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Imaging features of lung mass
Hyperdense pulmonary mass Cavitating pulmonary mass
  • Granuloma (most common)
  • Pulmonary hamartoma
  • Bronchogenic carcinoma
  • Carcinoid tumours
  • Pulmonary metastases:
  • Mucoid calcification of mucinous adenocarcinoma
  • Breast carcinoma
  • Gastrointestinal tract adenocarcinoma
  • Dystrophic calcification:
  • Papillary thyroid carcinoma
  • Giant cell tumor of bone
  • Synovial sarcoma
  • Treated pulmonary metastases
  • Osteosarcoma
  • Chondrosarcoma

Cancer

  • Bronchogenic carcinoma (most common)
  • Squamous cell carcinoma

Autoimmune

  • Granulomas (Wegener's granulomatosis)
  • Rheumatoid arthritis
  • Rheumatoid nodules

Vascular

  • Septic pulmonary embolus

Infections (bacterial/fungal)

  • Pulmonary abscess
  • Pulmonary tuberculosis

Trauma

  • Pneumatocoeles

Youth

  • CPAM
  • Pulmonary sequestration
  • Bronchogenic cyst


Classification of Benign and Malignant Pulmonary Mass
Lung mass (location) Benign Malignant
Endobronchial
  • Bronchial atresia
  • Bronchial hamartoma
  • Bronchogenic cysts
  • Pulmonary bacterial abscess
  • Bronchial anthracofibrosis
  • Allergic bronchopulmonary aspergillosis
  • Squamous dysplasia of lung
  • Squamous cell lung carcinoma
Parenchymal
  • Granuloma
  • Pulmonary hamartoma
  • Pulmonary bacterial abscess
  • Pulmonary infract septic
  • Pulmonary emboli
  • Bronchogenic carcinoma
  • Carcinoid tumors
  • Pulmonary metastases
  • Papillary thyroid carcinoma
  • Giant cell tumor of bones
  • Synovial sarcoma
Pleural
  • Pleural effusion
  • Empyema
  • Hemothorax
  • Lipoma
  • Splenosis
  • Tuberculosis
  • Mesothelioma
  • Metastasic pleural disease
  • Invasive thymoma
  • Pleural fibrosarcoma
  • Pleural liposarcoma
  • Primary pleural lymphoma
  • Pleural synovial sarcoma



Radiologic Features Suggestive of Benign or Malignant Solitary Pulmonary Nodules
Adapted from American Academy of Family Physicians [1]
Radiologic feature Benign Malignant
Size < 5 mm > 10 mm
Border Smooth Irregular or spiculated
Density Dense, solid Nonsolid, “ground glass”
Calcification Typically a benign feature, especially in “concentric,” “central,” “popcorn-like,” or “homogeneous” patterns Typically noncalcified, or “eccentric” calcification
Doubling time Less than one month; more than one year One month to one year



Recommendations for Follow-up and Management of Nodules <8 mm Detected Incidentally at Non-screening CT

Nodule Size (mm) Low risk patients High risk patients
Less than or equal to 4 |No follow-up needed. Follow-up at 12 months. If no change, no further imaging needed.
>4 - 6 Follow-up at 12 months. If no change, no further imaging needed. Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change.
>6 - 8 Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change. Initial follow-up CT at 3 - 6 months and then at 9 -12 and 24 months if no change.
> 8 Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy Same at for low risk patients

Note: Newly detected indeterminate nodule in persons 35 years of age or older.[2]

  • Low risk patients: Minimal or absent history of smoking and of other known risk factors.
  • High risk patients: History of smoking or of other known risk factors.




Differential Diagnosis for Solitary Pulmonary
Adapted from Erasmus et al. [1]
Differential Diagnosis Causes
Malignant neoplasms
  • Bronchogenic carcinoma
  • Carcinoid tumor
  • Pulmonary lymphoma
  • Pulmonary sarcoma
  • Solitary metastases
Benign neoplasms
  • Hamartoma
  • Adenoma
  • Lipoma
Infectious inflammatory
  • Granuloma (tuberculous/fungal)
  • Nocardia infection
  • Round pneumonia
  • Abscess
Non-infectious inflammatory
  • Rheumatoid arthritis
  • Wegener's granulomatosis
  • Sarcoidosis
Vascular
  • Arteriovenous malformation
  • Infarction
  • Hematoma
Congenital
  • Bronchial atresia
Miscellaneous
  • External object
  • Pseudotumor
  • Pleural thickening



