Tumours of the Lung and Mediastinum-Adegboye

7/24/2019 Tumours of the Lung and Mediastinum-Adegboye

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CARDIOTHORACIC

CORE LECTURES

ADEGBOYE V.O.


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TUMOURS OF THE LUNG

AND MEDIASTINUM


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Topics of Discussion

TUMOURS OF THE LUNG:

PRIMARY MALIGNANT &

BENIGN. SECONDARY METASTATIC.


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MALIGNANT LUNG.

1-BRONCHIAL GLAND TUMOURS.

2-LUNG CANCERS.

3- METASTATIC.


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BENIGN TUMOURS.

1- ORIGIN

UNKNON!H"#$"%$"'T(#"%$"

)'C*("# +(** .2-E,%(*"* +(**)!,",*$" &,*/,).

3-M()0(#$"*!#$"' L,$"'

L($/$"

-O%(#)!$4+)" "))+"%(0

*/$,0 %))4('5"6%$" (%+


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PRESENTATION AND

DIAGNOSIS OF BENIGNTUMOURS.M)% ")/$,%$"%+',(#,(#"**/ *+"%(0 '

+5#"/ 6067.

F(8 (60#6+"* A#(

)/$,%$"%+:((+%) #6+"*++*4)6.

D(6%( 0"76)) 9 T))4( . C5#"/)$(%$() +"#"+%(#)%+ $)% %$() 6%),(++.

S*%"#/ P4*$6"#/ 604*( SPN; -$)%+"**(6767' ,#(


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MAMAGEMENT OF LESIONS

POSITIVE (676%/ ") % (

()%"*)(0: (5+)6! *467

+6)(#


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BRONCHIAL GLAND

TUMOURS. USED TO BE CALLED BRONCHIAL

ADENOMA SUGGESTING BENIGNITY NOT BENIGN

FIVE DISPARATE TUMOURS.

1-B#6+"* C"#+60

2-A0(60 C/)%+ CA.

3-M4+"(,0(#$0 C".

-B#6+"* $4+4) 7*"60 "0(6$".

?-P*($#,+ $5(0 %4$4#

B#6+"* 7*"60


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Bronchi! Crcinoi".

A** #6+"* 7*"60 %4$4#)

"#)( #$ 0(#(6% +(**).

BRONCHIALCARCINOID-@? OF THIS GROUP.

-$"6)%($ # *"#

#6+4): )/$,%$)

)%#4+%6 & 6*"$"%6.


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S#$p%o$s of Bronchi!

Crcinoi". C47-'D/),6(" &

H"($,%/))3'C"#+60

S/60#$( 2-3. N% )((6 8% ,(#,(#"**()6.

S"$( +*6+"* ("%4#() ")

APUD "$6( ,#(+4#)#4,%"( 0(+"#5/*"%(;T4$4#)


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Di&nosis

C/%*7/ #6+"* #4)67*8 /(*0.

FNAC=F#(6 )(+%60(#6+"%( (%8((6 #6+"*+"#+60 "60 )$"** +(** +" 6 +")().

B#6+)+,/ & ,)/ "($##"7('


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TREAMENT.

RESECTION: E60)+,+

B#6+%$/ F#$"* #()(+%6 R"0%(#",/ C($%(#",/.

R",0*/ "%"* 0)(")(. C"#+60 )/60#$( ()% %#("%(0

/ #()(+%6 %4$4#.


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LUNG CANCER

? *467 %4$4#)

"#( $"*76"6%.M"#%/ +"6 (

+*"))(0 6%: )> +(**

+"9"0(6 +"9 *"#7(+(** +"9 )$"** +(** +".


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CLINICAL PRESENTION.

? SYMPTOMATIC. 2 )/$,%$) ,#$"#/ %4$4#.

32 )/$,%$) $(%")%"%+),#("0. 3 )/)%($+ )/$,%$)8% *))'

$"*")('"6#(5" ;

H7 "


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PRESENTATION

CONTNS. S/$,%$) "60 )76) 0(,(60 6:

H/)%*7+"* 6067)

I6%#6)+ %4$4# *7/.-7#8%#"%(' ,"#"6(,*")%+ )/60#$()

A6"%$+ *+"%6

S%"7( ,#()(6%"%6


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HISTOLOG' AND

PRESENTATION S CELL CA AND SM CELL CA-

CENTRALLY LOCATED.!BRONCHIAL OCCLUSIONSUMPTOMS.

ADENO CA & LARGE CELL CA ASYMPTOMATIC ,(#,(#"*

604*( # ,"#(%"* ,*(4#"* # +()%8"** 6


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PULMONAR'MANIFESTATION. FROM BRONCHUS AND LUNG INVOLVEMENT.

COUGH-?'BRONCHIALIRRITATION. DYSPNOEA-?-'BRONCHIAL

OCCLUSION'EFFUSION- PERIPHERALLESION9

HEEJING-LESS ?'PARTIALOBTRUCTION PRO BRONCHUS.

HAEMOPTYSIS-2?-. STREAKY

CENTRALLY LOCATED TUMOURS. PNEUMONIC SYMPTOMS. LUNG ABCESS.


