Pancoast tumor differential diagnosis: Difference between revisions

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__NOTOC__
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{{Pancoast tumor}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Pancoast_tumor]]
{{CMG}}{{AE}}{{Mazia}}
{{CMG}}; {{AE}}{{Mazia}}


==Overview==
==Overview==
Pancoast tumor must be differentiated from other [[causes]] of [[mass]] located in the [[apical]] region of the [[chest]] which may present with [[pain]] in the [[Shoulder|shoulder region]]. [[Differential diagnosis]] includes most common other [[conditions]] that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[shoulder pain]], unexplained [[weight loss]], unexplained [[loss of appetite]], and [[fatigue]] such as [[superior vena cava syndrome]], [[thoracic outlet syndrome]], [[cervical disk disease]], [[pneumonia]]/[[bronchitis]], [[carcinoid tumor]], [[infectious]] [[granuloma]] and [[Thyroid mass causes|thyroid mass]].


==Differential Diagnosis==
Pancoast tumor must be differentiated from other causes of [[mass]] located in the [[Apical|apical region]] of the [[chest]] which may present with [[pain]] in the [[Shoulder-joint|shoulder region]].The table below summarizes the findings that differentiate [[apical]] [[mass]] in the [[chest]] from the most common other [[conditions]] that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], [[shoulder pain]], [[Weight loss|unexplained weight loss]], [[Loss of appetite|unexplained loss of appetite]], and [[fatigue]]




==Differential Diagnosis==
=== '''The following table summarizes the differentiation of various lung tumors based on histological and topographical features:<ref><nowiki>{{Small cell lung cancer [Internet]. BMJ Publishing Group Limited 2015 [updated 2014 Oct 29]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/1081/diagnosis/differential.html<nowiki>}}</nowiki></ref><ref name="pmid24455507">{{cite journal| author=Bhatt M, Kant S, Bhaskar R| title=Pulmonary tuberculosis as differential diagnosis of non-small cell lung cancer | journal=South Asian J Cancer | year= 2012 | volume= 1 | issue= 1 | pages= 36-42 | pmid=24455507 | doi=10.4103/2278-330X.96507 | pmc=PMC3876596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24455507  }}</ref><ref name="pmid22242302">{{cite journal| author=Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S| title=[Lung abscess which needed to be distinguished from lung cancer; report of a case]. | journal=Kyobu Geka | year= 2011 | volume= 64 | issue= 13 | pages= 1204-7 | pmid=22242302 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22242302  }} </ref><ref name="pmid24008649">{{cite journal| author=Matsuoka T, Uematsu H, Iwakiri S, Itoi K| title=[Chronic eosinophilic pneumonia presenting as a solitary nodule, suspicious of lung cancer;report of a case]. | journal=Kyobu Geka | year= 2013 | volume= 66 | issue= 10 | pages= 941-3 | pmid=24008649 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24008649  }} </ref><ref name="emedicine">{{cite web | last = Beeson | first = Michael S | title = Superior Vena Cava Syndrome | url=http://www.emedicine.com/emerg/topic561.htm | accessdate = 2008-03-24 }}</ref><ref name="wikibooks">Radiation Oncology/Palliation/SVC Syndrome. WikiBooks https://en.wikibooks.org/wiki/Radiation_Oncology/Palliation/SVC_Syndrome Accessed on January 13, 2016</ref><ref name="pmid18349457">{{cite journal |vauthors=Bruzzi JF, Komaki R, Walsh GL, Truong MT, Gladish GW, Munden RF, Erasmus JJ |title=Imaging of non-small cell lung cancer of the superior sulcus: part 1: anatomy, clinical manifestations, and management |journal=Radiographics |volume=28 |issue=2 |pages=551–60; quiz 620 |date= 2008 |pmid=18349457 |doi=10.1148/rg.282075709 |url=}}</ref><ref name="pmid24102007">{{cite journal |vauthors=Foroulis CN, Zarogoulidis P, Darwiche K, Katsikogiannis N, Machairiotis N, Karapantzos I, Tsakiridis K, Huang H, Zarogoulidis K |title=Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment |journal=J Thorac Dis |volume=5 Suppl 4 |issue= |pages=S342–58 |date=September 2013 |pmid=24102007 |pmc=3791502 |doi=10.3978/j.issn.2072-1439.2013.04.08 |url=}}</ref><ref name="pmid27429965">{{cite journal |vauthors=Marulli G, Battistella L, Mammana M, Calabrese F, Rea F |title=Superior sulcus tumors (Pancoast tumors) |journal=Ann Transl Med |volume=4 |issue=12 |pages=239 |date=June 2016 |pmid=27429965 |pmc=4930518 |doi=10.21037/atm.2016.06.16 |url=}}</ref><ref>[http://www.mountsinai.org/Other/Diseases/Thoracic%20outlet%20syndrome Thoracic outlet syndrome]
Pancoast tumor must be differentiated from other causes of mass located in the apical region of the chest which may present with pain in the shoulder region.
Mount Sinai Hospital, New York</ref><ref>Stepansky F, Hecht EM, Rivera R, Hirsh LE, Taouli B, Kaur M, Lee VS. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics. 2008 Jan-Feb;28(1):e28. Epub 2007 Oct 29. PMID 17967936 </ref><ref name="radio">Superior Vena Cava Syndrome.Dr Amir Rezaee and Radswiki et al. Radiopedia http://radiopaedia.org/articles/superior-vena-cava-obstruction Accessed on January 13, 2016</ref>'''<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> ===
The table below summarizes the findings that differentiate apical mass in the chest from the most common other conditions that cause [[hemoptysis]], [[cough]], [[dyspnea]], [[wheeze]], [[chest pain]], shoulder pain, unexplained weight loss, unexplained loss of appetite, and [[fatigue]]<ref><nowiki>{{Small cell lung cancer [Internet]. BMJ Publishing Group Limited 2015 [updated 2014 Oct 29]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/1081/diagnosis/differential.html<nowiki>}}</nowiki></ref>.<ref name="pmid24455507">{{cite journal| author=Bhatt M, Kant S, Bhaskar R| title=Pulmonary tuberculosis as differential diagnosis of non-small cell lung cancer | journal=South Asian J Cancer | year= 2012 | volume= 1 | issue= 1 | pages= 36-42 | pmid=24455507 | doi=10.4103/2278-330X.96507 | pmc=PMC3876596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24455507  }}</ref><ref name="pmid22242302">{{cite journal| author=Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S| title=[Lung abscess which needed to be distinguished from lung cancer; report of a case]. | journal=Kyobu Geka | year= 2011 | volume= 64 | issue= 13 | pages= 1204-7 | pmid=22242302 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22242302  }} </ref><ref name="pmid24008649">{{cite journal| author=Matsuoka T, Uematsu H, Iwakiri S, Itoi K| title=[Chronic eosinophilic pneumonia presenting as a solitary nodule, suspicious of lung cancer;report of a case]. | journal=Kyobu Geka | year= 2013 | volume= 66 | issue= 10 | pages= 941-3 | pmid=24008649 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24008649  }} </ref>
{| class="wikitable"
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! 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;'''


| align="center" style="background:#f0f0f0;" |'''Condition/disease'''
MMP's: Mettaloprotineases matrix ;  GFAP: Glial fibrocilliary acid protein
|-
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk/Epidemiology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cells
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
| rowspan="3" style="background:#DCDCDC;" align="center" |'''Pancoast Tumor'''
| colspan="2" style="background:#DCDCDC;" align="center" |'''[[Squamous cell carcinoma of the lung|Squamous cell carcinoma (SCC)]]'''
|
*Cigarette smokers
* [[Arsenic]]
|
* [[Epithelial cells]]
|
* Central
|
* White or grey lesions
* Focal carbon pigment deposits
* [[Cavitation|Cavitations]]
* Intraluminal polypoid masses
* [[Infiltration (medical)|Infiltration]]


| align="center" style="background:#f0f0f0;" |'''Signs/symptoms'''
|
* Exophytic
* Intra-epithelial 
* Without invasion


