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Chest Imaging > Pulmonary neoplasms and neoplastic-like conditions > Flashcards

Pulmonary neoplasms and neoplastic-like conditions Flashcards

1
Q

an opacity completely stable in size for than 2 years is considered

A

benign

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2
Q

in patient under the age of 35, particularly a nonsmoker without a history of malignancy, an SPN is invariably a

A

granuloma, hamartoma or an inflammatory lesion

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3
Q

SPNs in a patient over 35 years of age should never be followed radiographically without tissue confirmation unless benign patterns are seen such as

A

calcification or the presence of intralesional fat or there has been radiographically documented lack of growth over a minimum of 2 years

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4
Q

An SPN that arises more than 2 years after the diagnosis of an extrathoracic malignancy and proves to be malignant is almost always a

A

primary lung tumor rather than a metastasis

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5
Q

exceptions to the rule in which SPNs of more than 2 years after an extrathoracic malignancy diagnosis has been made is almost alwats a primary lung tumor except for what extrathoracic malignancies

A

breast and melanoma

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6
Q

lung cancer presenting as a solid SPN has a doubling time of approximately

A

180 days

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7
Q

some benign lesions that may exhibit a growth rate similar to that of malignant lesions

A

hamartomas and histoplasmosis

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8
Q

malignant SPNs that may have a doubling time of greater than 2 years

A

well-differentiated adenocarcinoma and carcinoid tumors

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9
Q

Altho size does not reliably discriminate benign from malignant SPNs, the larger the lesion, the greater the likelihood its

A

Malignant

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10
Q

Masses exceeding __ cm in diameter are usually malignant

A

4 cm

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11
Q

Malignancies that may have a perfectly smooth margin

A

Carcinoid tumor, adenocarcinoma, solitary metastasis

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12
Q

Benign lesions that have a spiculated border include

A

Lipoid pneumonia, organizing pneumonia, tuberculomas, mass lesions of progressive massive fibrosis in complicated silicosis

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13
Q

Presence of small “satellite” nodules around the periphery of a dominant nodule is strongly suggestive of

A

Benign disease such as granulomatous infection

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14
Q

Presence of a halo of ggo encircling an SPN in an immunocompromised, neutropenic patient should suggest diagnosis of

A

Invasive fungal disease

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15
Q

An area of pleural thickening with a “comet” tail of bronchi and vessels entering the hilar aspect of mass and associated lobar volume loss is characteristic of

A

Rounded atelectasis

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16
Q

Probably the single most important factor in characterizing the lesion as benign or indeterminate

A

Density

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17
Q

Complete, central or peripheral rim-like calcification within an SPN is specific for a

A

Healed granuloma from tuberculosis or histoplasmosis

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18
Q

Concentric or laminated calcification indicates a

A

Granuloma

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19
Q

a bronchogenic carcinoma that arises in an area of previous granulomatous infection may engulf a preexisting calcified granuloma as it enlarges. In thi situation, the calcification will be

A

eccentric

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20
Q

Identification of fat within an SPN is diagnostic of a

A

pulmonary hamartoma

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21
Q

majority of subsolid nodules that persist beyond 3 months reflect

A

adenocarcinoma

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22
Q

majority of pure ground glass nodules are

A

benign

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23
Q

ground glass nodules <6mm in diameter almost invariably reflect

A

atypical adenomatous hyperplasia or focal fibrosis

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24
Q

pure ground glass nodules >6mm may reflect malignancy, the minority that are malignant represent

A

indolent lepidic-predominant adenocarcinoma

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25
Q

cystic lesions with wall thickening or nodularity that are malignant are usually

A

adenocarcinoma

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26
Q

demonstration of an air bronchogram or bubbly lucencies within an SPN is highly suspicious for

A

adenocarcinoma

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27
Q

all malignant lesions virtually demonstrates an increase in attenuation of greater than ___HU

