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Oncodiagnosis Panel: 1999

Cancer of the Lung: Oncodiagnosis¹

¹ From the Departments of Radiation Oncology (R.K.), Diagnostic Radiology (M.H.C.), Thoracic and Cardiovascular Surgery (J.B.P.), Thoracic/Head and Neck Medical Oncology (F.V.F.), and Pathology (J.Y.R.), University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 97, Houston, TX 77030; the Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC (W.D.T.); and the Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee (R.W.B.). From the Oncodiagnosis Panel at the 1999 RSNA scientific assembly. Received March 5, 2001; revision requested April 2 and received May 21; accepted May 31. Address correspondence to R.K. (e-mail: rkomaki@mdanderson.org).

View larger version (174K): [in a new window]   Figure 1a.   Radiologic findings in a 43-year-old man with a 40-pack-year smoking history who developed limited small cell carcinoma of the right lung. (a) Posteroanterior radiograph shows a relatively large mass (*) in the right lung with an enlarged right hilum (arrow). A lateral radiograph showed the same observations. (b) CT image obtained at the level of the lower hila shows the mass (*). A small component of lower subcarinal lymphadenopathy is present (arrowhead). (c) CT image obtained more cephalad shows adenopathy involving the right hilum (arrow) and subcarinal region (arrowheads). (d) CT image obtained at the level of the aortic arch shows right paratracheal lymphadenopathy (arrow). The images reveal no findings that indicate the histologic features of the malignancy. Therefore, the radiologic TNM stage of the lesion is T2 N2 M0 because the primary tumor is larger than 3 cm in diameter, mediastinal lymphadenopathy is present, and there is no evidence of other metastases.

View larger version (119K): [in a new window]   Figure 1b.   Radiologic findings in a 43-year-old man with a 40-pack-year smoking history who developed limited small cell carcinoma of the right lung. (a) Posteroanterior radiograph shows a relatively large mass (*) in the right lung with an enlarged right hilum (arrow). A lateral radiograph showed the same observations. (b) CT image obtained at the level of the lower hila shows the mass (*). A small component of lower subcarinal lymphadenopathy is present (arrowhead). (c) CT image obtained more cephalad shows adenopathy involving the right hilum (arrow) and subcarinal region (arrowheads). (d) CT image obtained at the level of the aortic arch shows right paratracheal lymphadenopathy (arrow). The images reveal no findings that indicate the histologic features of the malignancy. Therefore, the radiologic TNM stage of the lesion is T2 N2 M0 because the primary tumor is larger than 3 cm in diameter, mediastinal lymphadenopathy is present, and there is no evidence of other metastases.

View larger version (116K): [in a new window]   Figure 1c.   Radiologic findings in a 43-year-old man with a 40-pack-year smoking history who developed limited small cell carcinoma of the right lung. (a) Posteroanterior radiograph shows a relatively large mass (*) in the right lung with an enlarged right hilum (arrow). A lateral radiograph showed the same observations. (b) CT image obtained at the level of the lower hila shows the mass (*). A small component of lower subcarinal lymphadenopathy is present (arrowhead). (c) CT image obtained more cephalad shows adenopathy involving the right hilum (arrow) and subcarinal region (arrowheads). (d) CT image obtained at the level of the aortic arch shows right paratracheal lymphadenopathy (arrow). The images reveal no findings that indicate the histologic features of the malignancy. Therefore, the radiologic TNM stage of the lesion is T2 N2 M0 because the primary tumor is larger than 3 cm in diameter, mediastinal lymphadenopathy is present, and there is no evidence of other metastases.

View larger version (106K): [in a new window]   Figure 1d.   Radiologic findings in a 43-year-old man with a 40-pack-year smoking history who developed limited small cell carcinoma of the right lung. (a) Posteroanterior radiograph shows a relatively large mass (*) in the right lung with an enlarged right hilum (arrow). A lateral radiograph showed the same observations. (b) CT image obtained at the level of the lower hila shows the mass (*). A small component of lower subcarinal lymphadenopathy is present (arrowhead). (c) CT image obtained more cephalad shows adenopathy involving the right hilum (arrow) and subcarinal region (arrowheads). (d) CT image obtained at the level of the aortic arch shows right paratracheal lymphadenopathy (arrow). The images reveal no findings that indicate the histologic features of the malignancy. Therefore, the radiologic TNM stage of the lesion is T2 N2 M0 because the primary tumor is larger than 3 cm in diameter, mediastinal lymphadenopathy is present, and there is no evidence of other metastases.

View larger version (226K): [in a new window]   Figure 2.   Small cell lung carcinoma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows small cells (arrows) with scanty cytoplasm, ill-defined borders, nuclear molding, hyperchromatic nuclei, and absent or inconspicuous nucleoli. The cells are round, oval, or spindle shaped.

