Sandbox lung cancer differential: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
Line 88: | Line 88: | ||
* Pale yellow to tan cut surfaces | * Pale yellow to tan cut surfaces | ||
| | | | ||
* | * Non-encapsulated | ||
* Multicystic masses | * Multicystic masses | ||
* [[Cuboidal cells|Cuboidal cell]] linning | * [[Cuboidal cells|Cuboidal cell]] linning | ||
Line 583: | Line 583: | ||
*[[Myoepithelial cells]] | *[[Myoepithelial cells]] | ||
| | | | ||
* | * Endobronchial | ||
| | | | ||
* Solid to gelatinous in texture | * Solid to gelatinous in texture | ||
Line 629: | Line 629: | ||
* [[MCM2]] | * [[MCM2]] | ||
* [[Ki-67]] | * [[Ki-67]] | ||
* Cytokeratin 5/6 | * [[Cytokeratin|Cytokeratin 5/6]] | ||
* | * [[Bcl-2]] | ||
* VEGF | * [[VEGF]] | ||
* Folate binding protein | * Folate binding protein | ||
* p16 | * [[P16 (gene)|p16]] | ||
| | | | ||
| rowspan="3" | | | rowspan="3" | | ||
* Liver | * [[Liver]] | ||
* Brain | * [[Brain]] | ||
* Bone | * [[Bone]] | ||
* Spleen | * [[Spleen]] | ||
|- | |- | ||
| colspan="2" |'''Atypical adenomatous hyperplasia''' | | colspan="2" |'''Atypical adenomatous hyperplasia''' | ||
Line 646: | Line 646: | ||
* [[Clara cell secretory protein|Clara cell specific 10kDd protein]] | * [[Clara cell secretory protein|Clara cell specific 10kDd protein]] | ||
| | | | ||
* Pleura | * [[Pleurae|Pleura]] | ||
* Upper lobes | * Upper lobes | ||
| | | | ||
* Multiple grey to yellow foci | * Multiple grey to yellow foci | ||
* 1mm to 10mm in size | * 1mm to 10mm in size | ||
| | | | ||
* Intranuclear inclusions | * Intranuclear inclusions | ||
* Clara cells and type II pneumocytes | * [[Clara cell|Clara cells]] and [[Pneumocytes|type II pneumocytes]] | ||
* Thickened alveolar walls | * Thickened alveolar walls | ||
* Discontinuous lining of cells | * Discontinuous lining of cells | ||
* Moderate atypia | * Moderate atypia | ||
* Pseudopapillae | * Pseudopapillae | ||
| | | | ||
* CEA | * [[CEA]] | ||
* MMPs | * [[MMP|MMPs]] | ||
* E-cadherin | * [[E-cadherin]] | ||
* ß-catenin | * [[Beta-catenin|ß-catenin]] | ||
* CD44v6 | * [[CD44|CD44v6]] | ||
* TTF-1 | * [[TTF-1]] | ||
* TP53 | * [[TP53]] | ||
| | | | ||
* Typically not visualized on radiographs | * Typically not visualized on [[Radiography|radiographs]] | ||
* Small non-solid nodules | * Small non-solid nodules | ||
* Ground glass opacity | * Ground-glass opacity | ||
|- | |- | ||
| colspan="2" |'''Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia''' | | colspan="2" |'''Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia''' | ||
| | | | ||
* Pulmonary neuroendocrine cells | * [[Pulmonary]] [[neuroendocrine cells]] | ||
| | | | ||
* Endobronchial | * Endobronchial | ||
| | | | ||
* Early lesions | * Early lesions are: | ||
** Small, gray-white nodules | ** Small, gray-white nodules | ||
** Resembling ‘miliary bodies’ | ** Resembling ‘miliary bodies’ | ||
* Larger carcinoid tumors are | * Larger [[carcinoid]] tumors are: | ||
** Firm | ** Firm | ||
** Homogeneous | ** Homogeneous | ||
** Well-defined | ** Well-defined | ||
** Grey or yellow-white masses | ** Grey or yellow-white masses | ||
| | | | ||
