Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2] ## Overview[edit | edit source] Adenocarcinoma of the lung must be differentiated from atypical adenomatous hyperplasia of the lung, adenocarcinoma in situ, squamous cell carcinoma of the lung, small cell carcinoma of the lung, malignant mesothelioma, and metastatic adenocarcinoma. ## Differentiating Adenocarcinoma of the Lung from other Diseases[edit | edit source] Adenocarcinoma of the lung must be differentiated from:[1] * Atypical adenomatous hyperplasia of the lung * Adenocarcinoma in situ * Squamous cell carcinoma of the lung * Small cell carcinoma of the lung * Malignant mesothelioma * Metastatic adenocarcinoma * Colorectal adenocarcinoma * Breast adenocarcinoma * Invasive ductal carcinoma of the breast * Invasive lobular carcinoma * Amyloidosis * Pulmonary tuberculosis * Non-Hodgkin's lymphoma (NHL) * Hodgkin's lymphoma * Thymoma * Tracheal tumors * Thyroid mass * Arteriovenous malformation * Wegener's granulomatosis * Sarcoidosis * Lung abscess[2] * Pneumonia * Fungal infection * Chronic eosinophilic pneumonia[3] ## Differentiating Lung Cancer from Other Diseases[edit | edit source] ##### Lung cancer must be differentiated from other cavitary lung lesions. The table below summarizes the differentiation:[edit | edit source] Causes of lung cavities | Differentiating Features | Differentiating radiological findings | Diagnosis confirmation | | | * Malignancy (Primary lung cancer)[4] * Elderly male or female[4] * Chronic smokers * Presents with a low-grade fever, absence of leukocytosis, systemic complaints weight loss, fatigue * Absence of factors that predispose to gastric content aspiration, no response to antibiotics within 10 days * Hemoptysis is commonly associated with bronchogenic carcinoma * A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities[5] [6] * Bronchoalveolar lavage cytology shows malignant cells * Biopsy of lung * Pulmonary Tuberculosis * Mostly in endemic areas * Symptoms include productive cough, night sweats, fever, and weight loss * CXR and CT demonstrates cavities in the upper lobe of the lung * Sputum smear positive for acid-fast bacilli and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria. * Necrotizing Pneumonia * Any age group * Acute, fulminant life threating complication of prior infection * >100.4 °F fever, with hemodynamic instability * Worsening pneumonia-like symptoms * CXR demonstrates multiple cavitary lesions * Pleural effusion and empyema are common findings * CBC is positive for causative organism * Loculated empyema * Children and elderly are at risk * Pleuritic chest pain, dry cough, fever with chills * Dullness to percussion decreased breath sounds, and reduced vocal resonance on examination * Empyema appears lenticular in shape and has a thin wall with smooth luminal margins * Thoracocentesis * Granulomatosis with polyangiitis (Wegener's)[7] * Women are more commonly effected than man[8] * Kidneys are also involved * Upper respiratory tract symptoms, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis. * Lower respiratory tract symptoms (e.g. hemoptysis, cough, dyspnea) * Renal symptoms, hematuria, red cell casts * Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR * Positive for P-ANCA * Biopsy of the tissue involved shows necrotizing granulomas[7] * Rheumatoid nodule * Elderly females of 40-50 age group * Manifestation of rheumatoid arthritis * Presents with other systemic symptoms including symmetric arthritis of the small joints of the hands and feet with morning stiffness are common manifestations * Pulmonary nodules with cavitation are located in the upper lobe (Caplan syndrome) on X-ray * Positive for both rheumatoid factor and anticyclic citrullinated peptide antibody. * Sarcoidosis * More common in African-American females * Often asymptomatic except for enlarged lymph nodes[9] * Associated with restrictive lung disease * Erythema nodosum * Lupus pernio (skin lesions on face resembling lupus) * Bell palsy * Epithelioid granulomas containing microscopic Schaumann and asteroid bodies * On CXR bilateral adenopathy and coarse reticular opacities are seen * CT of the chest demonstrates extensive hilar and mediastinal adenopathy * Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.