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Primary Bronchogenic Carcinoma (LUNG CANCER)

Primary Bronchogenic Carcinoma (LUNG CANCER). SHEN JIN The First Affiliated Hospital of Kunming Medical College. Outlook. 1. Pathologic Characteristics 2. Clinical Features 3. Imagine Manifestations 4. Diagnosis and Differential Diagnosis. Pathologic Characteristics. 1.Difinition

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Primary Bronchogenic Carcinoma (LUNG CANCER)

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

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

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

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

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

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

  7. Growth in early central type

  8. Inner Across

  9. Inner Growth Histology Gross

  10. Enlarge Growth

  11. Infitralting Growth

  12. Infitralting Growth Gross Histology

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

  14. Early Stage: • No signs! No symptoms!

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

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

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

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

  19. Imaginal Manifestations • Central Type • Peripheral Type • Diffuse Type

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

  21. 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

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

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

  24. 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)

  25. Chest Film Atelectasis Completely obstructed

  26. 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.

  27. The Transverse “S” Sign

  28. Squamous carcinoma of left lung

  29. CT Scan Hilar mass obstructed

  30. CT Scan Atelectasis ObstructivePneumonia

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

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

  33. Peripheral Type of Lung Cancer Imaginal Manifestations 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)

  34. 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.

  35. 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.

  36. 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:

  37. spuclated Pleural tail sign nocthed Air bronchogram

  38. Peripheral Type: Chest Film Small Infiltrating lesion

  39. Peripheral Type: Chest Film air bronchiologram

  40. Peripheral Type: Chest Film lobulated configuration. Notched

  41. Peripheral Type cavity, irregular inner wall

  42. Peripheral Type: CT Scan 3D CT spiculated

  43. Peripheral Type Pancoast’ tumors (apical)

  44. Peripheral Type: CT Scan Pleural Indrawn Sign

  45. Peripheral Type: CT Scan cavity Small Infiltrating lesion

  46. Peripheral Type: CT Scan lobulated air bronchiologram

  47. Peripheral Type: CT Scan Pleural Indrawn Sign spiculated

  48. 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.

  49. 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)

  50. Diffuse Type

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