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Difference between revisions of "Lung metastasis"
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(Created page with "'''Lung metastasis''', also '''pulmonary metastasis''' and '''metastatic lung disease''', is relatively common and generally carries a poor prognosis. ==General== *Relatively...") |
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Ewing sarcoma - intermed mag.jpg | |||
| Width = | |||
| Caption = Lung metastasis ([[Ewing sarcoma]]). [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = | |||
| Subtypes = | |||
| LMDDx = primary lung cancer ([[adenocarcinoma of the lung]], [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]]), [[pulmonary meningothelial-like nodule]], [[carcinoid tumourlet]], [[carcinoid lung tumour]] | |||
| Stains = | |||
| IHC = TTF-1 (-ve useful if non-squamous), CK20 (+ve suggestive colorectal carcinoma), CK7 (-ve useful if non-squamous), GATA3 (+ve suggestive UCC) | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = lung nodules - typically multiple and peripheral | |||
| Grossing = | |||
| Site = [[lung]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-history of malignancy | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = relatively common | |||
| Bloodwork = | |||
| Rads = peripheral lung lesions, typically multiple | |||
| Endoscopy = | |||
| Prognosis = usually poor | |||
| Other = | |||
| ClinDDx = lung primary, abscess, multiple benign lung tumours as may be seen in [[DIPNECH]] | |||
| Tx = dependent on primary site, occasionally surgical | |||
}} | |||
'''Lung metastasis''', also '''pulmonary metastasis''' and '''metastatic lung disease''', is relatively common and generally carries a poor prognosis. | '''Lung metastasis''', also '''pulmonary metastasis''' and '''metastatic lung disease''', is relatively common and generally carries a poor prognosis. | ||
==General== | ==General== | ||
*Relatively common. | *Relatively common. | ||
==Gross== | |||
*Typically peripheral, multiple, well-circumscribed & white/tan masses. | |||
*May be diffuse without an obvious mass +/- septal thickening. | |||
<gallery> | |||
Image: Metastatic_prostatic_adenocarcinoma_(3944215449).jpg | Prostate carcinoma. (WC/Rosen) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Variable - dependent on site of origin. | *Variable - dependent on site of origin. | ||
*[[Colorectal adenocarcinoma]] - usually distinctive morphologically: | |||
**Typically gland forming. | |||
***Ellipsoid/elongated pseudostratified nuclei with moderate [[nuclear atypia]]. | |||
***+/-Dirty necrosis. | |||
*Others: | |||
**[[Urothelial carcinoma]] - may mimic [[squamous cell carcinoma of the lung]]. | |||
**Upper GI adenocarcinoma (e.g. [[gastric adenocarcinoma]]) - may mimic [[lung adenocarcinoma]]. | |||
**Breast carcinoma - esp. [[ductal carcinoma of the breast]] - may mimic [[lung adenocarcinoma]]. | |||
DDx: | |||
*Primary lung tumour, e.g. [[lung adenocarcinoma]], [[lung squamous cell carcinoma]], [[small cell carcinoma of the lung]]. | |||
*[[Pulmonary meningothelial-like nodule]].<ref name=pmid23109985>{{Cite journal | last1 = Kfoury | first1 = H. | last2 = Arafah | first2 = MA. | last3 = Arafah | first3 = MM. | last4 = Alnassar | first4 = S. | last5 = Hajjar | first5 = W. | title = Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature. | journal = Korean J Pathol | volume = 46 | issue = 1 | pages = 87-91 | month = Feb | year = 2012 | doi = 10.4132/KoreanJPathol.2012.46.1.87 | PMID = 23109985 }}</ref> | |||
*[[Carcinoid tumourlet]]. | |||
*[[Carcinoid lung tumour]]. | |||
[[ | ===Images=== | ||
<gallery> | |||
Image:Ewing sarcoma - intermed mag.jpg | Lung metastasis ([[Ewing sarcoma|ES]]) - intermed. mag. (WC/Nephron) | |||
Image:Ewing sarcoma - high mag.jpg | Lung metastasis (ES) - high mag. (WC/Nephron) | |||
Image:Ewing sarcoma - very high mag.jpg | Lung metastasis (ES) - very high mag. (WC/Nephron) | |||
</gallery> | |||
<gallery> | |||
Image:Metastatic prostatic adenocarcinoma (5917779709).jpg | Prostate carcinoma. (WC/Rosen) | |||
Image:Metastatic prostatic adenocarcinoma (5918338484).jpg | Prostate carcinoma. (WC/Rosen) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
*TTF-1 -ve | *TTF-1 -ve/+ve. | ||
*CK20 +ve/-ve | **Negative suggestive of metastasis... unless it is [[squamous carcinoma]]. | ||
*GATA3 +ve/-ve | *CK20 +ve/-ve. | ||
**Positive in colorectal carcinoma - very useful. | |||
**Negative in lung primaries. | |||
*GATA3 +ve/-ve. | |||
**Usu. +ve in [[urothelial carcinoma]]. | |||
**Negative in lung primaries.<ref>{{Cite journal | last1 = Chang | first1 = A. | last2 = Amin | first2 = A. | last3 = Gabrielson | first3 = E. | last4 = Illei | first4 = P. | last5 = Roden | first5 = RB. | last6 = Sharma | first6 = R. | last7 = Epstein | first7 = JI. | title = Utility of GATA3 immunohistochemistry in differentiating urothelial carcinoma from prostate adenocarcinoma and squamous cell carcinomas of the uterine cervix, anus, and lung. | journal = Am J Surg Pathol | volume = 36 | issue = 10 | pages = 1472-6 | month = Oct | year = 2012 | doi = 10.1097/PAS.0b013e318260cde7 | PMID = 22982890 }}</ref> | |||
*CK7 -ve/+ve. | |||
**Positive in lung adenocarcinoma and small carcinoma of the lung. | |||
**Positive in a number of other tumours - breast, upper GI tract, thyroid, mesothelioma, [[salivary gland]]. | |||
**Negative in poorly differentiated carcinoma of the lung and squamous carcinoma of the lung. | |||
==See also== | ==See also== | ||