Differential Diagnosis Similar Features Differentiating Features
Pulmonary tuberculosis
  • Cough, weight loss, fatigue, and dyspnea
  • In pulmonary tuberculosis, differentiating features include: size increase despite optimal medical therapy, patients age is usually younger, hemoptysis is an early feature, and CXR anatomical predilection for upper lobes
Lung abscess
  • Non-productive cough, weight loss, and chest pain
  • In lung abscess, differentiating features include: acute or sub-acute onset, CXR anatomical predilection for upper lobes, and usually resolve with antibiotic
Pneumonia
  • Cough, weight loss, fatigue, and dyspnea
  • In pneumonia, differentiating features include: good response to antibiotics, acute onset, predilection on CXR is consolidation, laboratory markers indicate infection
Pulmonary fungal infection
  • Non-productive cough, weight loss, fatigue, and dyspnea
  • In pulmonary fungal infection, differentiating features include: CXR findings: air-cresecent sign, no response to antibioitcs, and mimics tuberculosis
Other non-small cell lung cancers (adenocarcinoma and squamous cell lung cancer)
  • Non-productive cough, weight loss, fatigue, and dyspnea
  • In other non-small cell lung cancers , differentiating features include: histopathologica features, such as larger size of the anaplastic cells, a higher cytoplasmic-to-nuclear size ratio, and a lack of "salt-and-pepper" chromatin



Differential Diagnosis Similar Features Differentiating Features
Pulmonary tuberculosis
  • In pulmonary tuberculosis, differentiating features include: increase in diameter despite optimal medical therapy, patients age is usually younger, hemoptisis is an early feature, and CXR anatomical predilection for upper lobes
Sarcoidosis
  • In lung abscess, differentiating features include: acute or subacute onset, CXR anatomical predilection for upper lobes, and usually resolve with antibiotic
Pneumonia
  • Cough, fatigue, and dyspnea
  • In pneumonia, differentiating features include: good response to antibiotics, acute onset, predilection on CXR is consolidation, laboratory markers indicate infection
Pulmonary fungal infection
  • In primary fungal infection, differentiating features include: CXR findings: air-cresecent sign, no response to antibioitcs, and mimcs tuberculosis
Metastases
  • In metastases, differentiating features include: multicentricity, involvement of the contralateral hemitorax, and usually primary cancer is known




Stage (TNM criteria) Standard Treatment Options
Occult
  • Surgery
Stage 0
  • Surgery
  • Endobronchial therapies
Stages IA and IB
  • Surgery
  • Radiation therapy
  • IB, if the tumor is >4cm, surgery and chemotherapy
Stages IIA and IIB
  • Surgery
  • Neoadjuvant chemotherapy
  • Adjuvant chemotherapy
  • Radiation therapy
Stage IIIA

Resected or resectable disease

  • Surgery
  • Neoadjuvant therapy
  • Adjuvant therapy

Unresectable disease

  • Radiation therapy
  • Chemoradiation therapy

Superior sulcus tumors

  • Radiation therapy alone
  • Radiation therapy and surgery
  • Concurrent chemotherapy with radiation therapy and surgery
  • Surgery alone (for selected patients)

Tumors that invade the chest wall

  • Surgery
  • Surgery and radiation therapy
  • Radiation therapy alone
  • Chemotherapy combined with radiation therapy and/or surgery
Stage IIIB
  • Sequential or concurrent chemotherapy and radiation therapy
  • Chemotherapy followed by surgery (for selected patients)
  • Radiation therapy alone
Stage IV
  • Cytotoxic combination chemotherapy (first line)
  • Combination chemotherapy with bevacizumab or cetuximab
  • EGFR tyrosine kinase inhibitors (first line)
  • EML4-ALK inhibitors in patients with EML-ALK translocations
  • Immune checkpoint inhibition with nivolumab for selected patients with squamous or nonsquamous metastatic