| align="center" style="background:#f0f0f0;" |'''Tests'''
* Cells with clear [[cytoplasm]]
* Peripheral palisading of nuclei.
* Poor differentiation
|
* [[Keratin]]
* [[Cytokeratin|Cytokeratins]]
* [[CEA]]
* [[Thyroid transcription factor-1]] ([[TTF-1]])
| rowspan="3" |
'''[[Chest x-ray]]:''' Lordotic view on [[chest x-ray]] is helpful in visualizing Pancoast tumor because of its characteristic location in the [[Apical|apical portion]] of the [[lung]].
* [[opacity]] at the [[apex]] of the [[lung]] or in the superior sulcus area, the spread of the [[tumor]] can result in [[rib]] [[invasion]] that is observed as a [[bone]] destruction of [[posterior]] [[ribs]], [[vertebral body]] [[Infiltration (medical)|infiltration]].
* [[Enlargement of organs|Enlargement]] of the [[mediastinum]].
* '''[[CT scan]]''' is [[diagnostic]] of Pancoast tumor. [[CT scan]] has a limited ability to determine the extent of [[invasion]] of the [[primary tumor]] into adjoining structures when compared to [[MRI scan]]. [[Subclavian|Subclavian-vessel involvement]] is assessed by [[CT scanning|contrast CT scanning]].
* '''[[MRI]]''' is helpful in the [[diagnosis]] of Pancoast tumor. [[MRI]] offers greater detail in the evaluation of [[chest wall]] [[invasion]], [[examination]] of [[vascular]] structures and [[Brachial plexus|brachial plexus involvement]] and resectability of the [[tumor]]. Other [[diagnostic]] studies for evaluating the spread of Pancoast tumor include [[Scintigraphy|bone scintigraphy]], [[PET scan]], [[Molecular|molecular tests]] and [[biopsy]].
|
* [[Liver]]
* [[Breast]]
* [[Bone]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" |'''[[Small cell carcinoma]]'''
|
* [[Smoking]]
* [[Radon]] exposure
|
* Bronchial precursor cell
|
* 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
|
* [[CD56]]
* [[Chromogranin]]
* [[Synaptophysin]]
* [[TTF-1]]
|
* Bone marrow
* Liver
|-
| colspan="2" style="background:#DCDCDC;" align="center" |'''[[Adenocarcinoma]]'''
|
* [[Smoking]]
|
* Columnar cells of bronchioles
|
* Peripheral
|
* Single or multiple lesions
* Different in size
* Peripheral distribution
* Gray-white central fibrosis
* [[Pleural]] puckering
* Anthracotic pigmentation
** [[Necrosis]]
** [[Cavitation]]
** [[Hemorrhage]]
* Lobulated or ill defined edges
|
*Nuclear atypia
*Eccentrically placed nuclei
*Abundant [[cytoplasm]] with mucin [[Vacuole|vacuoles]]
*Often conspicuous [[nucleoli]]
*Lack of intercellular bridges.
*Different patterns, include: [[acinar]], lepidic, micropapillary, [[papillary]], and solid.
|
* Epithelial markers 
* [[CEA]]
* [[Cytokeratin|CK7]]
* [[TTF-1]]
|Aerogenous spread is characteristic
* [[Brain]]
* [[Bone]]
* [[Adrenal glands]]
* [[Liver]]
* [[Kidney]]
* Gastrointestinal Tract
|-
! 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>
|-
| rowspan="2" style="background:#DCDCDC;" align="center" + |'''[[Papilloma]]'''<ref name="pmid3969658">{{cite journal |vauthors=Maxwell RJ, Gibbons JR, O'Hara MD |title=Solitary squamous papilloma of the bronchus |journal=Thorax |volume=40 |issue=1 |pages=68–71 |date=January 1985 |pmid=3969658 |pmc=459982 |doi= |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''[[Squamous cell papilloma]]'''
|
* [[Human papillomavirus|HPV 6]] and [[Human papillomavirus|11]]
* Men
* Median age of diagnosis is 54 years
|
* [[Epithelial cells]]
|
* Endobronchial
|
* Cauliflower-like lesions
* Tan-white soft to semifirm protrutions
|
* Loose fibrovascular core
* Stratified squamous epithelium
* Acanthosis
* Binucleate forms and perinuclear halos
* [[Koilocytosis]]
|
* N/A
|
* Well circumscribed
* Homogenous
* Non-calcified
* Solitary mass
|
* N/A
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Glandular papilloma'''
|
* Rare
* Mean age of diagnosis is 68 years
|
* [[Goblet cells]] of [[respiratory epithelium]]
|
* Endobronchial
|
* White to tan endobronchial [[Polyp|polyps]] that measure from 0.7-1.5 cm
|
* Thick arborizing stromal stalks
* Thin-walled [[blood vessels]]
* Non-ciliated or ciliated [[epithelium]]
|
* N/A
|
* Well circumscribed
* Homogenous
* Non-calcified
* Solitary mass
|
* N/A
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |'''Adenom'''a<ref name="pmid9817965">{{cite journal |vauthors=Shiota Y, Matsumoto H, Sasaki N, Taniyama K, Hashimoto S, Sueishi K |title=Solitary bronchioloalveolar adenoma of the lung |journal=Respiration |volume=65 |issue=6 |pages=483–5 |date=1998 |pmid=9817965 |doi=10.1159/000029319 |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Alveolar adenoma'''
|
* Mean age of diagnosis is 53 years
* Female predominance
|
* Alveolar [[pneumocytes]]
* Septal [[mesenchyme]]
|
* All lung lobes
* Lower lobes
* Hilar
|
* 0.7-6.0 cm
* Well demarcated smooth
* Lobulated, multicystic
* Soft to firm
* Pale yellow to tan cut surfaces
|
* Non-encapsulated
* Multicystic masses
* [[Cuboidal cells|Cuboidal cell]] linning
* Squamous metaplasia
* Myxoid and [[Collagen|collagenous]] interstitium
|
* [[Keratin]]
* [[CEA]]
* Surfactant protein
* [[TTF-1]]
* [[Actin]]
|
* Well circumscribed
* Homogenous
* Non-calcified
* Solitary mass
|
* N/A
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Papillary adenoma'''<ref name="pmid28409070">{{cite journal |vauthors=Kanchustambham V, Saladi S, Patolia S, Mahmoud Assaf S, Stoeckel D |title=A Rare Case of a Benign Primary Pleomorphic Adenoma of the Lung |journal=Cureus |volume=9 |issue=3 |pages=e1069 |date=March 2017 |pmid=28409070 |pmc=5375953 |doi=10.7759/cureus.1069 |url=}}</ref>
|
* Mean age of diagnosis is 32 years
* Male predominance
|
* Bronchioloalveolar cell
|
* No lobar predilection
* Involves alveolar parenchyma
|
* Well defined
* Encapsulated
* Soft, spongy to firm mass
* Granular gray white/ brown
* 1.0- 4.0 cm
|
* [[Infiltration (medical)|Infiltration]]
* [[Papillary]] growth pattern
* Fibrovascular cores
* [[Cuboidal epithelia|Cuboidal]] to [[Columnar epithelia|columnar epithelial]] linning
* Cilitated and oxyphilic cells
* Occasional [[eosinophilic]] intranuclear inclusions
|
* [[Cytokeratin]]
* [[Clara cell secretory protein|Clara cell protein]]
* [[TTF-1]]
* Surfactant apoprotein
* [[CEA]]
|
* Incidental finding
|
* N/A
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Mucinous cystadenoma'''
|
* No sex predilection
* Mean age of diagnosis is 52 years
|
* Mucus glands of the [[bronchus]]
|
* Central
|
* White-pink to tan
* Smooth and shiny tumors
* Gelatinous mucoid solid core
* 0.7-7.5 cm
|
* Numerous [[mucin]]-filled cystic spaces
* Non-dilated microacini, glands, tubules and papillae
|
* EMA
* [[Cytokeratin|Cytokeratins]]
* [[CEA]]
|
* Coin lesion
* Air-meniscus sign
|
* N/A
|-
! colspan="11" style="background:#4479BA; color: #FFFFFF;" align="center" + |Malignant Lung Tumors<ref name="pmid7863581">{{cite journal |vauthors=Kelley LC, Puette M, Langheinrich KA, King B |title=Bovine pulmonary blastomas: histomorphologic description and immunohistochemistry |journal=Vet. Pathol. |volume=31 |issue=6 |pages=658–62 |date=November 1994 |pmid=7863581 |doi=10.1177/030098589403100605 |url=}}</ref>
|-
|-
|Pancoast Tumor
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
|The most common symptoms of Pancoast tumor include cough, hemoptysis, dyspnea, chest pain, lack of appetite, weight loss, fatigue. Symptoms of Pancoast Syndrome resulting from Pancoast tumor include shoulder pain along the vertebral border of the scapula, Horner's syndrome and weakness of hand muscles. Less common symptoms of Pancoast syndrome include paraplegia.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cell
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |'''[[Squamous cell carcinoma of the lung|Squamous cell carcinoma]] (SCC)'''<ref name="pmid5528918">{{cite journal |vauthors=Roth E, Smidt D |title=[Studies on early ejaculate collection using electroejaculation in German improved land-swines and Goettinger miniature pigs] |language=German |journal=Berl. Munch. Tierarztl. Wochenschr. |volume=83 |issue=1 |pages=7–11 |date=January 1970 |pmid=5528918 |doi= |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Papillary'''
| rowspan="3" |
* Cigarette smokers
* [[Arsenic]]
| rowspan="3" |
* Epithelial cells
| rowspan="3" |
* Central
| rowspan="3" |
* White or grey lesions
* Focal carbon pigment deposits
* [[Cavitation|Cavitations]]
* Intraluminal polypoid masses
* [[Infiltration (medical)|Infiltration]]
|
|
* Exophytic
* Intra-epithelial 
* Without invasion
| rowspan="3" |
* [[Keratin]]
* [[Cytokeratin|Cytokeratins]]
* [[CEA]]
* [[Thyroid transcription factor-1]] ([[TTF-1]])
| rowspan="3" |
* Lobar or entire lung collapse
* Shift of the [[mediastinum]] to the ipsilateral side
* Hilar, perihilar or [[Mediastinal mass|mediastinal masses]]
| rowspan="3" |
* [[Liver]]
* [[Breast]]
* [[Bone]]
|-
|-
|Superior Vena Cava Syndrome
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Clear cell'''
|Superior vena cava syndrome patients gradually develop symptoms as the malignancies increase in size. Symptoms occur when obstruction of venous blood flow back to the heart igradually, and may worsen with postural changes. Symptoms are quite varied among benign and malignant superior vena cava syndrome. They can range from sub-clinical presentation to death.The most common symptoms include the following dyspnea, cough, swelling of the face, neck, trunk, and arms. Less common symptoms include the following hoarseness, chest pain, problems swallowing and/or talking, coughing up blood, headache, [[swallowing|lightheadedness]], decreased alertness, [[headache|dizziness]], [[lightheadedness|fainting]], sensation of [[decreased alertness|head]] or [[decreased alertness|ear]] "fullness", vision changes.2tion of [[head]] or [[ear]] "fullness", vision changes.
|
|
* Cells with clear [[cytoplasm]]
|-
|-
| Thoracic outlet syndrome
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Basaloid'''
|
|
* Peripheral palisading of nuclei.
* Poor differentiation
|-
| colspan="3" style="background:#DCDCDC;" align="center" + |'''[[Small cell carcinoma]]'''<ref name="pmid16226617">{{cite journal |vauthors=Jackman DM, Johnson BE |title=Small-cell lung cancer |journal=Lancet |volume=366 |issue=9494 |pages=1385–96 |date=2005 |pmid=16226617 |doi=10.1016/S0140-6736(05)67569-1 |url=}}</ref>
|
* [[Smoking]]
* [[Radon]] exposure
|
* Bronchial precursor cell
|
* 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
|
* [[CD56]]
* [[Chromogranin]]
* [[Synaptophysin]]
* [[TTF-1]]
|
|
* Hilar or perihilar masses
* [[Mediastinal lymphadenopathy]]
* Lobar collapse
|
* Bone marrow
* Liver
|-
|-
|Cervical Disk Disease
| rowspan="10" style="background:#DCDCDC;" align="center" + |'''[[Adenocarcinoma]]'''<ref name="Kumar-adenocarcinoma">{{cite book |chapter=Chapter 13, box on morphology of adenocarcinoma |author=Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson |title=Robbins Basic Pathology|publisher=Saunders |location=Philadelphia |isbn=1-4160-2973-7 |edition=8th}}</ref><ref name="pmid17625570">{{cite journal| author=Soda M, Choi YL, Enomoto M, Takada S, Yamashita Y, Ishikawa S et al.| title=Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. | journal=Nature | year= 2007 | volume= 448 | issue= 7153 | pages= 561-6 | pmid=17625570 | doi=10.1038/nature05945 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17625570  }}</ref><ref>Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/File:Adenocarcinoma_%283950819000%29.jpg</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Acinar adenocarcinoma'''
| rowspan="10" |
* [[Smoking]]
| rowspan="10" |
* Columnar cells of bronchioles
| rowspan="10" |
* Peripheral
| rowspan="10" |
* Single or multiple lesions
* Different in size
* Peripheral distribution
* Gray-white central fibrosis
* [[Pleural]] puckering
* Anthracotic pigmentation
** [[Necrosis]]
** [[Cavitation]]
** [[Hemorrhage]]
* Lobulated or ill defined edges
|
|
* Irregular-shaped glands
* [[Malignant]] cells:
** Hyperchromatic nuclei
** Fibroblastic stroma
| rowspan="10" |
* Epithelial markers 
* [[CEA]]
* [[Cytokeratin|CK7]]
* [[TTF-1]]
| rowspan="10" |
* Peripheral nodules under 4.0 cm in size
* Central location as a hilar or perihilar mass
* Rarely show cavitations.
* Hilar adenopathy
* Adenocarcinomas account for the majority of small peripheral cancers identified radiologically.
| rowspan="10" |Aerogenous spread is characteristic
* Brain
* Bone
* Adrenal glands
* Liver
* Kidney
* Gastrointestinal Tract
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Papillary adenocarcinoma'''
|
* [[Papillae]]
* [[Necrosis]]
* Surrounding invasion
* [[Cuboidal epithelia|Cuboidal]] to [[Columnar epithelia|columnar epithelial]] linning
* [[Mucinous]] or non-mucinous
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |'''Bronchio-alveolar carcinoma'''
| style="background:#DCDCDC;" align="center" + |'''Non-mucinous'''
|
* [[Clara cell|Clara cells]]
* [[Pneumocytes|Type II cells]]
|-
| style="background:#DCDCDC;" align="center" + |'''Mucinous'''
|
* Low grade differentiation
* Composed of:
** Tall [[Columnar epithelia|columnar cells]]
** Basal nuclei
** Pale cytoplasm resembling goblet cells
** Varying amounts of cytoplasmic mucin
* Cytologic atypia
|-
| 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'''
| style="background:#DCDCDC;" align="center" + |'''Fetal adenocarcinoma'''
|
* Consists glandular elements:
** Tubules of [[glycogen]]-rich
** Non-ciliated cells
** Subnuclear and supranuclear [[glycogen]] [[vacuoles]]
** Rounded morules of polygonal cells with abundant [[eosinophilic]] and finely granular [[cytoplasm]]
|-
| style="background:#DCDCDC;" align="center" + |'''Mucinous (“colloid”) carcinoma'''
|
* Dissecting pools of [[mucin]] containing [[neoplastic]] cells
|-
| style="background:#DCDCDC;" align="center" + |'''Mucinous cystadenocarcinoma'''
|
* Partial [[fibrous tissue]] capsule
* Central [[cystic]] change with [[mucin]] pooling
* [[Neoplastic]] [[mucinous]] [[epithelium]] grows along alveolar walls
|-
| 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'''
|
* Clear cells with no nuclei
|-
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cell
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
| rowspan="5" style="background:#DCDCDC;" align="center" + |'''[[Large cell carcinoma of the lung|Large cell carcinoma]]'''<ref name="pmid24221342">{{cite journal |vauthors=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 |title=Large cell carcinoma of the lung: clinically oriented classification integrating immunohistochemistry and molecular biology |journal=Virchows Arch. |volume=464 |issue=1 |pages=61–8 |date=January 2014 |pmid=24221342 |doi=10.1007/s00428-013-1501-6 |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Basaloid large cell carcinoma of the lung'''
| rowspan="5" |
* Approximately 10% of lung cancers
* [[Smoking]]
| rowspan="5" |
* [[Neuroendocrine cells|Neuro endocrine cells]]
* Suprabasal bronchial cells
| rowspan="5" |
* Peripheral masses
* [[Bronchi]]
| rowspan="5" |
* Soft, pink-tan tumor


