Sandbox lung cancer differential: Difference between revisions
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* Pulmonary vascular changes in primary tumors are characterized by vascular infiltration, destruction and occlusion whereas in secondary tumors intravascular embolisation and extravasation predominate. | * Pulmonary vascular changes in primary tumors are characterized by vascular infiltration, destruction and occlusion whereas in secondary tumors intravascular embolisation and extravasation predominate. | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="11" |Malignant | ! colspan="11" |Benign Lung Tumors | ||
|- | |||
! | |||
! | |||
! | |||
!Risk/Epidemiology | |||
!Pleuripotent cells | |||
!Topography | |||
!Gross | |||
!Histology | |||
!Immunohistochemistry | |||
!Imaging | |||
!Mets | |||
|- | |||
| rowspan="3" |Papilloma | |||
| colspan="2" |Squamous cell | |||
| | |||
* HPV 6 and 11 | |||
* | |||
| | |||
* Endonronchial | |||
| | |||
* Cauliflower-like lesions | |||
* Tan-white soft to semifirm protrutions | |||
| | |||
* Loose fibrovascular core | |||
* Stratified squamous epithelium | |||
* Acanthosis | |||
* Wrinkled nuclei | |||
* Binucleate forms and perinuclear halos | |||
* Koilocytosis | |||
* Dyskeratotic cells | |||
* Large atypical cells | |||
* Occasional mitotic figure | |||
| | |||
* N/A | |||
| | |||
| | |||
| | |||
|- | |||
| colspan="2" |Glandular | |||
| | |||
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|- | |||
| colspan="2" |Mixed | |||
| | |||
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|- | |||
| rowspan="4" |Adenoma | |||
| colspan="2" |Alveolar adenoma | |||
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|- | |||
| colspan="2" |Papillary adenoma | |||
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|- | |||
| colspan="2" |Mucinous cystadenoma | |||
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|- | |||
| colspan="2" |Lymphoproliferative | |||
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|- | |||
| rowspan="6" |Miscelleneous | |||
| colspan="2" |Harmatoma | |||
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|- | |||
| colspan="2" |Sclerosing hemangioma | |||
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|- | |||
| colspan="2" |Clear cell tumor | |||
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|- | |||
| colspan="2" |Germ cell tumors | |||
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|- | |||
| colspan="2" |Intrapulmonary thymoma | |||
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|- | |||
| colspan="2" |Melanoma | |||
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|- | |||
! colspan="11" |Malignant Lung Tumors | |||
|- | |- | ||
! colspan="3" |Variant of lung carci | ! colspan="3" |Variant of lung carci | ||
Line 15: | Line 177: | ||
!Pleuripotent cell | !Pleuripotent cell | ||
!Topography | !Topography | ||
!Gross | |||
!Histology | !Histology | ||
!Immunohistochemistry | !Immunohistochemistry | ||
!Imaging | !Imaging | ||
Line 29: | Line 191: | ||
| rowspan="4" | | | rowspan="4" | | ||
* Central | * Central | ||
| rowspan="4" | | | rowspan="4" | | ||
* White or grey lesions | * White or grey lesions | ||
Line 39: | Line 197: | ||
* Intraluminal polypoid masses | * Intraluminal polypoid masses | ||
* Infiltration | * Infiltration | ||
| | |||
* Exophytic | |||
* Intra-epithelial | |||
* Without invasion | |||
| rowspan="4" | | | rowspan="4" | | ||
* Keratin | * Keratin | ||
Line 73: | Line 235: | ||
* Bronchial precursor cell | * Bronchial precursor cell | ||
| | | | ||
| | |||
* White-tan, soft, friable perihilar masses. | |||
* Extensive necrosis. | |||
* 5% peripheral coin lesions | |||
| | | | ||
* Sheet-like growth | * Sheet-like growth | ||
Line 80: | Line 246: | ||
* Rosette formation | * Rosette formation | ||
* High mitotic rate | * High mitotic rate | ||
| | | | ||
* CD56 | * CD56 | ||
Line 104: | Line 266: | ||
| rowspan="11" | | | rowspan="11" | | ||
* Peripheral | * Peripheral | ||
| rowspan="11" | | | rowspan="11" | | ||
* Single or multiple lesions | * Single or multiple lesions | ||
Line 116: | Line 277: | ||
