Lung
Other tumors
Metastases


Topic Completed: 1 February 2018

Minor changes: 16 September 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: Metastatic lung tumor [title]

Roseann Wu, M.D., M.P.H.
Page views in 2019: 4,469
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Cite this page: Wu R. Metastases. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumormetastases.html. Accessed September 28th, 2020.
Definition / general
  • Lung is a common site of metastases; usually multiple, bilateral, sharply outlined, rapidly growing, more pleomorphic and necrotic than lung primaries
  • May appear as multiple discrete nodules in periphery of lung or as lymphangitic carcinomatosis (peribronchial and perivascular patterns via lymphatics)
  • Rarely appear as intralymphatic microscopic foci that cause pulmonary hypertension
  • Metastases can also be from other lung primaries (Am J Surg Pathol 2009;33:1752)
Essential features
  • Lung is a common site of metastatic disease and may be the first or only site of metastatic involvement
  • Lung metastases are generally multiple, well circumscribed and tend to grow rapidly
  • A history of malignancy is helpful in determining the primary site but a panel of immunohistochemical stains can help support the diagnosis
ICD coding
  • ICD-10: C78.00 - Secondary malignant neoplasm of unspecified lung
  • ICD-10: C78.01 - Secondary malignant neoplasm of right lung
  • ICD-10: C78.02 - Secondary malignant neoplasm of left lung
Epidemiology
  • In autopsy studies, 20 - 50% of patients with malignancy had lung metastasis (Cancer 1981;47:2595)
Sites
  • Generally peripheral lung but can also be endobronchial
Pathophysiology
Etiology
  • Mostly hematogenous or lymphogenous spread from primary site
Clinical features
  • Usually asymptomatic or may present with nonspecific cough, chest pain, hemoptysis, spontaneous pneumothorax (J Surg Oncol 2014;109:42)
Diagnosis
  • Typically detected by imaging, specifically CT scans
  • Confirmation by cytologic or histologic sampling
Radiology description
  • CT scans are preferred modality
  • Single or multiple, peripheral, well circumscribed nodule(s)
  • Limited detection of subcentimeter disease
Radiology images

Contributed by Fulvio Lonardo, M.D.
Pancreas: adenocarcinoma

Pancreas: adenocarcinoma



Images hosted on other servers:
Malignant melanoma<br>shows pulmonary<br>nodules

Malignant melanoma
shows pulmonary
nodules

Multiple round nodules and masses in both lungs

Multiple round nodules and masses in both lungs

Cannonball lung metastases in patient with colon cancer

Cannonball lung metastases in patient with colon cancer

Multiple lung metastases

Multiple lung metastases

Prognostic factors
  • Clinical variables associated with prolonged survival after lung metastasectomy in colorectal cancer patients
    • Prolonged disease free interval between primary tumor and metastasis, normal prethoracotomy carcinoembryonic antigen, absence of thoracic node involvement and single pulmonary lesion (Ann Surg Oncol 2013;20:572)
  • Complete resection and longer disease free interval > 6 months associated with better survival (Surg Oncol 2012;21:237)
Case reports
Treatment
  • Chemotherapy, immunotherapy, other systemic therapy
  • Criteria for pulmonary metastasectomy: primary site of disease controlled, complete resection of lung metastasis feasible, patient able to tolerate procedure, no better alternative treatments (J Surg Oncol 2014;109:42)
  • Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) may be considered for small, solitary, peripheral tumors
Gross description
    Patterns associated with specific primaries
  • Central cavitation: colonic adenocarcinoma, leiomyosarcoma, squamous cell carcinoma of upper aerodigestive tract
  • Intrabronchial masses: breast, colon, kidney
  • Lymphangitic carcinomatosis: breast, choriocarcinoma, pancreas, prostate, stomach
  • Nodular metastases: breast, GI, kidney, melanoma, sarcoma
  • Tumor emboli: breast, choriocarcinoma, liver, stomach
Gross images

Contributed by Roseann Wu, M.D., M.P.H.
Lung wiht metastatic tumor

Lung with metastatic tumor



Images hosted on other servers:
Multiple tumor nodules Multiple tumor nodules

Multiple tumor nodules

Microscopic (histologic) description
  • Dependent on site of origin (colorectal cancer, bone and soft tissue sarcoma, renal cell carcinoma, melanoma, head and neck tumors, germ cell tumors and many others)
  • Evidence for breast metastasis over lung primary: comedonecrosis, solid nests, trabecular architecture, cribriform growth pattern (Am J Clin Pathol 2009;131:122)
Microscopic (histologic) images

Contributed by Roseann Wu, M.D., M.P.H., Debra Zynger, M.D., Case #318 and Fulvio Lonardo, M.D.
Metastatic colon CA to lung 25x

Metastatic colon CA to lung 25x

Clear cell renal<br>cell carcinoma<br>metastatic to lung

Clear cell renal
cell carcinoma
metastatic to lung

Prostatic<br>adenocarcinoma<br>metastatic to lung

Prostatic
adenocarcinoma
metastatic to lung

Testicular germ<br>cell tumor (teratoma)<br>metastatic to lung

Testicular germ
cell tumor (teratoma)
metastatic to lung

Jaw: ameloblastoma<br>metastatic to lung

Jaw: ameloblastoma
metastatic to lung


Pancreas: adenocarcinoma Pancreas: adenocarcinoma

Pancreas: adenocarcinoma

Cytology images

Contributed by Roseann Wu, M.D., M.P.H.
Metastatic renal cell carcinoma to lung

Metastatic renal cell carcinoma to lung



Images hosted on other servers:
Bladder, urothelial carcinoma

Bladder, urothelial carcinoma

Positive stains
Negative stains
  • TTF1 and Napsin A may be helpful to exclude primary lung adenocarcinoma
Differential diagnosis
  • Primary lung carcinoma: acini, lepidic growth, nuclear pseudoinclusions, central scar (Am J Clin Pathol 2009;131:122)
  • Inflammatory nodule or benign neoplasm
Board review style question #1
    For which malignancy is pulmonary metastasectomy most commonly performed and reported?

  1. Colorectal cancer
  2. Germ cell tumors
  3. Melanoma
  4. Osteosarcoma
  5. Renal cell carcinoma
Board review answer #1
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