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Neoplasms of Lung, Pleura, and Mediastinum Classification Disease Etiology Epidemiology Pathology Clinical
Neoplasms of Lung, Pleura, and Mediastinum Classification Disease Etiology Epidemiology Pathology Clinical
Neoplasms of Lung, Pleura, and Mediastinum Classification Disease Etiology Epidemiology Pathology Clinical
Prognostic Variables:
1) Non-Small Cell Lung Carcinoma (NSCLC)
a. Definitely: Stage, performance status, weight loss
b. Possibly: Gender, ploidy, k-ras mutation, p53 protein accumulation
c. Not: age, histology
2) Small Cell Lung Carcinoms (SCLC)
a. Definitely: State, performance status
b. Probably: Gender (male worse than female), age, # of metastatic sites
Classification Disease Etiology Epidemiology Pathology Clinical
Primary Lung Radiology: Mean age = 52
Melanoma High Res CT may detect M=F
bronchial wall mass Must be distinguished from solitary met
Gross: 5-10% of pts have unknown primary (b/c
Endobronchial mass (tracheal or bronchial) some primarys regress)
Micro:
Highly variable architecture and cytology
May be unpigmented (amelanotic)
Mesothelioma Asbestos? Assoc w/ asbestos Radiology:
exposure Diffuse pleural involvement
May have assoc effusion
Micro:
Malignant
Deeply invasive growth pattern
Epithelial, spindle cell, or biphasic
EM shows long microvilli
Keratin + by IHC
Pulmonary Most common Multiple nodules favor mets vs primary
Metastases neoplasms neoplasms (except BAC)
involving the lung Can involve pleura and have assoc pleural
effusion
Morphology, histology, and physical usually
identify the primary site, butt assignment of
primary may require IHC
Carcinoma Breast, GI, Renal (can metastisize
anywhere), Head/neck squamous cell
carcinoma
Sarcoma Osteosarcoma
Soft tissue sarcoma
(both can involve lung; more common in
Metastatic Disease kids)
Melanoma Radiology: Extrapulmonary primary melanoma much
Multiple nodules favor mets, but mets can be more common than pulmonary primary
Solitary melanoma
Micro: No known primary in 5-10% of cases
Variable architecture & cytology
S100 +/- HMB45 reactive
Neoplasms of the Mediastinum
Classification Disease Etiology Epidemiology Pathology Clinical
Neural and Nerve Schwannoma
Posterior Sheath Neoplasms Neurofibroma
Mediastinum Lymphomas Hodgkins disease
Non-Hodgkins lymphoma
Bronchogenic Cysts Non-neoplastic lung
Middle
Lymphomas Hodgkins disease
Medastinum
Non-Hodgkins lymphoma
Lymphomas Hodgkins disease
Non-Hodgkins lymphoma
Thymoma Assoc w/ Most common tumor in Radiology: 2/3 of MG have/will have a thymoma
Myasthenia the mediastinum Variable involvement of adjacent organs 1/3 of thymoma pts have/will have MG
Gravis (MG) (invasive thymomas breach the pleura)
Anterior/Superior Micro:
Mediastinum Thymoma: bland, non-invasive
(4 Ts) Invasive Thymoma: bland but invasive
(Thymoma and Invasive Thymoma are
neoplasms of thymic epithelium)
Thymic carcinoma; malignant carcinoma
Teratoma Pediatric
Thyroid/Parathyroid Endocrine