[10] * Biopsy of lung shows non-caseating granuloma * Bronchiolitis obliterans (Cryptogenic organizing pneumonia)[11][12] * Rare condition and mimics asthma, pneumonia and emphysema * It is caused by drug or toxin exposure, autoimmune diseases, viral infections, or radiation injury * People working in industries are at high risk * Presents with fever, cough, wheezing, and shortness of breath over weeks to months[13] * Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.[14] * Biopsy of the lung[12] * Pulmonary function tests demonstrate low fev1/fvc * Langerhans cell Histiocytosis[15] * Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years * Clinical presentation varies, but symptoms generally include months of dry cough, fever, night sweats, and weight loss * Skin is involved in 80% of the cases, scaly erythematous rash is typical * Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.[16] * Biopsy of the lung ### The following table summarizes the differentiation of various lung tumors based on histological and topographical features:[17][edit | edit source] Abrevations: HPV: human papillomavirus; CEA: Carcino embryogenic antigen; TTF1: Thyroid transcription factor-1; EMA: Epithelial membrane antigen; CK: Cyto keratin; CD: Cluster differentiation; NCAM: Neural Cell Differentiation Molecule; MMP's: Mettaloprotineases matrix ; GFAP: Glial fibrocilliary acid protein Benign Lung Tumors[18] Benign lung tumor | Risk/Epidemiology | Pleuripotent cells | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Papilloma[19] | Squamous cell papilloma | * HPV 6 and 11 * Men * Median age of diagnosis is 54 years * Epithelial cells * Endobronchial * Cauliflower-like lesions * Tan-white soft to semifirm protrutions * Loose fibrovascular core * Stratified squamous epithelium * Acanthosis * Binucleate forms and perinuclear halos * Koilocytosis * N/A * Well circumscribed * Homogenous * Non-calcified * Solitary mass * N/A Glandular papilloma | * Rare * Mean age of diagnosis is 68 years * Goblet cells of respiratory epithelium * Endobronchial * White to tan endobronchial polyps that measure from 0.7-1.5 cm * Thick arborizing stromal stalks * Thin-walled blood vessels * Non-ciliated or ciliated epithelium * N/A * Well circumscribed * Homogenous * Non-calcified * Solitary mass * N/A Adenoma[20] | Alveolar adenoma | * Mean age of diagnosis is 53 years * Female predominance * Alveolar pneumocytes * Septal mesenchyme * All lung lobes * Lower lobes * Hilar * 0.7-6.0 cm * Well demarcated smooth * Lobulated, multicystic * Soft to firm * Pale yellow to tan cut surfaces * Non-encapsulated * Multicystic masses * Cuboidal cell linning * Squamous metaplasia * Myxoid and collagenous interstitium * Keratin * CEA * Surfactant protein * TTF-1 * Actin * Well circumscribed * Homogenous * Non-calcified * Solitary mass * N/A Papillary adenoma[21] | * Mean age of diagnosis is 32 years * Male predominance * Bronchioloalveolar cell * No lobar predilection * Involves alveolar parenchyma * Well defined * Encapsulated * Soft, spongy to firm mass * Granular gray white/ brown * 1.0- 4.0 cm * Infiltration * Papillary growth pattern * Fibrovascular cores * Cuboidal to columnar epithelial linning * Cilitated and oxyphilic cells * Occasional eosinophilic intranuclear inclusions * Cytokeratin * Clara cell protein * TTF-1 * Surfactant apoprotein * CEA * Incidental finding * N/A Mucinous cystadenoma | * No sex predilection * Mean age of diagnosis is 52 years * Mucus glands of the bronchus * Central * White-pink to tan * Smooth and shiny tumors * Gelatinous mucoid solid core * 0.7-7.5 cm * Numerous mucin-filled cystic spaces * Non-dilated microacini, glands, tubules and papillae * EMA * Cytokeratins * CEA * Coin lesion * Air-meniscus sign * N/A Malignant Lung Tumors[22] Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Squamous cell carcinoma (SCC)[23] | Papillary | * Cigarette smokers * Arsenic * Epithelial cells * Central * White or grey lesions * Focal carbon pigment deposits * Cavitations * Intraluminal polypoid masses * Infiltration * Exophytic * Intra-epithelial * Without invasion * Keratin * Cytokeratins * CEA * Thyroid transcription factor-1 (TTF-1) * Lobar or entire lung collapse * Shift of the mediastinum to the ipsilateral side * Hilar, perihilar or mediastinal masses * Liver * Breast * Bone Clear cell | * Cells with clear cytoplasm Basaloid | * Peripheral palisading of nuclei. * Poor differentiation Small cell carcinoma[24] | * Smoking * Radon exposure * Bronchial precursor cell * Peripheral * White-tan, soft, friable perihilar masses * Extensive necrosis * 5% peripheral coin lesions * Sheet-like growth * Nesting * Trabeculae * Peripheral palisading * Rosette formation * High mitotic rate * CD56 * Chromogranin * Synaptophysin * TTF-1 * Hilar or perihilar masses * Mediastinal lymphadenopathy * Lobar collapse * Bone marrow * Liver Adenocarcinoma[25][26][27] | Acinar adenocarcinoma | * Smoking * Columnar cells of bronchioles * Peripheral * Single or multiple lesions * Different in size * Peripheral distribution * Gray-white central fibrosis * Pleural puckering * Anthracotic pigmentation * Necrosis * Cavitation * Hemorrhage * Lobulated or ill defined edges * Irregular-shaped glands * Malignant cells: * Hyperchromatic nuclei * Fibroblastic stroma * Epithelial markers * CEA * CK7 * TTF-1 * Peripheral nodules under 4.0 cm in size * Central location as a hilar or perihilar mass * Rarely show cavitations. * Hilar adenopathy * Adenocarcinomas account for the majority of small peripheral cancers identified radiologically. | Aerogenous spread is characteristic * Brain * Bone * Adrenal glands * Liver * Kidney * Gastrointestinal Tract Papillary adenocarcinoma | * Papillae * Necrosis * Surrounding invasion * Cuboidal to columnar epithelial linning * Mucinous or non-mucinous Bronchio-alveolar carcinoma | Non-mucinous | * Clara cells * Type II cells Mucinous | * Low grade differentiation * Composed of: * Tall columnar cells * Basal nuclei * Pale cytoplasm resembling goblet cells * Varying amounts of cytoplasmic mucin * Cytologic atypia Mixed non-mucinous and mucinous or indeterminate | * Mixed type of cells * Low to high grade differentiated cells. Solid adenocarcinoma with mucin production | Fetal adenocarcinoma | * Consists glandular elements: * Tubules of glycogen-rich * Non-ciliated cells * Subnuclear and supranuclear glycogen vacuoles * Rounded morules of polygonal cells with abundant eosinophilic and finely granular cytoplasm Mucinous (“colloid”) carcinoma | * Dissecting pools of mucin containing neoplastic cells Mucinous cystadenocarcinoma | * Partial fibrous tissue capsule * Central cystic change with mucin pooling * Neoplastic mucinous epithelium grows along alveolar walls Signet ring adenocarcinoma | * Focal * Cells with nuclei displaced to sides * Components of other cells are present. Clear cell adenocarcinoma | * Clear cells with no nuclei Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Large cell carcinoma[28] | Basaloid large cell carcinoma of the lung | * Approximately 10% of lung cancers * Smoking * Neuro endocrine cells * Suprabasal bronchial cells * Peripheral masses * Bronchi * Soft, pink-tan tumor * Necrosis and occasional hemorrhage * Cavitations * Exophytic bronchial growth * Invasive growth pattern * Peripheral palisading * Small, monomorphic, cuboidal fusiform * Chromogranin * Synaptophysin * CD56 * Cytokeratin * Large, peripheral masses * Pleura * Liver * Bone * Brain * Abdominal lymph nodes * Pericardium Clear cell carcinoma of the lung | * Clear cells Lymphoepithelioma-like carcinoma of the lung | * Syncytial growth pattern * Eosinophilic nucleoli * Lymphocytic infiltration * Invasive * Amyloid deposition Large-cell lung carcinoma with rhabdoid phenotype | * Eosinophilic cytoplasmic globules * Small foci of adenocarcinoma * Eosinophilic inclusions Mixed type | * Mixture of: * Adenocarcinoma * Squamous cell carcinoma * Giant cell carcinoma * Spindle cell carcinoma Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Sarcomatoid carcinoma[29] | Carcinosarcoma | * Accounts for only 0.3-1.3% of all lung malignancies * Mean age at diagnosis is 60 years * Tobacco smoking * Asbestos exposure * Undifferentiated epithelial cells * Central or peripheral * Upper lobes * > 5 cm * Well circumscribed * Grey, yellow or tan creamy, gritty, * Mucoid and/or hemorrhagic with significant necrosis * Sessile or pedunculated * Infiltrative * Biphasic * Mixture of carcinomatous and sarcomatous cells * Keratin * S-100 * No specific imaging features * Aggressive tumor * Esophagus, jejunum, and rectum * Kidney Spindle cell carcinoma | * Only spindle shaped tumor cells * Lymphoplasmacytic infiltrates * Keratin * EMA * Cytokeratin * Vimentin * CEA * TTF-1 Giant cell carcinoma | * Multi- and/or mononucleated tumor giant cells Pleomorphic carcinoma | * Poorly differentiated * Mixture of spindle cells and/or giant cells * Fibrous or myxoid stroma Pulmonary blastoma | * Biphasic * Mixture of epithelial and mesenchymal stroma * Keratin * EMA * CEA * Chromogranin A Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Carcinoid tumor[30] | Typical carcinoid Atypical carcinoid * Most common in males * Mean age of diagnosis 45 * Neuroendocrine cells of lung * Typical carcinoids are throughout the lungs * Atypical carcinoid is more commonly peripheral * Firm, well demarcated, tan to yellow tumors * Uniform polygonal cells * Nuclear atypia * Pleomorphism * The most common patterns are the organoid and trabecular * Highly vascularized fibrovascular stroma * Focal necrosis * Cytokeratin * Chromogranin * Synaptophysin * CD57 * CD56 * S-100 protein * Well defined pulmonary nodules * Calcifications is often seen. * Intense contrast enhancement * Liver * Bone Salivary gland tumors[31] | Mucoepidermoid carcinoma | * Most patients presents in the third and fourth decade * Constitutes of less than 1% tumor * No association with cigarette smoking or other risk factors * Primitive cells of tracheobronchial origin * Bronchial glands * Ranging in size from 0.5-6 cm * Soft, polypoid, and pink-tan in colour * High-grade lesions are infiltrative * Exophytic endobronchial growth * Surface epithelium lacking changes of in-situ carcinoma * Absence of individual cell keratinization * Transitional areas to low grade mucoepidermoid carcinoma * GFAP * Well-circumscribed oval or lobulated mass * Calcifications * Post-obstructive pneumonic infiltrates * Rare * Liver * Bones * Adrenal gland * Brain Adenoid cystic carcinoma | * Constitutes less than 1% of all lung tumors * Most commonly seen in fourth and fifth decades of life * Primitive cells of tracheobronchial origin * Trachea * Gray-white or tan polypoid lesions * Size ranges from 1–4 cm * Infiltrative margins * Invades other cell layers * Heterogeneous cellularity * Cribriform pattern * Perineural invasion * Immunoperoxidase * Cytokeratin * Vimentin * Actin * Calponin * S-100 protein * p53 * GFAP * Well circumscribed * Nodule * Liver * Brain * Bone * Spleen * Kidney * Adrenal glands Epithelial-myoepithelial carcinoma | * Age ranges from 33 to 71 years * No association with smoking * Myoepithelial cells * Endobronchial * Solid to gelatinous in texture * White to gray in colour * Myoepithelial cells * Dual layer of cells lining ducts * Low mitotic activity * MNF116 * EMA * SMA and S-100 * Reflects airway obstruction * Breast Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Preinvasive lesions[32] | Squamous carcinoma in situ | * Most commonly seen in fifth or sixth decades * Mostly seen in women * Basal cells of squamous epithelium * Bronchi * Focal or multi-focal plaque-like greyish lesions * Nonspecific erythema * Even nodular or polypoid lesions * Goblet cell hyperplasia * Basal cell hyperplasia * Squamous dysplasia * Angiogenic squamous dysplasia * Micropapillomatosis * EGFR * HER2/neu * p53 * MCM2 * Ki-67 * Cytokeratin 5/6 * Bcl-2 * VEGF * Folate binding protein * p16 * Cauliflower like * Mosaic pattern * Liver * Brain * Bone * Spleen Atypical adenomatous hyperplasia | * Surfactant apoprotein * Clara cell specific 10kDd protein * Pleura * Upper lobes * Multiple grey to yellow foci * 1mm to 10mm in size * Intranuclear inclusions * Clara cells and type II pneumocytes * Thickened alveolar walls * Discontinuous lining of cells * Moderate atypia * Pseudopapillae * CEA * MMPs * E-cadherin * ß-catenin * CD44v6 * TTF-1 * TP53 * Typically not visualized on radiographs * Small non-solid nodules * Ground-glass opacity Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia | * Pulmonary neuroendocrine cells * Endobronchial * Early lesions are: * Small, gray-white nodules * Resembling ‘miliary bodies’ * Larger carcinoid tumors are: * Firm * Homogeneous * Well-defined * Grey or yellow-white masses * Nodular aggregates * Fibrosis due to proliferation * Invade locally * Fibrous stroma aggregates to form ‘tumorlets’. * Carcinoids are tumorlets >5cm. * Keratin * CEA * Mosaic pattern of air trapping * Sometimes with nodules * Thickened bronchial and bronchiolar walls Variants of lung carcinoma | Risk Factors/Epidemiology | Pleuripotent cell | Topography | Gross | Histology | Immunohistochemistry | Imaging | Metastasis Mesenchymal tumors[33] | Epithelioid haemangioendothelioma / Angiosarcoma | * Caucasian * 80% are women * Endothelial cells * Intravascular * 0.3-2.0 cm circumscribed mass * Gray-white or gray-tan firm tissue * Yellow flecks * Central calcifications * Cut surface has a cartilaginous consistency * Round to oval-shaped nodules * Central sclerosis * Hypocellular zone * Peripheral cellular zone * Calcifications * Intranuclear cytoplasmic inclusions * CD31 * CD34 * Factor VIII (von Willebrand factor) * Cytokeratin * Multiple * Bilateral * Small nodules * 1-2 cm in size * Can mimic pulmonary Langerhans’ cell histiocytosis. * Calcifications * Liver * Bone * Soft tissue Pleuropulmonary blastoma | * Most common in children * Median age of diagnosis is 2 years * Thoracic splanchnopleural mesenchyme * Pleura * Lung * Purely cystic * Thin-walled * Rarely solid * Firm to gelatinous * Upto 15 cm * Type I * Purely cystic * Lined by respiratory type epithelium * Underneath malignant cells * Type II * Partial or complete overgrowth of the septal stroma * Type III * Mixed cells * Vimentin * S-100 protein * Unilateral * Localized airfilled cysts * Septal thickening or an intracystic mass * Brain * Spinal cord * Skeletal system * Eyes * Pancreas Chondroma | * Young women * Chondrocytes * Cartilaginous cells * Peripheral lesions in lung * Primary lesion seen in * Stomach * Bone * Paraganglia * Peripheral * Solid lesions * Calcified * Capsulated lobules * Hypocellular * Features of malignancy are absent * N/A * Multiple * Well circumscribed lesions * “Pop-corn” calcifications * Benign