Sandbox lung cancer differential: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
! colspan="8" |Benign lung tumor
! colspan="9" |Benign lung tumor
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! colspan="3" |
! colspan="3" |
!Epidemiology
!Risk factors
!Gross pathology
!Histopathology
!Histopathology
!Immunohistochemistry
!Immunohistochemistry
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| rowspan="2" |Squamous cell papilloma
| rowspan="2" |Squamous cell papilloma
|Exophytic
|Exophytic
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* HPV 6 and 11
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* Cauliflower-like tan-white soft to semifirm excrescences protruding into bronchial lumens
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* Loose fibrovascular core
* Stratified squamous epithelium
* Acanthosis
* Wrinkled nuclei
* Binucleate forms and perinuclear halos
* Koilocytosis
* Dyskeratotic cells
* Large atypical cells
* Occasional mitotic figures   
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|Endobronchial
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| colspan="2" |Glandular papilloma
| colspan="2" |Glandular papilloma
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| colspan="2" |Mixed squamous cell and glandular papilloma
| colspan="2" |Mixed squamous cell and glandular papilloma
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| rowspan="9" |Adenomas
| rowspan="9" |Adenomas
| colspan="2" |Alveolar adenoma
| colspan="2" |Alveolar adenoma
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| colspan="2" |Papillary adenoma
| colspan="2" |Papillary adenoma
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| rowspan="2" |Adenomas of the salivary gland type
| rowspan="2" |Adenomas of the salivary gland type
|Mucous gland adenoma
|Mucous gland adenoma
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|Pleomorphic adenoma
|Pleomorphic adenoma
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| colspan="2" |Mucinous cystadenoma
| colspan="2" |Mucinous cystadenoma
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| rowspan="4" |Lymphoproliferative tumors
| rowspan="4" |Lymphoproliferative tumors
|Marginal zone B-cell lymphoma of the MALT type
|Marginal zone B-cell lymphoma of the MALT type
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|Diffuse large B-cell lymphoma
|Diffuse large B-cell lymphoma
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|Lymphomatoid granulomatosis
|Lymphomatoid granulomatosis
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|Langerhans cell histiocytosis
|Langerhans cell histiocytosis
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| rowspan="8" |Miscellaneous tumors
| rowspan="8" |Miscellaneous tumors
| colspan="2" |Harmatoma
| colspan="2" |Harmatoma
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| colspan="2" |Sclerosing hemangioma
| colspan="2" |Sclerosing hemangioma
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| colspan="2" |Clear cell tumor
| colspan="2" |Clear cell tumor
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| rowspan="3" |Germ cell tumors
| rowspan="3" |Germ cell tumors
|Mature tratoma  
|Mature tratoma  
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|Immature teratoma
|Immature teratoma
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|Other germ cell tumours
|Other germ cell tumours
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| colspan="2" |Intrapulmonary thymoma
| colspan="2" |Intrapulmonary thymoma
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| colspan="2" |Melanoma
| colspan="2" |Melanoma
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| colspan="3" |Metastatic tumors
| colspan="3" |Metastatic tumors
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Revision as of 19:39, 5 March 2018

