Lung mass differential diagnosis: Difference between revisions

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Revision as of 21:32, 24 January 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2], Eiman Ghaffarpasand, M.D. [3]

Overview

Lung mass may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies, from other diseases that cause chronic cough, hemoptysis, and weight loss.

Differential Diagnosis

The table below summarizes the findings that differentiate lung masses according to clinical features, laboratory findings, imaging features, histological features, and genetic studies.^[1]^[2]
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

Type	Category	Disease		Risk/Epidemiology	Pleuripotent cells	Topography	Gross	Histology	Immunohistochemistry	Imaging	Metastasis
Benign	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
	Papilloma^[3]	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
	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

References

↑ 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.
↑ 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.
↑ Maxwell RJ, Gibbons JR, O'Hara MD (January 1985). "Solitary squamous papilloma of the bronchus". Thorax. 40 (1): 68–71. PMC 459982. PMID 3969658.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Jackman DM, Johnson BE (2005). "Small-cell lung cancer". Lancet. 366 (9494): 1385–96. doi:10.1016/S0140-6736(05)67569-1. PMID 16226617.
↑ 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.
↑ 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.
↑ Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/File:Adenocarcinoma_%283950819000%29.jpg
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Greenberg AK, Yee H, Rom WN (2002). "Preneoplastic lesions of the lung". Respir. Res. 3: 20. PMC 107849. PMID 11980589.
↑ Koenigkam-Santos M, Sommer G, Puderbach M, Safi S, Schnabel PA, Kauczor HU, Heussel CP (April 2014). "Primary intrathoracic malignant mesenchymal tumours: computed tomography features of a rare group of chest neoplasms". Insights Imaging. 5 (2): 237–44. doi:10.1007/s13244-013-0306-0. PMC 3999366. PMID 24407922.

[pmid10682770-1] 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.

[pmid23077446-2] 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.

[pmid3969658-3] Maxwell RJ, Gibbons JR, O'Hara MD (January 1985). "Solitary squamous papilloma of the bronchus". Thorax. 40 (1): 68–71. PMC 459982. PMID 3969658.

[pmid9817965-4] 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.

[pmid28409070-5] 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.

[pmid7863581-6] 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.

[pmid5528918-7] 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.

[pmid16226617-8] Jackman DM, Johnson BE (2005). "Small-cell lung cancer". Lancet. 366 (9494): 1385–96. doi:10.1016/S0140-6736(05)67569-1. PMID 16226617.

[Kumar-adenocarcinoma-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.

[pmid17625570-10] 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.

[11] Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/File:Adenocarcinoma_%283950819000%29.jpg

[pmid24221342-12] 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.

[pmid24088577-13] 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.

[pmid19212636-14] 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.

[pmid23789697-15] 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.

[pmid11980589-16] Greenberg AK, Yee H, Rom WN (2002). "Preneoplastic lesions of the lung". Respir. Res. 3: 20. PMC 107849. PMID 11980589.

[pmid24407922-17] Koenigkam-Santos M, Sommer G, Puderbach M, Safi S, Schnabel PA, Kauczor HU, Heussel CP (April 2014). "Primary intrathoracic malignant mesenchymal tumours: computed tomography features of a rare group of chest neoplasms". Insights Imaging. 5 (2): 237–44. doi:10.1007/s13244-013-0306-0. PMC 3999366. PMID 24407922.

