Primary Bronchogenic CarcinomaPrimary Bronchogenic Carcinoma (LUNG CANCER)(LUNG CANCER)

SHEN JIN

The First Affiliated Hospital of Kunming Medical CollegeThe First Affiliated Hospital of Kunming Medical College

OutlookOutlook 1. Pathologic Characteristics1. Pathologic Characteristics

2. Clinical Features2. Clinical Features

3. Imagine Manifestations3. Imagine Manifestations

4. Diagnosis and Differential Diagnosis4. Diagnosis and Differential Diagnosis

Pathologic CharacteristicsPathologic Characteristics

1.Difinition1.Difinition Arise from the bronchial

epithelium, bronchial glands and epithelium of the alveolus.

2.Histologic Classification:2.Histologic Classification:

Squamous Carcinoma 40% Undifferentiated Carcinoma 25% Adenocarcinoma 30% Alvelolar Cell Carcinoma 5% *non-small cell and small cell

3. Location Classification:3. Location Classification:

Central Type Peripheral Type Diffuse Type

4. Growth Type:4. Growth Type: Inner Wall Outer Wall Across Wall Enlarge Infitrate

Growth in early central typeGrowth in early central type

AcrossAcross InnerInner

Inner GrowthInner Growth

GrossGross HistologyHistology

Enlarge GrowthEnlarge Growth

Infitralting GrowthInfitralting Growth

Infitralting Growth

GrossGross HistologyHistology

The clinical features are variable

correlated with the histological type,

site, and degree of development of

the carcinoma.

Clinical FeaturesClinical Features

Early Stage:Early Stage:

No signs! No symptoms!No signs! No symptoms!

Sign and Symptom 1.Manifestation Of Respiratory System:1.Manifestation Of Respiratory System: Cough Hemoptysis Sputum Breathlessness Stridor Chest pain

Sign and Symptom

2.Spread and Invasion:2.Spread and Invasion:

1).Pleura---effusion, pleuritic pain and chest wall pain.

Sign and Symptom

2).Mediastinum--- Left recurrent laryngeal nerve palsy Superior vena caval obstruction Dysphagia Phrenic nerve paralysis Pancoast’ tumors: Horner’s syndro

me

Sign and Symptom

3. Other abnormal:3. Other abnormal: Endocrine and metabolic

manifestations Neuromuscular manifestations Connective tissue and osseous

manifestations

Imaginal Manifestations Central TypeCentral Type

Peripheral TypePeripheral Type

Diffuse TypeDiffuse Type

Central Type of lung Central Type of lung CancerCancer

Early Stage :Early Stage :

No Abnormal X-ray Findings

Imaginal Manifestations

Central Type of lung Central Type of lung CancerCancer

Chest film + CT scansThe Direct Signs

1.Hilar mass: Unilateral hilar enlargement Increased density of hilum tumor mass and lymph nodes

Imaginal Manifestations

Central Type of lung Central Type of lung CancerCancer

2.Abnormality of bronchi (Encroachment )

Intralumen nodule Thickening Wall Irregular narrowing Completely obstructed

Imaginal Manifestations

Central Type of lung Central Type of lung CancerCancer

CT scans can demonstrate the ab

normality of bronchi and hilar mass clearly.

Imaginal Manifestations

Central Type of lung Central Type of lung CancerCancer

Indirect Signs:Indirect Signs: (Airway Obstruction)

1.Obstructive Emphysema (overinflation of lung) Rare 2%

2.Obstructive Atelectasis (collapse) Very common 3.Obstructive Pneumonia (consolidatio

n)

Imaginal Manifestations

Chest FilmChest Film

Completely obstructedCompletely obstructedAtelectasisAtelectasis

Central Type of lung Central Type of lung CancerCancer

Transverse “s” sign: The typical sign of lung cancer of right

upper lobe. This are the superior lobar atelectasis

and hilar tumor.

