and documentation of images are not stan­
dardized. For these reasons, the extraction of basic 
information about specific problems in diagnostic ra­
diology is often difficult to collect and to present in 
statistically treatable terms. Furthermore, the collec­
tion of clinical radiologic information is frequently a 
discontinuous process influenced by personal interest, 
training, and trial and error. Improved examination 
technique increases knowledge, which in turn im­
proves technique. This feedback makes clinical radio­
logic research a dynamic process. The statistical pre­
requisite of uniformity is therefore often very difficult 
to achieve in any large srudy. Twenty-eight ye-ars ago the author was impre-s:sed by 
chest radiographs of a patient with a peripheral carci­
noma of the lung and a peculiar pattern of air-filled 
lung separating peripheral "atelectasis" from the car­
cinoma (Fig. 1: 2). In the next decade not one single 
additional case was recognized among several thou­
sand patients with lung tumours. The explanation is 
not to be found simply in inadequate techniques of radiographic examination. It is mainly the result of 
lacking knowledge about what to look fQr. Radiolo­
gists' visual search patterns are of fundamental impor­
tance in diagnostic radiology . Improved visual search 
can lead to improvements not only of radiographic 
technique , but also to improved rates of detection of 
specific radiologic findings. Similar situations, familiar to experienced radiolo­
gists, are probably infrequently appreciated by our 
non-radiological colleagues who have not been exposed 
to the almost impossib le task of combining long-term 
research with standardization in radiologic technique 
and interpretation. so .. called "routine technique" in 
chest radiography varies considerably between differ­
ent instit utions and different radiologists. So-called 
"special films", e.g., oblique chest radiographs, vary 
even more in technical quality. Also, radiographic 
quality has gradually improved over the past decades 
for a muhjtude of technical reasons. With this background it is obvious that exact statis­
tical figures over three decades of personal experience 
can not always be presented. Nevertheless, on the basis 
of personal experience of reviewing chest radiographs 
of more than 7 000 patients with tumours in the lungs, 
the author estimates that corona structures of the lung, 
described in 1969 (1), should now be recognized on 
Delectability of corona structures II "routine" examinations in 20 to 30 per cent of patients 
whose tumours are periphera l 10 the hila and larger 
than approximately 2.5 em. Some technical radiographic and radiologic com­
ments are now in order. So·called routine radiograp hs 
are often far from sufficient as a basis for proper 
clinical radiologica l research. One or two of the signs 
of corona structures may be detected on a single chest 
radiograp h, but all the signs are rarely seen on one 
radiograph. Different projections and expOsure tech­
niques are often required. For reasons which will be 
described later, certain structural signs are sometimes 
complete ly lacking. A "good routine technique" is, 
however, essential for the preliminary detection of the 
radiographic signs. Some general remarks will, for that 
reason, be made on the author's technique of chest 
radiography. The importance of oblique views in routine chest 
radiography is unfortunately seldom fully recognized. In our institution oblique views are included in the 
routine procedure for chest radiography, in addition to 
the traditional pOsteroanter ior and lateral views. Any 
physician with experience in bronchograp hy will im­
mediately understand why the oblique views are of 
fundamental impOrtance for a radiologic approach to 
structural analysis of the lungs. In the lungs, only the central bronchi and the cen­
tral pulmonary vessels are oriented predominant ly in 
the sagittal and coronal planes. For structural analyses 
of the peripheral pulmonary parenchyma, oblique pro­
jections are very helpful (300-40° to the left and to the 
right). Sometimes fluoroscopic examination may per~ 
mit exact positioning and coning of the x-ray beam 10 
optimize expOsure technique. ExpOsure rime must be kept as short as pOssible to 
eliminate blur caused by motion. When expOsure time 
exceeds 10 ms, motion blur often prevents the recogni­
tion of the radiating struccures, arches and arcades. This motion blur is mostly caused by the pulsations of 
the pulmonary vessels and the transmitted pulsations 
of the heart. ExpOsure rimers usually require pro­
longed exposure rime, which is paid for by unnecessary 
motion blur. They also interfere with the usc of shut­
ters in chest radiograp hy, which is even more serious 
with regard to image quality and dose reduc tion. Ex­
pOsure timers can advantageo usly be omitted in chest 
radiogr•phy. ExpOsure time also can be reduced by 
elevating tube kilovoltage at the expense of filament 
current. 150-190 kVp has therefore been our standard 
in routine filming. At these energy levels a decrease in 
comrast wiJI occur. This drawback is, however, coun­
terbalanced by the reduced disturbing effect of the 
calcium of the ribs. The e>pOSure time can in frontal 
and oblique views be kept at 1-6 ms at 300 rnA 
current. Lowering of contrast by this technique is of 
obvious disadvantage for the recognition of density 
12 Delectability of corona structures differences between the "A" zone and surrounding 
tissue. Radiographs obtained with relatively low rube 
tension improve contrast between the "A" zone and 
"B" zone but at the expense of considerable loss in 
resolution of detail. Other radiographic technical considerations pertain 
to clinical radiologic study of small objects. X -rays are 
generated in a focal spot of a small bur finite area, e.g., 
0.3 by 0.25 mm'. The size of the effective focal SpOt in 
relation to the size of the object is critical, as also is the 
homogeneity of the x-ray output. Variations of intensi­
ty from different parts of the focal SpOt may nor only 
produce distortion of the image but actual false im­
ages, e.g., multiplication of structures in the radio­
graph. A final radiograph ic pOint concerns those structures 
which produce lines as fmc as threads in a radiograph. Is it really pOssible to see in the lung thread fine struc­
tures whose diameters are of the order of the diameter 
of a small focal SpOt, i.e., are considerab ly less than 
one mm? Is it not likely that for radiography to show 
such threadfine structures they must have an absorp­
tion coefficient considerab ly higher than rhe surround­
ing tissue? Perhaps these structures arc shaped as thin 
sheets and are oriented tangentia lly to the beam? In histological sections of lungs which in radio­
graphs have shown threadfine structures, no calcium 
or other opaque material which could produce a 
marked increase in absorption has ever been repOrted. A dense absorber, however, is not a prerequisite for 
the production of radiographica lly visible, threadfme 
opacities. The material in these structures may have 
the same absorption coefficient as the material of sur­
rounding lung tissue. The amount of material per unit 
volume in the threadfine structures may be greater 
than in the surrounding lung. SuperimpOsitio n of a 
large number of threads may also produce such effects. The indjvidua J thread-structure might "drown" as an 
average increased density compared with the density 
of surrounding lung. If many small structures are 
randomly dispersed they will appear in the radiogr•ph 
as a result of summation, which statistically can be 
expressed as a gaussian distribution. It is therefore 
impOrtant to recall that the images of the threads do 
not necessarily correspOnd to specific threads in the 
tissue. Instead, we see their statistical representation. The biokinetic principles of structural development 