A

15 HU after contrast administration

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28
Q

if SPN is <6 mm in low risk patients, what is the management

A

no follow up needed

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29
Q

if SPN is >6 mm in low risk patients, what is the management

A

optional follow-up, at 12th month

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30
Q

if SPN is 6-8 mm in low risk patients, what is the management

A

CT @ 6-12 months, consider @ 18-24 months

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31
Q

if SPN is 6-8 mm in high risk patients, what is the management

A

follow up CT @ 6-12 months, then @ 18-24 months

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32
Q

if SPN is >8mm in low risk patients, what is the management

A

consider CT @ 3 months, PET/CT or biopsy

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33
Q

if SPN is >8 mm in high risk patients, what is the management

A

consider CT @ 3months, PET/CT or biopsy

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34
Q

if SPN is subsolid <6 mm, what is the management

A

no follow up needed, ff up @2 and 4 years if suspicious

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35
Q

ground glass > or = to 6mm, what is the management

A

CT @ 6-12 months then every 2 years x 5 years; if solid component or growth, consider resection

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36
Q

part solid nodule > or = to 6 mm

A

ff up CT @3-6 months, if stable and solid component <6 mm, annual CT x 5 years; persistent part-solid nodules highly suspicious- PET CT for solid component >6 mm

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37
Q

a doubling time of SPN of less than 30 days or greater than 2 years represent a benign or malignant lesion?

A

benign

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38
Q

because most SPNs are peripherally situated in the lung, what is the procedure of choice for tissue sampling?

A

transthoracic needle biospy

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39
Q

peripheral lesions that are too small for successful TNB can be sampled with

A

video-assisted thoracoscopic surgery (VATS)

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40
Q

SPNs that are centrally situated with a large bronchus entering the lesion should undergo

A

transbronchoscopic biopsy

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41
Q

Majority of carcinoid tumors are located where, which present with wheezing, atelectasis or obstructive pneumonitis

A

central endobronchial lesions

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42
Q

reflects a benign neoplasm composed of an abnormal arrangement of the mesenchymal and epithelial elements found in normal lung

A

pulmonary hamartoma

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43
Q

pulmonary hamartomas are usually seen at what age

A

4th to 5th decades of life

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44
Q

a confident diagnosis of hamartoma can be made when HRCT shows a nodule or mass demonstrating a smooth lobulated border and containing focal fat

A

a smooth lobulated border and containing focal fat

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45
Q

calcification in hamartoma if present, demonstrates what pattern

A

popcorn like

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46
Q

low grade B-cell lymphomas that present in adults in therir 50s. most common radiographic finding is an SPN or focal airspace opacity

A

non-hodgkin lymphoma

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47
Q

classified as an adenoma and typically affects females and presents as a solitary, smoothly marginated juxtapleural nodule that enhances densely due to its vascular nature

A

sclerosing pneumocytoma (hemangioma)

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48
Q

characterized histologically by myofibroblasts which are spindle cells admixed with chronic inflammation–containing plasma cells. these lesions appear as smoothly marginated SPNs in children and young adults

A

inflammatory myofibroblastic tumor (plasma cell granuloma, inflammatory pseudotumor)

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49
Q

true or false, in lipoid pneumonia, spiculated appearance is not uncommon, as the oild may produce a chronic inflammatory reaction in the surrounding lung that leads to fibrosis

A

true

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50
Q

fluid-filled cystic lesions of the lung that can produce and SPN

A

bronchogenic cyst

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51
Q

90% of the bronchogenic cysts can be found in the

A

middle mediastinum

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52
Q

appears on CT as an intraparenchymal air-fluid levle wihin a thin-walled localized air collection (usually in the upper lobe) with typical bullous changes in other portions of lung

A

bronchogenic cyst

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53
Q

a recent history of lower respiratory tract infection in this mass-like lung lesion will be present

A

focal organizing pneumonia

54
Q

hematoma or traumatic lung cyst can present as

A

round opacities often containing air or an air/fluid level

55
Q

99% of malignant epithelial neoplasms of lungs arise from the

A

bronchi

56
Q

bronchogenic carcinoma are subdivided in the four main histologic subtypes

A

adenocarcinoma, squamous cell carcinoma, small cell carcinoma and large cell carcinoma

