| 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
|
| Benign Lung Tumors[2]
|
| Benign lung tumor
|
Risk/Epidemiology
|
Pleuripotent cells
|
Topography
|
Gross
|
Histology
|
Immunohistochemistry
|
Imaging
|
Metastasis
|
| Papilloma[3]
|
Squamous cell papilloma
|
- HPV 6 and 11
- Men
- Median age of diagnosis is 54 years
|
|
|
- Cauliflower-like lesions
- Tan-white soft to semifirm protrutions
|
- Loose fibrovascular core
- Stratified squamous epithelium
- Acanthosis
- Binucleate forms and perinuclear halos
- Koilocytosis
|
|
- Well circumscribed
- Homogenous
- Non-calcified
- Solitary mass
|
|
| Glandular papilloma
|
- Rare
- Mean age of diagnosis is 68 years
|
|
|
- White to tan endobronchial polyps that measure from 0.7-1.5 cm
|
|
|
- Well circumscribed
- Homogenous
- Non-calcified
- Solitary mass
|
|
| Adenoma[4]
|
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
|
|
| Papillary adenoma[5]
|
- Mean age of diagnosis is 32 years
- Male predominance
|
|
- No lobar predilection
- Involves alveolar parenchyma
|
- Well defined
- Encapsulated
- Soft, spongy to firm mass
- Granular gray white/ brown
- 1.0- 4.0 cm
|
|
|
|
|
| Mucinous cystadenoma
|
- No sex predilection
- Mean age of diagnosis is 52 years
|
|
|
- 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
|
|
| Malignant Lung Tumors[6]
|
| Variants of lung carcinoma
|
Risk Factors/Epidemiology
|
Pleuripotent cell
|
Topography
|
Gross
|
Histology
|
Immunohistochemistry
|
Imaging
|
Metastasis
|
| Squamous cell carcinoma (SCC)[7]
|
Papillary
|
|
|
|
|
- Exophytic
- Intra-epithelial
- Without invasion
|
|
|
|
| Clear cell
|
|
| Basaloid
|
- Peripheral palisading of nuclei.
- Poor differentiation
|
| Small cell carcinoma[8]
|
|
|
|
- White-tan, soft, friable perihilar masses
- Extensive necrosis
- 5% peripheral coin lesions
|
- Sheet-like growth
- Nesting
- Trabeculae
- Peripheral palisading
- Rosette formation
- High mitotic rate
|
|
|
|
| Variants of lung carcinoma
|
Risk Factors/Epidemiology
|
Pleuripotent cell
|
Topography
|
Gross
|
Histology
|
Immunohistochemistry
|
Imaging
|
Metastasis
|
| Adenocarcinoma[9][10][11]
|
Acinar adenocarcinoma
|
|
- Columnar cells of bronchioles
|
|
- 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
|
- Consists glandular elements:
|
| 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[12]
|
Basaloid large cell carcinoma of the lung
|
- Approximately 10% of lung cancers
- Smoking
|
|
|
|
- Invasive growth pattern
- Peripheral palisading
- Small, monomorphic, cuboidal fusiform
|
|
|
|
| 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[13]
|
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[14]
|
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[15]
|
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
|
|
- 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
|
- 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
|
|
|
- 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[16]
|
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
|
|
|
- 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
|
| Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
|
|
|
- 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[17]
|
Epithelioid haemangioendothelioma / Angiosarcoma
|
|
|
|
- 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
|
- Type I
- Type II
- Partial or complete overgrowth of the septal stroma
- Type III
|
|
- Unilateral
- Localized airfilled cysts
- Septal thickening or an intracystic mass
|
|
| Chondroma
|
|
|
- Peripheral lesions in lung
- Primary lesion seen in
|
|
- Capsulated lobules
- Hypocellular
- Features of malignancy are absent
|
|
- Multiple
- Well circumscribed lesions
- “Pop-corn” calcifications
|
|
| Congenital peribronchial myofibroblastic tumor
|
- Rare
- Sporadic
- Complicated by
|
|
|
- 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
|
|
| 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
|
|
| Inflammatory myofibroblastic tumor
|
|
|
|
- Yellowish-gray discoloration
- Average size of 3.0 cm
- Non-encapculated
- Calcifications
- No local invasion
|
|
|
- Solitary mass
- Regular borders
- Spiculated appearance
- Accompanied by
|
|
| 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
|
|
|
|