around lung lesions have also been studied in the 
female breast. These studies were performed as it 
seemed likely that the principles might be valid also in 
organs other than the lung. The female breast was 
selected because anatomica lly and physiologically it is 
very different from lung and because it offers suitable 
conditions for finely detailed radiographic studies. The case material of breast tumours is selective. Mammogra ms from routine health examinations and from patients with breast symptoms have been studied 
with regard to the possible existence of structural 
changes similar to those observed in the lung. No 
quantitative estimation of the structural changes has 
bec. ::n au em pLed. h was found in a mixed material from 
several hospitals that strikingly similar structural 
changes can sometimes be observed around breast and 
lung cancers. The biokinetic mechanisms proposed to 
explain these similarities were then examined by dif­
ferent in vitro and in vivo studies in dogs. The radiographic studies were made both with con­
ventional radiographic breast examinations using com· 
pression of the breast and in certain cases xeroradio­
graphy without compress ion. Most of the "conven­
tionaJ" mammographies were made with HDiagnos t 
M" (l'hilips/C. H. F. Muller), which is provided with 
a built-in six pulse generator. The tube potential has 
usually been 25-30 kVp, the rotating molybdenum 
anode has had a nominal 0.6 mm focal spot. To the 
beryllium window has been added a molybdenu m fil­
ter. The focus-film distan:e has usually been 40 em. The exposures have been made with an automatic exposure timer (Amplimat ) and a mobile ionization 
chamber and light localizer. Standard craniocauda l, 
lateral and oblique projections have been available in 
all cases. Sampling of cellular material for diagnosis and im· 
planting of electrodes for measurements of electric 
potentials in breast tumours were made with a stereo­
taxic instrument , Mammotest (Tekniska Rontgcncen­
traleo AB, P.O. Box50100, S-10405 Stockholm, Swe­
den). For the implantation of electrodes in lung tumours, 
a versatile biplane fluoroscopic unit was also developed, 
which is now available under the trade name of 
Angioscope (Siemens-Eiema AB, Fack S-171 20 Solna, 
Sweden). Reference 
1. Nordenstr"m, B.: New trends and technique s in roc;n1gcn diag· 
nosis of bronchial carcjnoma.ln: Simon, M., Pmchen, E. j., and 
Le May, Al. (cds. ): Frontiers of Pulmonar y Radiology. New 
York. Grune and Stratton, 1969. p. 380. Detectability of corona structures 13 III. Corona structures around 
malignant and benign 
neoplasms in the lung 
Despite the frequency of pulmonary neop lasms in con­
temporary radiologic experience, corona structures 
around these neoplasms have thus far not enjoyed 
adequate description. In this chapter it is anempted to 
correct this deficiency in radiologic analysis of lung 
tumours. Previously, three of the corona structures have been 
reported, the 11A" and "B" zones and the radiating 
structures (6). Once the author became aware of these 
characteristic appearances, their presence became de­
tected around approximately 25 per cent of pulmonary 
masses larger than about 2.5 em in diameter and pe· 
ripheral to the hila. Adctitional corona structures are 
now found. Previous descriptions were incomplete. To appreciate the analysis in this book of the func­
tional and morphologic significan ce of the corona 
structures , their accurate description is essential. In 
this chapter, the most important radiographic coronal 
manifestations will first be described: the "A" and 
"B, zones, radiating structures, the arches and ar· 
cades, circular structure displacement and vascular 
narrowing . Other radiogr•phi cally visible structures 
will then be described: lamellae, infiltmted str•nds, 
and retraction pockets. All of these structural changes 
will be seen in later chapters to represent interactions 
14 Malignant and benign neoplasms among specific pathophysiological events induced by 
the pathological tissue (see, e.g., Chapter XV). As a preliminary example, Fig. III: 1 illustrates a 
centrally necrotic adenocarcinoma in the periphery of 
the right upper lobe. All the corona structures are 
usually not evident in a single radiograph. The radio­
graphic signs may be quite subtle. A. "A" zone 
The "A" zone is radiographically seen as a halo or 
arcuate radiolucent area around all or a portion of an 
intrapulmonary radiopaque mass (Figs. III: 1-9). The 
"A" zone is less opaque than the surrounding pulmo­
nary parenchyma. The width of the "A" zone ranges 
from 2 mm to 8 em in the present material, but it is 
usually between 5 to 30 mm wide. The width often 
varies in different parts of the zone. The inner border 
of the "A" zone is limited by the surface of the 
tumour. The outer border of the "A" zone is usually ill­
defined (Figs. III: 2, 4, 5). In the periphery of the "A" 
zone, radiopacity frequently increases graduaUy until Fig. Ill: I. Well differentiated adenocarcinoma of lung, 
frontal radjograph. A radiolucent, 1-2 em broad, "A'' zone 
(A) surrounds the tumour. The "B" zone (B) lies peripheral 
to the "A" zone,and is smaller and slightly more radiopaque. Histologically, the centre of the cancer was necrotic, evi~ 
dent on the radiograph as ill-defined , central radiolucency 
(N), Structures radiate from the tumour's surface. An opa­
que y-shaped band, here called a lamella (L), overlies the 
mass. At the sharp interface berween the "A" and ''B" 
zones, a 2 em long arcade (arrows) is seen. Close inspecrion 
suggests it is formed by a number of tiny arches, each 1-2 
mm broad. Fig. Ill: 3. Squamous cell carcinoma,lef t upper lobe. (a) left anterjor oblique radiograph ·shows radiating struc* 
rures, including lamellae (arrows). "A .. and "B" zones arc 
corresponding ly labelled. (b) Left posterior oblique radi(}-Fig. I J I: 2. Poorly differenriated squamous cell carcinoma of 
the left lung, frontal radiograph. The tumour is surrounded 
by a radiolucent "A" zone, which isdiffu.sc, irregular, and 
0.5-1 em broad. Jts outer margin is indistinct . grnph shows a 12 mm broad, rndiolucent "A" zone (A). Along: its superolateral ponion a radiopaque ''B" zone {B) 
has a well-defined margin against the"A" zone (arrowheads ). Elsew·hcre the margin of the "A" zone is ;poorly defined. Malignant and benign neoplasms 15 Fig.lll:4 . Small ceU carcinoma, upper lobe, left lung, 
frontal radiograph. The "A" zone is about 5 mm wide. A 
"8" zone is seen as an irregular infiltration lateral to the tu~ 
mour. The border between the radiolucent ·• A" zone and 
the radiopaque ''8" zone is poorly defined. it reaches the level of the surrounding lung parenchy­
ma. A sharp outer border of the "A" zone, on the other 
hand, is observed characteristically only against a 148" 
zone situated between the tumour and the periphery of 
the lung (Figs. I: 2, III: I, 3, 9). Computerized tomo· 
graphy will occasionally be more sensitive than plain 
radiograph s in detecting these changes (Figs. III: 8, 
34). No characteristic malignant cell type is associated 
with corona changes. An "A" zone can be seetr around 
different histological types of maligtzalll tumour> itz the 
Lung. For some time the author thought that an "A, zone 
was a radiographic sign of cancer. It is not so. An "A" 
zone can be found around some benign tumours as 
well as around primary and metastatic lung tumours of 
different types and degrees of differentiat.ioo. (As will 
be seen in the next chapter, corona structures may 
even develop around inflammator y lesions.) Two cases 
will now illustrate an "A" zone around a benign tu­
mour. In Fig. III: 6a, a hamartoma is seen surrounded by 
some discrete, 5~ mm long, radiating structures and 
an irregular circle of vessels 4-5 em in diameter. Six 
years later(Fig. III: 6b), a radiolucent zone, S-12 mm 
broad, surrounds the tumour. This zone is indistin­