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@@ Line 7: / Line 7: @@
 ==Differential Diagnosis==
-*The table below summarizes the findings that differentiate lung masses according to clinical features, laboratory findings, imaging features, histological features, and genetic studies.<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 lung masses according to clinical features, laboratory findings, imaging features, histological features, and genetic studies.<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><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>
+*'''''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
 {| class="wikitable"
-! 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; MMP's: Mettaloprotineases matrix;  GFAP: Glial fibrocilliary acid protein
 |-
-! 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>
+!Type
-|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Category
-! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Benign lung tumor
+! colspan="2" |Disease
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk/Epidemiology
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pleuripotent cells
@@ Line 24: / Line 23: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Metastasis
 |-
+| rowspan="5" |Benign
 | 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]]'''
@@ Line 174: / Line 174: @@
 * 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>
 |-
+!
 ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
@@ Line 186: / Line 188: @@
 ! 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'''
@@ Line 219: / Line 222: @@
 * [[Bone]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Clear cell'''
 |
 * Cells with clear [[cytoplasm]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Basaloid'''
 |
@@ Line 228: / Line 233: @@
 * 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>
 |
@@ Line 260: / Line 266: @@
 * Liver
 |-
+|
 | 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'''
@@ Line 303: / Line 310: @@
 * Gastrointestinal Tract
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Papillary adenocarcinoma'''
 |
@@ Line 311: / Line 319: @@
 * [[Mucinous]] or non-mucinous
 |-
+|
 | rowspan="3" style="background:#DCDCDC;" align="center" + |'''Bronchio-alveolar carcinoma'''
 | style="background:#DCDCDC;" align="center" + |'''Non-mucinous'''
@@ Line 317: / Line 326: @@
 * [[Pneumocytes|Type II cells]]
 |-
+|
 | style="background:#DCDCDC;" align="center" + |'''Mucinous'''
 |
@@ Line 327: / Line 337: @@
 * Cytologic atypia
 |-
+|
 | style="background:#DCDCDC;" align="center" + |'''Mixed non-mucinous and mucinous or indeterminate'''
 |
@@ Line 332: / Line 343: @@
 * 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'''
@@ Line 341: / Line 353: @@
 ** 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'''
 |
@@ Line 351: / Line 365: @@
 * [[Neoplastic]] [[mucinous]] [[epithelium]] grows along alveolar walls
 |-
+|
 | style="background:#DCDCDC;" align="center" + |'''Signet ring adenocarcinoma'''
 |
@@ Line 357: / Line 372: @@
 * 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
@@ Line 371: / Line 388: @@
 ! 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'''
@@ Line 407: / Line 425: @@
 * [[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'''
 |
@@ Line 419: / Line 439: @@
 * [[Amyloid]] deposition
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Large-cell lung carcinoma with rhabdoid phenotype'''
 |
@@ Line 425: / Line 446: @@
 * [[Eosinophilic]] inclusions
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Mixed type'''
 |
@@ Line 433: / Line 455: @@
 ** 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
@@ Line 443: / Line 466: @@
 ! 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'''
@@ Line 475: / Line 499: @@
 * [[Kidney]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Spindle cell carcinoma'''
 |
@@ Line 487: / Line 512: @@
 * [[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'''
 |
@@ Line 497: / Line 524: @@
 * Fibrous or myxoid [[stroma]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Pulmonary blastoma'''
 |
@@ Line 507: / Line 535: @@
 * [[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
@@ Line 517: / Line 546: @@
 ! 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'''
@@ Line 553: / Line 583: @@
 * [[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]]'''
@@ Line 585: / Line 616: @@
 * [[Brain]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Adenoid cystic carcinoma'''
 |
@@ Line 624: / Line 656: @@
 * [[Adrenal glands]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Epithelial-myoepithelial carcinoma'''
 |
@@ Line 648: / Line 681: @@
 * [[Breast]]
 |-
+!
 ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
@@ Line 658: / Line 692: @@
 ! 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'''
@@ Line 701: / Line 736: @@
 * [[Spleen]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Atypical adenomatous hyperplasia'''
 |
@@ Line 732: / Line 768: @@
 * Ground-glass opacity
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia'''
 |
@@ Line 760: / Line 797: @@
 * Thickened [[bronchial]] and bronchiolar walls
 |-
+!
 ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Variants of lung carcinoma
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Risk Factors/Epidemiology
@@ Line 770: / Line 808: @@
 ! 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>
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Epithelioid haemangioendothelioma / Angiosarcoma'''
@@ Line 809: / Line 848: @@
 * [[Soft tissue]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Pleuropulmonary blastoma'''
 |
@@ Line 847: / Line 887: @@
 * [[Pancreas]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Chondroma'''
 |
@@ Line 876: / Line 917: @@
 * [[Benign tumor|Benign]] in nature
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Congenital peribronchial myofibroblastic tumor'''
 |
@@ Line 909: / Line 951: @@
 * Rare
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Diffuse pulmonary lymphangiomatosis'''
 |
@@ Line 941: / Line 984: @@
 * Bone
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Inflammatory myofibroblastic tumor'''
 |
@@ Line 983: / Line 1,027: @@
 * Rare
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Pulmonary artery sarcoma'''
 |
@@ Line 1,022: / Line 1,067: @@
 * [[Mediastinum]]
 |-
+|
 | colspan="2" style="background:#DCDCDC;" align="center" + |'''Pulmonary vein sarcoma'''
 |

Lung mass differential diagnosis: Difference between revisions

Revision as of 21:32, 24 January 2019

Overview

Differential Diagnosis

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