| '''Pneumonia/bronchitis'''||Typical symptoms include [[fever]], cough, [[dyspnea]], and chest pain; recurrent pneumonia or bronchitis in a smoker or former smoker should raise the suspicion of lung cancer||'''CXR''' is the first test performed; '''[[CT]] imaging''' can be helpful to evaluate pulmonary masses that might not be well visualised with chest x-ray; '''bronchoscopy''' can also be used to assess for endobronchial lesions or to biopsy suspicious pulmonary masses
* [[Necrosis]] and occasional [[hemorrhage]]
* [[Cavitation|Cavitations]]
* Exophytic bronchial growth
|
*Invasive growth pattern
*Peripheral palisading
*Small, monomorphic, cuboidal fusiform
| rowspan="5" |
*[[Chromogranin]]
*[[Synaptophysin]]
*[[CD56]] 
*[[Cytokeratin]]
| rowspan="5" |
* Large, peripheral masses
| rowspan="5" |
* [[Pleura]]
* [[Liver]]
* [[Bone]]
* [[Brain]]
* Abdominal [[Lymph node|lymph nodes]]
* [[Pericardium]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Clear cell carcinoma of the lung'''
|
* [[Clear cell|Clear cells]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Lymphoepithelioma-like carcinoma of the lung'''
|
* Syncytial growth pattern
* [[Eosinophilic]] nucleoli
* [[Lymphocyte|Lymphocytic]] infiltration
* Invasive
* [[Amyloid]] deposition
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Large-cell lung carcinoma with rhabdoid phenotype'''
|
* [[Eosinophilic]] [[cytoplasmic]] globules
* Small foci of [[adenocarcinoma]]
* [[Eosinophilic]] inclusions
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Mixed type'''
|
* Mixture of:
** [[Adenocarcinoma]]
** [[Squamous cell carcinoma]]
** Giant cell carcinoma
** Spindle cell carcinoma
|-
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cell
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
| rowspan="5" style="background:#DCDCDC;" align="center" + |'''Sarcomatoid carcinoma'''<ref name="pmid24088577">{{cite journal |vauthors=Huang SY, Shen SJ, Li XY |title=Pulmonary sarcomatoid carcinoma: a clinicopathologic study and prognostic analysis of 51 cases |journal=World J Surg Oncol |volume=11 |issue= |pages=252 |date=October 2013 |pmid=24088577 |pmc=3850921 |doi=10.1186/1477-7819-11-252 |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Carcinosarcoma'''
| rowspan="5" |
* Accounts for only 0.3-1.3% of all lung malignancies
* Mean age at diagnosis is 60 years
* Tobacco [[smoking]]
* [[Asbestos|Asbestos exposure]]
| rowspan="5" |
* Undifferentiated [[epithelial cells]]  
| rowspan="5" |
* Central or peripheral
* Upper lobes
| rowspan="5" |
* > 5 cm
* Well circumscribed
* Grey, yellow or tan creamy, gritty,  
* Mucoid and/or [[hemorrhagic]] with significant [[necrosis]]
* [[Sessile]] or [[pedunculated]]
* Infiltrative
|
* Biphasic
* Mixture of [[carcinomatous]] and sarcomatous cells
|
* [[Keratin]]
* [[S-100]]
| rowspan="5" |
* No specific imaging features 
| rowspan="5" |
* Aggressive tumor
* [[Esophagus]], [[jejunum]], and [[rectum]]
* [[Kidney]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Spindle cell carcinoma'''
|
* Only spindle shaped tumor cells
* Lymphoplasmacytic infiltrates
| rowspan="3" |
* [[Keratin]]
* EMA
* [[Cytokeratin]]
* [[Vimentin]]
* [[CEA]]
* [[TTF-1]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Giant cell carcinoma'''
|
* Multi- and/or mononucleated tumor [[giant cells]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Pleomorphic carcinoma'''
|
* Poorly differentiated
* Mixture of [[spindle cells]] and/or [[giant cells]]
* Fibrous or myxoid [[stroma]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Pulmonary blastoma'''
|
* Biphasic
* Mixture of [[Epithelium|epithelial]] and  mesenchymal [[Stromal cell|stroma]]
|
* [[Keratin]]
* EMA
* [[CEA]]
* [[Chromogranin A]]
|-
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cell
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
| style="background:#DCDCDC;" align="center" + |'''[[Carcinoid tumor]]'''<ref name="pmid19212636">{{cite journal |vauthors=Dahabreh J, Stathopoulos GP, Koutantos J, Rigatos S |title=Lung carcinoid tumor biology: treatment and survival |journal=Oncol. Rep. |volume=21 |issue=3 |pages=757–60 |date=March 2009 |pmid=19212636 |doi= |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Typical carcinoid'''
'''Atypical carcinoid'''  
|
* Most common in males
* Mean age of diagnosis 45
|
* [[Neuroendocrine cells]] of lung
|
* Typical [[Carcinoid|carcinoids]] are throughout the lungs