guishable from an "A" zone as seen around a malig­
nant tumour. Confirmation of the marked radiolu­
cency of the "A" zone is shown by a densitometric 
recording across the lung, the "A" zone and the tu­
mour. 16 Malignant and benign neoplasms Fig.///: 5. Carcinoma of breast, metastatic to the upper 
lobe, left lung, frontal radiograph. The tumour is surround­
ed by a faint, radiolucent "A" zone medially, inferiorly, and 
laterally. The periphery of the "A" zone is poorly defmcd. Another hamartoma (Fig. III: 7) is illustrated sur­
rounded by a 1-8 mm broad "A" zone. A photograph­
ic "edge enhancement" and "Mach effect" (7, II) as 
possible sources of error can be excluded in this case 
because of the irregular and variable width of the "A" 
zone. Furthermore, comparab le differences of density, 
e.g., between ribs and lungs, do not show any edge 
enhancement artefacts in this radiograph. 1 
Computerized tomograp hy may be more sensitive to 
"A" zone radiolucencies than plain radiographs. Fig. III: 8 a shows a plain radiograph of a metastatic mela­
noma in the right upper lobe. No clear "A" zone can be 
seen around the tumour. In the computerized tomo­
gram (Fig. III: 8 b), on the other hand, the rQdiolu­
ceot zone is easily recognized, as well as circular devi­
ation of vessels around the '"A" zone. 1 Evaluation of d~nsicy differences in photographic films is subjcc:t 
to several errors: the so<allcd adjacency effects and Mach effects 
mus1 bt considered. Tbe most common errors are the appearance of 
enhanced density along the «ige of a den$e area, known as the 
border effect ~ and dcxreased density outside the border effect. known as the fringe effect. The border effect is oflen referred to as 
the Mach line and the two effects together as the edge cffett. They 
are partly produced during film dt\'elopment because t.he devdoper 
affects not only the surface of the film but also 1he emulsion. Hori1.ontal diffusion of fresh developer within the emulsion en­
hances the developing prOttSs within a nearby area of higher expo­
! )ure. On the other hand, the reactive products of development also 
djffuse in tht opposjte direction through the boundary of diffe:rc:nt 
exposure. Such reactive products tend to inhibit development in the 
less e.xposcd side of the boundary . The edge effect occurs within a 
t'()atively restricted area adjacent to t.he boundary where the expo­
sure gndient is 5teep; usu.ally it is less than a millimetre wide. Tbe 
visual analogue to t.be photographic border and fringe effects is 
called the Mach effect. Ph)"$iologica lly an inu:nse stimulus of pan of 
the retina results in a lower signal from adjacent retinal ceiJs. This 
compensatory mechanim is called latenJ inhibition. The inu:n.se 
signal is on t.he ot.ber hand enhanced. Thil visual mechanism en­
hanclt'S cons.ider::ably the vi$u:al recognition of strue.tu.res. Fig./11:6 . Hamartoma , right lung, frontal radiograph. (a) A radiolucent "A" zooe surrounding the tumour is 
suggested. (b) Six years later, the tumour has grown 
slightly. An "A*' zone: now definitely surrounds it. Tbe 
peripher·.tl margins of the "A" zone arc generally indis­
tinct. (c) A densitometric recording of the radiogr•ph 
b is shown, obtained at the level of the black horizon· 
tal line. Peaks of the tracing are obtained by the low at· 
tenuation for x-rays in the "A" zone. Fig. I II: 7. Hamartoma, right lung, frontal radiograph. A 
narrow "A'' zone of varying width surrounds the tumour. A 
pulmonary vessel (arrow) appears no1 to uaverse the '1 A, 
zone. Fig.ll/:8. Pulmonary metastasis from an cxtrathoracic rna· 
lign•nt melanoma . (a) Fronwl F3diogroph, right uppcF lobe. No definite .. A" zone is apparent . (b) Computerized tomo· 
graphy shows a radiolucent "A" zone around the rumour. Blood vessels appear devi.ared around the margin oft he "A" 
zone. Malignant and benign neoplasms 17 B. Small arches and arcades 
Before a gcncr•l description of the different appear· 
anccs of the "8" zone can be offered, sp<.-cific d<-scrip­
tion is appropriate for those parts of the interface of 
lhc .. A .. and "B .. zones which arc well defined, i.e., 
the arcades and small arches. Wherever the "A" zone sharply borders the "B" 
zone, small arches characterize the interface. Each arch 
is from one to five mm wide. The convexities of these 
arches are always directed away from the lesion. The 
18 Malignant and benign neoplasms Fig. III: 9. Moderately well differentiated 5qWI· 
mous cell carcinoma, upper lobet left lung (same pa· 
tient as in Fig. Ill: 27 .} A small arcade (arrows} 
formed by 1-2 mm wide arches is seen between "A'' 
and "8" zones in (a} left anterior oblique, (b) pos· 
reroanterior , and (t) left pOsterior obHque radio-­
graphs. The conveltities of the arches and arcades 
are direc.ted away from the surface of the rumour. The june lion between the two z.oncs is well demar· 
cated superolaterally (seen as a slightly undulating 
line or arcade). The individual arches of the arcade 
can be: most easily recognized in a and h. The pres· 
encc of an arcade comprised of small arches is an 
important diagnostic sign differentiating a "B" zone 
from local thickening of the pleura. arches hang together in rows which are here called 
arcades. The arches and arcades often appear as a line 
or lines of increased radiopacity. Characteri stic exam· 
pies of small arches forming arcades between "A" and 
"B" zones can be seen in Figs. III: I, 9, 10, 13. Small arches forming a shon arcade arc seen in Fig. III: 9. In the left anterior oblique projeCLion (a}, the 
arcade (arrow) projects over the mid·part of the tu· 
mour, a moderately well differentiated squamou s cell 
carcinoma. In the posteroanterior view (b), the arcade 
is seen superior and lateral to the tumour. In both a Fig.///: 10. Large cell car· 
cinoma in the right lung of a 
67-year·old man. Coarse 
structures radiate more or 
less perpendicularly to the 
surface of the tumour. They 
pass through the 2-4 em 
broad ··A" zone into the 
.. 8" zone. In a posteroante­
rior radiograph (a), the: in­
terface between the "A" and 
"8" zones (arrows) is seen 
as a slightly undulating line. In the right posterior ob· 
lique projection (b), the in· 
te.rface is seen as individual, 
small, 2-3 mm wide arches 
fonning a 10 em long ar· 
cad e. 
and b the convexities of the 1-2 mm wide arches are 
each directed away from the tumour. Some small radi· 
ating structures in b can also be seen in the "A" zone, 
ending at the edges where the small arches make con· 
tact with each other. This tumour contains a cavity with some air and has 
an indentation in its inferior border (c). It is likely that 
the indentation represents partial collapse of the sur­
face of the tumour. Such collapse may cause the for­
mation of what are here called lamellae, which arc seen 
either at the surface or projected over the tumour as opaque thick lines (sec Section F on formation of 
lamellae). This case also illustrates the importance of radiogra­
phic positioning of the patient for correct analysis of 
structures. Oblique projections in this instance aided 
differential diagnosis of the radiopacity here called the 
"B" zone. Distinguishing a "B" zone from local plcu· 
raJ thickening may be important clinically. The small arches and arcades may be found seem­
ingly far from a pulmonary tumour. A giant cell carci­
noma, seen in the posteroanterior view (Fig. Ill: 10), 
Malignant and benign neoplasms I 9 Fig. Ill: II. Oemons~talion of disappearance of"B" zone 
and arcade after injec1ion of air inro 1he pleural space. PJeo. rnorphic carcinoma (7) in a 6l·year-old man. (a) .. A" and 
"8" zones in a 15• right posterior oblique radiogrnph. The 
arcade, a biconvex interface, defines the superolateral mar­
gin of Lhe ''A.·· zone:. The junction of the lWO c;on\'c:xilic:~ (ar­
row) appears retracted toward the tumour. (h) 20' right an· 
terior oblique projec-ti>n. Radiating structures are seen supc .. 