** Hemorrhage. | ** Hemorrhage. | ||
* Lobulated or ill defined edges. | * Lobulated or ill defined edges. | ||
| | |||
| rowspan="11" | | | rowspan="11" | | ||
* Epithelial markers (AE1/AE3, CAM 5.2) | * Epithelial markers (AE1/AE3, CAM 5.2) | ||
Line 200: | Line 362: | ||
* Peripheral masses | * Peripheral masses | ||
* Bronchi | * Bronchi | ||
| rowspan="5" | | | rowspan="5" | | ||
* Soft, pink-tan tumor | * Soft, pink-tan tumor | ||
Line 210: | Line 368: | ||
* Cavitations. | * Cavitations. | ||
* Exophytic bronchial growth | * Exophytic bronchial growth | ||
| | |||
*Invasive growth pattern | |||
*Peripheral palisading | |||
*Small, monomorphic, cuboidal fusiform | |||
| rowspan="5" | | | rowspan="5" | | ||
*[[Chromogranin]] | *[[Chromogranin]] | ||
Line 264: | Line 426: | ||
* Central or peripheral | * Central or peripheral | ||
* Upper lobes | * Upper lobes | ||
| rowspan="5" | | | rowspan="5" | | ||
* > 5 cm | * > 5 cm | ||
Line 274: | Line 433: | ||
* Sessile or pedunculated | * Sessile or pedunculated | ||
* Infiltrative | * Infiltrative | ||
| | |||
* Biphasic | |||
* Mixture of carcinomatous and sarcomatous cells | |||
| | | | ||
* Keratin | * Keratin | ||
Line 326: | Line 488: | ||
* AC is more commonly peripheral | * AC is more commonly peripheral | ||
| | |||
* Firm, well demarcated, tan to yellow tumors. | |||
| | | | ||
* Uniform polygonal cells | * Uniform polygonal cells | ||
Line 333: | Line 497: | ||
* Highly vascularized fibrovascular stroma | * Highly vascularized fibrovascular stroma | ||
* Focal necrosis | * Focal necrosis | ||
| | | | ||
* Cytokeratin | * Cytokeratin | ||
Line 360: | Line 522: | ||
| | | | ||
* Bronchial glands | * Bronchial glands | ||
| | |||
* Ranging in size from 0.5-6 cm | |||
* Soft, polypoid, and pink-tan in colour | |||
* High-grade lesions are infiltrative | |||
| | | | ||
* Exophytic endobronchial growth | * Exophytic endobronchial growth | ||
Line 365: | Line 531: | ||
* Absence of individual cell keratinization | * Absence of individual cell keratinization | ||
* Transitional areas to low grade mucoepidermoid carcinoma. | * Transitional areas to low grade mucoepidermoid carcinoma. | ||
| | | | ||
* | * | ||
Line 390: | Line 552: | ||
| | | | ||
* Trachea | * Trachea | ||
| | | | ||
* Gray-white or tan polypoid lesions. | * Gray-white or tan polypoid lesions. | ||
Line 401: | Line 558: | ||
* Infiltrative margins. | * Infiltrative margins. | ||
| | |||
* Invades other cell layers. | |||
* Heterogeneous cellularity | |||
* Cribriform pattern | |||
* Perineural invasion | |||
| | | | ||
* Immunoperoxidase | * Immunoperoxidase | ||
Line 427: | Line 589: | ||
| | | | ||
* Endobronchia | * Endobronchia | ||
| | |||
* Solid to gelatinous in texture | |||
* White to gray in colour | |||
| | | | ||
* Myoepithelial cells | * Myoepithelial cells | ||
* Dual layer of cells lining ducts. | * Dual layer of cells lining ducts. | ||
* Low mitotic activity. | * Low mitotic activity. | ||
| | | | ||
* MNF116 | * MNF116 | ||
Line 449: | Line 611: | ||
| | | | ||
* Bronchi | * Bronchi | ||
| | |||
* Focal or multi-focal plaque-like greyish lesions | |||
* Nonspecific erythema | |||
* Even nodular or polypoid lesions | |||
| | | | ||
* Goblet cell hyperplasia | * Goblet cell hyperplasia | ||
Line 459: | Line 625: | ||
* Micropapillomatosis | * Micropapillomatosis | ||
| | | | ||
* EGFR | * EGFR | ||
Line 485: | Line 647: | ||
* Pleura | * Pleura | ||
* Upper lobes | * Upper lobes | ||
| | |||
* Multiple grey to yellow foci | |||
* 1mm to 10mm in size. | |||
| | | | ||
* Intranuclear inclusions | * Intranuclear inclusions | ||
Line 492: | Line 657: | ||
* Moderate atypia. | * Moderate atypia. | ||
* Pseudopapillae | * Pseudopapillae | ||
| | | | ||
* CEA | * CEA | ||
Line 518: | Line 680: | ||
| | | | ||
* Endobronchial | * Endobronchial | ||
| | | | ||
* Early lesions | * Early lesions | ||
Line 533: | Line 689: | ||
** Well-defined | ** Well-defined | ||
** Grey or yellow-white masses. | ** Grey or yellow-white masses. | ||
| | |||
* Nodular aggregates | |||
* Fibrosis due to proliferation | |||
