Sandbox lung cancer differential

*   * Differentiation of primary and secondary lung tumors is difficult due to overlapping histologic features.
* Topography, size and form of pulmonary growth pattern are important aspects for the differential diagnosis.
* The following table summarizes the differentiation of various lung tumors based on histological and topographical features:[1]

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

* 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

Glandular papilloma |

* Rare
* Mean age of diagnosis is 68 years

* Goblet cells of respiratory epithelium

* Endobronchial

* White to tan endobronchial 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

Adenoma[4] | 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 cell linning
* Squamous metaplasia
* Myxoid and collagenous interstitium

* Keratin
* CEA
* Surfactant protein
* TTF-1
* Actin

* Well circumscribed
* Homogenous
* Non-calcified
* Solitary mass

* N/A

Papillary adenoma[5] |

* 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
* Papillary growth pattern
* Fibrovascular cores
* Cuboidal to columnar epithelial linning
* Cilitated and oxyphilic cells
* Occasional eosinophilic intranuclear inclusions

* Cytokeratin
* Clara cell protein
* TTF-1
* Surfactant apoprotein
* CEA

* Incidental finding

* N/A

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
* Cytokeratins
* CEA

* Coin lesion
* Air-meniscus sign

* N/A

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 |

* Cigarette smokers
* Arsenic

* Epithelial cells

* Central

* White or grey lesions
* Focal carbon pigment deposits
* Cavitations
* Intraluminal polypoid masses
* Infiltration

* Exophytic
* Intra-epithelial
* Without invasion

* Keratin
* Cytokeratins
* CEA
* Thyroid transcription factor-1 (TTF-1)

* Lobar or entire lung collapse
* Shift of the mediastinum to the ipsilateral side
* Hilar, perihilar or mediastinal masses

* Liver
* Breast
* Bone

Clear cell |

* Cells with clear cytoplasm

Basaloid |

* Peripheral palisading of nuclei.
* Poor differentiation

Small cell carcinoma[8] |

* 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

Variants of lung carcinoma  | Risk Factors/Epidemiology  | Pleuripotent cell  | Topography  | Gross  | Histology  | Immunohistochemistry  | Imaging  | Metastasis
Adenocarcinoma[9][10][11] | Acinar 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

* Irregular-shaped glands
* Malignant cells:
* Hyperchromatic nuclei
* Fibroblastic stroma

* Epithelial markers
* CEA
* CK7
* TTF-1

* 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 |

* Papillae
* Necrosis
* Surrounding invasion
* Cuboidal to columnar epithelial linning
* Mucinous or non-mucinous

Bronchio-alveolar carcinoma | Non-mucinous |

* Clara cells
* Type II cells

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:
* Tubules of glycogen-rich
* Non-ciliated cells
* Subnuclear and supranuclear glycogen vacuoles
* Rounded morules of polygonal cells with abundant eosinophilic and finely granular cytoplasm

Mucinous (“colloid”) carcinoma |

* Dissecting pools of mucin containing neoplastic cells

Mucinous cystadenocarcinoma |

* Partial fibrous tissue capsule
* Central cystic change with mucin pooling
* Neoplastic mucinous epithelium grows along alveolar walls

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

* Neuro endocrine cells
* Suprabasal bronchial cells

* Peripheral masses
* Bronchi

* Soft, pink-tan tumor

* Necrosis and occasional hemorrhage
* Cavitations
* Exophytic bronchial growth

* Invasive growth pattern
* Peripheral palisading
* Small, monomorphic, cuboidal fusiform

* Chromogranin
* Synaptophysin
* CD56
* Cytokeratin

* Large, peripheral masses

* Pleura
* Liver
* Bone
* Brain
* Abdominal lymph nodes
* Pericardium

Clear cell carcinoma of the lung |

* Clear cells

Lymphoepithelioma-like carcinoma of the lung |

* Syncytial growth pattern
* Eosinophilic nucleoli
* Lymphocytic infiltration
* Invasive
* Amyloid deposition

Large-cell lung carcinoma with rhabdoid phenotype |

* Eosinophilic cytoplasmic globules
* Small foci of adenocarcinoma
* Eosinophilic inclusions

Mixed type |

* Mixture of:
* Adenocarcinoma
* Squamous cell carcinoma
* Giant cell carcinoma
* Spindle cell carcinoma

Variants of lung carcinoma  | Risk Factors/Epidemiology  | Pleuripotent cell  | Topography  | Gross  | Histology  | Immunohistochemistry  | Imaging  | Metastasis
Sarcomatoid carcinoma[13] | Carcinosarcoma |

