Sandbox lung cancer differential: Difference between revisions
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* Topography, size and form of pulmonary growth pattern are important aspects for the differential diagnosis. | * Topography, size and form of pulmonary growth pattern are important aspects for the differential diagnosis. | ||
* '''<u>The following table summarizes the differentiation of various lung tumors based on histological and topographical features:</u>'''<ref name="pmid10682770">{{cite journal |vauthors=Erasmus JJ, Connolly JE, McAdams HP, Roggli VL |title=Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions |journal=Radiographics |volume=20 |issue=1 |pages=43–58 |date=2000 |pmid=10682770 |doi=10.1148/radiographics.20.1.g00ja0343 |url=}}</ref> | * '''<u>The following table summarizes the differentiation of various lung tumors based on histological and topographical features:</u>'''<ref name="pmid10682770">{{cite journal |vauthors=Erasmus JJ, Connolly JE, McAdams HP, Roggli VL |title=Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions |journal=Radiographics |volume=20 |issue=1 |pages=43–58 |date=2000 |pmid=10682770 |doi=10.1148/radiographics.20.1.g00ja0343 |url=}}</ref> | ||
{| class="wikitable" | |||
! colspan="11" |Abrevations: | |||
HPV: human papillomavirus; CEA: Carcino embryogenic antigen; TTF1: '''Thyroid transcription factor-1; EMA: Epithelial membrane antigen; CK: Cyto keratin; CD: Cluster differentiation; NCAM: Neural Cell Differentiation Molecule;''' | |||
MMP's: Mettaloprotineases matrix ; GFAP: Glial fibrocilliary acid protein | |||
|- | |||
! colspan="11" style="background:#4479BA; color: #FFFFFF;" align="center" + |Benign Lung Tumors<ref name="pmid23077446">{{cite journal |vauthors=Gümüştaş S, Inan N, Akansel G, Ciftçi E, Demirci A, Ozkara SK |title=Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging |journal=Radiol Oncol |volume=46 |issue=2 |pages=106–13 |date=June 2012 |pmid=23077446 |pmc=3472932 |doi=10.2478/v10019-012-0021-3 |url=}}</ref> | ! colspan="11" style="background:#4479BA; color: #FFFFFF;" align="center" + |Benign Lung Tumors<ref name="pmid23077446">{{cite journal |vauthors=Gümüştaş S, Inan N, Akansel G, Ciftçi E, Demirci A, Ozkara SK |title=Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging |journal=Radiol Oncol |volume=46 |issue=2 |pages=106–13 |date=June 2012 |pmid=23077446 |pmc=3472932 |doi=10.2478/v10019-012-0021-3 |url=}}</ref> | ||
|- | |- | ||
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* Bronchial precursor cell | * Bronchial precursor cell | ||
| | | | ||
* Peripheral | |||
| | | | ||
* White-tan, soft, friable perihilar masses | * White-tan, soft, friable perihilar masses | ||
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** Fibroblastic stroma | ** Fibroblastic stroma | ||
| rowspan="10" | | | rowspan="10" | | ||
* Epithelial markers | * Epithelial markers | ||
* | * [[CEA]] | ||
* CK7 | * [[Cytokeratin|CK7]] | ||
* TTF-1 | * [[TTF-1]] | ||
| rowspan="10" | | | rowspan="10" | | ||
* Peripheral nodules under 4.0 cm in size | * Peripheral nodules under 4.0 cm in size | ||
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* Adrenal glands | * Adrenal glands | ||
* Liver | * Liver | ||
* Kidney | |||
* Gastrointestinal Tract | |||
|- | |- | ||
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Papillary adenocarcinoma''' | | colspan="2" style="background:#DCDCDC;" align="center" + |'''Papillary adenocarcinoma''' | ||
