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[PBR] Pulmo 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

3 Malignancies that may have a perfectly smooth margin

A
  • Carcinoid tumor,
  • adenocarcinoma,
  • solitary metastasis
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12
Q

4 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

invasive pulmonary aspergillosis.

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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 or central 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

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

A

adenocarcinoma

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22
Q

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

A

adenocarcinoma

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23
Q

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

A

15 HU after contrast administration

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24
Q

if SPN is less than or = 4 mm in low-risk patients, what is the management

A

no follow up needed

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25
Q

if SPN is less than or = 4 mm in high-risk patients, what is the management

A

follow-up CT @ 12 months

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26
Q

if SPN is >4-6 mm in low-risk patients, what is the management?

A

follow-up CT @ 12 months

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27
Q

if SPN is >4-6 mm in high-risk patients, what is the management

A

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

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28
Q

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

A

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

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29
Q

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

A

follow up CT @ 3-6months
then CT @ 9-12 months,
then @ 24 months

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30
Q

The only exception to the published recommendations is for subsolid (i.e., ground-glass or mixed solid/ground-glass attenuation) nodules for which

A

a greater than 2-year follow-up is likely necessary given the indolent nature and more typical slow growth of subsolid malignancies.

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31
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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32
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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33
Q

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

A

video-assisted thoracoscopic surgery (VATS)

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34
Q

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

A

transbronchoscopic biopsy

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35
Q

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

A

central endobronchial lesions

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36
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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37
Q

pulmonary hamartomas are usually seen at what age

A

4th to 5th decades of life

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38
Q

a confident diagnosis of hamartoma can be made when HRCT shows a nodule or mass demonstrating?

A

a smooth lobulated border and containing focal fat

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39
Q

calcification in hamartoma if present, demonstrates what pattern

A

popcorn like

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40
Q
  1. low-grade B-cell lymphomas that present in adults in their 50s. the most common radiographic finding is an SPN or focal airspace opacity
  2. connective tissue tumor that arises within the lung from the pericyte, a cell associated with the arteriolar and capillary endothelium. On chest radiographs, these lesions are seen as SPNs and are indistinguishable from
    bronchogenic carcinoma.
A
  1. non-hodgkin lymphoma

2. Hemangiopericytoma

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41
Q
  1. 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
  2. Arising from the smooth muscle of the airways or pulmonary vessels. These are rare neoplasm that present as endobronchial or intrapulmonary lesions with equal frequency. Radiographically, the parenchymal lesions are sharply marginated, smooth or lobulated nodules or masses. The histologic distinction of benign from malignant
    lesions is difficult. Similarly, fibromas and neurofibromas appearing as SPNs lack distinguishing radiographic features.
A
  1. sclerosing pneumocytoma (hemangioma)

2. leiomyomas and leiomyosarcomas

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42
Q
  1. 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
  2. benign neoplasm arising from neural elements in the central airways or parenchyma. The skin is the most common site for these tumors. These tumors may present as SPNs but are more commonly seen as endobronchial masses. half of lung lesions present with obstructive pneumonitis because of their endobronchial location.
A
  1. inflammatory myofibroblastic tumor (plasma cell granuloma, inflammatory pseudotumor)
  2. granular cell tumor (granular cell myoblastoma)
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43
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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44
Q

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

A

bronchogenic cyst

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45
Q

90% of the bronchogenic cysts can be found in the

A

middle mediastinum

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46
Q
  1. appears on CT as an intraparenchymal air-fluid level within a thin-walled localized air collection (usually in the upper lobe) with typical bullous changes in other portions of the lung
  2. The inadvertent aspiration of mineral oils ingested by elderly patients to treat constipation may produce a localized pulmonary lesion. Patients with gastroesophageal reflux or disordered swallowing mechanisms are at particular risk. Radiographically, a focal area of airspace opacification or a solid mass may be seen in the lower lobes. A spiculated appearance to the edge of the mass is not uncommon, as the oil may produce a chronic inflammatory reaction in the surrounding lung that leads to fibrosis. While CT can demonstrate fat within the lesion, most patients with the mass-like form of this entity
    require resection for definitive diagnosis (see Fig. 19.40).
A
  1. Superinfection of a lung bulla may produce an SPN or mass.
  2. Lipoid Pneumonia.
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47
Q
  1. a recent history of lower respiratory tract infection in this mass-like lung lesion will be present
  2. rare intrapulmonary lesions that arise more
    commonly within the tracheobronchial tree to produce atelectasis. The demonstration of fat attenuation on CT is diagnostic.
A
  1. focal organizing pneumonia