Maintenance therapy following first-line chemotherapy

  • Endobronchial laser therapy and/or brachytherapy (for obstructing lesions)
  • External-beam radiation therapy (primarily for palliation of local symptomatic tumor growth)
Recurrent
  • Radiation therapy (for palliation)
  • Chemotherapy or kinase inhibitors alone EGFR inhibitors in patients with/without EGFR mutations
  • EML4-ALK inhibitors in patients with EML-ALK translocations
  • Surgical resection of isolated cerebral metastasis (for highly selected patients)
  • Laser therapy or interstitial radiation therapy (for endobronchial lesions)
  • Stereotactic radiation surgery (for highly selected patients)


Type of tumor Biopsy findings
Lung adenocarcinoma
Squamous cell lung carcinoma
  • Central nucleus
  • Dense appearing cytoplasm, usu. eosinophilic
  • Small nucleolus
  • Intracellular bridges - classic
Large cell lung carcinoma
  • Large polygonal cells and anaplastic cells
  • Solid nests without obvious squamous or glandular differentiation
  • Moderately abundant cytoplasm
  • Well defined cell borders
  • Vesicular nuclei, prominent nucleoli
Adenosquamous carcinoma
  • Substantial amounts of squamous and glandular differentiation
  • Positive stains for TTF1 and p63 in squamous component
Sarcomatoid carcinoma
  • Sarcoma-like differentiation
  • Spindle cells vary morphologically from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern
  • Moderate to abundant, dense, eosinophilic cytoplasm
Carcinoid tumor
  • Medium sized polygonal cells with lightly eosinophilic cytoplasm
  • Low nuclear grade, round to oval finely granular nuclei; may have rosettes or small acinar structures with variable mucin
  • Scanty vascular stroma, occasionally amyloid stroma with bone
Salivary gland tumor
  • Organized in round and sometimes confluent islands, rich in matrix and with dispersed condrocyte-type cells





Organization Screening Guidelines for Non Small Cell Lung Cancer
Adapted from CDC (2016) [1]
Organization Groups eligible for screening Year
American Academy of Family Practice Evidence is insufficient to recommend for or against screening 2013
American Association of Thoracic Surgery

1. Age 55 to 79 years with 30 pack year smoking history. 2. Long term lung cancer survivors who have completed 4 years of surveillance without recurrence and who can tolerate lung cancer treatment following screening to detect second primary lung cancer until the age of 79. 3. Age 50 to 79 years with a 20 pack year smoking history and additional comorbidity that produces a cumulative risk of developing lung cancer ≥ 5% in 5 years

2012

American Cancer Society

Age 55 to 74 years with ≥30 pack year smoking history, who either currently smoke or have quit within the past 15 years, and who are in relatively good health.

2015

American College of Chest Physicans

Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years

2013

American Society of Clinical Oncology

Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years

2012

American Lung Association

Age 55 to 74 years with ≥ 30 pack year smoking history and no history of lung cancer

2012

Medicaid Services

Age 55 to 77 years with ≥ 30 pack year smoking history and smoking cessation < 15 years

2015

National Comprehensive Cancer Network

Age 55 to74 years with ≥30 packyear smoking history and smoking cessation < 15 years OR Age ≥ 50 years and ≥20 pack year smoking history and additional risk factor (other than secondhand smoke exposure

2015

U.S Preventive Services Task Force

Age 55 to 80 years with ≥30 pack year smoking history and smoking cessation < 15 years.

2013




Procedure Advantages Disadvantages
Thoracotomy (surgical opening of the chest) Allows the most thorough inspection and sampling of lymph node stations, may be followed by resection of tumor, if feasible Most invasive approach, not indicated for staging alone, significant risk of procedure-related morbidity
Left parasternal mediastinotomy (or anterior mediastinotomy) Permits evaluation of the aortopulmonary window lymph nodes More invasive; false-negative rate approximately 10%.
Chamberlain procedure Access to station 5 (aortopulmonary window lymph node) Limited applications, invasive
Cervical mediastinoscopy Still considered the gold standard (usual comparitor) by many, excellent for 2RL 4RL Does not cover all medastinal lymph node stations, particularly subcarinal lymph nodes (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9), the aortopulmonary window lymph nodes (station 5), and the anterior mediastinal lymph nodes (station 6); false-negative rate approximately 20%; invasive
Video-assisted thoracoscopy Good for inferior mediastinum, station 5 and 6 lymph nodes Invasive, does not cover superior anterior mediastinum
Transthoracic percutaneous fine needle aspiration (FNA) under CT guidance More widely available than some other methods Traverses a lot of lung tissue, therefore high pneumothorax risk, some lymph node stations inaccessible
Bronchoscopy with blind transbronchial FNA (Wang needle) Less invasive than above methods Relatively low yield, not widely practiced, bleeding risk



