Difference between revisions of "Lung metastasis"

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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]].


[[Colorectal adenocarcinoma]] - usually distinctive morphologically:
DDx:
*Typically gland forming.
*Primary lung tumour, e.g. [[lung adenocarcinoma]], [[lung squamous cell carcinoma]], [[small cell carcinoma of the lung]].
**Ellipsoid/elongated pseudostratified nuclei with moderate [[nuclear atypia]].
*[[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>
**+/-Dirty necrosis.
*[[Carcinoid tumourlet]].
*[[Carcinoid lung tumour]].


Others:
===Images===
*[[Urothelial carcinoma]] - may mimic [[squamous cell carcinoma of the lung]].
<gallery>
*Upper GI adenocarcinoma (e.g. [[gastric adenocarcinoma]]) - may mimic [[lung adenocarcinoma]].
Image:Ewing sarcoma - intermed mag.jpg | Lung metastasis ([[Ewing sarcoma|ES]]) - intermed. mag. (WC/Nephron)
*Breast carcinoma - esp. [[ductal carcinoma of the breast]] - may mimic [[lung adenocarcinoma]].
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 (may be positive).
*TTF-1 -ve/+ve.
*CK20 +ve/-ve (+ve in colorectal carcinoma, -ve in lung primaries).
**Negative suggestive of metastasis... unless it is [[squamous carcinoma]].
*GATA3 +ve/-ve (usu. +ve in [[urothelial carcinoma]], -ve 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>).
*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==

Latest revision as of 05:25, 9 February 2016

Lung metastasis
Diagnosis in short

Lung metastasis (Ewing sarcoma). H&E stain.
LM DDx 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
IHC TTF-1 (-ve useful if non-squamous), CK20 (+ve suggestive colorectal carcinoma), CK7 (-ve useful if non-squamous), GATA3 (+ve suggestive UCC)
Gross lung nodules - typically multiple and peripheral
Site lung
Clinical history +/-history of malignancy
Prevalence relatively common
Radiology peripheral lung lesions, typically multiple
Prognosis usually poor
Clin. DDx lung primary, abscess, multiple benign lung tumours as may be seen in DIPNECH
Treatment dependent on primary site, occasionally surgical

Lung metastasis, also pulmonary metastasis and metastatic lung disease, is relatively common and generally carries a poor prognosis.

General

  • Relatively common.

Gross

  • Typically peripheral, multiple, well-circumscribed & white/tan masses.
  • May be diffuse without an obvious mass +/- septal thickening.

  • Prostate carcinoma. (WC/Rosen)

Microscopic

Features:

DDx:

Images

  • Lung metastasis (ES) - intermed. mag. (WC/Nephron)

  • Lung metastasis (ES) - high mag. (WC/Nephron)

  • Lung metastasis (ES) - very high mag. (WC/Nephron)

  • Prostate carcinoma. (WC/Rosen)

  • Prostate carcinoma. (WC/Rosen)

IHC

  • TTF-1 -ve/+ve.
  • CK20 +ve/-ve.
    • Positive in colorectal carcinoma - very useful.
    • Negative in lung primaries.
  • GATA3 +ve/-ve.
  • 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

References

  1. ↑ Kfoury, H.; Arafah, MA.; Arafah, MM.; Alnassar, S.; Hajjar, W. (Feb 2012). "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.". Korean J Pathol 46 (1): 87-91. doi:10.4132/KoreanJPathol.2012.46.1.87. PMID 23109985.
  2. ↑ Chang, A.; Amin, A.; Gabrielson, E.; Illei, P.; Roden, RB.; Sharma, R.; Epstein, JI. (Oct 2012). "Utility of GATA3 immunohistochemistry in differentiating urothelial carcinoma from prostate adenocarcinoma and squamous cell carcinomas of the uterine cervix, anus, and lung.". Am J Surg Pathol 36 (10): 1472-6. doi:10.1097/PAS.0b013e318260cde7. PMID 22982890.
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