* Nodular aggregates | * [[Nodular]] aggregates | ||
* Fibrosis due to proliferation | * [[Myelofibrosis|Fibrosis]] due to [[proliferation]] | ||
* Invade locally | * Invade locally | ||
* Fibrous stroma aggregates to form ‘tumorlets’. | * [[Fibrous]] [[stroma]] aggregates to form ‘tumorlets’. | ||
* Carcinoids are tumorlets >5cm. | * [[Carcinoid|Carcinoids]] are tumorlets >5cm. | ||
| | | | ||
| | | | ||
* Mosaic pattern of air trapping | * Mosaic pattern of air trapping | ||
* Sometimes with nodules | * Sometimes with nodules | ||
* Thickened bronchial and bronchiolar walls | * Thickened [[bronchial]] and bronchiolar walls | ||
|- | |- | ||
| rowspan="8" |'''Mesenchymal tumors'''<ref name="pmid24407922">{{cite journal |vauthors=Koenigkam-Santos M, Sommer G, Puderbach M, Safi S, Schnabel PA, Kauczor HU, Heussel CP |title=Primary intrathoracic malignant mesenchymal tumours: computed tomography features of a rare group of chest neoplasms |journal=Insights Imaging |volume=5 |issue=2 |pages=237–44 |date=April 2014 |pmid=24407922 |pmc=3999366 |doi=10.1007/s13244-013-0306-0 |url=}}</ref> | | rowspan="8" |'''Mesenchymal tumors'''<ref name="pmid24407922">{{cite journal |vauthors=Koenigkam-Santos M, Sommer G, Puderbach M, Safi S, Schnabel PA, Kauczor HU, Heussel CP |title=Primary intrathoracic malignant mesenchymal tumours: computed tomography features of a rare group of chest neoplasms |journal=Insights Imaging |volume=5 |issue=2 |pages=237–44 |date=April 2014 |pmid=24407922 |pmc=3999366 |doi=10.1007/s13244-013-0306-0 |url=}}</ref> | ||
Line 702: | Line 702: | ||
| | | | ||
* Caucasian | * Caucasian | ||
* 80% are women | * 80% are women | ||
| | | | ||
* Endothelial cells | * Endothelial cells | ||
| | | | ||
* Intravascular | * [[Intravascular]] | ||
| | | | ||
* 0.3-2.0 cm circumscribed mass | * 0.3-2.0 cm circumscribed mass | ||
* Gray-white or gray-tan firm tissue | * Gray-white or gray-tan firm tissue | ||
* Yellow flecks | * Yellow flecks | ||
* Central calcifications | * Central [[Calcification|calcifications]] | ||
* Cut surface has a cartilaginous consistency | * Cut surface has a [[cartilaginous]] consistency | ||
| | | | ||
* Round to oval-shaped nodules | * Round to oval-shaped [[nodules]] | ||
* Central [[sclerosis]] | |||
* Hypocellular zone | |||
* Peripheral cellular zone | |||
* | * [[Calcification|Calcifications]] | ||
* Intranuclear [[cytoplasmic]] [[inclusions]] | |||
| | | | ||
* CD31 | * [[CD31]] | ||
* CD34 | * [[CD34]] | ||
* | * [[Factor VIII]] ([[von Willebrand factor]]) | ||
* Fli1 | * Fli1 | ||
* FKBP12 | * FKBP12 | ||
* Cytokeratin | * [[Cytokeratin]] | ||
| | | | ||
* Multiple | * Multiple | ||
* Bilateral | * Bilateral | ||
* Small nodules | * Small nodules | ||
* 1-2 cm in size | * 1-2 cm in size | ||
* Can mimic pulmonary Langerhans’ cell histiocytosis. | * Can mimic [[Langerhans cell histiocytosis|pulmonary Langerhans’ cell histiocytosis]]. | ||
* Calcifications | * [[Calcification|Calcifications]] | ||
| | | | ||
* Liver | * [[Liver]] | ||
* Bone | * [[Bone]] | ||
* Soft tissue | * [[Soft tissue]] | ||
|- | |- | ||
| colspan="2" |'''Pleuropulmonary blastoma''' | | colspan="2" |'''Pleuropulmonary blastoma''' | ||