Procedure Advantages

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Endobronchial ultrasound (EBUS)
  • Direct visualization of lymph node stations.
  • Complements EUS: covers lymph node stations 2R and 4R which are difficult to access by EUS
  • Lower false-negative rate than with blind transbronchial FNA and fewer complications
  • More invasive than EUS, few practitioners, but rapidly growing in popularity
Endoscopic ultrasound (EUS)
  • Least invasive modality
  • Uses the esophagus to access mediastinal lymph nodes
  • Excellent for staging lymph nodes
  • Useful for station 2L and 4L, L adrenal, celiac lymph node
  • Cannot reliably access right sided paratracheal lymph node stations 2 R and 4R
  • Accurate discrimination of primary hilar tumors and involved lymph nodes is important




Differential Diagnosis Similar Features Differentiating Features
Pulmonary tuberculosis Chronic cough, weight loss, hemoptysis, nocturnal diaphoresis, dyspnea In pulmonary tuberculosis, differentiating features include: increase in diameter despite optimal medical therapy, patients age is usually younger, hemoptisis is an early feature, and CXR anatomical predilection for upper lobes
Lung abscess Chronic cough, weight loss, hemoptysis, and dyspnea In lung abscess, differentiating features include: acute or subacute onset, CXR anatomical predilection for upper lobes, and usually resolve with antibiotic
Pneumonia Chronic cough, weight loss, hemoptysis, and dyspnea In pneumonia, differentiating features include: good response to antibiotics, acute onset, predilection on CXR is consolidation, laboratory markers indicate infection.
Fungal infection Chronic cough, weight loss, hemoptysis, and dyspnea In fungal infection, differentiating features include: CXR findings: air-cresecent sign, no response to antibioitcs, and mimcs tuberculosis.
Chronic eosinophilic pneumonia Chronic cough, weight loss, hemoptysis, and dyspnea In chronic eosinophilic pneumonia , differentiating features include: followed by a parasite infection or medication exposure, and increased serum IgE levels


Age-adjusted incidence of lung cancer by histological type
Adapted from Wikipedia [3]
All types 66.9
Adenocarcinoma 22.1
Squamous-cell carcinoma 14.4


Age-adjusted incidence of lung cancer by histological type
Adapted from Wikipedia [3]
Type Incidence per 100,000 per year
All types

66.9

Adenocarcinoma

22.1

Squamous-cell carcinoma

14.4



Classification: Mucoepidermoid Carcinomas
Adapted from Radiopedia [4]
Salivary gland-confined carcinomas
  • Major salivary glands (50%)
  • Parotid gland (40%)
  • Submandibular gland (7%)
  • Sublingual gland (3%)
  • Minor salivary glands (50%)
  • Palate (most common)
  • Retromolar area
  • Floor of the mouth
  • Buccal mucosa
  • Lip
  • Tongue
Other organ mucoepidermoid carcinomas
  • Thyroid
  • Lung



WHO histological classification system
Adapted from WHO/IARC (2006) [4]
Main types Subtypes Prevalence
Adenocarcinoma
  • Adenocarcinoma, mixed
  • Acinar adenocarcinoma
  • Papillary adenocarcinoma
  • Bronchioloalveolar carcinoma
  • Nonmucinous
  • Mucinous
  • Mixed nonmucinous and mucinous or indeterminate
  • Solid adenocarcinoma with mucin production
  • Fetal adenocarcinoma
  • Mucinous (“colloid”) carcinoma
  • Mucinous cystadenocarcinoma
  • Signet ring adenocarcinoma
  • Clear cell adenocarcinoma
  • 40% of lung cancers
Squamous cell carcinoma
  • Papillary
  • Clear cell
  • Small cell
  • Basaloid
  • 25% of lung cancers
Large cell carcinoma
  • Large cell neuroendocrine carcinoma
  • Basaloid carcinoma
  • Lymphoepithelioma-like carcinoma
  • Clear cell carcinoma
  • Large cell carcinoma with rhabdoid phenotype
  • 10% of lung cancer
Less common types
Adenosquamous carcinoma
  • No subtypes
  • Less than 5%
Sarcomatoid carcinoma
  • Pleomorphic carcinoma
  • Spindle cell carcinoma
  • Giant cell carcinoma
  • Carcinosarcoma
  • Pulmonary blastoma
  • Less than 5%
Carcinoid tumor
  • Typical carcinoid
  • Atypical carcinoid
  • Less than 5%
Salivary gland tumor
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Epithelial-myoepithelial carcinoma
  • Less than 5%



