Lung metastasis

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

Lung metastasis
Diagnosis in short

Lung metastasis (Ewing sarcoma). H&E stain.
LM DDx primary lung cancer
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 +/-hx of cancer
Prevalence relatively common
Radiology peripheral lung lesions, typically multiple
Prognosis usually poor
Clin. DDx lung primary, abscess

General

  • Relatively common.

Gross

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

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.

Others:

Images

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. 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.