57
Q

most common type of lung cancer, accounting for approximately 43% of all lung carcinomas. it has the weakest association with smoking and most common subtype of nonsmokers

A

adenocarcinoma

58
Q

adenocarcinomas are usually found in

A

upper lobes, 1/4 of cases are in the central portions of lungs

59
Q

arises from bronchiolar or alveolar epithelium and have an irregular or spiculated appearance where they invade adjacent lung producing an irregularly marginated pulmonary nodule or mass

A

adenocarcinoma

60
Q

the presence of ground glass densities in adenocarcinoma presenting as an SPN represents

A

lepidic growth of tumor cells along the alveolar walls

61
Q

solid (soft tissue component) in adenocarcinoma reflects

A

invasive tumor

62
Q

second most common subtype of lung cancer, accounting for approximately 23% of all cases. this tumor arises centrally within a lobar or segmental bronchus

A

squamous cell carcinoma

63
Q

these tumors are polypoid masses that grow into the bronchial lumen while simultaneously invading the bronchial wall

A

squamous cell carcinoma

64
Q

common radiographic findings include a hilar mass with or without obstructive pneumonitis or atelectasis. central necrosis is common in large tumors; cavitation may be seen if communication has occurred between the central portion of mass and the bronchial lumen

A

squamous cell carcinoma

65
Q

presence of keratin pearls and intercellular bridges are specific for what tumor

A

squamous cell carcinoma

66
Q

treatment for adenocarcinoma

A

stage I-II surgery, stage III-IV XRT/chemo

67
Q

treatment for squamous cell carcinoma

A

stage I-II surgery, stage III-IV- XRT/chemo

68
Q

treatment of small cell carcinoma

A

chemotherapy

69
Q

treatment for large cell carcinoma or carcinoid tumor

A

variable

70
Q

type of neuroendocrine tumor of the lung, accounts for 13% of bronchogenic carcinomas and arises centrally within the main or lobar bronchi

A

small cell carcinoma

71
Q

these tumors are most malignant neoplasms arising from bronchial neuroendocrine (kulchitsky) cells and are alternatively referred as kulchitsky cell cancers of KCC-3

A

small cell carcinoma

72
Q

typical carcinoid tumors (small cell ca) that represent least malignant type

A

KCC-1

73
Q

atypical carcinoid tumors (small cell ca) that represent intermediate in aggressiveness

A

KCC-2

74
Q

exhibits a small endobronchial component invading the bronchial wall and peribronchial tissues early in the course of the disease. this produces a hilar or mediastinal mass with extrinsic bronchial compression and obstruction. Invasuin of the submucosal and peribronchial lymphatics leads to local lymph node enlargement and hematogeneous dissemination

A

small cell carcinoma

75
Q

diagnosed when a non small cell lung cancer lacks the histologic characteristics of squamous cell carcinoma or adenocarcinoma. tumors tend to arise peripherally as a solitary mass and is often large at the time of presentation

A

large cell carcinoma

76
Q

in addition to cigarette smoke, well-recognized risk factors for the development of lung cancer include

A

COPD, emphysema, asbestos exposure, previous Hodgkin lymphoma, radon exposure and diffuse interstitial or localized lung fibrosis

77
Q

carcinogens in cigarette smoke produce

A

cellular atypia and squamous metaplasia of bronchiolar epithelium, that may precede malignant transformation

78
Q

two histologic subtypes with the strongest association with cigarette smoking in men

A

small cell carcinoma and squamous cell carcinoma

79
Q

subtype that is associated with cigarette smoking in women

A

all histologic subtypes

80
Q

patients previously treated for mediastinal hodgkin disease with radiation, chemotherapy or a combination of two have an eightfold increase in lung cancer begining how many years after tx

A

10 years

81
Q

diffuse interstitial fibrosis in patients with usual interstitial pneumonitis due to scleroderma, rheumatoid lung disease or idiopathic pulmonary fibrosis has been associated with an increased incidence of what type of bronchogenic ca