Genes Presence in non small cell-lung cancers
EGFR
  • EGFR mutations are present in approximately 10% to 15% of all non-small cell lung cancers
KRAS
  • Mutations are present in approximately 30% of pulmonary adenocarcinomas
  • Mutations are present in approximately 5% of pulmonary squamous cell carcinomas
  • Associated with carcinomas with mucinous histology
ALK
  • Mutations are present in approximately 5% of all non-small cell lung cancers
HER2
  • Mutations are present in approximately 4% of adenocarcinomas
BRAF
  • Mutations are present in less than 2% of adenocarcinomas
ROS-1
  • Mutations are present in less than 2% of adenocarcinomas


Classification
Adapted from Radiopedia [4]

Salivary gland-confined carcinomas
  • Major salivary glands (50%)
  • Parotid gland (40%)
  • Submandibular gland (7%)
  • Sublingual gland (3%)
  • Minor salivary glands (50%)
  • Palate (most common)
  • Retromolar area
  • Floor of the mouth
  • Buccal mucosa
  • Lip
  • Tongue
Other organ mucoepidermoid carcinomas
  • Thyroid
  • Lung




Mucoepidermoid carcinoma staging
Adapted from American Joint Committee on Cancer (AJCC). 1998 [5]

Tumor
  • T1 - 2cm or less w/o extraparenchymal extension
  • T2 - >2cm but not greater than 4cm; and w/o extraparenchymal extension
  • T3 - >4cm or with extraparenchymal extension
  • T4a - invades skin,mandible, ear canal or facial nerve
  • T4b - invades skull base, pterygoid plates or encases carotid
Nodes
  • NX - Cannot be assessed
  • N0 - No regional lymph nodes metastasis
  • N1 - Single ipsilateral lymph node, <= 3cm in greatest dimension
  • N2
  • N2a - Single ipsilateral lymph node, 3-6 cm in greatest dimension
  • N2b - Multiple ipsilateral lymph nodes, <= 6cm in greatest dimension
  • N2c - Bilateral or contralateral lymph nodes, <= 6cm in greatest dimension
  • N3 - Lymph node(s) >6 cm in greatest dimension
Overall stage
  • I - T1 N0
  • II - T2 N0
  • III - T3 N0-1, or T1-3 N1
  • IVA - T4a N0-2, or T1-4a
  • IVB - T4b N0-3, or T1-4b N3
  • IVC - M1


Differential Diagnosis Similar Features Differentiating Features
Benign mixed tumor Painless parotid swelling and facial deformity In benign mixed tumor , differentiating features include: histopathological findings
Warthin tumor Painless swelling and facial deformity In warthin tumor differentiating features include: multicentric presentation (20%) and are usually small (1-4 cm), highly associated with smoking
Adenoid cystic carcinoma Swelling on salivary gland and facial deformity In adenoid cystic carcinoma, differentiating features include: tendency for perineural extension, distribution, and mainly occur in relation to the airways
Metastasis Painless swelling and facial deformity In metastasis, differentiating features include: primary tumor origin, and histopathological findings.