* Atypical carcinoid is more commonly peripheral
|
* Firm, well demarcated, tan to yellow tumors
|
* Uniform polygonal cells
* Nuclear atypia
* [[Pleomorphism]]
* The most common patterns are the organoid and trabecular
* Highly vascularized fibrovascular stroma
* Focal [[necrosis]]
|
* [[Cytokeratin]]
* [[Chromogranin]]
* [[Synaptophysin]]
* [[CD57]]
* [[CD56]]
* [[S-100 protein]]
|
* Well defined [[pulmonary]] nodules
* [[Calcification|Calcifications]] is often seen.
* Intense contrast enhancement
|
* [[Liver]]
* [[Bone]]
|-
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |'''Salivary gland tumors'''<ref name="pmid23789697">{{cite journal |vauthors=Elnayal A, Moran CA, Fox PS, Mawlawi O, Swisher SG, Marom EM |title=Primary salivary gland-type lung cancer: imaging and clinical predictors of outcome |journal=AJR Am J Roentgenol |volume=201 |issue=1 |pages=W57–63 |date=July 2013 |pmid=23789697 |pmc=3767141 |doi=10.2214/AJR.12.9579 |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''[[Mucoepidermoid carcinoma]]'''
|
* Most patients presents in the third and fourth decade
* Constitutes of less than 1% tumor
* No association with [[cigarette smoking]] or other risk factors
|
* Primitive cells of tracheobronchial origin
|
* 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
* Surface [[epithelium]] lacking changes of in-situ [[carcinoma]]
* Absence of individual cell [[keratinization]]
* Transitional areas to low grade [[mucoepidermoid carcinoma]]
|
* [[GFAP]]
|
* Well-circumscribed oval or lobulated mass
* [[Calcification|Calcifications]]
* Post-obstructive pneumonic infiltrates
|
* Rare
* [[Liver]]
* [[Bones]]
* [[Adrenal gland]]
* [[Brain]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Adenoid cystic carcinoma'''
|
* Constitutes less than 1% of all lung tumors
* Most commonly seen in fourth and fifth decades of life
|
* Primitive cells of tracheobronchial origin
|
* [[Trachea]]
|
* Gray-white or tan polypoid lesions


| '''Carcinoid tumor'''||Often asymptomatic with normal physical examination; may cause cough, dyspnea, [[hemoptysis]], unilateral wheezing, or post-obstructive pneumonia if the tumor is endobronchial or compressing the central bronchi ||'''CT chest:''' 80% of carcinoid tumors appear as an endobronchial nodule and 20% as a parenchymal nodule, with smooth, rounded borders and is highly vascularized; '''flexible [[bronchoscopy]]''' shows raised, pink, vascular, lobulated lesions; '''endobronchial forceps biopsy''' is usually required for pathology to be diagnostic; bronchial brushings, sputum specimens, and lavage fluid rarely provide sufficient tissue for a conclusive diagnosis
* Size ranges from 1–4 cm


* Infiltrative margins
|
* Invades other cell layers
* Heterogeneous cellularity
* Cribriform pattern
* Perineural invasion
|
* [[Immunoperoxidase]]
* [[Cytokeratin]]
* [[Vimentin]]
* [[Actin]]
* [[Calponin]]
* [[S-100 protein]]
* [[p53]]
* [[GFAP]]
|
* Well circumscribed
* Nodule
|
* [[Liver]]
* [[Brain]]
* [[Bone]]
* [[Spleen]]
* [[Kidney]]
* [[Adrenal glands]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Epithelial-myoepithelial carcinoma'''
|
* Age ranges from 33 to 71 years
* No association with [[smoking]]
|
*[[Myoepithelial cells]]
|
* Endobronchial
|
* Solid to gelatinous in texture
* White to gray in colour
|
* [[Myoepithelial cells]]
* Dual layer of cells lining ducts
* Low mitotic activity
|
* MNF116
* EMA
* [[SMA]] and [[S-100]]
|
* Reflects [[airway obstruction]]
|
* [[Breast]]
|-
|-
 
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
| '''Metastatic cancer from a non-thoracic primary site'''||Signs and symptoms depend on the location of the primary tumor and distant disease and may include pain, weight loss, malaise, cough, dyspnea, clubbing, or focal wheezing; physical findings may be present depending on the location and extent of the disease||'''CT chest''' shows one or multiple nodules of variable sizes from diffuse micronodular opacities (miliary) to well-defined masses, lesions are often irregular and in the periphery of the lower lung zones; '''CT/MRI head, CT abdomen and pelvis:''' extrapulmonary cancers that commonly [[metastasis]] to the lung include melanoma, [[thyroid]] carcinoma, esophageal cancer; ovarian cancer; sarcomas; and adenocarcinomas of the colon, breast, kidney, and testis; '''PET-FDG scan''' shows increased uptake in both primary and distant sites, certain metastatic lesions, such as renal cell carcinoma, have a lower probability of 18-fluorodeoxyglucose (FDG) uptake; '''CT-guided transthoracic needle aspiration (TTNA)''' can reveal characteristic malignant cells, pneumothorax complicates 20% to 30% of TTNA procedures, the choice between bronchoscopy and TTNA is based on lesion size, location, risks, and local expertise; '''biopsy during flexible bronchoscopy and biopsy''' may show characteristic malignant cells, bronchoscopy has a 100% yield for endobronchial lesions (which are extremely rare in metastatic deposits from other primary tumors)
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cell
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |'''Preinvasive lesions'''<ref name="pmid11980589">{{cite journal |vauthors=Greenberg AK, Yee H, Rom WN |title=Preneoplastic lesions of the lung |journal=Respir. Res. |volume=3 |issue= |pages=20 |date=2002 |pmid=11980589 |pmc=107849 |doi= |url=}}</ref>
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Squamous carcinoma in situ'''
| rowspan="3" |
* Most commonly seen in fifth or sixth decades
* Mostly seen in women
|
* Basal cells of squamous epithelium
|
* [[Bronchi]]
|
* Focal or multi-focal plaque-like greyish lesions
* Nonspecific [[erythema]]
* Even nodular or polypoid lesions
|
* [[Goblet cell]] [[hyperplasia]]


