solitary pulmonary nodules Flashcards
3 NSCLC cancers
- adenocarcinoma
- squamous cell carcinoma
- large cell
- periphery; ground glass opacity
- slow growing & invades lymphatics sooner
- less associated w/ pulmonary sx
- bronchioalveolar is subtype
adenocarcinoma
- slow growing along bronchial wall
- tend to be cavitary
- peripheral version often invade chest wall
SCC
- rapid growth & spread
- bulky tumors often in periphery
- associated w/ necrosis but NOT cavitation
large cell
difficult to treat
- starts near bronchus and spreads widely & fast
- Most common cause of SVC syndrome, pancoast tumor sx and paraneoplastic syndrome
- longer survival if wedged out before chemo/rad
SCLC
- slow growing
- smooth, round, lobulated
- minimal PET activity
- surgical wedge resection or lobectomy
carcinoid of the lung
SPN
Single, well circumscribed rounded dense pulmonary lesion, 3cm or less in diameter completely surrounded by parenchyma w/o evidence of adenopathy or atelectasis
what causes majority of benign nodules
infectious granulomas
most common mediastinal tumor
thymoma
most common presentation of benign SPN
hamartoma (benign fatty tissue)
- CXR– solitary, smooth, lobulated, “popcorn” calcified slow growing
- CT– calcification w/ central fat
what is this most likely?
hamatoma
if you get a hamartoma, what do you do exclude malignancy
biopsy (hard to do w/ FNA)
- most common inhaled mycoses causing mild pulm. Sxs that resolve
- bird dropping, caves/bat dropping
- midwest/mississippi & ohio river; SE US
- calcified SPN, no growth in 2 yrs, negative IPPD
histoplasmosis
- homeless, recent travel, foreign born, drug users, HIV
- CXR: cavitary lesion, segmental consolidation @ apex
- positive IPPD
MTB
- southwest US soil
- cough, pleuritic CP, rash
- CXR– resolving abscess
Coccidioidomycosis
- pigeon droppings worldwide
- no sx vs fever, cough, chest pain
- CXR– single or multiple infiltrates, ipsilateral adenopathy, mimics Ca
cryptococcus
nodules ____ mm needs a PET scan
8-10mm
which two malignant lesions are falsely negative on PET scans
- bronchoalveolar
- carcinoid
which medication can cause falsely positive PET scan
metformin
required FEV1 for lobectomy
1.0 liter
8-10mm can get surgery if.. (4)
- good chance for malignance
- PET scan positive
- FEV1 over 1 liter
- positive or unequivocal biopsy
best surgery for indeterminate peripheral SPN; also the method of choice for dx & resection for SPN
VATS w/ diagnostic wedge resection
procedure if positive frozen section
lobectomy
for each, state if likely benign or malignant
- spiculated
- lobulated
- central or diffuse
- stable growth at 2 yrs
- spiculated– malignant
- lobulated– either
- central or diffuse– benign
- stable– benign UNLESS ground glass opacity