has a central air-filled cavity and rather coarse radiat­
ing structures which are arranged more or less perpen­
dicularly in relation to the tumour surface. The radiat­
ing structures pass through a 4 em broad "A" zone 
and deeply into a "B" zone. The interface between the 
"A" and "B" zones is well demarcated in Fig. Ill: lOa (arrows). In the right posterior oblique view 
(b), a projection is chosen which shows a row of small 
arches forming one slightly curved arcade. These arch­
es each have a width of about 3 mm (arrows). The 
positions and clear definition of the interface between 
the "Au and "B" zones, as well as the passing of the 
radiating structure~ through the interface, indicate 
that the arcade is not caused by the interlobar pleura. 20 Malignant and benign neoplasms rior to the tumour. Arrows indicate the arcade. (c) and (d) 
Same projections as a and b, respective-ly , after insuffiation 
of air into the pleural space. The pleural space is open, the 
"8" zone has disappeared , and the visceral pleura is normal 
(arrows). In this case, the dis2ppearancc oftht "B" zone 
!$Ugge:)t~ thai it w.a~ c.:au~ by a local fluid c.:ulh:. :tiuu iu tbc 
lung between the tumour and rhe pleura. C. "B" zone, including its 
demonstration in a dog model 
The "B" zone is a region of increased radiopacity 
peripheral to the "A" zone. Its opadty is greater not 
only than that of the "A'' zone but also than that of 
normal lung. It often, but not always (see, e.g., Fig. I: 2), extends from the periphery of the radiolucent 
"A" zone to the pleura. /\ number of representative 
examples will be reviewed. In Fig. 111: I the "A" zone is very prominent, while 
the "B" zone appears only as a rather discrete radiopa­
city supcrolateral to the "A" zone. At the interface Fig. Ill: 12. Vanishing "B" zone after injection of .Ur into 
the pleural space. (a) Squamous cell carcinoma in the right 
lung of a 68·year·old woman. Irregular, tiny, radiating struc· 
rures and "A" and '"Bu zon~ arc present. A "B" zone in 
broad contact with the pleura should not be misinterpreted 
between the uA" and "B, zones a 2 em long arcade is 
seen as a slightly undulating line. The poorly differentiated squamous cell carcinoma 
in Fig. Ill: 3 is surrounde-d by a clearly visible "A" 
zone, particularly apparent in a left posterior oblique 
projection (b). The "B" zone is seen laterally to the 
"A" zone between the-chest wall and the row of archc'$ 
(arrowhead s). The "A" zone around the small cc.ll carcinoma in Fig. Ill: 4 is only about 2 mm wide. Lateral to the tumour 
is also seen an irregular (5 x 1.5 em) radiopacity which 
represent s a "B" zone. The presence of an "A" zone 
between the tumour surface and tl1is opacity (the "B" 
zone) is here of decisive importan ce for the differentia l 
diagnosis between a usn zone on the one hand, and 
tumour, atelectasis , pleural thickening or broncho­
pneumonia on the other. Whenever the increased radiopacity extends to the 
chest wall, thickening of the pleura becomes an alter­
nate diagnostic possibility to a "B" zone, as in the 
moderatel y well differentiat ed squamous cell carcino· 
ma in Fig. Ill: 9c. In such instances local pleural as pleural thickening or extension of tumour into the chest 
walL (h) After air was injected into the pleural space, the 
uB'' zone disappeared. Normally thin visceral pleura (ar· 
rows) is evident medial to the air cap. thickening will not show an opaque line of arches such 
as in Fig. III: 9 a-c. A direct proof of the real character 
of this type of radiopacity can be presented as follows: 
The pleomorphic adenocarcinoma seen in Fig. III: II shows a typical "B" zone in direct contact with 
the pleura (Fig. Ill: II a). In another projection (Fig. III: II b) the tumour is seen surrounded by some radi­
ating thin structures. After air was introduced into the 
pleural space, the "B" zone disappeared (Fig. Ill: II c, d, corresponding to Fig. 111: II a, b, respec­
tively). The visceral pleura is thin and normal over the 
lung. A similar case is shown in Fig. III: 12a. This squa­
mous cell carcinoma shows irregular "pleural thicken­
ing" (B) lateral to the tumour. After air was intro· 
duccd int.o the pleura (b), the pleural space is seen to 
be open, the visceral pleura appears normally thin, and 
the "pleural thickening" has disappeared . Finally, a squamous cell carcinoma is seen in Fig. lll: 13a surrounded by an "A" zone and a "B" zone. The inferior part of the "B" zone shows a sharp 
borderline. The upper border is unsharp and vanishes 
Malignant and benign neoplasms 21 diffusely. The smaU arches form an arcade between 
the "A" and "B" zones, not easily seen in Fig. Ill: Ba. Using a high resolution image intensifier it 
became possible to identify the small arches (Fig. Ill: 13 b). After a small amount of air was introduced 
into the pleura, the "B" zone disappeared (Fig. III: 13c). The pleural space is seen to be free and the 
visceral pleura normally thin. These examples indicate the practical importance of 
recognizing a "B" zone. Hazy radiopacity peripheral 
to a tumour does not necessarily represent the usually 
considered possibilities of pneumonia, atelectasis, 
pleural thickening or a direct overgrowth by the tu· 
mour. It may be caused by a "B" zone which disap­
pears when the pleural space is opened. Already these observations suggest the origin of the 
"B" zones. In some way tissue fluid must be involved. If increased fluid in lung peripheral to a tumour is 
22 Malignant and benign neoplasms Fig. 111:13. Vanishing ''B" zone after air placed in the pleu· 
cal space. (a) Squamous cell carcinoma in the apical segment 
of the right lower lobe in a 72·yc.ar·old man. "A" and "8" 
zones can be. xcn, the: "B" zone extending to the pleura. The interface between .. A" and "B" zones consjsts of small 
arches forming a 3-4 em long arcade. (b) 1-l mm wide arch· 
es at the interface of the .. A" and ''8" zones are seen in a 
100x 100 mm radiograph obtained from the output phos· 
phor of a high resolution image intensifier. The margin of 
the uB" zone is unsharp superiorl) ' and sharp inferiorly (for 
further discussion, see Fig. Ill: 19 and text). (c) After a per· 
cutaneous needle biopsy, a small amount of air entered the 
pleural space, revealing a normally thin visceral pleur11. The 
"B" zone and the arcade with small arches have disappeared. caused by lymphatic stasis, then an early consequence 
of such stasis should be widening of the lymphatic 
channels periphera l to the tumour. An example of this 
possibility is suggested in Fig. III: 14. A rather large 
tumour is seen in the posterior basal segment of the 
right lower lobe. In pulmonary parenchy ma distal to 
the tumour a "B" zone is seen, only 1-2 mm wide but 
10 em long. Irregularly non-branching structures are 
evident in the parenchyma between the tumour and 
the "B" zone. These structures are each a millimetre 
wide, linear, and have been interpreted as widened 
interlobular spaces (arrows), analogous to Kerley's B· 
lines (4). The radiograph ic appearance of this narrow 
"B" zone differs from that of a normal interlobar 
pleura. Comparison can also be noted superiorly in 
Fig. III: 14, where a portion of normal interlobar pleu· 
ra between tbc middle and upper lobes is seen (P). In experimental attempts to produce at least some of Pig. Ill: 14. Large carcinoma in the lower 
right hilar region of a 52-ye:ar-o ld man. A 
1.5 mm thick and 10 em long "8" zone (8) 
is seen in the lung parenchymll 1-1.5 em 
from the chest wall. Between the tumour 
and the "8" zone some non branching 
structures, each a mm wide·, can be seen 
(arrows), interpreted as widened interlobar 
spaces due to stasis of lymph. Along the lat· 
cral chest wall and in the inlcrlobar fissure 
(P) there is no evidence for an increased 
amount of pleural fluid. Fig.///: 15. Experimenta l 
demonstration of focal pul­
monary oedema by an artifli· 
c-ia1 "tumour" in a dog lung, 
and the subsequen t disap­
pearance of the oedema. ( a) 
Lateral projection, anterior 
and cranial portions of a 
dog's chest. (b) After pcrcu.· 
taneous injection of 1.5 ml 
of a polymeriz ing plastic 
material mixed with barium 
sulphate powder, an artifi­
cial radiopaque lUmour was 
produced. (c) After three 
months an infiltrat.ion simll· 
lating atelectasis or thick­
ened pleura was seen be· 
tween the pleura and the C 
plastic tumour. (d) The post 
rnor1.em specimen showed 
no pleurolthic kening or in­
fihtaLion in the lung corre­
sponding to the infiltration 
seen in vivo. The infiltration 
has been inrerpreted as )(X.-al 
oedema due to blocking of 
the draining lymph channels 
of the lung by the plt>StiC 
htumour". The occurrence 
and djsappcarance of the iru· 
filtr-.&tc in the dog, as in liv .. 