| | | | ||
* Most common in children | * Most common in children | ||
* Median age of diagnosis is 2 years | * Median age of diagnosis is 2 years | ||
| | | | ||
* Thoracic splanchnopleural mesenchyme | * [[Thoracic]] splanchnopleural [[mesenchyme]] | ||
| | | | ||
* Pleura | * [[Pleurae|Pleura]] | ||
* Lung | * [[Lung]] | ||
| | | | ||
* Purely cystic | * Purely cystic | ||
Line 756: | Line 756: | ||
| | | | ||
* Type I | * Type I | ||
** Purely cystic | ** Purely [[cystic]] | ||
** Lined by respiratory type epithelium | ** Lined by [[respiratory]] type [[epithelium]] | ||
** Underneath malignant cells | ** Underneath [[malignant]] [[cells]] | ||
* Type II | * Type II | ||
** Partial or complete overgrowth of the septal stroma | ** Partial or complete overgrowth of the septal [[stroma]] | ||
* Type III | * Type III | ||
** Mixed cells | ** Mixed cells | ||
| | | | ||
* Vimentin | * [[Vimentin]] | ||
* S-100 protein | * [[S-100 protein]] | ||
| | | | ||
* Unilateral | * Unilateral | ||
Line 771: | Line 771: | ||
* Septal thickening or an intracystic mass | * Septal thickening or an intracystic mass | ||
| | | | ||
* Brain | * [[Brain]] | ||
* Spinal cord | * [[Spinal cord]] | ||
* Skeletal system | * [[Skeletal system]] | ||
* Eyes | * [[Eye|Eyes]] | ||
* Pancreas | * [[Pancreas]] | ||
|- | |- | ||
| colspan="2" |'''Chondroma''' | | colspan="2" |'''Chondroma''' | ||
Line 781: | Line 781: | ||
* Young women | * Young women | ||
| | | | ||
* Chondrocytes | * [[Chondrocyte|Chondrocytes]] | ||
* Cartilaginous cells | * Cartilaginous cells | ||
| | | | ||
* Peripheral lesions in lung | * Peripheral lesions in [[lung]] | ||
* | * Primary lesion seen in | ||
** Stomach | ** [[Stomach]] | ||
** Bone | ** [[Bone]] | ||
** Paraganglia | ** [[Paraganglia]] | ||
| | | | ||
* Peripheral | * Peripheral | ||
* Solid lesions | * Solid lesions | ||
* Calcified | * [[Calcified lesion|Calcified]] | ||
| | | | ||
* Capsulated lobules | * Capsulated lobules | ||
* Hypocellular | * Hypocellular | ||
* Features of malignancy are absent | * Features of [[malignancy]] are absent | ||
| | | | ||
* N/A | * N/A | ||
Line 804: | Line 804: | ||
* “Pop-corn” calcifications | * “Pop-corn” calcifications | ||
| | | | ||
* Benign tumor | * [[Benign tumor]] | ||
|- | |- | ||
| colspan="2" |'''Congenital peribronchial myofibroblastic tumor''' | | colspan="2" |'''Congenital peribronchial myofibroblastic tumor''' | ||
Line 811: | Line 811: | ||
* Sporadic | * Sporadic | ||
* Complicated by | * Complicated by | ||
** | ** [[Polyhydramnios]] | ||
** Non-immune hydrops fetalis | ** [[Hydrops fetalis|Non-immune hydrops fetalis]] | ||
| | | | ||
* Spindle cells | * [[Spindle cells]] | ||
| | | | ||
| | | | ||
Line 821: | Line 821: | ||
* Non-encapsulated | * Non-encapsulated | ||
* Smooth or multinodular surface | * Smooth or multinodular surface | ||
* The cut surface has a tann-grey to yellow-tan fleshy appearance | * The cut surface has a tann-grey to yellow-tan fleshy appearance | ||
* | * [[Hemorrhage]] | ||
* | * [[Necrosis]] | ||
| | | | ||
* Fascicles of spindle cells | * [[Fascicles]] of [[spindle cells]] | ||