A

adenocarcinoma

82
Q

most common radiographic finding in lung cancer

A

an SPN (size between 2mm and 3 cm) or lung mass (3 cm or larger), and a hilar mass with or without bronchial obstruction

83
Q

marked mediastinal nodal enlargement producing a lobulated mediastinal contour is characteristic of

A

small cell carcinoma

84
Q

most common finding if there is obstruction of bronchial lumen by the endobronchial component of a tumor

A

resorptive atelectasis or obstructive pneumonitis of lung distal to the obstructing lesion

85
Q

ocassionally, lung mass producing the lobar atelectasis creates a central convexity in the normally concave contour of the collapsed lobe, producing the

A

S sign of Golden

86
Q

walls of cavitating neoplasms tend to be ____ than those of cavitary inflammatory lesions

A

thicker and more nodular

87
Q

a peripheral neoplasm arising in that portion of the lung apex, indented superiorly by the subclavian artery

A

pancoast (superior sulcus) tumor

88
Q

presents with arm pain and muscular atrophy attributable to brachial plexus involvement, Horner syndrome from involvement of sympathetic change and shoulder pain from chest wall invasion

A

pancoast tumor

89
Q

most common cause of SVC syndrome

A

lung cancer

90
Q

represents invasion of the lymphatic changgels of the lung by tumor

A

lymphangitic carcinomatosis

91
Q

pathophysiology of lymphangitic carcinomatosis

A

invasion of lymphatics or neoplastic involvement of the hilar and mediastinal nodes, leads to retrograde (centrifugal) lymphatic flow with dilatation of lymphatic channels, interstitial deposits of tumor and fibrosis

92
Q

appears as smooth or beaded thickening of the interlobular septa and bronchovascular interstitium

A

lymphangitic carcinomatosis

93
Q

current theshold for lung cancer detection appears to be a lesion size of

A

> or equal to 8mm

94
Q

Tumor invasion of mediastinum with involvement of heart, great vessels, trachea, carina, esophagus, diaphragm, or recurrent laryngeal nerve precludes

A

Resection

95
Q

True or false, localized invasion of the pericardium does not prevent resection

A

True

96
Q

True or false: tumors that involve a main bronchus are resectable regardless of their distance from the carina

A

True

97
Q

True or false: malignant pleural or pericardial thickening, nodularity or effusion is M1a disease and precludes curative resection

A

True

98
Q

Features that strongly suggests pleural invasion

A

Pleural thickening >1cm, lobulated pleural thickening or circumferential pleural thickening

99
Q

True or false: contralateral hilar/mediastinal or supraclavicular nodal disease is unresectable

A

True

100
Q

Lung Parenchymal involvement in what type of lymphoma is 2-3x more common

A

Hodgkin disease

101
Q

Most cases of primary pulmonary non hodgkin lymphoma arise from

A

BALT and represent low grade B-cell lymphomas

102
Q

BALT lymphomas are also termed as _____ and have been associated with autoimmune diseases, in particular Sjögren syndome and RA

A

Extranodal marginal zone lymphomasp

103
Q

Presents a T-cell rich primary pulmonary B cell lymphoma associated with epstein-barr virus

A

Lymphomatoid granulomatosis

104
Q

Radiographic features of lymphomatoid granulomatosis

A

Multiple nodular opacities with a lower lobe predilection. Cavitation as a result of vascular invasion is common

105
Q

Related inflammatory conditions associated with autoimmune and immunologic diseases including Sjögren syndrome,RA, myasthenia gravis and immunocompromised states including common variable munodeficiency and HIV infection

A

Follicular bronchiolitis, lymphocytic interstitial pneumonitis and nodular lymphoid hyperplasia

106
Q

Ct findings in follicular bronchiolitis, LIP and nodular lymphoid hyperplasia

A

Diffuse ground-glass opacity, poorly defined centrilobular nodules, interlobular septal thickening, and thin-walled cysts