ing patients, is further dis­
cussed in Fig. Ill: 16. Malignant and benign neoplasms 23 -... ...... 
P, ~ 
IY= q P, 
'I 
P.>~>P. ~ > P, 
P, > ~ q < Q, ~Oedema 
Fig. Ill: 16. Proposed mechanism for local oedema periph· 
e.ral to a tumour in lung. A tumour (71 may obstruct some of 
the draining lymphatic channels and interlobular spaces be· 
tween pleura and hilar lymph nodes. Local pressures (P) will 
change, altering Oow of tissue Ouid (Q). Oedema will occur 
between the pleura and the tumour. For further explanation, 
see 1ex1. 1he radiographically observed changes, experimen1s 
were performed in ten dogs. On 1he preliminary assumption that a tumour me· 
chanically blocks lymph drainage, "tumours" were 
produced in the dog lungs by percutaneous injection of 
a polymerizing material (Crystic Tea® with an accel· 
erator Butanox®) made of liquid plastic admixed with 
barium sulfate powder. After the injection of 1.5 ml 
24 Malignant and benign neoplasms into the lung parenchyma, the material formed a solid, 
radiopaque "tumour" . In Fig. Ill: !Sa, a lateral view is seen of a dog's 
anterior upper Jobes before the injection. Fig. b shows 
the solid plastic "tumour" one hour after the injec· 
tion. In Fig. c, three months later, the plastic "tu· 
mour" has shrunken and lies in a cavity. Between the 
"tumour" and the pleura is seen an inftltration simu· 
lating pleural thickening or atelectasis. The dog was 
then desanguinated under deep general anaesthesia. The removed lung did not show any changes in the 
pleura. The radiograph seen in Fig. d was taken after 
gentle inflation of the specimen. No thickening of the 
pleura, atelectasis or infiltration can be seen in the 
lung. At microscopic examination i1 was found that the 
plastic "tumour'' was lying as a free body in a cavity 
which was outlined by a fibrous membrane. Otherwise 
no pathological changes were observed in the sur· 
rounding lung parenchyma or the pleura. In five of the 
ten dogs, radiographs revealed a "B" zone peripheral 
but not adjacent to the tumour, yet post mortem 
analysis showed no abnormalities in the apparently 
involved lung or pleura. These experiments with plastic "tumours" in dog 
lungs have convinced the author that these "tumours" 
block the lymphatic drainage between the pleural 
space and the hilum, thereby producing local oedema 
by stasis. As soon as 1he pleural space is opened, 
whether in vivo or post mortem, Ouid mus1 leave the 
"B" zone due lo retraction of the lung parenchyma 
Fig. Ill: 17. Two incongruent .. B., 
zones. Centrally located, cavitating car· 
cinoma in a 63·ycar-old man. The two 
ugu zones (arrows) are thin, each about 
2 mm wide and $tVe.ral em long. For ex­
planation, sec Fig. Ill: 19. and loss of the previously locally elevated turgor pres­
sure in the lung. Tbe pleur-.1.1 nuid is drained, at least 
in part, from the pleural space via the lymphatic chan­
nels in the interlobular and perivascular spaces toward 
the hi.lar lymph nodes and mediastinal lymphatic chan­
nels (2, 12). The direction of now from the pleural space into the 
interlobular lymphatic s of the lung was earlier studied 
by the author in dogs by means of lipiodol injection 
into the pleural space. Lymphography in man later 
also showed (5) that after lipiodol was injected slowly 
into the azygos lymph node via a thin needle, respira­
tion influenced its movement in the lymphatic: chan­
nels of the mediastinum. During expiration the lym­
phatics arc kinked and the now of lipiodol decreased. During inspiration the lymphatics ~come stretched 
and the forward now of lipiodol increased. When a tumour grows in pulmonary parenchyma 
and blocks some of the lymphatics , stasis with local 
oedema can be expected to occur, as indicated in 
Fig. III: 16. A decreasing mean pressure gradient 
P1>P3>P4 will be changed by a blocking rumour (T), 
so that the direction of emptying of tissue nuid in the 
blocked area will be altered. The pressure P~ of the 
tissue nuid close to a blocked draining channel must 
~elevated above the pleural pressure P 1 before it can 
enter the blocked channel. This alteration suggests the 
now of tissue nuid Q2 diminishes. Fluid collects in the 
lung tissue and lymphatic channels between the tu­
mour and the pleura. In lung only partly within the blocked area or nearly 
freely emptying, less oedema can be expected. This 
consideration can explain why the border of the "B" 
zone is diffuse or fading in certain portions. A sharp 
Fig./11:19 . Diagrammatic ex­
planation of Figs. Ill: 17 and 
18. Transverse section a 
<hrough left upper lobe. (a) Tumour (D lncated cen­
trally in a segment, not in· 
volving segmental border (S) 
or interlobar fissuc. Single 
.. A .• and .. 8" woes then de­
velop. (b) Tumour ~rrowine 
over the interfa"" (S) between 
tv. 'o segments may g.i\'c rise to 
two separ.tte "B" zones. That 
part of the .. 8" zooe which 
reaches segmenta l or lobar de­
marcation will end sharply. Otherwise it will appear un­
sharp(see also Fig. III: 13a). Differences of distance be· 
twee.n rum our and u B" zones 
may develop from differences 
of hydrostatic counterpressu re 
in different parts of the lung 
vs. elcctroosmoti c outflow of 
water from the tumour. Fig. Ill: /8. Squamous cell carcinoma in a 76-year--old 
woman in the upper pan of the right lung. Two arcades, 
each with smaU arches, appear as incongruent sectors of cir­
cles (arrows). For explanation, sec Fig. III: 19. 