* Accounts for only 0.3-1.3% of all lung malignancies
* Mean age at diagnosis is 60 years
* Tobacco smoking
* Asbestos exposure

* Undifferentiated epithelial cells

* Central or peripheral
* Upper lobes

* > 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

* No specific imaging features

* Aggressive tumor
* Esophagus, jejunum, and rectum
* Kidney

Spindle cell carcinoma |

* Only spindle shaped tumor cells
* Lymphoplasmacytic infiltrates

* Keratin
* EMA
* Cytokeratin
* Vimentin
* CEA
* TTF-1

Giant cell carcinoma |

* Multi- and/or mononucleated tumor giant cells

Pleomorphic carcinoma |

* Poorly differentiated
* Mixture of spindle cells and/or giant cells
* Fibrous or myxoid stroma

Pulmonary blastoma |

* Biphasic
* Mixture of epithelial and mesenchymal stroma

* Keratin
* EMA
* CEA
* Chromogranin A

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

* Neuroendocrine cells of lung

* Typical 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
* Calcifications is often seen.
* Intense contrast enhancement

* Liver
* Bone

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

* 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
* Calcifications
* Post-obstructive pneumonic infiltrates

* Rare
* Liver
* Bones
* Adrenal gland
* Brain

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

* 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

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

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

* Bronchi

* Focal or multi-focal plaque-like greyish lesions
* Nonspecific erythema
* Even nodular or polypoid lesions

* Goblet cell hyperplasia

* Basal cell hyperplasia

* Squamous dysplasia

* Angiogenic squamous dysplasia

* Micropapillomatosis

* EGFR
* HER2/neu
* p53
* MCM2
* Ki-67
* Cytokeratin 5/6
* Bcl-2
* VEGF
* Folate binding protein
* p16

* Cauliflower like
* Mosaic pattern

* Liver
* Brain
* Bone
* Spleen

Atypical adenomatous hyperplasia |

* Surfactant apoprotein
* Clara cell specific 10kDd protein

* Pleura
* Upper lobes

* Multiple grey to yellow foci
* 1mm to 10mm in size

* Intranuclear inclusions
* Clara cells and type II pneumocytes
* Thickened alveolar walls
* Discontinuous lining of cells
* Moderate atypia
* Pseudopapillae

* CEA
* MMPs
* E-cadherin
* ß-catenin
* CD44v6
* TTF-1
* TP53

* Typically not visualized on radiographs
* Small non-solid nodules

* Ground-glass opacity

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia |

* 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
* Fibrosis due to proliferation
* Invade locally
* Fibrous stroma aggregates to form ‘tumorlets’.
* Carcinoids are tumorlets >5cm.

* Keratin
* CEA

* 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 |

* Caucasian
* 80% are women

* Endothelial cells

* Intravascular

* 0.3-2.0 cm circumscribed mass
* Gray-white or gray-tan firm tissue
* Yellow flecks
* Central calcifications
* Cut surface has a cartilaginous consistency

* Round to oval-shaped nodules
* Central sclerosis
* Hypocellular zone
* Peripheral cellular zone
* Calcifications
* Intranuclear cytoplasmic inclusions

* CD31
* CD34
* Factor VIII (von Willebrand factor)
* Cytokeratin

* Multiple
* Bilateral
* Small nodules
* 1-2 cm in size
* Can mimic pulmonary Langerhans’ cell histiocytosis.
* Calcifications

* Liver
* Bone
* Soft tissue

Pleuropulmonary blastoma |

* Most common in children
* Median age of diagnosis is 2 years

* Thoracic splanchnopleural mesenchyme

* 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
* Eyes
* Pancreas

Chondroma |

* Young women

* Chondrocytes
* Cartilaginous cells

* Peripheral lesions in lung
* Primary lesion seen in
* Stomach
* Bone
* Paraganglia

* Peripheral
* Solid lesions
* Calcified

* Capsulated lobules
* Hypocellular
* Features of malignancy are absent

* N/A

* Multiple
* Well circumscribed lesions
* “Pop-corn” calcifications

* Benign in nature

Congenital peribronchial myofibroblastic tumor |

* Rare
* Sporadic
* Complicated by
* Polyhydramnios
* 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

Diffuse pulmonary lymphangiomatosis |

* Children
* Young adults of both sexes

* Smooth muscle cells of lymphatic vessels

* Along the lymphatic distribution

* Prominence of the bronchovascular bundles along
* Pleura
* Interlobular pulmonary septa
* Mediastinum

