PULMONARY NEOPLASMS QUESTIONS AND ANSWERS A+
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SPN?
solitary pulmonary nodule
SPN aka...
coin lesion
define SPN
isolated
not associated w/ infiltrate, atelectasis, adenopathy
<= 3 cm
CP for SPN
A/Sx
found incidentally on DX testing
most common etiologies for SPN
1. cancer (primary or metastatic)
2. infectious granuloma (TB/cocci/histo/blasto)
3. hamartoma ("popcorn calcifications")
4. scarring from previous infxn
most common SPN etiology
hamartoma (popcorn calcifications)
histoplasmosis/blastomycosis geographical predominance
central and east coast
Cocciodiomycosis geographical predominance
southwest region
alternative etiologies associated with SPN
1. vascular abnormalities
2. inflammatory abnormalities
3. infectious infiltration
4. misc (nipple shadow, amyloid)
what to consider in the evaluation of SPN?
1. age of patient
2. smoking HX
3. recent travel/place of living
4. recreational activities (hiking? cave diving?)
5. occupational (mechanic? roofer? farmer?)
6. reviewing and comparing current and previous diagnostics imaging
what is considered "low risk" for SPN risk assessment?
<30 y.o.
stable lesion for >= 2 yrs
characteristic benign calcification pattern
what is considered "high risk" for SPN risk assessment?
personal or family HX of cancer (previous TX w/ radiation, increased susceptibility to a
future cancer)
, abnormal nodule appearance
HX of smoking
upper lobe location
compare and contrast a benign vs. malignant SPN suggestions
types of calcifications of SPN
benign vs malignant SPN CT scan finding
what is the size cutoff for SPNs that would differentiate between low risk and
intermediate risk management?
>8mm
high risk = >8mm w/ smoking HX
average age of lung cancer DX
70 y.o.
risk factors associated with lung cancer
1. smoking HX (dose-risk relationship, includes 2nd hand smoke)
2. individual genetic susceptibility
3. asbestos exposure
4. previous radiation therapy to chest
5. personal/family HX of lung cancer
6. radon exposure
7. air pollution
8. COPD
9. pulmonary fibrosis
lung cancer w/o tobacco exposure risk factors
women>
Asian>
genetic component (Li-Fraumeni syndrome, EGFR pathogenic variants, possibly
BRCA2)
how is lung cancer categorized?
Small cell vs non-small cell
how can non-small cell be further categorized?
adenocarcinoma
squamous cell
large cell
describe key characteristics of adenocarcinoma
most common (95% smokers)
slow growing
malignancy developing from mucus glands or epithelial cells within or distal to
terminal bronchioles
what type of nodules are commonly associated with adenocarcinoma?
peripheral nodules or masses
Describe Adenocarcinoma in situ in the lungs
well-differentiated, dysplastic columnar cells
ground glass nodules on CT scan
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