Type of tumor Age Location Histological features Imaging features Origin Bone/Cartilage
Osteoma 40-50 years Skull bones Matured lamellar bone Sclerotic Benign Bone
Osteoid osteoma 10-20 years Short and long bone diaphysis Osteiod outlined by osteoblasts, incorporated in a fibrous stroma Sclerotic Benign Bone
Osteosarcoma 11-40 years Long bones metaphysis Osteoid and bone formed of malignant osteoblasts and fibroblasts Sclerotic Malignant Bone
Chondroma 30-60 years Small tubular bones of the hands and feet Maturated hyaline cartilage (enchondroma/ecchondroma), preserving lobulation Well-defined Malignant Cartilage
Chondrosarcoma 30-60 years Long bones metaphysic, axial skeleton Immature cartilage, no preserving lobulation, cells arranged in groups of two or four, with atypia and mitosis Well-defined Malignant Cartilage
Ewing sarcoma 5-25 years Long bones diaphysis Small, round, undifferentiated cells, no stroma, a lot of capillary arrangement. Ill-defined Malignant Bone
Giant cell tumor 20-40 years Knee Multinucleated giant cells, fusiform cells, mononuclear cells. Well-defined Malignant Bone
Metastases 50-90 years No site predilection Frequently adenocarcinomas. Metastases can be blastic or lytic depending on the tumor origin Sclerotic Malignant Bone





Stage Description
I
  • Inactive or static lesions
II
  • Actively growing lesions
  • Most osteochondromas occur in this stage.
III
  • Actively growing lesions that are locally destructive/aggressive
  • Deformity secondary to mass effect
  • Malignant degeneration
  • Low-grade chondrosarcoma


Differential Diagnosis Similar Features Differentiating Features
Enchondroma
  • Usually found in children, enchondromas are asymptomatic
  • These tumors arise from rests of growth plate
  • Located in the metaphyseal region
  • In enchondroma, differentiating features include:
  • Imaging features, such as endosteal scalloping, well circumscribed masses, and lytic lessions
Chondroblastoma
  • Benign cartilaginous neoplasm
  • Affects young patients
  • Located on long bones
  • In chondroblastoma, differentiating features include:
  • They arise in the epiphysis or apophysis of a long bone
  • Classical location is one-third of the tibia
Periosteal chondroma
  • Benign cartilaginous neoplasm
  • Commonly located on the proximal humerus and distal femur
  • Affects young patients
  • In periosteal chondroma, differentiating features include:
  • Symptomps are usually present for a long period of time
  • Imaging features include there is no stalk or peduncle as in an osteochondroma
Chondromyxoid fibroma
  • Benign cartilaginous neoplasm
  • Located in the metaphyseal region of long bones
  • In chondromyxoid fibroma, differentiating features include:
  • Occur in young adults (second and third decades)
  • Usually located in the tibia


Type of osteochondroma Features
Solitary osteochondroma
  • Non-hereditary
  • 85% of osteochondromas
  • No genetic mutations
  • Located in long bones, 85% of osteochondromas
  • Onset is in early adolescence
Multiple osteochondromas (hereditary)
  • Hereditary
  • Approximately 20% of osteochondromas
  • Related genetic mutations EXT-1 and EXT-2,
  • Early onset of disease (newborn or children)



Genes implicated in HNPCC Frequency of mutations in HNPCC families Locus
MSH2 approximately 60% 2p22
MLH1 approximately 30% 3p21
MSH6 7-10% 2p16
PMS2 relatively infrequent 7p22
PMS1 case report 2q31-q33
TGFBR2 case report 3p22
MLH3 disputed 14q24.3







Type of osteoid osteoma Characteristics
Intracortical Dense sclerosis around the nidus
Periosteal Periosteal reaction
Cancellous (medullary) Produces very little reactive bone
Subarticular Simulates arthritis as it produces synovial reactions