  • Differentiation of primary and secondary lun tumors is difficult due to overlapping histologic features.
  • Topography, size and form of pulmonary growth pattern are important aspects for the differential diagnosis.
  • Primary lung tumors are mainly localized in upper lobes as singular nodules, metastases in lower lobes as multiple lesions.
  • On the contarary, endobronchial primary or secondary squamous cell carcinomas findings of severe dysplasia and CIS of the bronchial epithelium are important.
  • Stroma and vascularisation pattern of primary and secondary lung tumors differ in distribution, arrangement and extracellular matrix components.
  • Pulmonary vascular changes in primary tumors are characterized by vascular infiltration, destruction and occlusion whereas in secondary tumors intravascular embolisation and extravasation predominate.
Malignant lung carcnimoma
Risk Factors Topography Histology Gross Immunohistochemistry Imaging Pulmonary growth pattern Mets Other differentiating features
Xray CT PET scan
Squamous cell carcinoma Papillary
  • Cigarette smokers
  • Arsenic
  • Centrally in the mainstem
  • Exophytic and endobronchial growth.
  • Limited amount of intraepithelial spread without invasion.
  • White or grey and, depending on the severity of fibrosis
  • Firm with focal carbon pigment deposits in the centre and star-like retractions on the periphery.
  • Cavitations.
  • Intraluminal polypoid masses and / or infiltrate through the bronchial wall into the surrounding tissues
  • High molecular weight keratin (34ßE12
  • Cytokeratins (5/6)
  • Carcinoembryonic antigen (CEA)
  • Low molecular weight keratin (35ßH11)
  • Thyroid transcription factor-1 (TTF-1)
  • Cytokeratin 7 (CK7)
  • In central SCC, lobar or entire lung collapse
    • Shift of the mediastinum to the ipsilateral side.
    • Central, segmental or subsegmental tumours can extend into regional lymph nodes
    • Appear as hilar, perihilar or mediastinal masses with or without lobar collapse.
  • Peripheral tumours
    • Presents as solitary pulmonary nodules (< 3 cm) or masses (> 3 cm).
    • Cavitations
    • Hilar opacities, atelectasis or peripheral masses
    • Mediastinal enlargement
    • Hemidiaphragmatic elevation
Clear cell
  • Predominantly composed of cells with clear cytoplasm.
Small cell
  • Poorly differentiated with small tumor cells
  • Focal squamous differentiation.
  • Lacks the characteristic nuclear features of small cell carcinoma.
  • Focal intercellular bridges or keratinization.
Basaloid
  • Prominent peripheral palisading of nuclei.
  • Poorly differentiated
  • Carcinomas with an extensive basaloid pattern but lacking squamous differentiation
Small cell carcinoma Combined small cell carcinoma
Adeno carcinoma Adenocarcinoma, mixed sub type
Acinar adenocarcinoma
Papillary adenocarcinoma
Bronchio-alveolar carcinoma Non-mucinous
Mucinous
Mixed non-mucinous and mucinous or indeterminate
Solid adenocarcinoma with mucin production Fetal adenocarcinoma
Mucinous (“colloid”) carcinoma
Mucinous cystadenocarcinoma
Signet ring adenocarcinoma
Clear cell adenocarcinoma
Large cell carcinoma Giant-cell carcinoma of the lung
Basaloid large cell carcinoma of the lung
Clear cell carcinoma of the lung
Lymphoepithelioma-like carcinoma of the lung
Large-cell lung carcinoma with rhabdoid phenotype
Large cell neuroendocrine carcinoma of the lung
Sarcomatoid carcinoma Pleomorphic carcinoma
Carcinosarcoma
Spindle cell carcinoma
Giant cell carcinoma
Pulmonary blastoma
Carcinoid tumour Typical carcinoid
Atypical carcinoid
Salivary gland tumours Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Epithelial-myoepithelial carcinoma
Preinvasive lesions Squamous carcinoma in situ
Atypical adenomatous hyperplasia
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
Mesenchymal tumors Epithelioid haemangioendothelioma
Angiosarcoma
Pleuropulmonary blastoma
Chondroma
Congenital peribronchial myofibroblastic tumor
Diffuse pulmonary lymphangiomatosis
Inflammatory myofibroblastic tumor

Synovial sarcoma

  • Monophasic
  • Biphasic
Pulmonary artery sarcoma
Pulmonary vein sarcoma
Benign lung tumor
Risk factors Gross pathology Histopathology Immunohistochemistry Topography Spread
Papilloma Squamous cell papilloma Exophytic
  • HPV 6 and 11
  • Cauliflower-like tan-white soft to semifirm excrescences protruding into bronchial lumens
  • Loose fibrovascular core
  • Stratified squamous epithelium
  • Acanthosis
  • Wrinkled nuclei
  • Binucleate forms and perinuclear halos
  • Koilocytosis
  • Dyskeratotic cells
  • Large atypical cells
  • Occasional mitotic figures
 Endobronchial
Inverted
Glandular papilloma
Mixed squamous cell and glandular papilloma
Adenomas Alveolar adenoma
Papillary adenoma
Adenomas of the salivary gland type Mucous gland adenoma
Pleomorphic adenoma
Mucinous cystadenoma
Lymphoproliferative tumors Marginal zone B-cell lymphoma of the MALT type
Diffuse large B-cell lymphoma
Lymphomatoid granulomatosis
Langerhans cell histiocytosis
Miscellaneous tumors Harmatoma
Sclerosing hemangioma
Clear cell tumor
Germ cell tumors Mature tratoma
Immature teratoma
Other germ cell tumours
Intrapulmonary thymoma
Melanoma
Metastatic tumors
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