* Bronchial invasion | * [[Bronchial]] invasion | ||
* Peribronchial distribution | * Peribronchial distribution | ||
* Cystic foci of | * Cystic foci of [[hemorrhage]] | ||
| | | | ||
* Vimentin | * [[Vimentin]] | ||
| | | | ||
* Well circumscribed | * Well circumscribed | ||
* | * Opaque hemithorax | ||
* Heterogeneous mass | * Heterogeneous mass | ||
| | | | ||
Line 842: | Line 842: | ||
* Young adults of both sexes | * Young adults of both sexes | ||
| | | | ||
* Smooth | * [[Smooth muscle cells]] of [[lymphatic vessels]] | ||
| | | | ||
* Along the lymphatic distribution | * Along the [[Lymphatic drainage|lymphatic distribution]] | ||
| | | | ||
* Prominence of the bronchovascular bundles along | * Prominence of the bronchovascular bundles along | ||
** Pleura | ** [[Pleurae|Pleura]] | ||
** Interlobular pulmonary septa | ** Interlobular pulmonary septa | ||
** Mediastinum | ** [[Mediastinum]] | ||
| | | | ||
* Anastomosing endothelial-lined cells along lymphatic routes | * Anastomosing endothelial-lined cells along lymphatic routes | ||
* Spindle cells | * [[Spindle cells]] | ||
* Intra alveolar siderophages | * Intra alveolar siderophages | ||
| | | | ||
* FVIIIrAg | * FVIIIrAg | ||
* Vimentin | * [[Vimentin]] | ||
* UEA | * UEA | ||
| | | | ||
* Increased interstitial markings | * Increased interstitial markings | ||
* Thickening of the | * Thickening of the: | ||
** Interlobular septa | ** Interlobular septa | ||
** Fissures | ** [[Fissure|Fissures]] | ||
** Central airways | ** Central airways | ||
** Pleura | ** [[Pleura]] | ||
| | | | ||
|- | |- | ||
| colspan="2" |'''Inflammatory myofibroblastic tumor''' | | colspan="2" |'''Inflammatory myofibroblastic tumor''' | ||
| | | | ||
* Previous viral infections | * Previous [[viral infections]] | ||
* HHV8 | * [[HHV-8|HHV8]] | ||
* Children | * Children | ||
| | | | ||
* Myofibroblastic cells | * [[Myofibroblasts|Myofibroblastic cells]] | ||
| | | | ||
* Localized to | * Localized to bronchi | ||
| | | | ||
* Solitary | * Solitary | ||
Line 885: | Line 885: | ||
* Yellowish-gray discoloration | * Yellowish-gray discoloration | ||
* Average size of 3.0 cm | * Average size of 3.0 cm | ||
* Non encapculated | * Non-encapculated | ||
* Calcifications | * [[Calcification|Calcifications]] | ||
* No local invasion | * No local invasion | ||
| | | | ||
* Mixture of spindle cells | * Mixture of [[spindle cells]] | ||
** Fibroblastic | ** [[Fibroblastic]] | ||
** Myofibroblastic | ** [[Myofibroblasts|Myofibroblastic]] | ||
* Arranged in fascicles | * Arranged in [[fascicles]] | ||
* Cytologic atypia | * Cytologic atypia | ||
* Touton type giant cells | * Touton type [[giant cells]] | ||
* Plasma cells | * [[Plasma cells]] | ||
* Lymphoid follicles | * [[Lymphoid follicles]] | ||
| | | | ||
* Vimentin | * [[Vimentin]] | ||
* Actin | * [[Actin]] | ||
* ALK1 | * ALK1 | ||
* p80 | * p80 | ||
Line 907: | Line 907: | ||
* Spiculated appearance | * Spiculated appearance | ||
* Accompanied by | * Accompanied by | ||
** Post-obstructive pneumonia | ** Post-obstructive [[pneumonia]] | ||
** Atelectasis | ** [[Atelectasis]] | ||
| | | | ||