View larger version (216K): [in a new window]   Figure 3.   Small cell lung carcinoma. Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows small tumor cells with scanty cytoplasm, finely granular chromatin, and no nucleoli. Arrows indicate the frequent instances of mitosis and apoptosis.

View larger version (156K): [in a new window]   Figure 4.   Squamous cell carcinoma. Photomicrograph (original magnification, x400; Papanicolaou stain) shows clusters of tumor cells (left arrow) and isolated tumor cells (right arrow) with evidence of keratinization.

View larger version (160K): [in a new window]   Figure 5a.   Radiologic findings in a 67-year-old man with moderately differentiated squamous cell carcinoma. (a) Posteroanterior radiograph shows a mass (*) overlapping aspects of the left hilum. (b) Lateral radiograph shows a homogeneous area of increased opacity (*) within the superior segment of the left lower lobe. Cutoff of the superior segmental bronchus (arrow) suggests that much of the area of increased opacity could represent postobstructive pneumonia. (c) CT image obtained at the level of the left pulmonary artery shows the mass with regions of necrosis within it (*). The anterior aspect of the lesion appears to invade the mediastinum posterior to the artery (arrowheads). (d) CT image obtained at the level of the right pulmonary artery shows involvement of the posterior left hilum with cutoff of the superior segmental bronchus (arrowhead) and subcarinal lymphadenopathy (arrow). It is difficult to distinguish necrosis within the mass from necrosis within postobstructive pneumonia. (e) CT image obtained after RT shows stabilized sequelae of the therapy. Note the volume loss in the region of the original mass with associated radiation bronchiectasis (arrowheads).

View larger version (167K): [in a new window]   Figure 5b.   Radiologic findings in a 67-year-old man with moderately differentiated squamous cell carcinoma. (a) Posteroanterior radiograph shows a mass (*) overlapping aspects of the left hilum. (b) Lateral radiograph shows a homogeneous area of increased opacity (*) within the superior segment of the left lower lobe. Cutoff of the superior segmental bronchus (arrow) suggests that much of the area of increased opacity could represent postobstructive pneumonia. (c) CT image obtained at the level of the left pulmonary artery shows the mass with regions of necrosis within it (*). The anterior aspect of the lesion appears to invade the mediastinum posterior to the artery (arrowheads). (d) CT image obtained at the level of the right pulmonary artery shows involvement of the posterior left hilum with cutoff of the superior segmental bronchus (arrowhead) and subcarinal lymphadenopathy (arrow). It is difficult to distinguish necrosis within the mass from necrosis within postobstructive pneumonia. (e) CT image obtained after RT shows stabilized sequelae of the therapy. Note the volume loss in the region of the original mass with associated radiation bronchiectasis (arrowheads).

View larger version (116K): [in a new window]   Figure 5c.   Radiologic findings in a 67-year-old man with moderately differentiated squamous cell carcinoma. (a) Posteroanterior radiograph shows a mass (*) overlapping aspects of the left hilum. (b) Lateral radiograph shows a homogeneous area of increased opacity (*) within the superior segment of the left lower lobe. Cutoff of the superior segmental bronchus (arrow) suggests that much of the area of increased opacity could represent postobstructive pneumonia. (c) CT image obtained at the level of the left pulmonary artery shows the mass with regions of necrosis within it (*). The anterior aspect of the lesion appears to invade the mediastinum posterior to the artery (arrowheads). (d) CT image obtained at the level of the right pulmonary artery shows involvement of the posterior left hilum with cutoff of the superior segmental bronchus (arrowhead) and subcarinal lymphadenopathy (arrow). It is difficult to distinguish necrosis within the mass from necrosis within postobstructive pneumonia. (e) CT image obtained after RT shows stabilized sequelae of the therapy. Note the volume loss in the region of the original mass with associated radiation bronchiectasis (arrowheads).

View larger version (117K): [in a new window]   Figure 5d.   Radiologic findings in a 67-year-old man with moderately differentiated squamous cell carcinoma. (a) Posteroanterior radiograph shows a mass (*) overlapping aspects of the left hilum. (b) Lateral radiograph shows a homogeneous area of increased opacity (*) within the superior segment of the left lower lobe. Cutoff of the superior segmental bronchus (arrow) suggests that much of the area of increased opacity could represent postobstructive pneumonia. (c) CT image obtained at the level of the left pulmonary artery shows the mass with regions of necrosis within it (*). The anterior aspect of the lesion appears to invade the mediastinum posterior to the artery (arrowheads). (d) CT image obtained at the level of the right pulmonary artery shows involvement of the posterior left hilum with cutoff of the superior segmental bronchus (arrowhead) and subcarinal lymphadenopathy (arrow). It is difficult to distinguish necrosis within the mass from necrosis within postobstructive pneumonia. (e) CT image obtained after RT shows stabilized sequelae of the therapy. Note the volume loss in the region of the original mass with associated radiation bronchiectasis (arrowheads).

