Lung mass differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2], Eiman Ghaffarpasand, M.D. [3]

Overview

Lung mass can be differentiated from other conditions that cause chronic cough, hemoptysis, and weight loss based on the clinical features, laboratory findings, imaging features, histological features, and genetic studies.

Differentiating Lung Mass from other Diseases

Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Benign Papilloma[4] Squamous cell papilloma
  • Endobronchial
  • Cauliflower-like lesions
  • Tan-white soft to semifirm protrusions
  • N/A
  • N/A
Glandular papilloma
  • Endobronchial
  • White to tan endobronchial polyps that measure from 0.7-1.5 cm
  • N/A
  • N/A
Adenoma[5] Alveolar adenoma
  • 0.7 - 6.0 cm
  • Well demarcated smooth
  • Lobulated, multicystic
  • Soft to firm
  • Pale yellow to tan cut surfaces
  • N/A
Papillary adenoma[6]
  • Bronchioloalveolar cell
  • Well defined
  • Encapsulated
  • Soft, spongy to firm mass
  • Granular gray white/ brown
  • 1.0- 4.0 cm
  • Incidental finding
  • N/A
Mucinous cystadenoma
  • Central
  • White-pink to tan
  • Smooth and shiny tumors
  • Gelatinous mucoid solid core
  • 0.7 - 7.5 cm
  • N/A
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Squamous cell carcinoma (SCC)[7] Papillary
  • Central
Clear cell
Basaloid
  • Peripheral palisading of nuclei
  • Poor differentiation
Small cell carcinoma[8]
  • Peripheral
  • White-tan, soft, friable perihilar masses
  • Extensive necrosis
  • 5% peripheral coin lesions
  • Sheet-like growth
  • Nesting
  • Trabeculae
  • Peripheral palisading
  • Rosette formation
  • High mitotic rate
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Adenocarcinoma[9][10][11] Acinar adenocarcinoma
  • Peripheral
Aerogenous spread is characteristic
Papillary adenocarcinoma
Bronchoalveolar carcinoma Non-mucinous
Mucinous
Mixed non-mucinous and mucinous or indeterminate
  • Mixed type of cells
  • Low to high grade differentiated cells
Solid adenocarcinoma with mucin production Fetal adenocarcinoma
Mucinous (“colloid”) carcinoma
Mucinous cystadenocarcinoma
Signet ring adenocarcinoma
  • Focal
  • Cells with nuclei displaced to sides
  • Components of other cells are present
Clear cell adenocarcinoma
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Large cell carcinoma[12] Basaloid large cell carcinoma of the lung
  • Invasive growth pattern
  • Peripheral palisading
  • Small, monomorphic, cuboidal fusiform
  • Large, peripheral masses
Clear cell carcinoma of the lung
Lymphoepithelioma-like carcinoma of the lung
Large-cell lung carcinoma with rhabdoid phenotype
Mixed type
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Sarcomatoid carcinoma[13] Carcinosarcoma
  • Central or peripheral
  • Upper lobes
Spindle cell carcinoma
  • Only spindle shaped tumor cells
  • Lymphoplasmacytic infiltrates
Giant cell carcinoma
Pleomorphic carcinoma
Pulmonary blastoma
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Carcinoid tumor[14] Typical carcinoid

Atypical carcinoid

  • Firm, well demarcated, tan to yellow tumors
Salivary gland tumors[15] Mucoepidermoid carcinoma
  • Ranging in size from 0.5 - 6 cm
  • Soft, polypoid, and pink-tan in color
  • High-grade lesions are infiltrative
  • Well-circumscribed oval or lobulated mass
  • Calcifications
  • Post-obstructive pneumonic infiltrates
Adenoid cystic carcinoma
  • Constitutes less than 1% of all lung tumors
  • Most commonly seen in the fourth and fifth decades of life
  • Gray-white or tan polypoid lesions
  • Size ranges from 1 - 4 cm
  • Infiltrative margins
Epithelial-myoepithelial carcinoma
  • Age ranges from 33 to 71 years
  • No association with smoking
  • Endobronchial
  • Solid to gelatinous in texture
  • White to gray in color
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Pre-invasive lesions[16] Squamous carcinoma in situ
  • Most commonly seen in fifth or sixth decades
  • Mostly seen in women
  • Cauliflower like
  • Mosaic pattern
Atypical adenomatous hyperplasia
  • Multiple grey to yellow foci
  • 1 mm to 10 mm in size
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
  • Endobronchial
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Mesenchymal tumors[17] Epithelioid hemangioendothelioma / Angiosarcoma
Pleuropulmonary blastoma
  • Purely cystic
  • Thin-walled
  • Rarely solid
  • Firm to gelatinous
  • Up to 15 cm in size
Chondroma
  • N/A
Congenital peribronchial myofibroblastic tumor
  • Rare
Type Category Disease Epidemiology Pleuripotent cells Location Gross pathology Histology Immunohistochemistry Imaging Metastasis
Malignant Mesenchymal tumors[17] Diffuse pulmonary lymphangiomatosis
Inflammatory myofibroblastic tumor
  • Rare
Pulmonary artery sarcoma
Pulmonary vein sarcoma
  • N/A

References

  1. 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.
  2. 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.
  3. 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.
  4. Maxwell RJ, Gibbons JR, O'Hara MD (January 1985). "Solitary squamous papilloma of the bronchus". Thorax. 40 (1): 68–71. PMC 459982. PMID 3969658.
  5. 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.
  6. 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.
  7. 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.
  8. Jackman DM, Johnson BE (2005). "Small-cell lung cancer". Lancet. 366 (9494): 1385–96. doi:10.1016/S0140-6736(05)67569-1. PMID 16226617.
  9. 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.
  10. 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.
  11. Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/File:Adenocarcinoma_%283950819000%29.jpg
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. Greenberg AK, Yee H, Rom WN (2002). "Preneoplastic lesions of the lung". Respir. Res. 3: 20. PMC 107849. PMID 11980589.
  17. 17.0 17.1 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.