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NON PULMONAR'

THORACIC MANIFESTATION PRIMARY TUMOUR INVASIONOF

CONTIGUOUS STRUCTURES.

ENLARGED TUMOUR BEARING

LYMPH NODES COMPRESSION OF

)TRUTURES. D,#"7$'+()% 8"**',#(6+

6(#


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PARANEOPLASTIC

S'NDROME OCCUR ITH OTHER TUMOURS BUT

MOST FREUENT ITH LUNG CA.

ESPECIALLY ! S CELL CA AND SM

CELL CA. MAY BE FIRST INDICATION OF

DISEASE LEADING TO EARLY

DIAGNOSIS.

HYPERTROPHIC PULMONARYOSTEOARTHROPATHY

ROLIFERATING PERIOSTITIS' END OF

LONG BONES.


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PARANEOPLASTIC

S'NDROME CONTNS I6",,#,#"%( ADH SECRETION ! IN

*467 +".H7()% 8% )$ +(** +". H/,(#+"*+($"

M/,"%+ 6(4#*7+ )/60#$($6); $)% +$$6 1 "


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METASTATIC

S'MPTOMS CNS: MOST COMMOM "#( )/$,%$)

6+#(")(0 6#"+#"6"* ,#())4#(

("0"+(' 6"4)("'


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DIAGNOSIS OF LUNG

CANCER HISTORY AND PHYSICAL

EAMINATION: SMOKING'

OCCUPATIONSMOKINGASBESTOS MULTIPLICATION

EFFECT;9 T LOSS OF

ADVANCED DISEASE.

SPUTUM CYTOLOGY@2.?OVERAL YIELD MORE ITH

MULTIPLE SPECIMENS.


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DIAGNOSIS CONTNS

CHEST RADIOGRAPHY

CT =MRI FNAB

TRANSTHORACIC!FLUOROSCOPIC OR CT GUIDED ITH

INCREASED YIELD INEPERIENCED HANDS..

BRONCHOSCOPY


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OTHER DIAGNOSTIC

METHODS CERVICAL MEDISTINOSCOPY

LEFT ANTERIOR

MEDIASTINOTOMY. SCALENE NODE BIOPSY

THORACOSCOPY.

THORACOTOMY.


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TREATMENT

SURGERYS; FOR LOCALISED

DISEASE.

CHEMOTHERAPYC%;- #METASTATIC DISEASE.

RADIOTHERAPY R%;-LOCAL

CONTROL.

C% +$6(0 8% R% (%%(# %"6

(%(# "*6( # "0


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TREAMENT CONTNS

SM CELL CA FREUENLY

0))($6"%(0 "% %$( ,#()(6%"%6

)4#7(#/ ) 6% #)% *6( (5+(,% 6 8(**

)(*(+%(0 +")().

O%(#) ! N6-)$ +(** +"%#("%$(6%

0(,(60 6 )%"7( 0)(")(. S4#


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MEDIASTINALTUMOURS MEDIASTINAL BORDERS:

MEDIASTINAL COMPARTMENTS

INITIALLY NO 3ANTEROSUPERIOR9

MIDDLE9 AND POSTERIOR.


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PRIMAR' TUMOURS

PRESENT AS MYRIADS OF

SYMPTOMS AND SIGNS.

NATURAL HISTORY!ASYMPTOMATIC TO BENIGN

SLO GROTH ITH MINIMAL

SYMPTOMS TO AGGRESSIVE'

INVASIVE NEOPLASM


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FRE(UENC' OF

MASSES NEUROGENIC-2

THYMOMAS-1

PRIMARY CYSTS-1@ LYMPHOMAS -13

GERM CELLS -1


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LOCATION OF

TUMOURS ANTEROSUPERIOR-?

POSTERIOR 2?

MIDDLE ---1


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COMMONEST

MASSES)% !oc%ions. ANTEROSUPERIOR:T/$+'L/$,

$"'G(#$ +(**' C"#+6$".

POSTERIOR: N(4#7(6+' C/)%).

MIDDLE:C/)%) "60 L/$,$").


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MALIGNANT

NEOPLASM 2?-2 OF MASSES.

FREUENCY


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CLINICAL FEATURES.

? TO ? SYMTOMATIC AT

PRESENTATION.

B(676 ? ")/$,%$"%+ "%,#()(6%"%6.

1? M"*76"6% ")/$,%$"%+

"% ,#()(6%"%6.

C*0#(6 ? )/$,%$"%+ "%

,#()(6%"%6 # "


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C!inic! f*%ur*s con%nS

COMMON : C()% ,"6'(


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DIAGNOSIS

HISTORY AND PHYSICALEAMINATION.

C RAY PA AND LATERAL. CT ITH CONTRAST

ROUTINE. INVASIVENESS CAN BE

STUDIED BY CT =MRI FNAB UNDER CT OR ECHO

GUIDIANCE.INCREASE YIELD.


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DIAGNOSIS+OTHERS.

MEDIASTINAL USS! ECHO

IODINE 131 SCAN FOR

THYROID. FDG POSITRON EMISSION.

POOL DATA AND APPLY

TREATMENT AS APPROPRIATE..

Tumours of the Lung and Mediastinum-Adegboye

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