* Invade locally | |||
* Fibrous stroma aggregates to form ‘tumorlets’. | |||
* Carcinoids are tumorlets >5cm. | |||
| | | | ||
| | | | ||
Line 549: | Line 711: | ||
| | | | ||
* Intravascular | * Intravascular | ||
| | |||
* 0.3-2.0 cm circumscribed mass | |||
* Gray-white or gray-tan firm tissue | |||
* Yellow flecks | |||
* Central calcifications | |||
* Cut surface has a cartilaginous consistency. | |||
| | | | ||
* Round to oval-shaped nodules | * Round to oval-shaped nodules | ||
Line 556: | Line 724: | ||
** Calcifications | ** Calcifications | ||
** Intranuclear cytoplasmic inclusions | ** Intranuclear cytoplasmic inclusions | ||
| | | | ||
* CD31 | * CD31 | ||
Line 590: | Line 752: | ||
* Pleura | * Pleura | ||
* Lung | * Lung | ||
| | |||
* Purely cystic | |||
* Thin-walled | |||
* Rarely solid | |||
* Firm to gelatinous | |||
* Upto 15 cm | |||
| | | | ||
* Type I | * Type I | ||
Line 599: | Line 767: | ||
* Type III | * Type III | ||
** Mixed cells | ** Mixed cells | ||
| | | | ||
* Vimentin | * Vimentin | ||
Line 631: | Line 793: | ||
** Bone | ** Bone | ||
** Paraganglia | ** Paraganglia | ||
| | |||
* Peripheral | |||
* Solid lesions | |||
* Calcified | |||
| | | | ||
* Capsulated lobules | * Capsulated lobules | ||
* Hypocellular | * Hypocellular | ||
* Features of malignancy are absent | * Features of malignancy are absent | ||
| | | | ||
* N/A | * N/A | ||
Line 658: | Line 820: | ||
* Spindle cells | * Spindle cells | ||
| | | | ||
| | | | ||
* 5-10 cm | * 5-10 cm | ||
Line 671: | Line 828: | ||
** Haemorrhage | ** Haemorrhage | ||
** Necrosis | ** Necrosis | ||
| | |||
* Fascicles of spindle cells. | |||
* Bronchial invasion | |||
* Peribronchial distribution | |||
* Cystic foci of haemorrhage | |||
| | | | ||
* Vimentin | * Vimentin | ||
Line 687: | Line 849: | ||
| | | | ||
* Along the lymphatic distribution. | * Along the lymphatic distribution. | ||
| | |||
* Prominence of the bronchovascular bundles along | |||
** Pleura | |||
** Interlobular pulmonary septa | |||
** Mediastinum | |||
| | | | ||
* Anastomosing endothelial-lined cells along lymphatic routes. | * Anastomosing endothelial-lined cells along lymphatic routes. | ||
Line 692: | Line 859: | ||
* Spindle cells | * Spindle cells | ||
* Intra alveolar siderophages | * Intra alveolar siderophages | ||
| | | | ||
* FVIIIrAg | * FVIIIrAg | ||
Line 720: | Line 882: | ||
| | | | ||
* Localized to bronchia | * Localized to bronchia | ||
| | | | ||
* Solitary | * Solitary | ||
Line 739: | Line 892: | ||
* Calcifications | * Calcifications | ||
* No local invasion | * No local invasion | ||
| | |||
* Mixture of spindle cells | |||
** Fibroblastic | |||
** Myofibroblastic | |||
* Arranged in fascicles | |||
* Cytologic atypia | |||
* Touton type giant cells. | |||
* Plasma cells | |||
* Lymphoid follicles | |||
| | | | ||
* Vimentin | * Vimentin | ||
Line 767: | Line 929: | ||
** Pulmonary valve, | ** Pulmonary valve, | ||
** Right ventricular outflow tract | ** Right ventricular outflow tract | ||
| | | | ||
* Mucoid or gelatinous clots filling vascular lumens | * Mucoid or gelatinous clots filling vascular lumens | ||
Line 778: | Line 935: | ||
** Bony/gritty or chondromyxoid foci | ** Bony/gritty or chondromyxoid foci | ||
** Haemorrhage and necrosis are common in high-grade tumors | ** Haemorrhage and necrosis are common in high-grade tumors | ||
| | |||
* Spindle cells in | |||
** A myxoid background | |||
** Collagenized stroma | |||
** Recanalized thrombi | |||
| | | | ||
* Vimentin | * Vimentin | ||
Line 801: | Line 963: | ||
| | | | ||
* Pulmonary vein | * Pulmonary vein | ||
| | | | ||
* Fleshy-tan tumor | * Fleshy-tan tumor | ||
Line 810: | Line 968: | ||
* 3.0- 20.0 cm | * 3.0- 20.0 cm | ||
* Invasion of wall of the vein. | * Invasion of wall of the vein. | ||
| | |||
* Smooth muscle differentiation | |||
* Moderate to highly cellular spindle cell neoplasms | |||
* Epithelioid morphology | |||
| | | | ||
* Vimentin | * Vimentin |
Revision as of 16:11, 9 March 2018
- Differentiation of primary and secondary lun tumors is difficult due to overlapping histologic features.