2. Lipomas

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48
Q

hematoma or traumatic lung cyst can present as

A

round opacities often containing air or an air/fluid level

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49
Q

99% of malignant epithelial neoplasms of lungs arise from the

A

bronchi

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50
Q

bronchogenic carcinoma are subdivided in the four main histologic subtypes

A

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

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51
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

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52
Q

adenocarcinomas are usually found in

A

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

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53
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

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54
Q

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

A

lepidic growth of tumor cells along the alveolar walls

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55
Q

solid (soft tissue component) in adenocarcinoma reflects

A

invasive tumor

56
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

57
Q

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

A

squamous cell carcinoma

58
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

59
Q

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

A

squamous cell carcinoma

60
Q

treatment for adenocarcinoma

A

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

61
Q

treatment for squamous cell carcinoma

A

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

62
Q

treatment of small cell carcinoma

A

chemotherapy

63
Q

treatment for large cell carcinoma or carcinoid tumor

A

variable

64
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

65
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

66
Q

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

A

KCC-1

67
Q

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

A

KCC-2

68
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

69
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

70
Q

in addition to cigarette smoke, well-recognized risk factors for the development of lung cancer include (6)

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

AbCDE-RP

71
Q

carcinogens in cigarette smoke produce

A

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

72
Q

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

A

small cell carcinoma and squamous cell carcinoma

73
Q

subtype that is associated with cigarette smoking in women

A

all histologic subtypes

74
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

75
Q

exposure to inhaled radioactive material, particularly radon, is associated with development of small cell carcinoma of lung after how many years from exposure

A

20 years

76
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

The link between viral infection and bronchogenic carcinoma comes chiefly from the study of jaagsiekte, a disease of sheep that closely resembles BAC of the lung in humans.

77
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

78
Q

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

A

small cell carcinoma

79
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

80
Q
  1. occasionally, lung mass-producing the lobar atelectasis creates a central convexity in the normally concave contour of the collapsed lobe, producing the
  2. An abnormal increase in lobar or whole lung volume is recognized radiographically by a bulging interlobar fissure marginating the obstructed lobe or by mediastinal shift, respectively, and is termed
  3. The lung with obstructive pneumonitis is not
    infected but rather shows a chronic inflammatory infiltrate and alveolar filling with lipid-laden macrophages the latter finding accounts for the descriptive terms
A
  1. S sign of Golden
  2. “drowned lung.”
  3. “golden” or “endogenous lipoid pneumonia.”
81
Q

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

A

thicker and more nodular

82
Q

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

A

pancoast (superior sulcus) tumor

83
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

84
Q

most common cause of SVC syndrome

A

lung cancer

85
Q

represents invasion of the lymphatic changgels of the lung by tumor

A

lymphangitic carcinomatosis

86
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

87
Q

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

A

lymphangitic carcinomatosis

88
Q

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

A

> or equal to 8mm

89
Q

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

A

Resection

90
Q

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

A

True

91
Q

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

A

True

False? carina = T4 = Stage IIIa

• although tracheal or tracheal carinal involvement (T4 tumor) can be treated by carinal resection with end-to-side anastomosis of the remaining bronchus to the tracheal stump (“sleeve pneumonectomy”), most surgeons would consider this an unresectable tumor.

92
Q

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

A

True

93
Q

3 Features that strongly suggests pleural invasion

A

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

94
Q

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

A

True

mediastinoscopy
•pretracheal
•anterior subcarinal 
•right tracheobronchial 
endobronchial ultrasound 
•pretracheal 
•paratracheal
•subcarinal
•hilar
•interlobar nodes
endoscopic ultrasound
•subcarinal
•paraesophageal
•inferior pulmonary ligament
95
Q

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

A

Hodgkin disease

96
Q

Most cases of primary pulmonary non hodgkin lymphoma arise from type and represent what kind of lymphoma?

