Thoracic Neoplasms - Exam 2 Flashcards
What is the mediatstinum?
the anatomically space between the lungs?
What are the MC masses in the anterior mediastinum?
Thymoma
Teratoma
Thyroid/Parathyroid tissue
What is a teratoma?
A teratoma is a rare type of germ cell tumor that may contain immature or fully formed tissue, including teeth, hair, bone and muscle. Most teratomas are benign but they can be malignant.
What are the MC middle mediastinum masses?
Granulomatous or metastatic lymphadenopathy
cysts
masses of vascular origin (pulmonary artery enlargement, aortic aneurysm)
What are the MC masses of the posterior mediastinum?
Neurogenic tumors, meningocele, meningomyelocele
Gastroenteric cysts, esophageal diverticula/tumor
Hiatal hernia, hernia through foramen of Bochdalek
Extramedullary hematopoiesis
1/2 of all mediastinal masses are _____ in nature. What do you do next? How do they normally present?
incidental
comprehensive PE
direct involvement or compression of normal cardiothoracic structures
What is Horner’s syndrome?
miosis (constriction of the pupil)
ptosis (drooping of the upper eyelid)
anhidrosis (absence of sweating of the face).
caused by damage to the sympathetic nerves of the face
If the mass is malignant in nature, what are you more likely to see?
constitutional symptoms (fever, night sweats, weight loss)
vs just s/s of the mass compressing on whatever underlying structure
What do you order if you suspect someone has a mediastinal mass?
initial- CXR
then CT WITH contrast
What are some additional tests you could consider when working up a mediastinal mass?
barium swallow (for esophageal)
doppler, CT/MRI angiography if thinking vascular
thyroid scan
PET scan
testicular/ovarian US
What are the 3 different options for biopsy? The option that you pick is based on the risk of ______
percutaneous- use CT guidance for exact location
endobronchial- if the mass is located immediately within the bronchial
surgical- either small enough that the mass can be resected at the time of biopsy or a larger mass
pick one based on the risk of malignant seeding
What is another name for a solitary pulmonary nodule? **What is the difference between a nodule and mass? What are some associated characteristics?
coin lesion
**nodule =less than or equal to 3cm (30mm) is a nodule
**mass= greater than 3cm (30mm)
isolated and round opacity, surrounded by normal lung tissue, not associated with infiltrate
most solitary pulmonary nodules are ______. What are the MC cause?
most are benign
infectious granulomas make up 80%
What are the two MC organisms for a infectious granuloma? What are the defining characteristics?
fungal: histoplasmosis or coccidioidomycosis
mycobacteria: TB or non-TB
Classically appear as a well-demarcated and fully-calcified or centrally calcified nodule
What is a hamartomas? How does it present?
noncancerous tumor made of an abnormal mixture of normal tissues and cells from the area in which it grows.
presents in middle age, grows slowly (over years)
How would a CXR define a hamartoma? CT?
both look histologically heterogenous
CXR - “popcorn” calcification
CT - areas of fat or alternating fat/calcifications
What is a pulmonary AV malformation? Is it benign or cancerous? What biopsy method is perferred?
a tangle of connecting arteries and veins
benign
AVOID bx of these lesions due to bleeding
What are the causes of malignant SPNs?
primary lung cancer
lung metastasis
carcinoid tumors
Which types of lung cancers present centrally? peripherally?
Small Cell Carcinoma - presents centrally
Squamous Cell Carcinoma- presents centrally
__________________
Adenocarcinoma - present peripherally
Large Cell Cancer - anywhere but often more peripheral
lung metastasis usually presents as ______ nodules. What are some common cancers?
multiple nodules
melanoma, sarcoma¹, and carcinomas of the bronchus, colon, breast, kidney, and testicle
What are the MC carcinoid tumors?
endobronchial, some (20%) present peripherally
What are the 3 types of non-small cell lung cancer?
squamous
adenocarcinoma
large cell cancer
**What are the risk factors for a SPN?
Smoking (increases with the pk yr hx)
Over the age of 35
Family history
Female sex
Emphysema
Previous malignancy
Asbestos
When would you want to repeat the CXR before ordering CT when evaluating SPN?
if suspected nodule is a nipple shadow
infection
nodule characteristics are pathognomonic for a benign lesion
After a CXR, what is the next step in imaging for SNP? What does the size of the nodule indicate?
chest CT w/o contrast
larger nodules have a higher rate of malignancy.
nodules greater than 2cm (20mm) have over a 50% chance of being malignant
What lung location have an increased probability of being malignant?
nodules found in the upper lobe have an increased probability of being malignant
What does the attenuation of the nodule indicate? What key phrase is a higher likelihood of malignancy
solid= less likely to be cancer
subsolid= higher likely of malignancy
“ground glass” equals bad news because no solid component so higher likelihood of cancer
What does the shape of nodule tell you about the likelihood of malignancy?
benign lesions: are smooth, with a well-defined edge
malignant lesions: are ill-defined, lobular or spiculated in appearance; may have peripheral halo on CT
What does the growth of the nodule tell you about the likelihood of it being malignant?
malignant: growth on serial imaging, q3-12 months
benign: solid nodule stable for 2 years
subsolid nodule that is stable for 5 years
What does the lesion calcification tell you about the likelihood of malignancy?
Benign lesions have dense calcification
Malignant lesions are associated with sparser calcification: stippled or eccentric patterns
What are the 4 benign calcification patterns? 2 malignant?
benign:
diffuse
central
popcorn
laminated
malignant:
stippled
eccentric
What is the management of SPN based on? What does the size tell you?
the probability of malignancy
> 30 mm (mass) - high risk - resection is recommended
≤ 30 mm nodule - determine probability for malignancy
**What does the Solitary Pulmonary Nodule Malignancy Risk Calculator estimate? **What are the 3 categories?
the probability that a lung nodule will be diagnosed as cancerous within a 2-4 year f/u period
**Low probability = < 5 %
Intermediate probability = 5-60%
high probability = > 60%
What is the management for high probability pulmonary nodule? What is considered high?
surgical resection and staging
greater than 60% risk