THORACIC Section 5: Lung Cancer: Mimics and Other Cancers

Question 1

Diagnosis?

Answer 1

Pulmonary Hamartoma

Question 2

Described to have macroscopic fat and “popcorn calcifications”

Answer 2

Pulmonary Hamartoma

Question 3

The most common benign lung mass

Answer 3

Pulmonary Hamartoma

Question 4

The most common lung tumor in patients with AIDS

Answer 4

Kaposi Sarcoma

Question 5

The favored location of Kaposi Sarcoma

Answer 5

tracheobronchial mucosa and perihilar lung

Question 6

Most common hepatic neoplasm in AIDS

Answer 6

Kaposi Sarcoma

Question 7

Flame Shaped opacities

Answer 7

Kaposi Sarcoma

Question 8

Diagnosis?

Describe the lesions

Answer 8

“Flame-shaped” Hilar opacities

Question 9

3 categories of metastatic lung disease

Answer 9

1. Direct Invasion
2. Hematogenous Mets
3. Lymphatic Carcinomatosis

Question 10

What type of metastatic disease do these common situations belong?

Esophageal CA
Lymphoma
Malignant Germ Cell Tumor

Answer 10

Direct Invasion

Question 11

This is seen with cancer of the
mediastinum, pleura, or chest wall. More rarely you are going to have mets to the pleura than
invading the lung. Even more rarely you can have malignant
mesothelioma, which can invade the lung

Answer 11

Direct Invasion

Question 12

The most common manifestation of hematogeneous mets to the lung

Answer 12

Pulmonary nodule

Question 13

Describe the pulmonary nodule as a common manifestation of the hematogenous mets to the lung

Answer 13

Multiple in a random distribution favoring the lower lobes

Question 14

“Cannonball Mets” are classically from what type of CA?

Answer 14

renal cell or choriocarcinoma (testicle)

Question 15

Main culprits of hematogenous mets

Answer 15

Breast, kidney, thyroid, colon and head and neck squamous cells - classically cavitate

Question 16

A prominent pulmonary vessel heading into a nodule

Answer 16

Feeding Vessel Sign

Question 17

What are the things to consider if you see a prominent vessel heading into a nodule?

Answer 17

1. Hematogenous mets or
2. Septic emboli

Question 18

The most common cause of unilateral Lymphangitic Carcinomatosis?

Answer 18

Bronchogenic Carcinoma invading the lymphatics

Question 19

The most common extrathoracic culprits of Lymphangitic Carcinomatosis

Answer 19

Breast
Stomach
Pancrease
Prostate

Question 20

CT finding of Lymphangitic Carcinomatosis (LC)

Answer 20

The finding is nodular thickening of the interlobular septa and subpleural interstitium. Unlike interstitial fibrosis, this thickening classically does NOT distort the pulmonary lobule

Question 21

What are the 4 flavors of Pulmonary Lymphoma?

Answer 21

Primary
Secondary
AIDS related
Post-transplant lymphoproliferative Disorder (PTLD)

Question 22

What are the radiographic patterns of Lymphoma?

Answer 22

Lymphangitic spread (uncommon)
parahilar airspace opacities
mediastinal lymphadenopathy

Question 23

This is a rare type of Pulmonary Lymphoma, and usually non-Hodgkin in subtype. You define it as the lack of extrathoracic involvement for 3 months. Almost always (80%) we are talking about a low grade MALToma.

Answer 23

Primary pulmonary Lymphoma

Question 24

Here we are talking about pulmonary involvement of a systemic lymphoma. This is much much much more common than primary lung lymphoma.

Answer 24

Secondary Pulmonary Lymphoma

Question 25

80-90% of lymphoma cases

Answer 25

Secondary NHL

Question 26

Type of Secondary Lymphoma

45% have intrathoracic disease at presentation

Answer 26

Secondary Non-Hodgkin Lymphoma

Question 27

Type of Secondary Lymphoma

25% have pulmonary
parenchymal disease

Answer 27

Secondary NHL

Question 28

Type of Secondary Lymphoma

Answer 28

Pulmonary involvement
frequently occurs in the
absence of mediastinal
disease

Question 29

Type of Secondary Lymphoma

Pulmonary involvement
frequently occurs in the
absence of mediastinal
disease

Answer 29

Secondary NHL

Question 30

Type of Secondary Lymphoma

10-20% of lymphoma
cases

Answer 30

Secondary HL

Question 31

Type of Secondary Lymphoma

85% have intrathoracic
disease at presentation

Answer 31

Secondary HL

Question 32

Type of Secondary Lymphoma

40% have pulmonary parenchymal disease

Answer 32

Secondary HL

Question 33

Type of Secondary Lymphoma

Lung involvement almost always associated with intrathoracic lymph node enlargement

Answer 33

Secondary HL

Question 34

Post-Transplant Lymphoprolipherative Lung Disease usually occurs when?

Answer 34

Within a year (late presentations >1 year have a more aggressive course)

Question 35

This is a B-Cell lymphoma,
with a relationship with EB Virus.

Answer 35

Post Transplant Lymphoprolipherative Disorders (PTLD)

Question 36

Type of Lymphoma

The typical look
is well-defined pulmonary nodules / mass, patchy airspace consolidation, halo sign, and interlobular
septal thickening.

Answer 36

PTLD

Question 37

This is the second most common lung tumor in
AIDS patients (Kaposi’s is first).

Answer 37

AIDS related pulmonary lymphoma (ARL)

Question 38

Aids Related Lymphoma (ARL) is seen in patients with a what CD4 levels?

Answer 38

CD4 < 100

Question 39

The most common radiologic presentation of ARL

Answer 39

multiple peripheral nodules ranging from 1 cm-5 cm

Question 40

What do you consider if you see and AIDS patient with lung nodules, pleural effusion and lymphadenopathy?

Answer 40

Lymphoma

Question 41

A potassium analog. Things with a functional Na/K/ATP pump tend to be alive.
Hence anything this is “alive” will be thallium positive.

Answer 41

Thallium

Question 42

is an Iron analog. Iron is an inflammatory marker (acute phase reactant) hence things that are “smoldering” tend to be gallium negative, and things that are inflamed - infection, active sarcoid, most cancers - tend to be Gallium hot.

Answer 42

Gallium

Question 43

Kaposi Sarcoma vs Lymphoma

Thallum Positve
Gallium Negative

Answer 43

Kaposi Sarcoma

Question 44

Kaposi Sarcoma vs Lymphoma

Thallum Positive
Gallium Positive

Answer 44

Lymphoma