Lung Unit

Alveolus
TUMORS OF THE LUNG

Histological
classification
Primary tumors
• Bronchogenic tumors
• Non-bronchogenic tumor
Secondary tumors (metastasis)
The incidence of the bronchogenic
tumors
1. Non-small cell lung Ca (NSCLC): 70-75%
a. SCC: 25 – 30 %
b. AdenoCa, including bronchioloalveolar
carcinoma: 30 – 35 %
c. Large cell Ca: 10 – 15 %
2. Small Cell Lung Ca (SCLC) : 20 – 25 %
3. Combined : 5 – 1 0 %
- SCC + adenoCa
- SCC + SCLC
Bronchogenic
Carcinoma
a b

c d
a. Squamous cell ca.: men >> women, smoking history
central bronchus
squamous metaplasia-displasia-Ca

b. Adenocarcinoma : bronchial/ bronchioloalveolar type

Women >> men, non smokers
pheripherally location
grow more slowly than SCC

c. Small cell ca : Highly malignant tumor

smokers, Hilar/ central
EM: neurosecretory granules
high response to chemotherapy

d. Large cell ca : Undifferentiated ca

 Cytologic diagnoses of lung cancer

a. Sputum specimen
b. FNA of Lnn : small cell ca
 Clinical Relevances of Lung Cancer
Bronchogenic carcinoma
• Silent, insidious lesion (become unresectable before they
produce symptoms)
• Prognosis is bad when these symptoms appear: hoarseness,
chest pain, superior vena cava syndrome, pericardial or
pleural effusion persistent segmental atelectasis/pneumonitis
• Very often the tumor presents with symptoms due to
metastasis to the brain (mental or neurologic changes), liver
(hepatomegali), or bone (pain)
• NSCLCs have a better prognosis (lobectomy is possible when
the tumor is detected before local spread or metastasis) than
SCLCs
 Clinical Relevances of Lung Cancer
Paraneoplastic Syndromes
1. Hypercalcemia due to secretion of parathyroid hormone-
related peptide --- SCC
2. Cushing syndrome (increased production of ACTH)
3. Syndrome of inappropriate secretion of antidiuretic
hormone (SIADH)
4. Neuromuscular syndrome, including a myasthenic
syndrome, peripheral neuropathy, and polymyositis.
5. Clubbing of the fingers and hypertrophic pulmonary
steoarthropathy
6. Hemtologic manifestation: migratory thrombophlebitis,
nonbacterial endocarditis, and dic --- adenocarcinoma
2,3,4,5, ----- small cell carcinoma
Bronchioloalveolar carcinoma

Terminal bronchoalveolar region

Peripheral portion of the lung
Males = females, all ages( 3rd decade- advanced years)
 BRONCHIAL CARCINOID

General remarks
• Arise from Kulchitsky cells (neuroendocrine cells lining
the bronchial mucosa)
• Occasionally occur in part of MEN
• Appear in early age (peak 40 years)
• 1-5% of all pulmonary neoplasms
• Mostly resectable and curable (not their neurondocrine
counterpart : small cell carcinoma)
BRONCHIAL CARCINOID
PATHOLOGY
• Small tumor : 3-4 cm
- polypoid
- penetrate the bronchial wall:
- collar- button lesion
• Microscopical features:
- nests of uniform round cells
• EM: dense-core granules
• IHC: serotonin, NSE, calcitonin etc
BRONCHIAL CARCINOID
SECONDARY TUMORS ( METASTASIS)
 Pleural tumors

Neoplasma:Mesothelioma
Lymphnode
stations
Lymphnode stations

Lymphnode stations are

shown projected onto a
chest-roentgenogram
 S C Carcinoma in situ
SCC in situ Bronchial washing

No gross mucosal abnormalities Bronchial brushing

 Early invasive SCC

SCC in situ with foci of early invasion (nodular Early invasive scc
thickening)
 SCC