View larger version (129K): [in a new window]   Figure 5e.   Radiologic findings in a 67-year-old man with moderately differentiated squamous cell carcinoma. (a) Posteroanterior radiograph shows a mass (*) overlapping aspects of the left hilum. (b) Lateral radiograph shows a homogeneous area of increased opacity (*) within the superior segment of the left lower lobe. Cutoff of the superior segmental bronchus (arrow) suggests that much of the area of increased opacity could represent postobstructive pneumonia. (c) CT image obtained at the level of the left pulmonary artery shows the mass with regions of necrosis within it (*). The anterior aspect of the lesion appears to invade the mediastinum posterior to the artery (arrowheads). (d) CT image obtained at the level of the right pulmonary artery shows involvement of the posterior left hilum with cutoff of the superior segmental bronchus (arrowhead) and subcarinal lymphadenopathy (arrow). It is difficult to distinguish necrosis within the mass from necrosis within postobstructive pneumonia. (e) CT image obtained after RT shows stabilized sequelae of the therapy. Note the volume loss in the region of the original mass with associated radiation bronchiectasis (arrowheads).

View larger version (200K): [in a new window]   Figure 6.   Squamous cell carcinoma. Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows individual keratinization (arrow) and intercellular bridges (arrowhead).

View larger version (183K): [in a new window]   Figure 7.   Poorly differentiated squamous cell carcinoma. Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows polygonal tumor cells. Keratinization and intercellular bridges are not easily discernible. The tumor resembles large cell carcinoma.

View larger version (130K): [in a new window]   Figure 8a.   Radiologic findings in a 38-year-old man with shoulder pain who was found to have a left apical mass; biopsy revealed poorly differentiated adenocarcinoma. (a) CT image obtained at the thoracic inlet shows extensive involvement of the area with encasement of the left subclavian artery (arrowhead) but no evidence of osseous involvement. Abutment of the mass with the posterior aspects of more anterior vessels (arrows) does not confirm invasion of these structures. (b) Axial MR image shows encasement of the proximal left subclavian artery (arrowheads) and abutment of the mass with the trachea (T), a vertebral body (V), and anterior vessels (arrows). (c) Coronal MR image shows encasement of the left subclavian artery (arrowheads) by the mass. Proximal nerve roots of the brachial plexus (long arrow) appear intact. The appearance of invasion into a vertebral body (short arrow) is a volume-averaging phenomenon, as the vertebral body was intact at evaluation of the full set of coronal images.

View larger version (157K): [in a new window]   Figure 8b.   Radiologic findings in a 38-year-old man with shoulder pain who was found to have a left apical mass; biopsy revealed poorly differentiated adenocarcinoma. (a) CT image obtained at the thoracic inlet shows extensive involvement of the area with encasement of the left subclavian artery (arrowhead) but no evidence of osseous involvement. Abutment of the mass with the posterior aspects of more anterior vessels (arrows) does not confirm invasion of these structures. (b) Axial MR image shows encasement of the proximal left subclavian artery (arrowheads) and abutment of the mass with the trachea (T), a vertebral body (V), and anterior vessels (arrows). (c) Coronal MR image shows encasement of the left subclavian artery (arrowheads) by the mass. Proximal nerve roots of the brachial plexus (long arrow) appear intact. The appearance of invasion into a vertebral body (short arrow) is a volume-averaging phenomenon, as the vertebral body was intact at evaluation of the full set of coronal images.

View larger version (138K): [in a new window]   Figure 8c.   Radiologic findings in a 38-year-old man with shoulder pain who was found to have a left apical mass; biopsy revealed poorly differentiated adenocarcinoma. (a) CT image obtained at the thoracic inlet shows extensive involvement of the area with encasement of the left subclavian artery (arrowhead) but no evidence of osseous involvement. Abutment of the mass with the posterior aspects of more anterior vessels (arrows) does not confirm invasion of these structures. (b) Axial MR image shows encasement of the proximal left subclavian artery (arrowheads) and abutment of the mass with the trachea (T), a vertebral body (V), and anterior vessels (arrows). (c) Coronal MR image shows encasement of the left subclavian artery (arrowheads) by the mass. Proximal nerve roots of the brachial plexus (long arrow) appear intact. The appearance of invasion into a vertebral body (short arrow) is a volume-averaging phenomenon, as the vertebral body was intact at evaluation of the full set of coronal images.

View larger version (209K): [in a new window]   Figure 9.   Poorly differentiated adenocarcinoma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows solid and poorly formed glandular components (arrows).

View larger version (206K): [in a new window]   Figure 10.   Moderately differentiated adenocarcinoma. Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows glands (arrows) formed by the tumor cells as well as a solid component (arrowhead).