* Anastomosing endothelial-lined cells along lymphatic routes

* Spindle cells
* Intra alveolar siderophages

* Vimentin

* Increased interstitial markings

* Thickening of the:
* Interlobular septa
* Fissures
* Central airways
* Pleura

* Skin
* Bone

Inflammatory myofibroblastic tumor |

* Previous viral infections
* HHV8
* Children

* Myofibroblastic cells

* Localized to bronchi

* Solitary

* Round rubbery masses

* Yellowish-gray discoloration
* Average size of 3.0 cm
* Non-encapculated
* Calcifications
* No local invasion

* Mixture of spindle cells
* Fibroblastic
* 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

Pulmonary artery sarcoma |

* Mean age of diagnosis is 49.3 years
* Commonly misdiagnosed as pulmonary embolism

* 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
* 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

* Findings overlap with those of chronic thromboembolic disease
* Decreased vascularity
* Heterogeneous soft tissue density
* Smooth vascular tapering

* Lung parenchyma
* Mediastinum

Pulmonary vein sarcoma |

* Most common in women
* Mean age of diagnosis is 49

* Smooth muscle

* 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 cell neoplasms
* Epithelioid morphology

* Vimentin
* Desmin
* Actin
* Keratin

* N/A

## Differentiation of lung cancer from other diseases with similar presentation[edit | edit source]

The following table summarizes the differentiation of lung cancer from other disease entities with similar presentation.[18][19][20][21][22]

Disease  | Clinical features

Signs & symptoms

| Radiological Findings  | Characterstic feature

|
|
|

Fever  | Cough  | Hemoptysis  | Dyspnea  | Chest pain  | Weight loss  | Night sweats
High-grade  | Low grade  | Productive  | Dry
Acute Lung abscess  | \+  | \-  | \+  | \-  | \-  | \-  | \+  | \-  | - |

* Air fluid level

* Foul smelling sputum
* H/o of prior infection or hospitalization
* Associated with risk factors like aspiration and alcoholism

Malignancy

(primary lung cancer)

| \-  | \+  | \-  | \+  | \+  | \-  | \-  | \+  | \+  |

* Coin-shaped lesion
* Thick wall(>15mm)
* Ground glass opacities

* Long h/o smoking
* Elderly male or female
* Broncho-alveolar lavage positive for malignant cells
* CT guided biopsy is required for confirmation and differentiation

Pulmonary Tuberculosis | \+  | \-  | \+  | \-  | \+  | \-  | \-  | \-  | \+  |

* Cavitations in the upper lobe of the lung

* People in endemic at high risk
* Cough >2 weeks with hemoptysis
* Acid fast stain positive for mycobacteria

Necrotizing Pneumonia | \+  | \-  | \+  |  | \+  | \-  | \+  | \-  | \-  |

* Multiple cavitary lesions

* Acute life-threatening condition
* Complication of pneumonia or lung abscess
* Multiple organisms responsible
* Prompt treatment with antibiotics is required
* Blood culture positive for causative organism

Empyema  | \+  | \-  | \+  | \-  | \+  | \+  | \+  | \-  | \-  |

* Homogeneous consolidations

* Blood culture positive for the causative agent

Bronchiectasis | \-  | \-  | \+  | \-  | \+  | \-  | \-  | \-  | \-  |

* Linear lucencies
* Tram tracking appearance
* Clustered cysts

* Increased pulmonary markings
* Honeycombing
* Atelectasis

* CT confirms the diagnosis

Wegners granulomatosis | \-  | \-  | \+  |  | \+  | \+  | \-  | \-  | \-  |

* Pulmonary nodules
* Cavities
* Infiltrates

* Seen mostly in female age group of 40-55 years
* Traid of Upper , lower respiratory tract and kidney disease
* Biopsy of involved organ confirms granulomas

Sarcoidosis | \+  | \-  | \+  | \-  | \+  | \-  | \-  | \+  | \+  |

* Bilateral adenopathy
* Coarse reticular opacities

* More common in African-american females
* Restrictive lung disease
* Biposy findings: epithelioid,granulomas, schaumann, asteroid bodies.

