Imaging of Lung Cancer
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Transcript of Imaging of Lung Cancer
Imaging of Lung Cancer
By: Ahmed Mostafa
Tumors of the Lung
•Malignant (NSCLC = Sq.cc 50- Adeno.c 20- Large.c.c10%)
(SCLC 20%)
•Locally malignant
•Mixed tumors (pul. Blastoma** – Carcino/sarcoma)
•Benign
•Metastasis
•HD
Abnormal Hilum
Larger --- Denser ---- loss of concavity
Vascular ----------- Smooth
LN -------------------- Lobulated
Carcinoma --------- Speculated
Abnormal Hilum (Cont.)
Abnormal Hilum (Cont.)
Central Br. Carcinoma•Abnormal hilum ….
•Bronchial obst. Distal changes
•Speculated = Dense streaks rad. From hilum
Growth along Vasc. or Br. CT sheath
•Lymphangitis carcinomatosis (R.N)
(Lymph. Obst Retrograde permeation)
•Cavitation (eccentric – thick wall – Biopsy? – Pn.thx)
•Metastasis
•Diaph. Paralysis = …med. invasion)
•HPAO
Collapse
Consolid.
Air trapping
Bronchocele
Bronchogenic Carcinoma
Bronchogenic Carcinoma (Cont.)
Small C.C: -Aggressive -Sensitive to chemotherapy -Para-malignant $
Bronchogenic Carcinoma (Cont.)
Doubling time
<6 m malignant
>18 m benign
Bronchogenic Carcinoma (Cont.)
Bronchogenic Carcinoma (Cont.)
Bronchogenic Carcinoma (Cont.)
Bronchogenic Carcinoma (Cont.)
Coin shadow
Growth rate
Edge
Calc. ?
Cavitation
Lymphangitis carcinomatosis
Pancoast Tumor
ApicalPleura
Ribs
Symp.chain
Brach. plexus
Broncho-alveolar Carcinoma
Peripheral Type -II pneumocytes, Clara cells,
Br-alv epith, Tote-potent stem cell
Grow along wall of acinus without
destruction preserve
architecture and regional perfusion
Secrete mucin Bronchorrhea
& consolidation-like patches
No br. lesion or adeno-Ca elsewhere
… ? Similar to ad.ca metastasis
ALV CELL CARC LL
Bronchogenic Carcinoma (Cont.)
Bronchogenic Carcinoma (Cont.)
Bronchogenic Carcinoma (Cont.)
Bronchogenic Carcinoma (Cont.)
HPOA
HPOA
T1Solitary pulmonary nodule < 3 cm diameter
T2• Mass> 3 cm• Invasion of visceral pleura• Involves major bronchus> 2 cm from carina• Lobar atelectasis
T3• Any tumor extending into chest wall, diaphragm,mediastinal fat, or pericardium• Whole lung atelectasis• < 2 cm from carina
T4• Any tumor invading heart, great vessels, trachea,esophagus, vertebral body, carina• Malignant pleural effusion• Satellite nodule in ipsilateral tumor lobe
N1Epsilateral hilar
T2Epsilateral mediastinal or midline
T3Contralateral mediastinal or supraclavicular
M0M1
Treatment
• Stage I and 2: Surgery followed by adjuvantchemotherapy in select caseso Radiation therapy or radiofrequency ablation maybe considered for medically non-operable
• Stage 3A: Neoadjuvant chemotherapy and radiationtherapy followed by surgery in select cases• Stage 3B: Chemotherapy and radiation therapy
o Surgery may be performed in select T4NO tumors
• Stage 4: Chemotherapy with palliative radiationtherapy in select caseso Solitary brain metastasis: Resection of brain lesion;followed by resection of primary tumor if possible
Locally Malignant Tumors
Adenoid cystic Ca. Carcinoid
Tr - carina - main br. Major bronchus ice burg – ext.br
Polypoid mass signs of obst…
Asthma-like picture APUD system of Arg
cells 5-HT
Carcinoid $
•Slower growth•Younger age•Not related to smoking
Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma
Benign TumorsEndo-bronchial
•Adenoma…? Papilloma Fibroma Lipoma ..etc
Pulmonary
Nodule (coin)
Rate of growth
Edge
Calc……..
Cavitation
HamartomaFat inhomog.
Epith.
Cartilage pop-corn calc.
Metastasis• Discrete• Miliary = snow-storm Stomach – thyroid – chorio.Ca
• Canon-ball Renal – seminoma
• Interstitial = ….• Mediastinal LNs
Calc.? Ost-Chond.sarcoma
After ttt
Mucin-sec Tr
Dystrophic
Cavitation + Pn.thx
Chorio-Ca-----Hgic + ARDS & DIC
Metastasis (cont.)
• Miliary = snow-storm Stomach – thyroid – chorio.Ca
Metastasis (cont.)
Hodgkin disease
Start in med. LNs Intra-pul. LNs
Sharp undulating
margins
Peri (br-Vs) & interlobar
lymphatics
NodulesLinear streaksShaggy edge
+ Pl. Eff Merge into patches Cavitate Chylous DD Edema
Hodgkin Disease (Cont.)
Hodgkin Disease (Cont.)
Hodgkin Disease (Cont.)
Lymphoma (Cont.)
Lymphoma (Cont.)
Lymphoma (Cont.)
MRI