* Rare | * Rare | ||
Line 915: | Line 915: | ||
| | | | ||
* Mean age of diagnosis is 49.3 years | * Mean age of diagnosis is 49.3 years | ||
* Commonly misdiagnosed as | * Commonly misdiagnosed as [[pulmonary embolism]] | ||
| | | | ||
* Mesenchymal cells of the intima | * [[Mesenchymal cell|Mesenchymal cells]] of the [[intima]] | ||
* Primitive cells of the bulbus cordi in the trunk of pulmonary artery | * Primitive cells of the bulbus cordi in the trunk of [[pulmonary artery]] | ||
| | | | ||
* Pulmonary trunk most commonly | * [[Pulmonary trunk]] most commonly involving: | ||
** Right pulmonary artery | ** [[Right pulmonary artery]] | ||
** Left pulmonary artery | ** [[Left pulmonary artery]] | ||
** Pulmonary valve | ** [[Pulmonary valve]] | ||
** Right ventricular outflow tract | ** [[Ventricular outflow tract|Right ventricular outflow tract]] | ||
| | | | ||
* Mucoid or gelatinous clots filling vascular lumens | * Mucoid or gelatinous clots filling vascular lumens | ||
Line 930: | Line 930: | ||
** Firm fibrotic areas | ** Firm fibrotic areas | ||
** Bony/gritty or chondromyxoid foci | ** Bony/gritty or chondromyxoid foci | ||
** | ** [[Hemorrhage]] and [[necrosis]] are common in high-grade tumors | ||
| | | | ||
* Spindle cells in | * Spindle cells in | ||
Line 937: | Line 937: | ||
** Recanalized thrombi | ** Recanalized thrombi | ||
| | | | ||
* Vimentin | * [[Vimentin]] | ||
* Osteopontin | * [[Osteopontin]] | ||
* Factor VIII | * [[Factor VIII]] | ||
* CD31 | * [[CD31]] | ||
* CD34 | * [[CD34]] | ||
| | | | ||
* Findings overlap with those of chronic thromboembolic disease | * Findings overlap with those of chronic [[thromboembolic disease]] | ||
* Decreased vascularity | * Decreased [[vascularity]] | ||
* Heterogeneous soft tissue density | * Heterogeneous [[soft tissue]] density | ||
* Smooth vascular tapering | * Smooth [[vascular]] tapering | ||
| | | | ||
* Lung | * [[Lung]] | ||
* Mediastinum | * [[Mediastinum]] | ||
|- | |- | ||
| colspan="2" |'''Pulmonary vein sarcoma''' | | colspan="2" |'''Pulmonary vein sarcoma''' | ||
| | | | ||
* Most common in women | * Most common in women | ||
* Mean age of diagnosis is 49 | * Mean age of diagnosis is 49 | ||
| | | | ||
* Smooth muscle | * [[Smooth muscle]] | ||
| | | | ||
* Pulmonary vein | * [[Pulmonary veins|Pulmonary vein]] | ||
| | | | ||
* Fleshy-tan tumor | * Fleshy-tan tumor | ||
* Can occlude the lumen of the involved vessel | * Can occlude the lumen of the involved vessel | ||
* 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 | * [[Smooth muscle]] differentiation | ||
* Moderate to highly cellular spindle cell neoplasms | * Moderate to highly cellular [[Spindle cells|spindle cell]] [[neoplasms]] | ||
* Epithelioid morphology | * [[Epithelioid]] morphology | ||
| | | | ||
* Vimentin | * [[Vimentin]] | ||
* Desmin | * [[Desmin]] | ||
* Keratin | * [[Actin]] | ||
* [[Keratin]] | |||
| | | | ||
| | | | ||
Line 978: | Line 979: | ||