| '''Infectious granuloma'''||History may include travel to endemic areas, pet/animal exposures, and specific leisure activities (e.g., caving); may feature cough, dyspnea, hemoptysis, weight loss, fever, joint aches, skin lesions, and night sweats, or no symptoms; many possible causes: ''[[Histoplasma capsulatum]]'', ''[[Mycobacterium tuberculosis]]'', ''[[Coccidioides immitis]]'', ''[[Cryptococcus neoformans]]'', ''[[Aspergillus]]'', ''[[Pseudallescheria boydii]]'', ''Fusarium'' species, [[zygomycetes]], and others; non-specific skin findings may be seen in [[atypical mycobacteria]] and [[cryptococcosis]]; [[lymphadenopathy]] may be present with active disease||'''CT-guided TTNA''' can be used for diagnostic sampling, pneumothorax complicates 20% to 30% of TTNA procedures, the choice between bronchoscopy and TTNA is based on lesion size, location, risks, and local expertise; '''CT chest''' typically shows lesions <2 cm diameter and round with smooth borders, old granulomatous disease may feature central, laminated, or diffuse calcification pattern, mediastinal lymphadenopathy without calcifications is sometimes present, nodules from angioinvasive fungi (e.g., Aspergillus, Pseudallescheria boydii, Fusarium species, and zygomycetes) may demonstrate the "halo sign" (ground-glass opacity surrounding the nodule),  occasionally, calcifications can be seen in the spleen or liver; '''fungal serologies:''' positive during active infection; '''flexible bronchoscopy and biopsy''' can sometimes provide sample for identification and culture and sensitivity of organism; '''PET:''' usually negative (<2.5 standardised uptake values), may be positive in active infectious processes
* [[Basal cell]] [[hyperplasia]]


|-
* [[Squamous]] [[dysplasia]]


| '''Sarcoidosis'''||Cough, dyspnea, [[fatigue]] weight loss, fever, night sweats, rash, eye pain, [[photophobia]] blurred vision, and red eye; pulmonary examination is usually unrevealing; can affect any organ, so physical findings depend on specific organs affected; skin lesions including maculopapular eruptions, subcutaneous nodular lesions, and red-purple skin lesions||'''CT chest:''' mediastinal adenopathy often present with sarcoid. Sarcoid nodules have predilection for upper zones, although can be located throughout the lung; '''flexible bronchoscopy and biopsy''' can demonstrate presence of non-caseating granulomas; '''CT-guided TTNA''' can provide access to material from some lesions inaccessible to flexible bronchoscopy; '''laboratory markers:''' ACE elevation may be seen in sarcoidosis but is non-specific
* [[Angiogenic]] [[squamous]] [[dysplasia]]  


* Micropapillomatosis
|
* [[EGFR]]
* [[HER2/neu]] 
* [[P53 (protein)|p53]]
* [[MCM2]]
* [[Ki-67]]
* [[Cytokeratin|Cytokeratin 5/6]]
* [[Bcl-2]]
* [[VEGF]]
* Folate binding protein
* [[P16 (gene)|p16]]
|
* Cauliflower like
* Mosaic pattern
| rowspan="3" |
* [[Liver]]
* [[Brain]]
* [[Bone]]
* [[Spleen]]
|-
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Atypical adenomatous hyperplasia'''
|
* Surfactant apoprotein
* [[Clara cell secretory protein|Clara cell specific 10kDd protein]]
|
* [[Pleurae|Pleura]]
* Upper lobes
|
* Multiple grey to yellow foci
* 1mm to 10mm in size
|
* Intranuclear inclusions
* [[Clara cell|Clara cells]] and [[Pneumocytes|type II pneumocytes]]
* Thickened alveolar walls
* Discontinuous lining of cells
* Moderate atypia
* Pseudopapillae
|
* [[CEA]]
* [[MMP|MMPs]]
* [[E-cadherin]]
* [[Beta-catenin|ß-catenin]]
* [[CD44|CD44v6]]
* [[TTF-1]]
* [[TP53]]
|
* Typically not visualized on [[Radiography|radiographs]]
* Small non-solid nodules


| '''Rheumatoid arthritis'''||Arthralgias, pain, skin nodules, [[pleural effusions]], [[pleuritis]], joint pain, and deformity||'''CT chest''' typically shows lung nodule 3 mm to 7 cm, predominantly in peripheral upper and mid-lung zones, may show cavitation; '''flexible bronchoscopy and biopsy''' shows rheumatoid necrobiotic nodule, necrobiotic nodules demonstrate a central zone of eosinophilic fibrinoid necrosis surrounded by palisading fibroblasts, the nodule often centered on necrotic inflamed blood vessels; '''laboratory markers:''' patients with lung nodules due to rheumatoid arthritis frequently have high levels of rheumatoid factor, although seronegative cases have been reported
* Ground-glass opacity
 
|-
|-
 
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia'''
| '''Wegener's granulomatosis'''||Cough, chest pain, dyspnea, hemoptysis, rhinorrhoea, epistaxis, ear/sinus pain, hoarseness, [[fever]], fatigue, anorexia, weight loss, palpable purpura, painful ulcers, uveitis, upper airway [[inflammation]], and sinus pain||'''CT chest shows''' solitary or multiple lung nodules, airways are frequently affected; '''Flexible bronchoscopy or CT-guided TTNA''' may show necrotising granulomatous inflammation; '''laboratory markers:''' anti-neutrophil cytoplasmic antibody (ANCA), ANCA testing results depend on the extent and severity of the disease
|
 
* [[Pulmonary]] [[neuroendocrine cells]]
|
* Endobronchial
|
* Early lesions are:
** Small, gray-white nodules
** Resembling ‘miliary bodies’
* Larger [[carcinoid]] tumors are:
** Firm
** Homogeneous
** Well-defined
** Grey or yellow-white masses
|
* [[Nodular]] aggregates
* [[Myelofibrosis|Fibrosis]] due to [[proliferation]]
* Invade locally
* [[Fibrous]] [[stroma]] aggregates to form ‘tumorlets’.
* [[Carcinoid|Carcinoids]] are tumorlets >5cm.
|
* [[Keratin]]
* [[CEA]]
|
* Mosaic pattern of air trapping
* Sometimes with nodules
* Thickened [[bronchial]] and bronchiolar walls
|-
|-
 
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
| '''Arteriovenous malformation'''||Dyspnea is uncommon, may cause [[hemoptysis]], pulmonary [[bruit]], arteriovenous communications, or hemorrhagic [[telangiectasia]] in the skin, mucous membranes, and other organs, cyanosis and finger clubbing may be present, eurological symptoms from cerebral aneurysms, cerebral emboli||'''CT chest''' shows round or oval nodule(s) with feeding artery and draining vein often identified, most common in lower lobes, multiple lesions in 30% of cases, usually round or oval, ranging from 1 cm to several cm in diameter; '''pulmonary angiography''' confirms presence and location of AVMs, identifies feeding arterial and venous structures, in cases of significant hemoptysis, pulmonary angiogram is combined with bronchial artery embolisation; '''ABG analysis''' may show decreased pO2 and decreased oxygen saturation when AV flow is severe., in cases of severe systemic AVMs, chronic hypoxemia may cause polycythemia
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cell
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Topography
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gross
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Histology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunohistochemistry
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
|-
|-
 
| rowspan="8" style="background:#DCDCDC;" align="center" + |'''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>
| '''Amyloidosis'''||Weight loss, [[paresthesias]], dyspnea, and fatigue are the most common symptoms associated with amyloidosis and are common to all systemic forms; weight loss of >9 kg is common; small vessel involvement can cause jaw or limb claudication, and rarely [[angina]]; amyloid purpura is present in about 1 in 6 patients, typically peri-orbital; eyelid petechiae are common; hepatomegaly >5 cm below the right costal margin is seen in 10% of patients and splenomegaly is usually of modest degree||'''CT chest''' shows lung involvement characterised by focal pulmonary nodules, tracheobronchial lesions, or diffuse alveolar deposits; '''serum immunofixation''' shows presence of monoclonal protein; urine immunofixation shows presence of monoclonal protein; '''immunoglobulin free light chain assay''' shows abnormal kappa to lambda ratio
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Epithelioid haemangioendothelioma / Angiosarcoma'''
 
|
* Caucasian
* 80% are women
|
* Endothelial cells
|
* [[Intravascular]]
|
* 0.3-2.0 cm circumscribed mass
* Gray-white or gray-tan firm tissue
* Yellow flecks
* Central [[Calcification|calcifications]]
* Cut surface has a [[cartilaginous]] consistency 
|
* Round to oval-shaped [[nodules]]
* Central [[sclerosis]]
* Hypocellular zone
* Peripheral cellular zone
* [[Calcification|Calcifications]]
* Intranuclear [[cytoplasmic]] [[inclusions]]
|
* [[CD31]]
* [[CD34]]
* [[Factor VIII]] ([[von Willebrand factor]])
* [[Cytokeratin]]  
|
* Multiple
* Bilateral
* Small nodules
* 1-2 cm in size
* Can mimic [[Langerhans cell histiocytosis|pulmonary Langerhans’ cell histiocytosis]].
* [[Calcification|Calcifications]]
|
* [[Liver]]
* [[Bone]]
* [[Soft tissue]]
|-
|-
 