Differential Diagnosis Similar Features Differentiating Features
Osteoblastoma
  • Benign, male predilection, and also present in long bones
  • In osteoblastoma, differentiating features include: uncommon tumor, affect the axial skeleton more frequently and lesions are typically larger than 2 cm
Brodie abscess
  • Present in children, limb pain, and ocassionaly affects long bones
  • In brodie abscess differentiating features include: fever, subacute onset, and location is usually affects the metaphysis of tubular bones
Osteosarcoma
  • Affects same group of population (children and adolescents), patients usually present with bone pain, and the location is usually long bones
  • In osteosarcoma, differentiating features include: malignancy, infiltration to surrounding tissue, and elevation of serum alkaline phosphatase (ALP)
Enostosis
  • Affects same group of population (children and adolescents), small size, and the location is usually long bones
  • In enostosis, differentiating features,include: pathognomonic radiological appearance, incidental finding
Differential Diagnosis Similar Features Differentiating Features
Fibrous dysplasia
  • Benign, often an incidental finding, and affects the same group of patients.
  • In fibrous dysplasia, differentiating features include: More common presentation is on ribs: 28%, no gender predilection, and complete resection is usually not possible.
Osteoblastoma
  • Benign, incidental, and male predilection.
  • In osteoblastoma, differentiating features include: normally affect the axial skeleton, lesions are typically larger than 2 cm, and surgical excision is often the treatment of choice.
Adamantinomas
  • Benign, slow growing, similar clinical onset.
  • In adamantinomas , differentiating features include: locally aggressive tumor, common in the 3rd to 5th decades of life, location is usually confined to the jaw.
Chronic sinusitis
  • Affects same group of population (young to middle aged adults), clinical onset is similar.
  • In chronic sinusitis, differentiating features include: fever, previous history of acute sinusitis, and lack of facial deformation or imaging findings compatible with osteoma.




Differential Diagnosis Similar Features Differentiating Features
Cardiac tamponade
  • Elevated jugular venous pressure, reduced diastolic filling of the right ventricle, and hypotension.
  • In cardiac tamponade, differentiating features include: muffled heart sounds, pericardial rub, and electrocardiographic changes.
Chronic obstructive pulmonary disease
  • Elevated jugular venous pulse (JVP), shortness of breath, and tachypnea.
  • In cardiac tamponade, differentiating features include: history of chronic bronchitis, coarse crackles with inspiration, and spirometry with FEV1/FVC < 70%.
Mediastinitis
  • Elevated venous pressure, tachypnea and shortness of breath.
  • In mediastinitis, differentiating features include: fever, positive confirmation of organisms and elevated leukocytes.
Pneumonia
  • Hypotension, tachypnea,cough, and chest pain.
  • In pneumonia, differentiating features include: Bronchial breath sounds, leukocytosis with left shift, positive blood culture and altered laboratory findings (procalitonin).
Acute respiratory distress syndrome
  • Low blood pressure,hypotension, and shortness of breath.
  • In cardiac acute respiratory distress syndrome, differentiating features include: acute onset, bilateral infiltrates on chest radiograph sparing costophrenic angles and pulmonary wedge pressure < 18 mmHg.
Syphilis
  • Enlarged lymph nodes, hypotension and dysphagia.
  • In syphilis, differentiating features include: Positive treponemal tests, history of unprotected sex, and superficial mucosal patches.


Differential Diagnosis Similar Features Differentiating Features
Familial adenomatous polyposis (FAP)
  • Familial inheritance, increased risk of colorectal cancer, extra-colonic tumors.
  • Autosomal recessive, 100+ polyps and age under 40, centinel tumors are differently located than HNPCC, such as: Osteomas, dental anomalies, congenital hypertrophy of the retinal pigment epithelium (CHRPE)
Juvenile polyposis
  • Familial inheritance, autosomal dominant, high risk of GI and non GI cancer, also a germline mutation.
  • Gastrointestinal hamartomatous polyps, on physical exam lip pigmentation is common.
Cowden syndrome
  • Rare autosomal dominant inherited disorder, increased risk of colorectal cancer, also has gene mutations.
  • Intestinal hamartomatous polyps, physical exam may show macrocephaly, gene affected PTEN.
  1. 1.0 1.1 1.2 Solitary Pulmonary Nodule: Morphological Evaluation. http://pubs.rsna.org/doi/pdf/10.1148/radiographics.20.1.g00ja0343 Accessed on March 15, 2016
  2. Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005 237: 395-400.
  3. 3.0 3.1 Lung Cancer Epidemiology. Wikipedia. https://en.wikipedia.org/wiki/Lung_cancer Accessed on February 17, 2016
  4. 4.0 4.1 4.2 Mucoepidermoid carcinoma. Radiopedia. Dr Frank Gailliard. http://radiopaedia.org/articles/mucoepidermoid-carcinoma-of-salivary-glands Accessed on February 17, 2016
  5. AJCC System for Staging of Benign and Malignant Salivary Gland Tumors. AJCC Accessed on February 18, 2016