in nature Congenital peribronchial myofibroblastic tumor | * Rare * Sporadic * Complicated by * Polyhydramnios * Non-immune hydrops fetalis * Spindle cells * Along the bronchi * 5-10 cm * Well-circumscribed * Non-encapsulated * Smooth or multinodular surface * The cut surface has a tann-grey to yellow-tan fleshy appearance * Hemorrhage * Necrosis * Fascicles of spindle cells * Bronchial invasion * Peribronchial distribution * Cystic foci of hemorrhage * Vimentin * Well circumscribed * Opaque hemithorax * Heterogeneous mass * Rare Diffuse pulmonary lymphangiomatosis | * Children * Young adults of both sexes * Smooth muscle cells of lymphatic vessels * Along the lymphatic distribution * Prominence of the bronchovascular bundles along * Pleura * Interlobular pulmonary septa * Mediastinum * Anastomosing endothelial-lined cells along lymphatic routes * Spindle cells * Intra alveolar siderophages * Vimentin * Increased interstitial markings * Thickening of the: * Interlobular septa * Fissures * Central airways * Pleura * Skin * Bone Inflammatory myofibroblastic tumor | * Previous viral infections * HHV8 * Children * Myofibroblastic cells * Localized to bronchi * Solitary * Round rubbery masses * Yellowish-gray discoloration * Average size of 3.0 cm * Non-encapculated * Calcifications * No local invasion * Mixture of spindle cells * Fibroblastic * Myofibroblastic * Arranged in fascicles * Cytologic atypia * Touton type giant cells * Plasma cells * Lymphoid follicles * Vimentin * Actin * p80 * Solitary mass * Regular borders * Spiculated appearance * Accompanied by * Post-obstructive pneumonia * Atelectasis * Rare Pulmonary artery sarcoma | * Mean age of diagnosis is 49.3 years * Commonly misdiagnosed as pulmonary embolism * Mesenchymal cells of the intima * Primitive cells of the bulbus cordi in the trunk of pulmonary artery * Pulmonary trunk most commonly involving: * Right pulmonary artery * Left pulmonary artery * Pulmonary valve * Right ventricular outflow tract * Mucoid or gelatinous clots filling vascular lumens * The cut surface may show * Firm fibrotic areas * Bony/gritty or chondromyxoid foci * Hemorrhage and necrosis are common in high-grade tumors * Spindle cells in * A myxoid background * Collagenized stroma * Recanalized thrombi * Vimentin * Osteopontin * Factor VIII * CD31 * CD34 * Findings overlap with those of chronic thromboembolic disease * Decreased vascularity * Heterogeneous soft tissue density * Smooth vascular tapering * Lung parenchyma * Mediastinum Pulmonary vein sarcoma | * Most common in women * Mean age of diagnosis is 49 * Smooth muscle * Pulmonary vein * Fleshy-tan tumor * Can occlude the lumen of the involved vessel * 3.0- 20.0 cm * Invasion of wall of the vein * Smooth muscle differentiation * Moderate to highly cellular spindle cell neoplasms * Epithelioid morphology * Vimentin * Desmin * Actin * Keratin * N/A ### The following table summarizes the differentiation of lung cancer from other disease entities with similar presentation.[4][5][7][34][15][edit | edit source] Disease | Clinical features Signs & symptoms | Radiological Findings | Characterstic feature | | | Fever | Cough | Hemoptysis | Dyspnea | Chest pain | Weight loss | Night sweats High-grade | Low grade | Productive | Dry Acute Lung abscess | \+ | \- | \+ | \- | \- | \- | \+ | \- | - | * Air fluid level * Foul smelling sputum * H/o of prior infection or hospitalization * Associated with risk factors like aspiration and alcoholism Malignancy (primary lung cancer) | \- | \+ | \- | \+ | \+ | \- | \- | \+ | \+ | * Coin-shaped lesion * Thick wall(>15mm) * Ground glass opacities * Long h/o smoking * Elderly male or female * Broncho-alveolar lavage positive for malignant cells * CT guided biopsy is required for confirmation and differentiation Pulmonary Tuberculosis | \+ | \- | \+ | \- | \+ | \- | \- | \- | \+ | * Cavitations in the upper lobe of the lung * People in endemic at high risk * Cough >2 weeks with hemoptysis * Acid fast stain positive for mycobacteria Necrotizing Pneumonia | \+ | \- | \+ | | \+ | \- | \+ | \- | \- | * Multiple cavitary lesions * Acute life-threatening condition * Complication of pneumonia or lung abscess * Multiple organisms responsible * Prompt treatment with antibiotics is required * Blood culture positive for causative organism Empyema | \+ | \- | \+ | \- | \+ | \+ | \+ | \- | \- | * Homogeneous consolidations * Blood culture positive for the causative agent Bronchiectasis | \- | \- | \+ | \- | \+ | \- | \- | \- | \- | * Linear lucencies * Tram tracking appearance * Clustered cysts * Increased pulmonary markings * Honeycombing * Atelectasis * CT confirms the diagnosis Wegners granulomatosis | \- | \- | \+ | | \+ | \+ | \- | \- | \- | * Pulmonary nodules * Cavities * Infiltrates * Seen mostly in female age group of 40-55 years * Traid of Upper , lower respiratory tract and kidney disease * Biopsy of involved organ confirms granulomas Sarcoidosis | \+ | \- | \+ | \- | \+ | \- | \- | \+ | \+ | * Bilateral adenopathy * Coarse reticular opacities * More common in African-american females * Restrictive lung disease * Biposy findings: epithelioid,granulomas, schaumann, asteroid bodies. Rheumatoid nodule | \- | \- | \- | \- | \- | \+ | \- | \+ | \- | * Pulmonary nodules * Cavitations on the upper lobe of lung * Rheumatoid arthritis * Positive for RF and ACP Langerhans cell Histiocytosis | \- | \- | \- | \- | \- | \+ | \+ | \+ | \- | * Thin-walled cystic cavities * Exclusively afflicts smokers * Musculoskeletal and skin is involved * Biopsy of the involved organ Bronchiolitis obliterans | \- | \- | \+ | \- | \+ | \+ | \+ | \- | \- | * Patchy consolidation, * Ground-glass opacities * Nodules * Biopsy ## References[edit | edit source] 1. ↑ Adenocarcinoma of the lung. Librepathology 2015. http://librepathology.org/wiki/index.php/Adenocarcinoma_of_the_lung 2. ↑ Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S (2011). "[Lung abscess which needed to be distinguished from lung cancer; report of a case]". Kyobu Geka. 64 (13): 1204–7. PMID 22242302.CS1 maint: Multiple names: authors list (link) 3. ↑ Matsuoka T, Uematsu H, Iwakiri S, Itoi K (2013). "[Chronic eosinophilic pneumonia presenting as a solitary nodule, suspicious of lung cancer;report of a case]". Kyobu Geka. 66 (10): 941–3. PMID 24008649.CS1 maint: Multiple names: authors list (link) 4. ↑ 4.0 4.1 4.2 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362. 5. ↑ 5.0 5.1 Mouroux J, Padovani B, Elkaïm D, Richelme H (1996). "Should cavitated bronchopulmonary cancers be considered a separate entity?". Ann. Thorac. Surg. 61 (2): 530–2. doi:10.1016/0003-4975(95)00973-6. PMID 8572761. 6. ↑ Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM (2005). "Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome". Radiology. 237 (1): 342–7. doi:10.1148/radiol.2371041650. PMID 16183941. 7. ↑ 7.0 7.1 7.2 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211. 8. ↑ Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ (2003). "Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients". Eur Radiol. 13 (1): 43–51. doi:10.1007/s00330-002-1422-2. PMID 12541109. 9. ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R (2001). "Clinical characteristics of patients in a case control study of sarcoidosis". Am. J. Respir. Crit. Care Med. 164 (10 Pt 1): 1885–9. doi:10.1164/ajrccm.164.10.2104046. PMID 11734441. 10. ↑ Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H (1989). "Pulmonary sarcoidosis: evaluation with high-resolution CT". Radiology. 172 (2): 467–71. doi:10.1148/radiology.172.2.2748828. 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