Rheumatoid nodule | \-  | \-  | \-  | \-  | \-  | \+  | \-  | \+  | \-  |

* Pulmonary nodules
* Cavitations on the upper lobe of lung

* Rheumatoid arthritis
* Positive for RF and ACP

Langerhans cell Histiocytosis | \-  | \-  | \-  | \-  | \-  | \+  | \+  | \+  | \-  |

* Thin-walled cystic cavities

* Exclusively afflicts smokers
* Musculoskeletal and skin is involved
* Biopsy of the involved organ

Bronchiolitis obliterans | \-  | \-  | \+  | \-  | \+  | \+  | \+  | \-  | \-  |

* Patchy consolidation,

* Ground-glass opacities

* Nodules

* Biopsy

## References[edit | edit source]

1. ↑ Erasmus JJ, Connolly JE, McAdams HP, Roggli VL (2000). "Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions". Radiographics. 20 (1): 43–58. doi:10.1148/radiographics.20.1.g00ja0343. PMID 10682770.
2. ↑ Gümüştaş S, Inan N, Akansel G, Ciftçi E, Demirci A, Ozkara SK (June 2012). "Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging". Radiol Oncol. 46 (2): 106–13. doi:10.2478/v10019-012-0021-3. PMC 3472932. PMID 23077446.
3. ↑ Maxwell RJ, Gibbons JR, O'Hara MD (January 1985). "Solitary squamous papilloma of the bronchus". Thorax. 40 (1): 68–71. PMC 459982. PMID 3969658.
4. ↑ Shiota Y, Matsumoto H, Sasaki N, Taniyama K, Hashimoto S, Sueishi K (1998). "Solitary bronchioloalveolar adenoma of the lung". Respiration. 65 (6): 483–5. doi:10.1159/000029319. PMID 9817965.
5. ↑ Kanchustambham V, Saladi S, Patolia S, Mahmoud Assaf S, Stoeckel D (March 2017). "A Rare Case of a Benign Primary Pleomorphic Adenoma of the Lung". Cureus. 9 (3): e1069. doi:10.7759/cureus.1069. PMC 5375953. PMID 28409070.
6. ↑ Kelley LC, Puette M, Langheinrich KA, King B (November 1994). "Bovine pulmonary blastomas: histomorphologic description and immunohistochemistry". Vet. Pathol. 31 (6): 658–62. doi:10.1177/030098589403100605. PMID 7863581.
7. ↑ Roth E, Smidt D (January 1970). "[Studies on early ejaculate collection using electroejaculation in German improved land-swines and Goettinger miniature pigs]". Berl. Munch. Tierarztl. Wochenschr. (in German). 83 (1): 7–11. PMID 5528918.CS1 maint: Unrecognized language (link)
8. ↑ Jackman DM, Johnson BE (2005). "Small-cell lung cancer". Lancet. 366 (9494): 1385–96. doi:10.1016/S0140-6736(05)67569-1. PMID 16226617.
9. ↑ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. "Chapter 13, box on morphology of adenocarcinoma". Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7.CS1 maint: Multiple names: authors list (link)
10. ↑ Soda M, Choi YL, Enomoto M, Takada S, Yamashita Y, Ishikawa S; et al. (2007). "Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer". Nature. 448 (7153): 561–6. doi:10.1038/nature05945. PMID 17625570.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
11. ↑ Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/File:Adenocarcinoma_(3950819000).jpg
12. ↑ Rossi G, Mengoli MC, Cavazza A, Nicoli D, Barbareschi M, Cantaloni C, Papotti M, Tironi A, Graziano P, Paci M, Stefani A, Migaldi M, Sartori G, Pelosi G (January 2014). "Large cell carcinoma of the lung: clinically oriented classification integrating immunohistochemistry and molecular biology". Virchows Arch. 464 (1): 61–8. doi:10.1007/s00428-013-1501-6. PMID 24221342.
13. ↑ Huang SY, Shen SJ, Li XY (October 2013). "Pulmonary sarcomatoid carcinoma: a clinicopathologic study and prognostic analysis of 51 cases". World J Surg Oncol. 11: 252. doi:10.1186/1477-7819-11-252. PMC 3850921. PMID 24088577.
14. ↑ Dahabreh J, Stathopoulos GP, Koutantos J, Rigatos S (March 2009). "Lung carcinoid tumor biology: treatment and survival". Oncol. Rep. 21 (3): 757–60. PMID 19212636.
15. ↑ Elnayal A, Moran CA, Fox PS, Mawlawi O, Swisher SG, Marom EM (July 2013). "Primary salivary gland-type lung cancer: imaging and clinical predictors of outcome". AJR Am J Roentgenol. 201 (1): W57–63. doi:10.2214/AJR.12.9579. PMC 3767141. PMID 23789697.
16. ↑ Greenberg AK, Yee H, Rom WN (2002). "Preneoplastic lesions of the lung". Respir. Res. 3: 20. PMC 107849. PMID 11980589.
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