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]]. | |||
[[ | 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== | ||
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)
.jpg)
Microscopic
Features:
- Variable - dependent on site of origin.
- Colorectal adenocarcinoma - usually distinctive morphologically:
- Typically gland forming.
- Ellipsoid/elongated pseudostratified nuclei with moderate nuclear atypia.
- +/-Dirty necrosis.
- Typically gland forming.
- 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.[1]
- Carcinoid tumourlet.
- Carcinoid lung tumour.
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)
.jpg)
.jpg)
IHC
- TTF-1 -ve/+ve.
- Negative suggestive of metastasis... unless it is squamous carcinoma.
- 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.[2]
- 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
- ↑ 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.
- ↑ 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.