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| style="background:#DCDCDC;" align="center" + |'''Mixed non-mucinous and mucinous or indeterminate''' | | style="background:#DCDCDC;" align="center" + |'''Mixed non-mucinous and mucinous or indeterminate''' | ||
| | | | ||
* Mixed type of cells | |||
* Low to high grade differentiated cells. | |||
|- | |- | ||
| rowspan="5" style="background:#DCDCDC;" align="center" + |'''Solid adenocarcinoma with mucin production''' | | rowspan="5" style="background:#DCDCDC;" align="center" + |'''Solid adenocarcinoma with mucin production''' | ||
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| style="background:#DCDCDC;" align="center" + |'''Signet ring adenocarcinoma''' | | style="background:#DCDCDC;" align="center" + |'''Signet ring adenocarcinoma''' | ||
| | | | ||
* Focal | |||
* Cells with nuclei displaced to sides | |||
* Components of other cells are present. | |||
|- | |- | ||
| style="background:#DCDCDC;" align="center" + |'''Clear cell adenocarcinoma''' | | style="background:#DCDCDC;" align="center" + |'''Clear cell adenocarcinoma''' | ||
| | | | ||
* Clear cells with no nuclei | |||
|- | |- | ||
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma | ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma | ||
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*[[Chromogranin]] | *[[Chromogranin]] | ||
*[[Synaptophysin]] | *[[Synaptophysin]] | ||
* | *[[CD56]] | ||
*[[Cytokeratin]] | *[[Cytokeratin]] | ||
| rowspan="5" | | | rowspan="5" | | ||
Line 537: | Line 549: | ||
* [[Chromogranin]] | * [[Chromogranin]] | ||
* [[Synaptophysin]] | * [[Synaptophysin]] | ||
* | * [[CD57]] | ||
* | * [[CD56]] | ||
* [[S-100 protein]] | * [[S-100 protein]] | ||
| | | | ||
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* Transitional areas to low grade [[mucoepidermoid carcinoma]] | * Transitional areas to low grade [[mucoepidermoid carcinoma]] | ||
| | | | ||
* | * [[GFAP]] | ||
| | | | ||
* Well-circumscribed oval or lobulated mass | * Well-circumscribed oval or lobulated mass | ||
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* [[Calponin]] | * [[Calponin]] | ||
* [[S-100 protein]] | * [[S-100 protein]] | ||
* | * [[p53]] | ||
* [[GFAP]] | * [[GFAP]] | ||
| | | | ||
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* [[CD34]] | * [[CD34]] | ||
* [[Factor VIII]] ([[von Willebrand factor]]) | * [[Factor VIII]] ([[von Willebrand factor]]) | ||
* [[Cytokeratin]] | * [[Cytokeratin]] | ||
| | | | ||
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* [[Spindle cells]] | * [[Spindle cells]] | ||
| | | | ||
* Along the bronchi | |||
| | | | ||
* 5-10 cm | * 5-10 cm | ||
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* Intra alveolar siderophages | * Intra alveolar siderophages | ||
| | | | ||
* [[Vimentin]] | * [[Vimentin]] | ||
| | | | ||
* Increased interstitial markings | * Increased interstitial markings | ||
Line 970: | Line 979: | ||
* [[Vimentin]] | * [[Vimentin]] | ||
* [[Actin]] | * [[Actin]] | ||
* p80 | * p80 | ||
| | | |
Latest revision as of 19:12, 22 March 2018
- Differentiation of primary and secondary lung tumors is difficult due to overlapping histologic features.
- Topography, size and form of pulmonary growth pattern are important aspects for the differential diagnosis.