borderline can, however, also ~ present in certain 
sites where the oedema extends toward obliterated 
interstitial spaces or interfaces ~tween two pulmonary 
segments or lobes. Wherever lymphatic collaterals arc extensive in rela­
tion to the size of blocking mass, demonstrab le lymph­
oedema may not ~ present. This consideration may 
explain the observed rarity of r•diographic "B'' zones 
b 
Malignant and benign neoplasms 25 a 
/ 
I 
\ 
Fig. II/: ZfJ. Inte-rlobular fluid accumulation periphera l to a 
cardnoma of the anterior segment. right upper lobe, in a 35· 
year-old man. (a) Posteroanterior projection . Three thin lin­
ear structures are apparent without definite contact with the 
rumour (arrows). (b) In the lateral view an "A •• zone and 
"Bn zone are seen. A linear strucrure (arrow) starts with a 
triangular base a1thc "8" zone and Utpcrs gradually inward 
mward the tumou_r. Inferior to the ''A" and 108" zones a tri­
angular atelectatic density (X) is seen. (c) After netdle biopsy 
a minimal amount of air appeared in the pleuraJ space (two 
arrows). The uA ''and .. 8 .. zones disappeared, but atelecta· 
sis (X) remained. The linear structure (single arrow) is still 
presenc. h is ime:rpreted as an interlobular space distended 
by oedema fluid retained in the space by capillllry force. when tumours are situated relatively far from the pleu­
ra. Occasionally not one but rwo "8" zo11es may be 
seen periphera l to a solitary mass (Fig. Ill: 17). In this 
example of a bronchogenic carcinoma with a central 
air-containing cavity, the "B" zones arc seen as two 
curved strucmres, about 2 mm thin and several em 
long. Two arcades may sometimes appear as incongru· 
cnt sectors of circles. Fig. Ill: 18, for example, shows a 
squamous cell carcinoma extending between the right 
upper and lower lobes with incongruent arcades be­
tween corresponding u A" and "B" zones. When local lymphoedema is viewed as one of the 
important mec·hanisms for producing 118" zones, it is 
easy to explain the development of two "B" zones by 
only one tumour. This phenomenon probably depends 
on the location of the tumour in relation to segmental 
anatomy of the lung, schematically illustrated in a 
horizontal cro~s section of the left lung in Fig. Ill: 19. 26 Malignant and benign neoplasms For instance, if a tumour (7) is centrally located in the 
anterior segment of an upper lobe (Fig. Ill: 19a), the 
site of any local lymphoede ma will be somewhere be­
tween the pleura and the tumour. Sharply demarcated 
borders may then develop against any limi[ing struc­
ture, e.g., the interlobar pleura or an interlobular 
septum. In Fig. 111: 19b the tumour is situa~ed in two 
adjoining pulmonary segmems. Such a location will 
cause local obstruction of lymph flow in different parts of the segments according to differences in sizes of the 
segments, hydrostatic pressures, etc. Such differences 
explain why a "B" zone sometimes shows one sharp 
edge while the other may be unsharp and appears to 
vanish into the lung parenchyma. The fact that the lymphoedema ("B" zone) does not 
extend to the edge of the tumour will be discussed 
rather extensively later on. Arches and arcades, radiat­
ing StrUCtures, displacementS Of tumour-surrounding 
structures, narrowing of vessels, as well as the forma­
tion of the "A" zones will be seen to relate to the 
development of pathological electric polarizati on 
which, under cenain conditions, may occur in a tu .. 
mour or tumour-like lesion. D. Interlobular fluid 
accumulation 
In the course of performing percutaneous needle bi­
opsies of pulmonary masses surrounded by "B" zones, 
a frequent observation has been that the zones vanish 
totally (or nearly totally) whenever air enters the pleu­
ral space. Even small pneumothoraces induce this 
change. The case shown in Fig. III: 20 (bronchogenic carci­
noma, right upper lobe) is particularly instructive be­
cause it illustrates the effect of a small pneumothorax 
on the "A" and "B" zones and on three, thin, rather 
distinct, linear structures which appear separated from 
the surface of the tumour, as seen on frontal view (a). In the lateral view (b) one of these Structures is seen to 
have a triangular or funnel-shaped base in the "B" 
zone and a line gradually tapering inward in the "A" 
zone (arrow). After needle biopsy of the tumour, a 2 
mm broad pneumothorax (two arrows) appeared (c). Most of the "A" and "B" zones then disappeared , 
including the funnel-shaped base of the thin line, 
which still can be seen isolated from the centrally 
located tumour (single arrow). The density (X), inferi­
or to lhe "A" and "B" zones and appearing to connect 
the tumour and pleura, has been interpreted as focal 
atelectasis not influenced by the pneumothorax. The 
thin line in the "A'' zone has been interpreted as local 
fluid in an interlobula .r space on the basis of tapering 
shape, broad connection with the border of the "B" 
zone, and absence of contact with the tumour. The 
retention of the thin line in spite of disappearance of 
most of the fluid speaks for such an interpretation, 
because Ouid in the interlobular space may be retained 
by capillary force. Pig. Ill: ll. Well differentiated squamous cell carcinoma in 
a 66·ycar·old man. Extremely thin, radiating structures 
make the tumour surface appear unsharp and "hairy'', 
E. Radiating structures 
These structures, when present, emerge from the sur­
face of the lesion and show a wide range of appearances. The radiating structures may be coarse or thin (Figs. III: I, 3, 9-11, 21-27). Often they extend several cen­
timetres out into the pulmonary parenchyma. Some­
times they arc very short. Often they are unevenly 
Fig. III: 22. Small primary adenocarcinoma in a 6S.year-old 
man. Short, blunt, radiating structures emanate from the tu­
mour. Malignant and benign neoplasms 27 Fig. II/: 24 Fig.///: 23. WeU differentiated squamous ceU carcinolllJI in 
a 63·year-old woman. (a) Posteroanterior projection. Granu­
lar radiating structures surround the tumour. (b) Lateral 
projection. (c) Posteroanterior view one year later (the pa· 
tient had refused treatment ). In spite of expanding growth of 
rhe rumour, scrucmres are still seen radiating from its sur­
face. Fig. Ill: 24. Metastatic breast carcinoma in an 82-year·old 
woma.n. Numerous , long, coarse radiating structures are ori­
ented perpendicular to the surface of the tumour. No pre· 
formed channels in the lung, such as lymphatics , have tllis 
course. Fig. Ill: 25. Metastatic adenocarcinoma in the left upper 
lobe of a 58-year-old woman. The tumour is adjacent to the 
pleura. Fine suuctures radiate more or less perpendicular to 
the surface of the tumour. Their courses diverge with respect 
to the hilum, whereas lymphatics and other preformed chao­
nels of the lung,s have a con\'ergent course. The dirC(:tiOn of 
the radiating suuctures is therefore related mainly to the sur­
face of the mmour and not ro the underlying gross morphol· 