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Pleuropulmonary blastoma'''
| '''Pulmonary tuberculosis'''||Cough longer than 2 to 3 weeks, discolored or bloody [[sputum]], night sweats, weight loss, loss of appetite, and/or pleuritic chest pain||'''Chest x-ray:''' primary disease commonly presents as middle and lower lung zone infiltrates, ipsilateral adenopathy, atelectasis from airway compression, and pleural effusion can be seen, reactivation-type (post-primary) pulmonary TB usually involves apical and/or posterior segment of right upper lobe, apicoposterior segment of left upper lobe, or superior segment of either lower lobe, with or without cavitation, as disease progresses it spreads to other segments/lobes; '''sputum smear:''' positive for acid-fast bacilli (AFB), sputum may be spontaneously expectorated or induced, and at least 3 specimens should be collected (minimum 8 hours apart, including an early morning specimen, which is the best way to detect ''Mycobacterium tuberculosis''), organisms other than ''M. tuberculosis'', especially on-tuberculous mycobacteria (e.g., ''M. kansasii'' and ''M. avium'' , may be positive for AFB stain; '''nucleic acid amplification tests (NAAT):''' positive for ''M. tuberculosis''  DNA or RNA amplification tests for rapid diagnosis, may be used on sputum or any sterile body fluid
|
 
* Most common in children
* Median age of diagnosis is 2 years
|
* [[Thoracic]] splanchnopleural [[mesenchyme]]
|
* [[Pleurae|Pleura]]
* [[Lung]]
|
* Purely cystic
* Thin-walled
* Rarely solid
* Firm to gelatinous
* Upto 15 cm
|
* Type I
** Purely [[cystic]]
** Lined by [[respiratory]] type [[epithelium]]
** Underneath [[malignant]] [[cells]]
* Type II
** Partial or complete overgrowth of the septal [[stroma]]
* Type III
** Mixed cells
|
* [[Vimentin]]
* [[S-100 protein]]
|
* Unilateral
* Localized airfilled cysts
* Septal thickening or an intracystic mass
|
* [[Brain]]
* [[Spinal cord]]
* [[Skeletal system]]
* [[Eye|Eyes]]
* [[Pancreas]]
|-
|-
 
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Chondroma'''
| '''Non-Hodgkin's lymphoma (NHL)'''||Aggressive NHL may present with fever, drenching night sweats, malaise, weight loss, cough, shortness of breath, abdominal discomfort, headache, change in mental status, dizziness, ataxia, pleural effusion, [[lymphadenopathy]], pallor, [[purpura]], [[jaundice]], hepatomegaly, splenomegaly, skin nodules, and abnormal neurological examination, low-grade NHL patients often minimally symptomatic or asymptomatic||'''CT chest:''' frequently anterior mediastinum, can determine if mass is cystic or solid and whether it contains calcium or fat, contrast enhancement provides information concerning vascularisation of the mass and relationship to adjacent structures; '''FBC with differential:''' shows thrombocytopenia, pancytopenia; '''Blood smear:''' shows nucleated red blood cells, giant platelets; '''lymph node biopsy with immunohistochemistry:''' shows characteristic cells, preferably obtain excisional or core biopsy to provide information on lymph node architecture; '''mediastinoscopy:''' used to sample mediastinal nodes
|
 
* Young women
|
* [[Chondrocyte|Chondrocytes]]
* Cartilaginous cells
|
* Peripheral lesions in [[lung]]
* Primary lesion seen in
** [[Stomach]]
** [[Bone]]
** [[Paraganglia]]
|
* Peripheral
* Solid lesions
* [[Calcified lesion|Calcified]]
|
* Capsulated lobules
* Hypocellular
* Features of [[malignancy]] are absent
|
* N/A
|
* Multiple
* Well circumscribed lesions
* “Pop-corn” calcifications
|
* [[Benign tumor|Benign]] in nature
|-
|-
 
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Congenital peribronchial myofibroblastic tumor'''
| '''Hodgkin's lymphoma'''||Predominantly a disease of young adults; most patients present with a several-month history of persistent adenopathy, most commonly of the cervical chain||'''Plain chest x-ray:''' typically shows mediastinal mass/large mediastinal [[adenopathy]]; '''PET scan:''' involved sites appear fluorodeoxyglucose (FDG)-avid (bright) with PET imaging; '''lymph node biopsy with immunohistochemistry:''' the Hodgkin's cell can be a characteristic Reed-Sternberg cell, or one of its variants, such as the lacunar cell in the nodular sclerosis subtype; in nodular lymphocyte-predominant Hodgkin's lymphoma, the characteristic cell is the [[lymphocytic]] and histiocytic (L&H) cell, also referred to as a popcorn cell
|
 
* Rare
* Sporadic
* Complicated by
** [[Polyhydramnios]]
** [[Hydrops fetalis|Non-immune hydrops fetalis]]
|
* [[Spindle cells]]
|
* Along the bronchi
|
* 5-10 cm
* Well-circumscribed
* Non-encapsulated
* Smooth or multinodular surface
* The cut surface has a tann-grey to yellow-tan fleshy appearance
* [[Hemorrhage]]
* [[Necrosis]]
|
* [[Fascicles]] of [[spindle cells]]
* [[Bronchial]] invasion
* Peribronchial distribution
* Cystic foci of [[hemorrhage]]
|
* [[Vimentin]]
|
* Well circumscribed
* Opaque hemithorax
* Heterogeneous mass
|
* Rare
|-
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Diffuse pulmonary lymphangiomatosis'''
|
* Children
* Young adults of both sexes
|
* [[Smooth muscle cells]] of [[lymphatic vessels]]
|
* Along the [[Lymphatic drainage|lymphatic distribution]]
|
* Prominence of the bronchovascular bundles along
** [[Pleurae|Pleura]]
** Interlobular pulmonary septa
** [[Mediastinum]]
|
* Anastomosing endothelial-lined cells along lymphatic routes


| '''Thymoma/thymic carcinoma'''||Approximately 30% of patients with thymoma are asymptomatic at the time of diagnosis; may also present with cough, chest pain, signs of upper airway congestion, superior vena cava syndrome, dysphagia, or hoarseness; may have features of paraneoplastic syndromes associated with thymoma including [[myasthenia gravis]], [[polymyositis]], [[lupus erythematosus]], [[rheumatoid arthritis]], thyroiditis, and [[Sjogren's syndrome]]; about 30% of patients have symptoms suggestive of myasthenia gravis (e.g., ptosis, double vision)||'''Plain chest x-ray:''' in 50% of the patients, thymomas are detected by chance with plain-film chest radiography; CT chest: 90% occur in anterior mediastinum; '''Positron emission tomography (PET):''' may be of value in determining malignancy and extramediastinal involvement; '''pre-operative biopsy:''' indicated if there are atypical features or if imaging suggests invasive tumor and patient is under consideration for induction therapy
* [[Spindle cells]]
* Intra alveolar siderophages
|
* [[Vimentin]]  
|
* Increased interstitial markings


* Thickening of the:
** Interlobular septa
** [[Fissure|Fissures]]
** Central airways
** [[Pleura]]
|
* Skin
* Bone
|-
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Inflammatory myofibroblastic tumor'''
|
* Previous [[viral infections]]
* [[HHV-8|HHV8]]
* Children
|
* [[Myofibroblasts|Myofibroblastic cells]]
|
* Localized to bronchi
|
* Solitary


| '''Bronchogenic cyst'''||Usually diagnosed in infancy and childhood, although 50% are diagnosed after 15 years of age; Approximately 50% of patients are asymptomatic; in adults, chest pain (often pleuritic) and dysphagia (due to esophageal compression) are the most common symptoms; may also feature recurrent cough and chest infection/pneumonia, superior vena cava syndrome, tracheal compression, and [[pneumothorax]]||'''Two-view chest radiography:''' typically shows a sharply demarcated spherical mass of variable size, most commonly located in the middle mediastinum around the carina, can appear as a solid tumor or show air-fluid level if cyst is infected or contains secretions; '''CT chest:''' frequently middle mediastinum, typically at level of the mediastinum, calcifications may also be seen; '''MRI:''' frequently middle mediastinum, typically at level of the [[mediastinum]], T2-weighted images show a homogeneous mass of moderate-to-bright intensity, on T1-weighted images, lesions may vary in intensity depending on protein content of the cyst
* Round rubbery masses


