Primary Bronchogenic Carcinoma (LUNG CANCER) SHEN JIN The First Affiliated Hospital of Kunming Medical College

Outlook 1. Pathologic Characteristics 1. Pathologic Characteristics 2. Clinical Features 2. Clinical Features 3. Imagine Manifestations 3. Imagine Manifestations 4. Diagnosis and Differential Diagnosis 4. Diagnosis and Differential Diagnosis

Pathologic Characteristics 1.Difinition 1.Difinition Arise from the bronchial epithelium, bronchial glands and epithelium of the alveolus.

2.Histologic Classification: 2.Histologic Classification: Squamous Carcinoma 40% Undifferentiated Carcinoma 25% Adenocarcinoma 30% Alvelolar Cell Carcinoma 5% *non-small cell and small cell

3. Location Classification: 3. Location Classification: Central Type Peripheral Type Diffuse Type

4. Growth Type: 4. Growth Type: Inner Wall Outer Wall Across Wall Enlarge Infitrate

Growth in early central type

Across Inner

Inner Growth Gross Histology

Enlarge Growth

Infitralting Growth

Gross Histology

The clinical features are variable correlated with the histological type, site, and degree of development of the carcinoma. Clinical Features Clinical Features

Early Stage: Early Stage: No signs! No symptoms! No signs! No symptoms!

Sign and Symptom 1.Manifestation Of Respiratory System: 1.Manifestation Of Respiratory System: Cough Hemoptysis Sputum Breathlessness Stridor Chest pain

Sign and Symptom 2.Spread and Invasion: 2.Spread and Invasion: 1).Pleura---effusion, pleuritic pain and chest wall pain.

Sign and Symptom 2).Mediastinum--- Left recurrent laryngeal nerve palsy Superior vena caval obstruction Dysphagia Phrenic nerve paralysis Pancoast ’ tumors: Horner ’ s syndrome

Sign and Symptom 3. Other abnormal: 3. Other abnormal: Endocrine and metabolic manifestations Neuromuscular manifestations Connective tissue and osseous manifestations

Imaginal Manifestations Central Type Central Type Peripheral Type Peripheral Type Diffuse Type Diffuse Type

Central Type of lung Cancer Central Type of lung Cancer Early Stage : Early Stage : No Abnormal X-ray Findings Imaginal Manifestations

Central Type of lung Cancer Chest film + CT scans The Direct Signs 1.Hilar mass: Unilateral hilar enlargement Increased density of hilum tumor mass and lymph nodes Imaginal Manifestations

Central Type of lung Cancer 2.Abnormality of bronchi (Encroachment ) Intralumen nodule Thickening Wall Irregular narrowing Completely obstructed Imaginal Manifestations

Central Type of lung Cancer CT scans can demonstrate the abnormality of bronchi and hilar mass clearly. Imaginal Manifestations

Central Type of lung Cancer Indirect Signs: (Airway Obstruction) 1.Obstructive Emphysema (overinflation of lung) Rare 2% 2.Obstructive Atelectasis (collapse) Very common 3.Obstructive Pneumonia (consolidation) Imaginal Manifestations

Chest Film Completely obstructed Atelectasis

Central Type of lung Cancer Transverse “ s ” sign: The typical sign of lung cancer of right upper lobe. This are the superior lobar atelectasis and hilar tumor. Imaginal Manifestations

The Transverse “S” Sign

Squamous carcinoma of left lung

CT Scan obstructed Hilar mass

CT Scan Atelectasis ObstructivePneumonia Obstructive Pneumonia

Central Type of lung Cancer Central Type of lung Cancer Late sign (typical ) Hilar Mass+ Atelectasis

Peripheral Type of Lung Cancer Peripheral Type of Lung Cancer Early Stage: D≤2cm SPN---Single Pulmonary Nodule Small Infiltrating lesion Imaginal Manifestations

Peripheral Type of Lung Cancer Typical Features Only One MASS in the Lung! 1. Location: anywhere 2.Size: any size but if D>4cm it is likely lung cancer. Doubling Time:120 days (median) Imaginal Manifestations

Peripheral Type of Lung Cancer Peripheral Type of Lung Cancer 3.Shape: spherical, oval, lobulated configuration. Notched (umbilicated) is very typical. 4.Border: clear (smooth), shaggy or cloudy( ill defined), spiculated infiltrating. Imaginal Manifestations

Peripheral Type of Lung Cancer 5.Densety: 1). Homogeneous 2).Calcification, very rare 3).Early, air bronchiologram or air bronchogram 4). Cavity, irregular inner wall, eccentric 5). Enhanced in CT scan. Imaginal Manifestations

Peripheral Type of Lung Cancer 6. Around Mass: Pleural Indrawn Sign: A tail appears as a peripheral line shadow between a mass and the pleura. 7.Others: Imaginal Manifestations

nocthed Air bronchogram spuclated Pleural tail sign

Peripheral Type: Chest Film Small Infiltrating lesion

Peripheral Type: Chest Film air bronchiologram

Peripheral Type: Chest Film lobulated configuration. Notched

Peripheral Type cavity, irregular inner wall

Peripheral Type: CT Scan spiculated 3D CT

Peripheral Type Pancoast ’ tumors (apical)

Peripheral Type: CT Scan Pleural Indrawn Sign

Peripheral Type: CT Scan cavity Small Infiltrating lesion

Peripheral Type: CT Scan air bronchiologram lobulated

Peripheral Type: CT Scan spiculated Pleural Indrawn Sign

Diffuse Type of Lung Cancer Bronchiolo-alveolar carcinoma 1. Diffuse nodule shadows in a lobe or multiple lobes of both lung. Feature: More low lobe and more or less confluent(consolidation), shaggy, air bronchogram. Imaginal Manifestations

Diffuse Type of Lung Cancer 2. Lung markings: shaggy,septal lines(kerley A and B) 3. Pleural: effusion. 4. Hilar and mediastinum: adenopathy (lymph node enlargement) Imaginal Manifestations

Diffuse Type

Diffuse Type: CT Scan Diffuse nodule Ground-glass shadow

Diagnosis and Differential Diagnosis 1. Central type: Key point : Mass in hilar+ Atelectasis+ Encroachment of bronchi DD: Bronchial Mucosa Tuberculosis

2. Perpheral type: Key point : Mass--- Lobulated, Notched, Spiculated, Air bronchiologram, Pleural tail sign. DD: Inflammatory Pseudotumor Pulmonary Hamartoma Tuberculoma

Thank you!