- Topography, size and form of pulmonary growth pattern are important aspects for the differential diagnosis.
- Primary lung tumors are mainly localized in upper lobes as singular nodules, metastases in lower lobes as multiple lesions.
- On the contarary, endobronchial primary or secondary squamous cell carcinomas findings of severe dysplasia and CIS of the bronchial epithelium are important.
- Stroma and vascularisation pattern of primary and secondary lung tumors differ in distribution, arrangement and extracellular matrix components.
- Pulmonary vascular changes in primary tumors are characterized by vascular infiltration, destruction and occlusion whereas in secondary tumors intravascular embolisation and extravasation predominate.
Benign Lung Tumors | ||||||||||
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Risk/Epidemiology | Pleuripotent cells | Topography | Gross | Histology | Immunohistochemistry | Imaging | Mets | |||
Papilloma | Squamous cell |
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Glandular | ||||||||||
Mixed | ||||||||||
Adenoma | Alveolar adenoma | |||||||||
Papillary adenoma | ||||||||||
Mucinous cystadenoma | ||||||||||
Lymphoproliferative | ||||||||||
Miscelleneous | Harmatoma | |||||||||
Sclerosing hemangioma | ||||||||||
Clear cell tumor | ||||||||||
Germ cell tumors | ||||||||||
Intrapulmonary thymoma | ||||||||||
Melanoma | ||||||||||
Malignant Lung Tumors | ||||||||||
Variant of lung carci
mao |
Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Mets | ||
Squamous cell carcinoma | Papillary |
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Clear cell |
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Small cell |
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Basaloid |
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Small cell carcinoma |
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Adeno carcinoma | Adenocarcinoma, mixed sub type |
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Aerogenous spread is characteristic
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Acinar adenocarcinoma | ||||||||||
Papillary adenocarcinoma |
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Bronchio-alveolar carcinoma | Non-mucinous |
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Mucinous |
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Mixed non-mucinous and mucinous or indeterminate | ||||||||||
Solid adenocarcinoma with mucin production | Fetal adenocarcinoma |
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Mucinous (“colloid”) carcinoma |
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Mucinous cystadenocarcinoma |
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Signet ring adenocarcinoma | ||||||||||
Clear cell adenocarcinoma | ||||||||||
Large cell carcinoma | Basaloid large cell carcinoma of the lung |
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Clear cell carcinoma of the lung |
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Lymphoepithelioma-like carcinoma of the lung |
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Large-cell lung carcinoma with rhabdoid phenotype |
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Mixed type |
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Sarcomatoid carcinoma | 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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Carcinoid tumour | Typical carcinoid
Atypical carcinoid |
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Salivary gland tumours | Mucoepidermoid carcinoma |
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Adenoid cystic carcinoma |
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Epithelial-myoepithelial carcinoma |
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Preinvasive lesions | 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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Mesenchymal tumors | Epithelioid haemangioendothelioma / Angiosarcoma |
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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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Benign lung tumor | ||||||||
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Risk factors | Gross pathology | Histopathology | Immunohistochemistry | Topography | Prognosis | |||
Papilloma | Squamous cell papilloma | Exophytic and Inverted |
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N/A |
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Glandular papilloma | Not specific |
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N/A |
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Mixed squamous cell and glandular papilloma |
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N/A |
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Adenomas | Alveolar adenoma | |||||||
Papillary adenoma | ||||||||
Adenomas of the salivary gland type | Mucous gland adenoma | |||||||
Pleomorphic adenoma | ||||||||
Mucinous cystadenoma | ||||||||
Lymphoproliferative tumors | Marginal zone B-cell lymphoma of the MALT type | |||||||
Diffuse large B-cell lymphoma | ||||||||
Lymphomatoid granulomatosis | ||||||||
Langerhans cell histiocytosis | ||||||||
Miscellaneous tumors | Harmatoma | |||||||
Sclerosing hemangioma | ||||||||
Clear cell tumor | ||||||||
Germ cell tumors | Mature tratoma | |||||||
Immature teratoma | ||||||||
Other germ cell tumours | ||||||||
Intrapulmonary thymoma | ||||||||
Melanoma | ||||||||
Metastatic tumors |