== Differentiation of lung cancer from other diseases with similar presentation == | == 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.<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref><ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref><ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref><ref name="pmid103772112">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref><ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref> | '''The following table summarizes the differentiation of lung cancer from other disease entities with similar presentation.'''<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref><ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref><ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref><ref name="pmid103772112">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref><ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan="3" |Disease | ! rowspan="3" |Disease | ||
Line 1,008: | Line 1,009: | ||
| + | | + | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | |'''-''' | ||
| | | | ||
*Air fluid level | *Air fluid level | ||
Line 1,032: | Line 1,033: | ||
*Ground glass opacities | *Ground glass opacities | ||
| | | | ||
*Long | *Long h/o [[smoking]] | ||
*Elderly male or female | *Elderly male or female | ||
* | *[[Bronchoalveolar lavage|Broncho-alveolar lavage]] positive for [[malignant]] [[cells]] | ||
*CT guided [[biopsy]] is required for confirmation and | *CT guided [[biopsy]] is required for confirmation and differentiation | ||
|- | |- | ||
|[[Tuberculosis, pulmonary|Pulmonary Tuberculosis]] | |[[Tuberculosis, pulmonary|Pulmonary Tuberculosis]] | ||
Line 1,048: | Line 1,049: | ||
| + | | + | ||
| | | | ||
* | *[[Cavitation|Cavitations]] in the upper lobe of the [[lung]] | ||
| | | | ||
*People in [[Endemic (epidemiology)|endemic]] at high risk | *People in [[Endemic (epidemiology)|endemic]] at high risk | ||
Line 1,067: | Line 1,068: | ||
*Multiple cavitary lesions | *Multiple cavitary lesions | ||
| | | | ||
*Acute life threatening condition | *Acute life-threatening condition | ||
*Complication of [[pneumonia]] or lung abscess | *Complication of [[pneumonia]] or [[lung abscess]] | ||
*Multiple [[organisms]] responsible | *Multiple [[organisms]] responsible | ||
* | *Prompt treatment with [[antibiotics]] is required | ||
* | *[[Blood culture]] positive for causative organism | ||
|- | |- | ||
|Empyema | |Empyema | ||
Line 1,086: | Line 1,087: | ||
*Homogeneous [[Consolidation (medicine)|consolidation]]<nowiki/>s | *Homogeneous [[Consolidation (medicine)|consolidation]]<nowiki/>s | ||
| | | | ||
*Blood culture positive for causative agent | *[[Blood culture]] positive for the causative agent | ||
|- | |- | ||
|[[Bronchiectasis]] | |[[Bronchiectasis]] | ||
Line 1,105: | Line 1,106: | ||
*Increased [[pulmonary]] markings | *Increased [[pulmonary]] markings | ||
*Honeycombing | *Honeycombing | ||
*[[ | *[[Atelectasis]] | ||
| | | | ||
* CT confirms the diagnosis | * CT confirms the diagnosis | ||
|- | |- | ||
|[[Wegener's granulomatosis|Wegners granulomatosis]] | |[[Wegener's granulomatosis|Wegners granulomatosis]] | ||
Line 1,121: | Line 1,122: | ||
| | | | ||
*[[Pulmonary]] [[nodules]] | *[[Pulmonary]] [[nodules]] | ||
*[[ | *[[Cavities]] | ||
*Infiltrates | *Infiltrates | ||
| | | | ||