ogy of the lung. distributed around a lesion. Radiating structures arc 
not necessarily seen when uA•t and t'B" zones arc 
present (Fig. Ill: 2, 4-7, 18). Radiating structures can be extremely thin. In Fig. III: 21 the surface of a well differentiated squamous 
cell carcinoma looks "hairy". The structures can be very short and blunt (Fig. III: 22, a small primary adenocarcinoma ). Note that 
this tumour is also surrounded by a 05-1 em broad 
.. A,. zone. Radiating structures occasionally appear discontinu­
ous, so the periphery of a tumour may seem grainy 
(Fig. Ill: 23, a well differentiated squamous cell carci­
noma). This case also illustrate> the behaviour of the 
structures around a tumour as it grows. At initial 
presentation (Fig. III: 23a, b), radiating structures 
and a cenain displacement of vessels away from the 
tumour are evident. The patient refused treatment. One year later (Fig. Ill: 23c), vessels are still displaced 
around the tumour and radiating structures remain 
perpendicularly arranged around its surface despite 
considerable growth of the tumour. Now a clearly 
visible "A" zone is also present. This case shows that 
both radial arrangement of structures around the tu­
mour and the "A" zone have net developed as a result 
of tumour collapse or contraction, such as might be 
caused by internal necrosis with subsequent inward 
retraction of surrounding lung structures. As the tu­
mour grew, so did the radiating structures. Radiating structures can be numerous , long, and 
rather coarse (Fig. Ill: 24, metastatic breast carcino­
ma). They are consequent ly not a sign of primary 
cancer. They are arranged more or Jess perpendicular ­
ly to the surface of a tumour (Figs. III: 25 and 26). An important feature of the radiating structures is 
that their directwns are getteral/y indepettdem of existing 
preformed channels in the lung. The radiating structures 
develop perpendicularly to the surface of the lesion. No preformed channels such as lymphatics can explain 
the configurations seen in Figs. III: 21-26. Tumour cells are sometimes seen histologically in 
the radiating structures close 10 the tumour surface 
(3). Often no tumour cells arc present in the distal 
parts of the radiating structures , which consist of "fi. brotic" materiaL 
The independence of the radiating structures from 
existing morphologic channels of tbc lung can be seen 
especially well for tumours situated close to the pleura. For example, the tumour in Fig. Ill: 25 is situated in 
the left upper lobe close to the pleura. Radiating struc­
rurcs appear more or less perpendicular to the surface 
of the tumour. They diverge in relation to the hilum. Draining lymph vessels, on the other hand, mainly 
converge tOward the hilum. Fig. I I I: 26. Poorly differentiated squamous cell carcinoma 
in the right upper lobe of a 60-year-old man. The tumour, 
adjacent to 1he pleura, shows radiaung srrucrures at its sur­
face. Their courses diverge, indicating that they are not fol· 
lowing pulmonary lymphatic channels. F. Coarse radiating structure s: 
lamellae and infiltrated 
strands 
Some radiating structures around pulmonary neo­
plasms often appear denser or thicker than neighbour­
ing radiating structures. A representative example is 
seen in Fig. III: 27, projected over the tumour as a 
dense line. In Fig. III: 9a-c, which represents differ­
ent projections of the same case, at least two such 
structures are seen. They are typically seen at the 
edge, outside the tumour (Fig. Ill: 9a) or projected 
over the tumour (Fig. Ill: 9 a-c), depending on the 
projection used. In Fig. HI: 27 a of the same patient, a 
10• left anterior oblique projection reveals two cross­
ing, linear, dense srructures projected over the tu· 
mour. The posteroanterior projection (Fig. IU: 27 b), 
however, shows linear structures mainly separated 
from the tumour. The obliquely crossing linc-. :.n Struc­
tures are outside the tumour and extend through the 
"A" zone to the "B" zone (Fig. III: 27 c). In this pro­
jection the tumour also shows an air·containing cavity 
and an indentation on its inferior margin. Central necrosis causing partial collapse of a rumour 
is known to occur from time to time. In such in­
stances, structures close to the surface of the rumour 
Malignant and benign neoplasms 29 Stage o 
development 
of bronchial 
tumour 
bronchus 
Stage 3 
reocclusion of bronchus 
and resorption of air 
leading to asymmetric 
tumour collapse and 
formation of lamellae Stage 1 
development 
of internal 
necrosis 
and 
radiating 
structures 
Fig. ! !I: Z8. PropOsed principle of formation of lamellae. Stage 0: A bronchus enters a pulmonary mass. Stage I: Ex­
centric local necrosis develops in the tumour and 1hin radial­
ing structures develop perpendicu lar lO its surface. Stage 2: 
Necrotic debris leaves the tumour via the bronchus and is re­
placed by air. Stage 3: The bronchus becomes blocked, lead· Fig. !JI: 27. Squamous cell carcinoma in the left upper 
lobe of a 70·year·o ld man. Same patjem as in Fig. IJJ:9. (a) At lease 1wo linear SlruC:t\m::s (3rrows) cross each other 
over Lhe rumour as seen in I 0° lef1 anterior oblique pro­
jeccion. (b) In che posteroanterior view these structure~ a.re 
seen panly projec1ed adjacenl to che l:ucral aspect or Lhe tu­
mour. "A" and "B" zones are also seen. Small arches form 
an arc..ade. (c) The rwo linear structures, rhe .. A" and .. B" 
zones, and the arcade are seen in a 3)0 lef1 aruerior oblique 
projection. Nme excentric air·containing caviry (n) in the 
rumour. Radiating s1rucrures in associalio n with a parual 
collapsed, necrotic tumour are here preliminarily called la­
mtllae. For further explanation, see Fig. Ill: 28. Stage 2 
evacuation 
of debris 
and inlet 
of air 
lamellae (90• projection) 
ing to resorpdon of the air in the tumou.r cavity. AsYmmetric 
collapse of the tumour tissue will then produce local coo· 
glomc.ration of radjating structures in the surrounding lung 
tissue. Lam~llae developed in this way may in certain projcc;· 
tions appear as if they are crossing the tumour. may undergo positional changes. Already developed 
radiating structures will rhen show partial displace­
ments in relation to each other, as is interpreted to 
have been the case in Fig. III: 27. Fig. Ill: 28 summa­
rizes this explanation of the pathogenesis of the dense 
linear structures: 
A rumou.r (Stage 0) develops central necrosis and 
radiating structures into the surrounding pulmonary 
parenchyma (Stage D). Necrotic material empties 
th.rough the supplying bronchus and air enters the 
remaining cavity (Stage Z). When the bronchus later 
bc<.X>mcs blocked, presumably by growth of the tu­
mour, the air resorbs and the tumour partially col­
lapses. As a consequence , the radiating structures be­
come displaced (Stage 3). This process gives rise to 
~:oarse, asymmetri~:al, dense, linear slru~:tures , whil:h 
are here called lamellae. They appear in radiographs 
either at the edge of the tumour or appear as if they 
were crossing it.
