Primary Bronchogenic Carcinoma (LUNG CANCER)

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Primary Bronchogenic Carcinoma (LUNG
CANCER)

• SHEN JIN
• The First Affiliated Hospital of Kunming Medical
  College

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Outlook

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

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Pathologic Characteristics

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

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

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

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

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Growth in early central type
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Inner
Across
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Inner Growth
Histology
Gross
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Enlarge Growth
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Infitralting Growth
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Infitralting Growth
Gross
Histology
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• Clinical Features

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

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• Early Stage
• No signs! No symptoms!

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Sign and Symptom

• 1.Manifestation Of Respiratory System
• Cough
• Hemoptysis
• Sputum
• Breathlessness
• Stridor
• Chest pain

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Sign and Symptom

• 2.Spread and Invasion
• 1).Pleura---effusion, pleuritic pain and chest
  wall pain.

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Sign and Symptom

• 2).Mediastinum---
• Left recurrent laryngeal nerve palsy
• Superior vena caval obstruction
• Dysphagia
• Phrenic nerve paralysis
• Pancoast tumors Horners syndrome

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Sign and Symptom

• 3. Other abnormal
• Endocrine and metabolic manifestations
• Neuromuscular manifestations
• Connective tissue and osseous manifestations

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Imaginal Manifestations

• Central Type
• Peripheral Type
• Diffuse Type

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Central Type of lung Cancer
Imaginal Manifestations

• Early Stage
• No Abnormal X-ray Findings

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Central Type of lung Cancer
Imaginal Manifestations

• Chest film CT scans
• The Direct Signs
• 1.Hilar mass
• Unilateral hilar enlargement
• Increased density of hilum
• tumor mass and lymph nodes

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Central Type of lung Cancer
Imaginal Manifestations

• 2.Abnormality of bronchi (Encroachment )
• Intralumen nodule
• Thickening Wall
• Irregular narrowing
• Completely obstructed

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Central Type of lung Cancer
Imaginal Manifestations

• CT scans can demonstrate the abnormality
  of bronchi and hilar mass clearly.

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Central Type of lung Cancer
Imaginal Manifestations

• Indirect Signs
• (Airway Obstruction)
• 1.Obstructive Emphysema (overinflation of lung)
  Rare 2
• 2.Obstructive Atelectasis (collapse)
• Very common
• 3.Obstructive Pneumonia (consolidation)

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Chest Film

• Completely obstructed

Atelectasis
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Central Type of lung Cancer
Imaginal Manifestations

• Transverse s sign
• The typical sign of lung cancer of right upper
  lobe.
• This are the superior lobar atelectasis and hilar
  tumor.

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The Transverse S Sign
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Squamous carcinoma of left lung
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CT Scan
Hilar mass
obstructed
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CT Scan
Atelectasis
Obstructive Pneumonia
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Central Type of lung Cancer

• Late sign (typical )
• Hilar Mass Atelectasis

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Peripheral Type of Lung Cancer
Imaginal Manifestations

• Early Stage D2cm
• SPN---Single Pulmonary Nodule
• Small Infiltrating lesion

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Peripheral Type of Lung Cancer
Imaginal Manifestations

• Typical Features
• Only One MASS in the Lung!
• 1. Location anywhere
• 2.Size any size but if Dgt4cm it is likely lung
  cancer. Doubling Time120 days (median)

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Peripheral Type of Lung Cancer
Imaginal Manifestations

• 3.Shape spherical, oval, lobulated
  configuration. Notched (umbilicated) is very
  typical.
• 4.Border clear (smooth), shaggy or cloudy( ill
  defined), spiculated infiltrating.

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Peripheral Type of Lung Cancer
Imaginal Manifestations

• 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.

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Peripheral Type of Lung Cancer
Imaginal Manifestations

• 6. Around Mass
• Pleural Indrawn Sign
• A tail appears as a peripheral line shadow
  between a mass and the pleura.
• 7.Others

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spuclated
Pleural tail sign
nocthed
Air bronchogram
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Peripheral Type Chest Film
Small Infiltrating lesion
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Peripheral Type Chest Film
air bronchiologram
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Peripheral Type Chest Film
lobulated configuration. Notched
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Peripheral Type
cavity, irregular inner wall
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Peripheral Type CT Scan
3D CT
spiculated
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Peripheral Type
Pancoast tumors (apical)
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Peripheral Type CT Scan
Pleural Indrawn Sign
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Peripheral Type CT Scan
cavity
Small Infiltrating lesion
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Peripheral Type CT Scan
lobulated
air bronchiologram
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Peripheral Type CT Scan
Pleural Indrawn Sign
spiculated
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Diffuse Type of Lung Cancer
Imaginal Manifestations

• 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.

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Diffuse Type of Lung Cancer
Imaginal Manifestations

• 2. Lung markings shaggy ,septal lines(kerley A
  and B)
• 3. Pleural effusion.
• 4. Hilar and mediastinum
• adenopathy (lymph node enlargement)

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Diffuse Type
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Diffuse Type CT Scan
Ground-glass shadow
Diffuse nodule
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Diagnosis and Differential Diagnosis

• 1. Central type
• Key point
• Mass in hilar Atelectasis Encroachment of
  bronchi
• DD Bronchial Mucosa Tuberculosis

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

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• Thank you!