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Primary Bronchogenic Carcinoma (LUNG CANCER)

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Primary Bronchogenic Carcinoma (LUNG CANCER) SHEN JIN The First Affiliated Hospital of Kunming Medical College Outlook 1. Pathologic Characteristics 2. – PowerPoint PPT presentation

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Title: Primary Bronchogenic Carcinoma (LUNG CANCER)


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 Horners 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
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

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
  • Completely obstructed

Atelectasis
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
Obstructive Pneumonia
31
Central Type of lung Cancer
  • Late sign (typical )
  • Hilar Mass Atelectasis

32
Peripheral Type of Lung Cancer
Imaginal Manifestations
  • Early Stage D2cm
  • 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 Dgt4cm it is likely lung
    cancer. Doubling Time120 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
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

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
51
Diffuse Type CT Scan
Ground-glass shadow
Diffuse nodule
52
Diagnosis and Differential Diagnosis
  • 1. Central type
  • Key point
  • Mass in hilar Atelectasis Encroachment of
    bronchi
  • DD Bronchial Mucosa Tuberculosis

53
  • 2. Perpheral type
  • Key point
  • Mass--- Lobulated , Notched, Spiculated ,
  • Air bronchiologram , Pleural tail sign.
  • DD Inflammatory Pseudotumor
  • Pulmonary Hamartoma
  • Tuberculoma

54
  • Thank you!
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