Lung metastasis

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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

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 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.