Imaginal Manifestations

The Transverse “S” Sign

Squamous carcinoma of left lungSquamous carcinoma of left lung

CT ScanCT Scan

obstructedobstructed Hilar mass

CT ScanCT Scan

AtelectasisAtelectasis ObstructiveObstructive PneumoniaPneumonia

Central Type of lung Central Type of lung CancerCancer

Late sign (typical )

Hilar Mass+ AtelectasisHilar Mass+ Atelectasis

Peripheral Type of Lung Peripheral Type of Lung CancerCancer

Early Stage: D≤2cm

SPN---Single Pulmonary Nodule

Small Infiltrating lesion

Imaginal Manifestations

Peripheral Type of Lung Peripheral Type of Lung CancerCancer

Typical FeaturesOnly One MASS in the Lung!

1. Location: anywhere

2.Size: any size but if D>4cm it is likely lung cancer. Doubling Time:120 days (median)

Imaginal Manifestations

Peripheral Type of Lung Peripheral Type of Lung CancerCancer

3.Shape: spherical, oval, lobulated configuration. Notched (umbilicated) is very typical.

4.Border: clear (smooth), shaggy or cloudy( ill defined), spiculated infiltrating.

Imaginal Manifestations

Peripheral Type of Lung Peripheral Type of Lung CancerCancer

5.Densety: 1). Homogeneous 2).Calcification, very rare 3).Early, air bronchiologram or air bronc

hogram 4). Cavity, irregular inner wall, eccentric 5). Enhanced in CT scan.

Imaginal Manifestations

Peripheral Type of Lung Peripheral Type of Lung CancerCancer

6. Around Mass: Pleural Indrawn Sign: A tail appears as a peripheral line

shadow between a mass and the pleura.

7.Others:

Imaginal Manifestations

nocthed

Air bronchogram

spuclated

Pleural tail sign

Peripheral Type: Chest Peripheral Type: Chest FilmFilm

Small Infiltrating lesion

Peripheral Type: Chest Peripheral Type: Chest FilmFilm

air bronchiologram

Peripheral Type: Chest Peripheral Type: Chest FilmFilm

lobulated configuration. Notched

Peripheral TypePeripheral Type

cavity, irregular inner wall

Peripheral Type: CT ScanPeripheral Type: CT Scan

spiculated 3D CT

Peripheral TypePeripheral Type

Pancoast’ tumors (apical)

Peripheral Type: CT ScanPeripheral Type: CT Scan

Pleural Indrawn Sign

Peripheral Type: CT ScanPeripheral Type: CT Scan

cavitySmall Infiltrating lesion

Peripheral Type: CT ScanPeripheral Type: CT Scan

air bronchiologram lobulated

Peripheral Type: CT ScanPeripheral Type: CT Scan

spiculated Pleural Indrawn Sign

Diffuse Type of Lung CancerDiffuse Type of Lung Cancer

Bronchiolo-alveolar carcinoma 1. Diffuse nodule shadows in a lobe or

multiple lobes of both lung.

Feature: More low lobe and more or less confluent(consolidation), shaggy, air bronchogram.

Imaginal Manifestations

Diffuse Type of Lung Diffuse Type of Lung CancerCancer

2. Lung markings: shaggy ,septal lines(kerley A and B)

3. Pleural: effusion.

4. Hilar and mediastinum: adenopathy (lymph node enlargement)

Imaginal Manifestations

Diffuse TypeDiffuse Type

Diffuse Type: CT ScanDiffuse Type: CT Scan

Diffuse nodule

Ground-glass shadow

Diagnosis and Differential Diagnosis

1. Central type: Key point : Mass in hilar+ Atelectasis+ Encroachm

ent of bronchi DD: Bronchial Mucosa Tuberculosis

2. Perpheral type: Key point : Mass--- Lobulated , Notched, Spiculate

d , Air bronchiologram , Pleural tail sign.

DD: Inflammatory Pseudotumor Pulmonary Hamartoma Tuberculoma

Thank you!