- The following table summarizes the differentiation of various lung tumors based on histological and topographical features:[1]
Abrevations:
HPV: human papillomavirus; CEA: Carcino embryogenic antigen; TTF1: Thyroid transcription factor-1; EMA: Epithelial membrane antigen; CK: Cyto keratin; CD: Cluster differentiation; NCAM: Neural Cell Differentiation Molecule; MMP's: Mettaloprotineases matrix ; GFAP: Glial fibrocilliary acid protein | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Benign Lung Tumors[2] | ||||||||||
Benign lung tumor | Risk/Epidemiology | Pleuripotent cells | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Papilloma[3] | Squamous cell papilloma |
|
|
|
|
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Glandular papilloma |
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|
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Adenoma[4] | Alveolar adenoma |
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Papillary adenoma[5] |
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Mucinous cystadenoma |
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Malignant Lung Tumors[6] | ||||||||||
Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Squamous cell carcinoma (SCC)[7] | Papillary |
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Clear cell |
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Basaloid |
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Small cell carcinoma[8] |
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Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Adenocarcinoma[9][10][11] | Acinar adenocarcinoma |
|
|
|
|
|
Aerogenous spread is characteristic
| |||
Papillary adenocarcinoma |
| |||||||||
Bronchio-alveolar carcinoma | Non-mucinous | |||||||||
Mucinous |
| |||||||||
Mixed non-mucinous and mucinous or indeterminate |
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Solid adenocarcinoma with mucin production | Fetal adenocarcinoma |
| ||||||||
Mucinous (“colloid”) carcinoma |
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Mucinous cystadenocarcinoma |
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Signet ring adenocarcinoma |
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Clear cell adenocarcinoma |
| |||||||||
Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Large cell carcinoma[12] | Basaloid large cell carcinoma of the lung |
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|
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|
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Clear cell carcinoma of the lung | ||||||||||
Lymphoepithelioma-like carcinoma of the lung |
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Large-cell lung carcinoma with rhabdoid phenotype |
| |||||||||
Mixed type |
| |||||||||
Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Sarcomatoid carcinoma[13] | Carcinosarcoma |
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Spindle cell carcinoma |
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Giant cell carcinoma |
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Pleomorphic carcinoma |
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Pulmonary blastoma |
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| ||||||||
Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Carcinoid tumor[14] | Typical carcinoid
Atypical carcinoid |
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Salivary gland tumors[15] | Mucoepidermoid carcinoma |
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Adenoid cystic carcinoma |
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Epithelial-myoepithelial carcinoma |
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Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Preinvasive lesions[16] | Squamous carcinoma in situ |
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Atypical adenomatous hyperplasia |
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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia |
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| ||||||
Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Mesenchymal tumors[17] | Epithelioid haemangioendothelioma / Angiosarcoma |
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|
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Pleuropulmonary blastoma |
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Chondroma |
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Congenital peribronchial myofibroblastic tumor |
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Diffuse pulmonary lymphangiomatosis |
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Inflammatory myofibroblastic tumor |
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Pulmonary artery sarcoma |
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Pulmonary vein sarcoma |
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Differentiation of lung cancer from other diseases with similar presentation
The following table summarizes the differentiation of lung cancer from other disease entities with similar presentation.[18][19][20][21][22]
Disease | Clinical features
Signs & symptoms |
Radiological Findings | Characterstic feature | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Cough | Hemoptysis | Dyspnea | Chest pain | Weight loss | Night sweats | |||||
High-grade | Low grade | Productive | Dry | ||||||||
Acute Lung abscess | + | - | + | - | - | - | + | - | - |
|
|
Malignancy | - | + | - | + | + | - | - | + | + |
|
|
Pulmonary Tuberculosis | + | - | + | - | + | - | - | - | + |
|
|
Necrotizing Pneumonia | + | - | + | + | - | + | - | - |
|
| |
Empyema | + | - | + | - | + | + | + | - | - |
|
|
Bronchiectasis | - | - | + | - | + | - | - | - | - |
|
|
Wegners granulomatosis | - | - | + | + | + | - | - | - |
| ||
Sarcoidosis | + | - | + | - | + | - | - | + | + |
|
|
Rheumatoid nodule | - | - | - | - | - | + | - | + | - |
|
|
Langerhans cell Histiocytosis | - | - | - | - | - | + | + | + | - |
|
|
Bronchiolitis obliterans | - | - | + | - | + | + | + | - | - |
|
|
References
- ↑ Erasmus JJ, Connolly JE, McAdams HP, Roggli VL (2000). "Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions". Radiographics. 20 (1): 43–58. doi:10.1148/radiographics.20.1.g00ja0343. PMID 10682770.
- ↑ Gümüştaş S, Inan N, Akansel G, Ciftçi E, Demirci A, Ozkara SK (June 2012). "Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging". Radiol Oncol. 46 (2): 106–13. doi:10.2478/v10019-012-0021-3. PMC 3472932. PMID 23077446.
- ↑ Maxwell RJ, Gibbons JR, O'Hara MD (January 1985). "Solitary squamous papilloma of the bronchus". Thorax. 40 (1): 68–71. PMC 459982. PMID 3969658.