* Yellowish-gray discoloration
* Average size of 3.0 cm
* Non-encapculated
* [[Calcification|Calcifications]]
* No local invasion
|
* Mixture of [[spindle cells]]
** [[Fibroblastic]]
** [[Myofibroblasts|Myofibroblastic]]
* Arranged in [[fascicles]]
* Cytologic atypia
* Touton type [[giant cells]]
* [[Plasma cells]]
* [[Lymphoid follicles]]
|
* [[Vimentin]]
* [[Actin]]
* p80
|
* Solitary mass
* Regular borders
* Spiculated appearance
* Accompanied by
** Post-obstructive [[pneumonia]]
** [[Atelectasis]]
|
* Rare
|-
|-
 
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Pulmonary artery sarcoma'''
| '''Tracheal tumors'''||Common symptoms include dyspnea, cough, hemoptysis, wheeze, and [[stridor]]; less commonly, hoarseness and dysphagia may be present||'''Plain chest radiographs''' are generally insensitive for detection of tracheal tumors, clues that may indicate the presence of a tracheal tumour include abnormal calcification, tracheal narrowing, post-obstructive pneumonia, and/or atelectasis; '''helical CT''' enables accurate calculation of tumor volumes and can help differentiate mucosal lesions from submucosal lesions; '''MRI''' can be useful in assessing extension into surrounding tissue and vascular anatomy; '''[[bronchoscopy]]''' allows direct visualisation, opportunity for biopsy, and potential for laser treatment
|
 
* Mean age of diagnosis is 49.3 years
* Commonly misdiagnosed as [[pulmonary embolism]]
|
* [[Mesenchymal cell|Mesenchymal cells]] of the [[intima]]
* Primitive cells of the bulbus cordi in the trunk of [[pulmonary artery]]
|
* [[Pulmonary trunk]] most commonly involving:
** [[Right pulmonary artery]]
** [[Left pulmonary artery]]
** [[Pulmonary valve]]
** [[Ventricular outflow tract|Right ventricular outflow tract]]
|
* Mucoid or gelatinous clots filling vascular lumens
* The cut surface may show
** Firm fibrotic areas
** Bony/gritty or chondromyxoid foci
** [[Hemorrhage]] and [[necrosis]] are common in high-grade tumors
|
* Spindle cells in
** A myxoid background
** Collagenized stroma
** Recanalized thrombi
|
* [[Vimentin]]
* [[Osteopontin]]
* [[Factor VIII]]
* [[CD31]]
* [[CD34]]
| rowspan="2" |
* Findings overlap with those of chronic [[thromboembolic disease]]
* Decreased [[vascularity]]
* Heterogeneous [[soft tissue]] density
* Smooth [[vascular]] tapering
|
* [[Lung]] parenchyma
* [[Mediastinum]]
|-
|-
 
| colspan="2" style="background:#DCDCDC;" align="center" + |'''Pulmonary vein sarcoma'''
| '''Thyroid mass'''||Symptoms and signs depend on size of mass; may be visible/palpable as lump on anterior aspect of neck; may present with [[dysphagia]], hoarseness, difficulty breathing, and pain in neck or throat; may also be signs and symptoms of hyper- or hypothyroidism depending on the nature of the mass||'''Laboratory testing''' should include thyroid function panel, with TSH, free T4, free T3; I-123 thyroid scan is ordered for patients with overt or subclinical [[hyperthyroidism]] a hyperfunctioning (hot) nodule is almost always benign, most nodules are hypofunctioning (cold) (most of these are benign, but malignant nodules are also cold); '''ultrasound and doppler''' can be used to define dimensions of thyroid nodules and solid/cystic component(s), features suspicious of malignancy include microcalcifications, a more tall-than-wide shape, hypervascularity, marked hypoechogenicity, or irregular margins, it can also guide fine-needle aspiration, which can reveal malignant cells or cyst fluid; '''CT neck''' can evaluate cervical lymph nodes in cases of medullary thyroid cancer, and extension of the scan into the chest can help evaluate a retrosternal thyroid mass
|
 
* Most common in women
* Mean age of diagnosis is 49
|
* [[Smooth muscle]]
|
* [[Pulmonary veins|Pulmonary vein]]
|
* Fleshy-tan tumor
* Can occlude the lumen of the involved vessel
* 3.0- 20.0 cm
* Invasion of wall of the [[vein]]
|
* [[Smooth muscle]] differentiation
* Moderate to highly cellular [[Spindle cells|spindle cell]] [[neoplasms]]
* [[Epithelioid]] morphology
|
* [[Vimentin]]
* [[Desmin]]
* [[Actin]]
* [[Keratin]]
|
* N/A
|}
|}
In [[superior vena cava syndrome]], obstruction of the [[superior vena cava]] by a tumor (mass effect) causes facial swelling, [[cyanosis]] and dilatation of the veins of the head and neck.
A pancoast tumor is an apical tumor that is typically found in conjunction with a smoking history. The clinical signs and symptoms can be confused with neurovascular compromise at the level of the thoracic outlet. The patient's smoking history, rapid onset of clinical signs and symptoms, and pleuritic pain can suggest an apical tumor.


==References==
==References==

Latest revision as of 20:43, 19 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Overview

Pancoast tumor must be differentiated from other causes of mass located in the apical region of the chest which may present with pain in the shoulder region. Differential diagnosis includes most common other conditions that cause hemoptysis, cough, dyspnea, wheeze, chest pain, shoulder pain, unexplained weight loss, unexplained loss of appetite, and fatigue such as superior vena cava syndrome, thoracic outlet syndrome, cervical disk disease, pneumonia/bronchitis, carcinoid tumor, infectious granuloma and thyroid mass.

Differential Diagnosis

Pancoast tumor must be differentiated from other causes of mass located in the apical region of the chest which may present with pain in the shoulder region.The table below summarizes the findings that differentiate apical mass in the chest from the most common other conditions that cause hemoptysis, cough, dyspnea, wheeze, chest pain, shoulder pain, unexplained weight loss, unexplained loss of appetite, and fatigue


The following table summarizes the differentiation of various lung tumors based on histological and topographical features:[1][2][3][4][5][6][7][8][9][10][11][12][13]

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

Risk/Epidemiology Pleuripotent cells Topography Gross Histology Immunohistochemistry Imaging Metastasis
Pancoast Tumor Squamous cell carcinoma (SCC)
  • Central
  • Exophytic
  • Intra-epithelial
  • Without invasion
  • Cells with clear cytoplasm
  • Peripheral palisading of nuclei.
  • Poor differentiation

Chest x-ray: Lordotic view on chest x-ray is helpful in visualizing Pancoast tumor because of its characteristic location in the apical portion of the lung.