Endobronchial SCC
Well differentiated SCC

Keratin mass
SCC moderately differentiated
Pearl formation

Individual cell keratinization

SCC moderately differentiated

Pearl formation

Central squamous differentiation

SCC poorly differentiated
Dense eosinophilic cytoplasm
 Adenocarcinoma

This lobectomy specimen shows a lobulated, somewhat glistening mass

Adenocarcinoma
Well differentiated
Adenocarcinoma
Moderately differentiated
Adenocarcinoma
Poorly differentiated
Adenocarcinoma
Cytology

3 dimension cell group, vacuolization

Bronchioloalveolar Carcinoma (BAC)
Nonmucinous type

Upper lobe is almost entirely consolidated by mucinous BAC, architecture is maintained,

and there is an absence of necrosis and hemorrhage
Bronchioloalveolar Carcinoma
(BAC)
Nonmucinous type
Bronchioloalveolar Carcinoma
(BAC)
Nonmucinous type
Bronchioloalveolar Carcinoma
(BAC)
Nonmucinous type
Bronchioloalveolar Carcinoma (BAC)
Mucinous type
Bronchioloalveolar Carcinoma
(BAC)
Mucinous type
Pattern of Spread

1. Direct extention to adjecent structure

2. Aerogenous spread
3. Lymphatic spread
4. Hematogenous dissemination
5. Pleural seeding
Pattern of Spread 1. Direct extention
Pattern of Spread 2. Aerogenous dissemination
Pattern of Spread 3. Lymphangitic spread
Pattern of Spread 5. Pleural seeding
 The Border of the Metastasis Tumor Mass

Alveolar soft part sarcoma, well circumscribed Irregular border: a nodule of metastatic leio-
with pushing border. Metastases often have myosarcoma extends into the interstitium of
this appearance. the surrounding lung
 Pattern of Metastasis
1. Milliary & Lymphangitic metastasis
2. Multinodular metastasis
3. “Cannonball” metastasis
4. Lymphangitic metastasis
5. Endobronchial metastasis
6. Intra-arterial metastasis
7. Pleural metastasis
8. Interstitial metastasis
9. Cavitary metastasis
 Pattern of Metastasis
Miliary & Lymphangitic Metastasis

-Numerous minute nodules and larger area of ill-defined consolidation

-Tthickening of the of small blood vessel, interlobular septa, and airways
 Pattern of Metastasis
Multinodular metastasis

Yellow appearance to the metastatic nodules: Black appearance in some nodules: primary
abundant fat content of primary tumor: renal- Tumor is malignant melanoma
cell carcinoma
 Pattern of Metastasis
“Cannonball” metastasis

Primary tumor: osteogenic sarcoma. A variety of tumors: sarcoma,

renal cell Ca, malignant melanoma, colorectal Ca, may produce this appearance
 Pattern of Metastasis
Lymphangitic metastasis

Primary tumor: leiomyosarcoma. Note the ar- Metastatic breast Ca. the perivascular lymphatics
borizing pattern produced by tumor within are markedly dilated and filled with clump of
Perivascular lymphatics tumor cells
 Pattern of Metastasis
Endobronchial metastasis

A nodular lesion protrudes into bronchial lumen

 Pattern of Metastasis
Endobronchial metastasis

A submucosal nodule of metastatic rhabdomyo- Microscopic involvement of the airway is far

sarcoma produces nodular protrusion of the More common than gross or clinically apparent
bronchial mucosa into the lumen involvement
 Pattern of Metastasis
Intra-arterial metastasis

The tumor embolus is coiled in worm-like Carcinomatous embolus in the lumen of small
fashion within the lumen of the artery artery
 Pattern of Metastasis
Pleural metastasis

Diffuse pleural metastasis simulating meso- Pleural metrastasis of adenocarcinoma

thelioma, the primary tumor is renal cell ca. mimicking mesothelioma
Solid ring of the tumor occupies the pleural
surface.
 Pattern of Metastasis
Interstitial metastasis

Interstitial metastasis of thymic carcinoid tumor Metastatic sarcomas more commonly adopt an
 nodular appearance. Interstitial pattern than epithelial tumors.
 Pattern of Metastasis
Cavitary metastasis

The primary tumor: teratoma of the testis  The hemorrhagic tumor has undergone
undergo cavitary changes when it metasta- multifocal cavitation.
sizes to the lung.