Line 1,158: | Line 1,159: | ||
| | | | ||
*[[Pulmonary]] [[nodules]] | *[[Pulmonary]] [[nodules]] | ||
*Cavitations on the upper lobe | *[[Cavitation|Cavitations]] on the upper lobe of lung | ||
| | | | ||
*[[Rheumatoid arthritis]] | *[[Rheumatoid arthritis]] | ||
Line 1,176: | Line 1,177: | ||
*Thin-walled cystic cavities | *Thin-walled cystic cavities | ||
| | | | ||
*Exclusively afflicts smokers | *Exclusively afflicts smokers | ||
*[[Musculoskeletal]] and [[skin]] is involved | *[[Musculoskeletal]] and [[skin]] is involved | ||
*Biopsy of the involved organ | *Biopsy of the involved organ | ||
Line 1,195: | Line 1,196: | ||
* Ground-glass opacities | * Ground-glass opacities | ||
* Nodules | * [[Nodules]] | ||
| | | | ||
* Biopsy | * Biopsy |
Revision as of 16:22, 21 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]
Benign Lung Tumors[2] | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Benign lung tumor | Risk/Epidemiology | Pleuripotent cells | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis | ||
Papilloma[3] | Squamous cell papilloma |
|
|
|
|
|
| |||
Glandular papilloma |
|
|
|
|
|
|
| |||
Adenoma[4] | Alveolar adenoma |
|
|
|
|
|
|
| ||
Papillary adenoma[5] |
|
|
|
|
|
|
|
| ||
Mucinous cystadenoma |
|
|
|
|
|
|
|
| ||
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 |
|
|
|
|
|
||||
Clear cell |
| |||||||||
Small cell |
| |||||||||
Basaloid |
| |||||||||
Small cell carcinoma[8] |
|
|
|
|
| |||||
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 | ||||||||||
Solid adenocarcinoma with mucin production | Fetal adenocarcinoma |
| ||||||||
Mucinous (“colloid”) carcinoma |
| |||||||||
Mucinous cystadenocarcinoma |
| |||||||||
Signet ring adenocarcinoma | ||||||||||
Clear cell adenocarcinoma | ||||||||||
Large cell carcinoma[12] | Basaloid large cell carcinoma of the lung |
|
|
|
|
|
|
|
| |
Clear cell carcinoma of the lung | ||||||||||
Lymphoepithelioma-like carcinoma of the lung |
| |||||||||
Large-cell lung carcinoma with rhabdoid phenotype |
| |||||||||
Mixed type |
| |||||||||
Sarcomatoid carcinoma[13] | Carcinosarcoma |
|
|
|
|
|
|
|||
Spindle cell carcinoma |
|
|||||||||
Giant cell carcinoma |
| |||||||||
Pleomorphic carcinoma |
| |||||||||
Pulmonary blastoma |
|
| ||||||||
Carcinoid tumor[14] | Typical carcinoid
Atypical carcinoid |
|
|
|
|
|
|
|||
Salivary gland tumors[15] | Mucoepidermoid carcinoma |
|
|
|
|
|
|
|
| |
Adenoid cystic carcinoma |
|
|
|
|
||||||
Epithelial-myoepithelial carcinoma |
|
|
|
|
|
|||||
Preinvasive lesions[16] | Squamous carcinoma in situ |
|
|
|
|
|||||
Atypical adenomatous hyperplasia |
|
|
|
|
| |||||
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia |
|
|
|
| ||||||
Mesenchymal tumors[17] | Epithelioid haemangioendothelioma / Angiosarcoma |
|
|
|
|
|
|
|||
Pleuropulmonary blastoma |
|
|
|
|
|
|||||
Chondroma |
|
|
|
|
|
|
|
|||
Congenital peribronchial myofibroblastic tumor |
|
|
|
|
||||||
Diffuse pulmonary lymphangiomatosis |
|
|
|
|
|
|
||||
Inflammatory myofibroblastic tumor |
|
|
|
|
|
| ||||
Pulmonary artery sarcoma |
|
|
|
|
|
|
||||
Pulmonary vein sarcoma |
|
|
|
|
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.