NEOPLASMS OF LUNG, PLEURA, AND MEDIASTINUM

Classification Disease Etiology Epidemiology Pathology Clinical

Hamartoma Not discussed Not discussed Radiology: Starts in adolescence adulthood
Solitary nodule +/- popcorn None in newborns (not
calcification; congenital)
Peripheral > central
Benign Gross: solitary, lobulated, cartilaginous
Epithelial Micro: normal tissues in
Neoplasms excess/disarray (=def. of hamartoma)
Squamous Assoc w/ human papilloma Not discussed Radiology: Children > adults
papillomatosis virus (HPV; Study w/ in situ Slow growing nodules (cauliflower Larynx > trachea > bronchi
hybrdization) like on bronchoscopy)
Micro: Squamous papillomas
Squamous cell Model of Pathogenesis of 1) Smokers (98%) Radiology: 1) May secrete PTH like cmpd (
carcinoma Bronchogenic Squamous 2) 20-30% of Central > peripheral patient may have hypercalcemia)
Carcinoma: Resp mucosa common Gross: 2) Will metastisize to regional
squamous metaplasia carcinomas Bronchi>Larynx>trachea (rare) nodes
squamous dysplasia Micro:
carcinoma in situ invasive +/- Desmosomes
squamous carcinoma +/- Keratin production (keratin pearls)
Adenocarcinoma Not discussed 1) 30-40% of common Radiology: Not discussed
carcinomas Peripheral > Central
2) Most common Micro:
carcinoma in non- +/- Glands;
smokers, but 80% occur +/- Mucin
Malignant
in smokers Bronchio-alveolar carcinoma subset
Epithelial
Neoplasms Bronchioalveolar Not assoc w/ smoking or virus Rising incidence Radiology: Not discussed
(non-small cell carcinoma (presently 20-25%) Peripheral (can be multifocal and
carcinoma) (subset of bilateral)
adenocarcinoma) Micro: Lepidic (butterfly-like) growth
pattern architecture retained, but
epithelium replaced by malignant
cells
+/- mucin
Unifocal or Multifocal (must
distinguish multifocal primary form
metastases)
Large cell undiff Not discussed 10% of common Radiology: Non-specific Differentiate from squamous cell
carcinoma carcinomas Micro: H&E undiff; favor b/c no desmosomes/keratin; from
adenocarcinoma (by EM) adenocarcinoma b/c no
glands/mucin
Classification Disease Etiology Epidemiology Pathology Clinical
Mature Not discussed NOT assoc w/ smoking Radiology: 1) Bronchial submucosal mass is
Carcinoid (<5% of pulm neoplasms) Central > peripheral typical
Tumor Micro: 2) Rare mets to regional nodes (5%),
Bland neuroendocrine neoplasm surgical resection 100% cure
Salt & Pepper chromatin
Synaptophysin/chromogranin positive (by IHC)
No mitotic figures or necrosis
Atypical Not discussed Radiology: Non-specific
Carcinoid Peripheral > central Capable of metastisis
Tumor Micro:
Neuroendocrine Bland neuroendocrine neoplasm
Neoplasms Rare mitotic figures
Focal necrosis
Prominent nucleoli
Small Cell Not discussed Common in smokers, rad Radiology: Ectopic ACTH, ADH, Eaton-
Carcinoma exposure Central in > 90% Lambert, carcinoid syndrome
20% of common neoplasms Freq. mets to LN & distant sites Commonly high stage @ presentation
Micro: surgery not indicated b/c tumor
Malignant cytology (salt&pepper has likely metastasized
chromatin) Responds well to chemo/RT, but low
No nucleoli 5 yr survival b/c relapses quickly
High mitotic activity & necrosis

Prognostic Variables:
1) Non-Small Cell Lung Carcinoma (NSCLC)
a. Definitely: Stage, performance status, weight loss
b. Possibly: Gender, ploidy, k-ras mutation, p53 protein accumulation
c. Not: age, histology
2) Small Cell Lung Carcinoms (SCLC)
a. Definitely: State, performance status
b. Probably: Gender (male worse than female), age, # of metastatic sites
Classification Disease Etiology Epidemiology Pathology Clinical
Primary Lung Radiology: Mean age = 52
Melanoma High Res CT may detect M=F
bronchial wall mass Must be distinguished from solitary met
Gross: 5-10% of pts have unknown primary (b/c
Endobronchial mass (tracheal or bronchial) some primarys regress)
Micro:
Highly variable architecture and cytology
May be unpigmented (amelanotic)
Mesothelioma Asbestos? Assoc w/ asbestos Radiology:
exposure Diffuse pleural involvement
May have assoc effusion
Micro:
Malignant
Deeply invasive growth pattern
Epithelial, spindle cell, or biphasic
EM shows long microvilli
Keratin + by IHC
Pulmonary Most common Multiple nodules favor mets vs primary
Metastases neoplasms neoplasms (except BAC)
involving the lung Can involve pleura and have assoc pleural
effusion
Morphology, histology, and physical usually
identify the primary site, butt assignment of
primary may require IHC
Carcinoma Breast, GI, Renal (can metastisize
anywhere), Head/neck squamous cell
carcinoma
Sarcoma Osteosarcoma
Soft tissue sarcoma
(both can involve lung; more common in
Metastatic Disease kids)
Melanoma Radiology: Extrapulmonary primary melanoma much
Multiple nodules favor mets, but mets can be more common than pulmonary primary
Solitary melanoma
Micro: No known primary in 5-10% of cases
Variable architecture & cytology
S100 +/- HMB45 reactive
 Neoplasms of the Mediastinum
Classification Disease Etiology Epidemiology Pathology Clinical
Neural and Nerve Schwannoma
Posterior Sheath Neoplasms Neurofibroma
Mediastinum Lymphomas Hodgkins disease
Non-Hodgkins lymphoma
Bronchogenic Cysts Non-neoplastic lung
Middle
Lymphomas Hodgkins disease
Medastinum
Non-Hodgkins lymphoma
Lymphomas Hodgkins disease
Non-Hodgkins lymphoma
Thymoma Assoc w/ Most common tumor in Radiology: 2/3 of MG have/will have a thymoma
Myasthenia the mediastinum Variable involvement of adjacent organs 1/3 of thymoma pts have/will have MG
Gravis (MG) (invasive thymomas breach the pleura)
Anterior/Superior Micro:
Mediastinum Thymoma: bland, non-invasive
(4 Ts) Invasive Thymoma: bland but invasive
(Thymoma and Invasive Thymoma are
neoplasms of thymic epithelium)
Thymic carcinoma; malignant carcinoma
Teratoma Pediatric
Thyroid/Parathyroid Endocrine