107
Q

Represents a specrrum of entities ranging from benign polyclonal lymphoid proliferation to aggressive non-hodgkin lymphoma that develop in a small percentage of transplant patients with lung transplant recipients most commonly affected

A

Posttransplant lymphoproliferative disorder

108
Q

Infection with what virus is responsible for most cases of posttransplant lymphoproliferative disorder

A

EBV

109
Q

Parenchymal imvolvement in leukemia usually takes the form of

A

Interstitial infiltration by leukemic cells, with resultant peribronchial cuffing and reticulonodular opacities

110
Q

An unusual pulmonary manifestation of leukemia is _____, which is seen in acute leukemia or those in blast crisis in whom the peripheral white blood cell count exceeds 100,000 to 200,000/cm3

A

Pulmonary leukocytosis

111
Q

Ct findings in Kaposi sarcoma

A

Typical peribronchovascular location of the opacities and may demonstrate air bronchograms traversing mass-like areas of confluent disease

112
Q

The mass-like opacities in kaposi sarcoma often parallel the long axis of bronchovascular structures and have been described as

A

Flame shaped

113
Q

Rare malignant lung tumor affecting children and young adults. These tumors tend to be extremely large at presentation

A

Pulmonary blastoma

114
Q

Preneoplastic proliferation of neuroendocrine cells found in the mucosa of small airways. Affected patients are middle-aged women that present either with asymptomatic small lung nodules that simulate metastatic disease or with symptoms of cough, dyspnea and wheezing diagnosed as

A

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

115
Q

Ct findings in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

A

Mosaic lung attenuation and air trapping ate typically seen on inspiratpry and expiratory ct

116
Q

most common benign tracheal tumors in adults

A

chondroma, fibroma, squamous cell papilloma, hemangioma, granular cell tumor

117
Q

sessile or pedunculated fibrous masses arising in the cervical trachea

A

fibromas

118
Q

hemangiomas are seen in the cervical trachea almost exclusively in what age group

A

infants and young children

119
Q

neoplasm that arises from the neural elements in the tracheal or bronchial wall. usually involve the cervical trachea or main bronchi but can arise in smaller bronchi

A

granular cell tumor

120
Q

intratracheal thyroid tissue is likewise goitrous and most commonly found in what portion of the trachea

A

posterolateral wall of cervical trachea

121
Q

presence of a small intraluminal and large extraluminal soft tissue component has given rise to the descriptive term “iceberg tumor”

A

carcinoid tumor

122
Q

benign neoplasm comprised of disorganized epithelial and mesenchymal elements normally found in the bronchus or lung

A

pulmonary hamartoma

123
Q

presents as pedunculated lesions in the bronchus with fatty centers covered by fibrous tissue that contain little cartilage

A

endobronchial hamartomas

124
Q

transpleural spread of tumor can be seen in cases of

A

invasive thymoma

125
Q

most common mediastinal malignancies to invade the lung are

A

esophageal carcinoma, lymphoma, malignant germ cell tumors or any malignancy metastasizing to mediastinal or hilar lymph nodes

126
Q

difference in radiologic appearance of pulmonary metastasis from primary bronchogenic carcinoma

A

mets- smooth in contour

primary lung ca- lobulated or spiculated

127
Q

nodular pulmonary metastases are usually smooth or lobulated lesions that are found in greater numbers in what portion of the lungs due to the greater pulmonary blood flow to these regions

A

periphery

128
Q

the demonstration of calcification within multiple pulmonary nodules in the abscence of a history of a primary bone forming neoplasm such as osteogenic sarcoma or chondrosarcoma is diagnostic of

A

granulomatous disease

129
Q

most common cause of unilateral lymphangitic carcinomatosis

A

bronchogenic carcinoma

130
Q

MC extrathoracic malignancies to produce lymphangitic carcinomatosis are

A

breast, stomach, pancreas, and prostate

131
Q

common causes of pulmonary arterial emboli due to their possible invasion of hepatic veins and renal veins, gaining access to the right heart and pulmonary vasculature

A

HCC and renal cell CA

Chest Imaging (9 decks)

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