TUMORS & METASTASIS chest diaease for physiotherapy.pptx

Pathology

1. Pulmonary tumors Dr:Ghada Hekal

2. Bronchial carcinoma • Pulmonary sarcoma and other primary malignant neoplasms • Benign pulmonary tumours • Benign lymphoproliferative disorders • Malignant lymphoproliferative disorders • Metastases • Evaluation of the solitary pulmonary nodule DD of pulmonary neoplasm

3. Imaging features The thoracic imaging features of bronchial carcinoma are discussed under three headings: -peripheral tumours -central tumours (arising in a large bronchus at or close to the hilum) -and staging intrathoracic spread of bronchial carcinoma . Bronchial carcinoma

4. Peripheral tumours bronchial carcinomas arise beyond the segmental bronchi, and in 30% a peripheral mass is the sole radiographic finding. Tumour shape and margins - Tumours at the lung apex ( Pancoast's tumours , superior sulcus tumours ) may resemble apical pleural thickening; however, the majority of peripheral lung cancers are approximately spherical or oval in shape. Lobulation , a sign that indicates uneven growth rates in different parts of the tumour , is common. Occasionally, a dumb-bell shape is encountered or two nodules are seen next to one another . -The term corona radiata is used to describe numerous fine strands radiating into the lung from a centralmass , sometimes with transradiant lung parenchyma between these strands.While not specific, this sign is highly suggestive of bronchial carcinoma Bronchial carcinoma

5. Central tumours The cardinal imaging signs of a central tumour are collapse/consolidation of the lung beyond the tumour and the presence of hilar enlargement, signs that may be seen in isolation or in conjunction with one another . Collapse/consolidation in association with central tumours Obstruction of a major bronchus often leads to a combination of atelectasis and retention of secretions with consequent pulmonary opacity , but collateral air drift may partially or completely prevent these postobstructive changes. Secondary infection may occur beyond the obstruction . - Pleural effusion (with dyspnoea ) is a feature of adenocarcinoma Bronchial carcinoma

6. Bronchial carcinoma in the left lower lobe showing typical rounded, slightly lobular configuration. The mass shows a notch posteriorly

7. Dense hilum. The right hilum is dense owing to a mass superimposed directly over it. The mass proved to be a squamous cell carcinoma.

8. CT demonstrating a second primary bronchogenic carcinoma in the right lung in a patient who had undergone a previous left pneumonectomy 7 years earlier. The new tumour has spiculated edges infiltrating into the adjacent lung (corona radiata ) .

9. Examples of neoplastic cavitation on chest radiography. (A) The cavity is eccentric (large cell undifferentiated carcinoma ). ( B) The inner wall of the cavity is irregular and an air–fluid level is present (squamous cell carcinoma). (C) The cavity wall is very thin (squamous cell carcinoma

10. Cavitating bronchogenic carcinoma . There is preservation of the extrapleural fat plane at the point of contact with the chestwall . Although the pleura may be involved the chest wall is likely to be otherwise spared.

11. Cavitation may be identified in tumours of any size and is best demonstrated by CT Squamous cell carcinoma is the most likely cell type to show cavitation. The walls of the cavity are of irregular thickness and may contain tumour nodules, but sometimes the wall has smooth inner and outer margins. The cavity wall is usually 8-mm thick or greater. Fluid levels are common. CT showing cavitating squamous cell carcinoma. The wall of the cavity is variable in thickness.

12. CT showing cavitating squamous cell carcinoma. The wall of the cavity is variable in thickness

13. Tumour calcification. Large bronchial carcinoma in left lower lobe showing extensive amorphous and cloud-like calcification. Initial examination; no treatment had been given.

14. (A) Extensive deep mediastinal invasion by primary bronchial carcinoma. (B) On lung windows there are pulmonary metastases .

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