A

BALT and represent low grade B-cell lymphomas

97
Q

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

A

Extranodal marginal zone lymphomas

98
Q

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

A

Lymphomatoid granulomatosis

Lymphoma = Lymphomatoid

99
Q

Radiographic features of lymphomatoid granulomatosis

A

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

granulomatosis → nodule → cavitation

100
Q

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

A
  • Follicular bronchiolitis,
  • lymphocytic interstitial pneumonitis and
  • nodular lymphoid hyperplasia
101
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

102
Q

Represents a spectrum of entities ranging from benign polyclonal lymphoid proliferation to aggressive non-Hodgkin’s lymphoma that develops in a small percentage of transplant patients with lung transplant recipients most commonly affected

A

Post transplant lymphoproliferative disorder

103
Q

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

A

EBV

104
Q

Parenchymal imvolvement in leukemia usually takes the form of

A

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

105
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

106
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

107
Q

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

A

Flame shaped

kAPOsi = APOy = flame shaped

108
Q

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

A

Pulmonary blastoma

109
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

110
Q

Ct findings in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

A

Mosaic lung attenuation and air trapping are typically seen on inspiratory and expiratory ct

111
Q

90% of all primary tracheal masses are benign or malignant?

A

malignant

112
Q

most common primary tracheal malignancy

A

squamous cell carcinoma

113
Q

majority of squamous cell ca of trachea arise from what part

A

distal trachea within 3 to 4 cm of tracheal carina

114
Q

2nd most common site of tracheal squamous cell ca

A

cervical trachea

115
Q

malignant neoplasm that arises from the tracheal salivary glands and account for 40% of primary tracheal malignancies

A

adenoid cystic carcinoma

116
Q

adenoid cystic carcinoma of trachea tends to involve what part

A

posterolateral wall of the distal 2/3 of trachea or main or lobar bronchi

117
Q

tracheal masses exceeding 2cm are likely to be benign or malignant?

A

malignant

118
Q

most common types of thyroid malignancy to invade the trachea

A

papillary and follicular

119
Q

4 extrathoracic primary tumors that are most often associated with hematogeneous endotracheal metastases are carcinomas of

BKCM

A

breast,
kidney,
colon and
melanoma

120
Q

5 most common benign tracheal tumors in adults

A
  • chondroma,
  • fibroma,
  • squamous cell papilloma,
  • hemangioma,
  • granular cell tumor
121
Q

sessile or pedunculated fibrous masses arising in the cervical trachea

A

fibromas

122
Q

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

A

infants and young children

123
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

124
Q

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

A

posterolateral wall of cervical trachea

125
Q

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

Histologically, these tumors show sheets or trabeculae of uniform cells separated by a fibrovascular stroma.

A

carcinoid tumor

Radiologically, central bronchial carcinoids present with atelectasis or pneumonia secondary to large airway obstruction.

A hyperlucent lobe or lung of diminished volume may result from incomplete obstruction or collateral airflow with reflex hypoxic vasoconstriction. this finding is also rarely seen in bronchogenic carcinoma.

Carcinoids arising within the lung have a propensity to involve the right upper and middle lobes and appear as well-defined, smooth or lobulated nodules or masses.

126
Q

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

A

pulmonary hamartoma

127
Q

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

A

endobronchial hamartomas

128
Q

transpleural spread of tumor can be seen in cases of

A

invasive thymoma

129
Q

most common mediastinal malignancies to invade the lung are (4)

A
  • esophageal carcinoma,
  • lymphoma,
  • malignant germ cell tumors or
  • nodal metastases (any malignancy metastasizing to mediastinal or hilar lymph nodes)
130
Q

difference in radiologic appearance of pulmonary metastasis from primary bronchogenic carcinoma

A

mets- smooth in contour

primary lung ca- lobulated or spiculated

131
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

peripheral portions of the lower lobes

132
Q

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

A

granulomatous disease

133
Q

most common cause of unilateral lymphangitic carcinomatosis

A

bronchogenic carcinoma

134
Q

4 MC extrathoracic malignancies to produce lymphangitic carcinomatosis are

BSPP

A

breast,
stomach,
pancreas, and
prostate

135
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

[PBR] Pulmo Imaging (9 decks)

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