631928626-Biologically-Closed-Electric-Ci-Bjorn-Nordenstrom-pdf.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Under the influence of weak unidirectiona l direct 
current (a few microamperes during 2-S weeks), hu· 
man breast fat develops in the anodic field solid "rods" 
of an epithelial type of cells. The rods arrange them­
selves lengthwise in the fibrous tissue in anodic groups 
surrounded by a sheet of circular fibres, containing 
fibroblast-like cells. Eventually the groups develop 
each a central lumen. These structures, which arc best 
developed close to the anode, have a" appearmrce wry 
much like mdogenously developed fibroadenosis in breast 
tissue. Close to the cathode, fat cells are simultaneously 
transformed into small "cells" with light cytoplasm 
8 Summary and a dark pOint-like nucleus (haematoxylin-eosin). They arrange themselves in cathodic groups around a 
central fibrous material. This material extends with 
radiating structures between the "cells" to a circular 
fibrous enclosure (without fibroblasts). The cathodic 
groups of cells arrange themselves as cathodic cores in 
the direction of the newly formed cathodic fibrous 
tissue. Some of these cores Jose their cells and leave a 
fibrous channel without cellular elements in its wall. Some cores gradually modify their cells and continue 
as anodic rods in the middle of the specimen. The light 
cathodic cells then gradually stain dark red-blue with 
hacmatOxylin ·cosin. Some cells in the cathodic field develop chamwl-like 
structures which have an appearance similar to emlogett· 
ous/y developed pathological vessels. The same type of cathodic channels, with an appear· 
ance of pathological vessels and anodic channels with 
fibrous walls containing fibroblast-like cells, could also 
be produced in normal, subcutaneous, human, ab· 
domina. fat specima. Further, in cathodic breast fat 
and abdominal fat, fibrous channels also develop with· 
out fibroblasts or cellular elements. When bidirectional current was passed over breast 
fat, thin anodic channels were produced. They con· 
tained fibroblast-like cells in their walls. The proposed existence of a fluctuating potemial aris· 
ing after injury to tissue is supported by in vitro experi· 
ments in which microcalcificatiom were produced in 
breast fat tissue. Fat removed from normal human 
breasts was expOsed to direct current (e. g. , 25 cou­
lombs at 10 V). Anodic, intracellu lar, "bush-like" 
structures developed. They contained no calcium, but 
could be identified in microradiographs. At trus pOint 
the current over the tissue sample was reversed. Our· 
ing trus second phase, calcium precipitated in the bush· 
like matrix, which now bad the histologic appearance of 
spontaneously developed microcalc ifications in breast 
cancer. Fat itself is a relatively poor electric conductor. The 
electric current over small specimens of fat tissue is 
therefore, after a few hours, usually in the range of a 
few microamperes. The time of treatment was there­
fore extended over weeks. During such long time 
periods, the current seems to protect the specimen 
from bacteriological decompOs ition. Not only weak currents but also low energies of 
current are capable of modifying the structure of tis­
sue, when the forces are allowed to act over a long 
time. Thus, the weak electric pulses around pacemak· 
er devices and the intracardia c electrode can cause 
fibrous tissue to form, but only after relatively long 
periods of time. Such considerations may suppOrt the 
theory that metabolic pOlarization of tissues or organs 
should also be capable of producing substantial ionic 
transpOrtS over BCEC systems. Fibrotic tissues such as tissue membranes and organ capsules may be the re­
sult. The studies presented suggest also that pathologi­
cal conditions in which calcium precipitates in tissue, 
including healing of fractures by electric current 
(which has been attempted by previous researcher ), 
need investigation in terms of BCEC. The structural changes around carcinomas of the 
breast are remarkably similar to the structural changes 
around masses in the lung, despite the differences in 
basic morphology of the two organs. It has therefore 
been concluded that the biokinetic background for 
their development may essentially be the same. The 
central mechanism for such modifications of structure 
appears related to physicochemical polarization of tis­
sues within biologically closed electric circuits. Under the assumption that the BCEC systems repre­
sent a physiologic transport mechanism which influ­
ences normal functions, including healing, it seems 
reasonable to speculate that artificial activation of 
BCEC sysrems offers rhe possibilil)l of enhancing healing. Direct current used for therapeutic purposes (elec­
troc. hemical ITeatment) raises many possibilitie s either 
for separate treatments with direct current or for com­
binations with other techniques. Verified cancers occasionally heal sponuzneous/y, ac­
cording to well established reports in the literature. Several possible explanations have been advanced and 
also criticized. In addition to the commonly suspected 
immunologic or hormonal causes, it is suggested here 
that the mechanism of healing via the VICC system 
may be involved. It is assumed that cancers, which develop internal 
necrosis, bleeding or infection obtain a release of cata· 
bolic energy which will activate their VICC system. This represents the start of a process of healing, includ­
ing accumulation of leukocytes, production of fibrosis, 
microthromboses and other changes in the environ­
ment of the tumour. In favourable cases, such changes 
around the tumour may preclude its survival. More 
commonly, such changes should only slow the rate of 
neoplastic growth, because of insufficient release of en­
ergy for complete healing of all tumour tissue. An 
additional supply of energy to drive the VICC system 
is, however, possible over implanted electrodes con­
nected roan external electric source of power. The suggested mechanism of a narural, but rarely 
complete process of spontaneous healing of cancers 
and how this mechanism may be supported, formed 
the rationale for a series of electrochemical treatment s 
of cancer. A localized cancer may even offer rat. her favourable 
possibilities for therapy with direct current between 
implanted electrodes connected to an external source 
of DC power. After an earlier pilot study to introduce 
a self-driving i11jury reaction by local electrocoagulation 
of tumours, five patients with inoperable metastases in t. hc lung were treated with direct current. This type of 
treatment represents, during treatment s, an externally 
driven system. It offers the advantage that any magni­
tude of energy can be applied to activate the biologic 
circuits. The drawback is, however, that we sti11 do 
not know enough about the mode of application to 
optimize the technique. As soon as the current is 
interrupted, a self-driving system will start in the tis­
sues. The direcrion of current will now reverse, com­
pared to the applied current. The tissues will take over 
the initiated process of healing. Eltctrochemical treatments have now been further 
modilicd and applied in a trial series of 26 cancers in 
20 patients. The study shows that some peripheral 
nonopcrable lung tumours can be treated successfully 
in patients with poor cardiorespiratory or general con­
dition. The tumour electrode is made anodic because 
cancer cells are generally considered to carry a surplus 
of fixed electronegative surface charges. In this way 
the tumour cells are kept attracted to the anode during 
treatment. After treatment, 13 of the tumours gradually disap­
peared or decreased in size, usually during the first 
three or four months. One of these tumours later 
increased in size. Thirteen patients have died, five 
from multiple metastases, four from brain metastases, 
one each from bronchopneumonia, abuse of alcohol, 
myocardial infarction, and suicide. The treatments 
have been free of mortality. Complications (e.
The application of a weak unidirectional direct current can transform the fat cells into epithelial-type "rods" that arrange themselves lengthwise in fibrous tissue, which is surrounded by a sheet of fibroblast-like cells.
What is the effect of applying a weak unidirectional direct current to human breast fat?
The purpose of electrochemical treatments is to activate the biokinetic background, which can lead to the development of fibrous tissue and potentially enhance healing.
What is the purpose of electrochemical treatments for cancer?
The "A" and "B" zones are radiographically visible structural changes that can be used to diagnose and differentiate between malignant and benign neoplasms.
What is the significance of the "A" and "B" zones in the context of radiography?
The limitation of radiographic technique is that it may not be able to detect "A" and "B" zones due to the lack of standardization in radiographic examination and interpretation, as well as the potential for errors in the analysis of radiographs.
What is the limitation of the radiographic technique in detecting "A" and "B" zones?
The proposed mechanism for the formation of radiating structures is that they are formed as a result of the physiological polarization of tissues within biologically closed electric circuits, which can lead to the development of new vessels and potentially enhance healing.
What is the proposed mechanism for the formation of radiating structures?