- ↑ Shiota Y, Matsumoto H, Sasaki N, Taniyama K, Hashimoto S, Sueishi K (1998). "Solitary bronchioloalveolar adenoma of the lung". Respiration. 65 (6): 483–5. doi:10.1159/000029319. PMID 9817965.
- ↑ Kanchustambham V, Saladi S, Patolia S, Mahmoud Assaf S, Stoeckel D (March 2017). "A Rare Case of a Benign Primary Pleomorphic Adenoma of the Lung". Cureus. 9 (3): e1069. doi:10.7759/cureus.1069. PMC 5375953. PMID 28409070.
- ↑ Kelley LC, Puette M, Langheinrich KA, King B (November 1994). "Bovine pulmonary blastomas: histomorphologic description and immunohistochemistry". Vet. Pathol. 31 (6): 658–62. doi:10.1177/030098589403100605. PMID 7863581.
- ↑ Roth E, Smidt D (January 1970). "[Studies on early ejaculate collection using electroejaculation in German improved land-swines and Goettinger miniature pigs]". Berl. Munch. Tierarztl. Wochenschr. (in German). 83 (1): 7–11. PMID 5528918.
- ↑ Jackman DM, Johnson BE (2005). "Small-cell lung cancer". Lancet. 366 (9494): 1385–96. doi:10.1016/S0140-6736(05)67569-1. PMID 16226617.
- ↑ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. "Chapter 13, box on morphology of adenocarcinoma". Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7.
- ↑ Soda M, Choi YL, Enomoto M, Takada S, Yamashita Y, Ishikawa S; et al. (2007). "Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer". Nature. 448 (7153): 561–6. doi:10.1038/nature05945. PMID 17625570.
- ↑ Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/File:Adenocarcinoma_%283950819000%29.jpg
- ↑ Rossi G, Mengoli MC, Cavazza A, Nicoli D, Barbareschi M, Cantaloni C, Papotti M, Tironi A, Graziano P, Paci M, Stefani A, Migaldi M, Sartori G, Pelosi G (January 2014). "Large cell carcinoma of the lung: clinically oriented classification integrating immunohistochemistry and molecular biology". Virchows Arch. 464 (1): 61–8. doi:10.1007/s00428-013-1501-6. PMID 24221342.
- ↑ Huang SY, Shen SJ, Li XY (October 2013). "Pulmonary sarcomatoid carcinoma: a clinicopathologic study and prognostic analysis of 51 cases". World J Surg Oncol. 11: 252. doi:10.1186/1477-7819-11-252. PMC 3850921. PMID 24088577.
- ↑ Dahabreh J, Stathopoulos GP, Koutantos J, Rigatos S (March 2009). "Lung carcinoid tumor biology: treatment and survival". Oncol. Rep. 21 (3): 757–60. PMID 19212636.
- ↑ Elnayal A, Moran CA, Fox PS, Mawlawi O, Swisher SG, Marom EM (July 2013). "Primary salivary gland-type lung cancer: imaging and clinical predictors of outcome". AJR Am J Roentgenol. 201 (1): W57–63. doi:10.2214/AJR.12.9579. PMC 3767141. PMID 23789697.
- ↑ Greenberg AK, Yee H, Rom WN (2002). "Preneoplastic lesions of the lung". Respir. Res. 3: 20. PMC 107849. PMID 11980589.
- ↑ Koenigkam-Santos M, Sommer G, Puderbach M, Safi S, Schnabel PA, Kauczor HU, Heussel CP (April 2014). "Primary intrathoracic malignant mesenchymal tumours: computed tomography features of a rare group of chest neoplasms". Insights Imaging. 5 (2): 237–44. doi:10.1007/s13244-013-0306-0. PMC 3999366. PMID 24407922.
- ↑ Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
- ↑ Mouroux J, Padovani B, Elkaïm D, Richelme H (1996). "Should cavitated bronchopulmonary cancers be considered a separate entity?". Ann. Thorac. Surg. 61 (2): 530–2. doi:10.1016/0003-4975(95)00973-6. PMID 8572761.
- ↑ Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
- ↑ Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
- ↑ Suri HS, Yi ES, Nowakowski GS, Vassallo R (2012). "Pulmonary langerhans cell histiocytosis". Orphanet J Rare Dis. 7: 16. doi:10.1186/1750-1172-7-16. PMC 3342091. PMID 22429393.