Small cell carcinoma
  • Bronchial precursor cell
  • 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
  • Bone marrow
  • Liver
Adenocarcinoma
  • Columnar cells of bronchioles
  • Peripheral
  • Single or multiple lesions
  • Different in size
  • Peripheral distribution
  • Gray-white central fibrosis
  • Pleural puckering
  • Anthracotic pigmentation
  • Lobulated or ill defined edges
  • Nuclear atypia
  • Eccentrically placed nuclei
  • Abundant cytoplasm with mucin vacuoles
  • Often conspicuous nucleoli
  • Lack of intercellular bridges.
  • Different patterns, include: acinar, lepidic, micropapillary, papillary, and solid.
Aerogenous spread is characteristic
Benign Lung Tumors[14]
Papilloma[15] Squamous cell papilloma
  • HPV 6 and 11
  • Men
  • Median age of diagnosis is 54 years
  • Endobronchial
  • Cauliflower-like lesions
  • Tan-white soft to semifirm protrutions
  • Loose fibrovascular core
  • Stratified squamous epithelium
  • Acanthosis
  • Binucleate forms and perinuclear halos
  • Koilocytosis
  • N/A
  • Well circumscribed
  • Homogenous
  • Non-calcified
  • Solitary mass
  • N/A
Glandular papilloma
  • Rare
  • Mean age of diagnosis is 68 years
  • Endobronchial
  • White to tan endobronchial polyps that measure from 0.7-1.5 cm
  • N/A
  • Well circumscribed
  • Homogenous
  • Non-calcified
  • Solitary mass
  • N/A
Adenoma[16] Alveolar adenoma
  • Mean age of diagnosis is 53 years
  • Female predominance
  • All lung lobes
  • Lower lobes
  • Hilar
  • 0.7-6.0 cm
  • Well demarcated smooth
  • Lobulated, multicystic
  • Soft to firm
  • Pale yellow to tan cut surfaces
  • Well circumscribed
  • Homogenous
  • Non-calcified
  • Solitary mass
  • N/A
Papillary adenoma[17]
  • Mean age of diagnosis is 32 years
  • Male predominance
  • Bronchioloalveolar cell
  • No lobar predilection
  • Involves alveolar parenchyma
  • Well defined
  • Encapsulated
  • Soft, spongy to firm mass
  • Granular gray white/ brown
  • 1.0- 4.0 cm
  • Incidental finding
  • N/A
Mucinous cystadenoma
  • No sex predilection
  • Mean age of diagnosis is 52 years
  • Central
  • White-pink to tan
  • Smooth and shiny tumors
  • Gelatinous mucoid solid core
  • 0.7-7.5 cm
  • Numerous mucin-filled cystic spaces
  • Non-dilated microacini, glands, tubules and papillae
  • Coin lesion
  • Air-meniscus sign
  • N/A
Malignant Lung Tumors[18]
Variants of lung carcinoma Risk Factors/Epidemiology Pleuripotent cell Topography Gross Histology Immunohistochemistry Imaging Metastasis
Squamous cell carcinoma (SCC)[19] Papillary
  • Epithelial cells
  • Central
  • Exophytic
  • Intra-epithelial
  • Without invasion
Clear cell
Basaloid
  • Peripheral palisading of nuclei.
  • Poor differentiation
Small cell carcinoma[20]
  • Bronchial precursor cell
  • 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
  • Bone marrow
  • Liver
Adenocarcinoma[21][22][23] Acinar adenocarcinoma
  • Columnar cells of bronchioles
  • Peripheral
  • Single or multiple lesions
  • Different in size
  • Peripheral distribution
  • Gray-white central fibrosis
  • Pleural puckering
  • Anthracotic pigmentation
  • Lobulated or ill defined edges
  • Irregular-shaped glands
  • Malignant cells:
    • Hyperchromatic nuclei
    • Fibroblastic stroma
  • Peripheral nodules under 4.0 cm in size
  • Central location as a hilar or perihilar mass
  • Rarely show cavitations.
  • Hilar adenopathy
  • Adenocarcinomas account for the majority of small peripheral cancers identified radiologically.
Aerogenous spread is characteristic
  • Brain
  • Bone
  • Adrenal glands
  • Liver
  • Kidney
  • Gastrointestinal Tract
Papillary adenocarcinoma
Bronchio-alveolar carcinoma Non-mucinous
Mucinous
  • Low grade differentiation
  • Composed of:
    • Tall columnar cells
    • Basal nuclei
    • Pale cytoplasm resembling goblet cells
    • Varying amounts of cytoplasmic mucin
  • Cytologic atypia
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
  • Clear cells with no nuclei
Variants of lung carcinoma Risk Factors/Epidemiology Pleuripotent cell Topography Gross Histology Immunohistochemistry Imaging Metastasis
Large cell carcinoma[24] Basaloid large cell carcinoma of the lung
  • Approximately 10% of lung cancers
  • Smoking
  • Soft, pink-tan tumor
  • 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
Variants of lung carcinoma Risk Factors/Epidemiology Pleuripotent cell Topography Gross Histology Immunohistochemistry Imaging Metastasis
Sarcomatoid carcinoma[25] Carcinosarcoma
  • Central or peripheral
  • Upper lobes
  • No specific imaging features 
Spindle cell carcinoma
  • Only spindle shaped tumor cells
  • Lymphoplasmacytic infiltrates
Giant cell carcinoma
Pleomorphic carcinoma
Pulmonary blastoma
Variants of lung carcinoma Risk Factors/Epidemiology Pleuripotent cell Topography Gross Histology Immunohistochemistry Imaging Metastasis
Carcinoid tumor[26] Typical carcinoid

Atypical carcinoid

  • Most common in males
  • Mean age of diagnosis 45
  • Atypical carcinoid is more commonly peripheral
  • Firm, well demarcated, tan to yellow tumors
  • Uniform polygonal cells
  • Nuclear atypia
  • Pleomorphism
  • The most common patterns are the organoid and trabecular
  • Highly vascularized fibrovascular stroma
  • Focal necrosis
Salivary gland tumors[27] Mucoepidermoid carcinoma
  • Most patients presents in the third and fourth decade
  • Constitutes of less than 1% tumor
  • No association with cigarette smoking or other risk factors
  • Primitive cells of tracheobronchial origin
  • Bronchial glands
  • Ranging in size from 0.5-6 cm
  • Soft, polypoid, and pink-tan in colour
  • 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 fourth and fifth decades of life
  • Primitive cells of tracheobronchial origin
  • Gray-white or tan polypoid lesions
  • Size ranges from 1–4 cm
  • Infiltrative margins
  • Invades other cell layers
  • Heterogeneous cellularity
  • Cribriform pattern
  • Perineural invasion
  • Well circumscribed
  • Nodule
Epithelial-myoepithelial carcinoma
  • Age ranges from 33 to 71 years
  • No association with smoking
  • Endobronchial
  • Solid to gelatinous in texture
  • White to gray in colour
Variants of lung carcinoma Risk Factors/Epidemiology Pleuripotent cell Topography Gross Histology Immunohistochemistry Imaging Metastasis
Preinvasive lesions[28] Squamous carcinoma in situ
  • Most commonly seen in fifth or sixth decades
  • Mostly seen in women
  • Basal cells of squamous epithelium
  • Focal or multi-focal plaque-like greyish lesions
  • Nonspecific erythema
  • Even nodular or polypoid lesions
  • Micropapillomatosis
  • Cauliflower like
  • Mosaic pattern
Atypical adenomatous hyperplasia
  • Multiple grey to yellow foci
  • 1mm to 10mm in size
  • Typically not visualized on radiographs
  • Small non-solid nodules
  • Ground-glass opacity
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
  • Endobronchial
  • Early lesions are:
    • Small, gray-white nodules
    • Resembling ‘miliary bodies’
  • Larger carcinoid tumors are:
    • Firm
    • Homogeneous
    • Well-defined
    • Grey or yellow-white masses
  • Mosaic pattern of air trapping
  • Sometimes with nodules
  • Thickened bronchial and bronchiolar walls
Variants of lung carcinoma Risk Factors/Epidemiology Pleuripotent cell Topography Gross Histology Immunohistochemistry Imaging Metastasis
Mesenchymal tumors[29] Epithelioid haemangioendothelioma / Angiosarcoma
  • Caucasian
  • 80% are women
  • Endothelial cells
  • 0.3-2.0 cm circumscribed mass
  • Gray-white or gray-tan firm tissue
  • Yellow flecks
  • Central calcifications
  • Cut surface has a cartilaginous consistency
Pleuropulmonary blastoma
  • Most common in children
  • Median age of diagnosis is 2 years
  • Purely cystic
  • Thin-walled
  • Rarely solid
  • Firm to gelatinous
  • Upto 15 cm
  • Unilateral
  • Localized airfilled cysts
  • Septal thickening or an intracystic mass
Chondroma
  • Young women
  • Capsulated lobules
  • Hypocellular
  • Features of malignancy are absent
  • N/A
  • Multiple
  • Well circumscribed lesions
  • “Pop-corn” calcifications
Congenital peribronchial myofibroblastic tumor
  • Along the bronchi
  • 5-10 cm
  • Well-circumscribed
  • Non-encapsulated
  • Smooth or multinodular surface
  • The cut surface has a tann-grey to yellow-tan fleshy appearance
  • Hemorrhage
  • Necrosis
  • Well circumscribed
  • Opaque hemithorax
  • Heterogeneous mass
  • Rare
Diffuse pulmonary lymphangiomatosis
  • Children
  • Young adults of both sexes
  • Prominence of the bronchovascular bundles along
  • Anastomosing endothelial-lined cells along lymphatic routes
  • Increased interstitial markings
  • Skin
  • Bone
Inflammatory myofibroblastic tumor
  • Localized to bronchi
  • Solitary
  • Round rubbery masses
  • Yellowish-gray discoloration
  • Average size of 3.0 cm
  • Non-encapculated
  • Calcifications
  • No local invasion
  • Solitary mass
  • Regular borders
  • Spiculated appearance
  • Accompanied by
  • Rare
Pulmonary artery sarcoma
  • Mucoid or gelatinous clots filling vascular lumens
  • The cut surface may show
    • Firm fibrotic areas
    • Bony/gritty or chondromyxoid foci
    • Hemorrhage and necrosis are common in high-grade tumors
  • Spindle cells in
    • A myxoid background
    • Collagenized stroma
    • Recanalized thrombi
Pulmonary vein sarcoma
  • Most common in women
  • Mean age of diagnosis is 49
  • Fleshy-tan tumor
  • Can occlude the lumen of the involved vessel
  • 3.0- 20.0 cm
  • Invasion of wall of the vein
  • N/A

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