نکات

The most common metastatic cancers to the lung are breast cancer, colorectal cancer, renal cell carcinoma, melanoma, sarcomas, and cancers of the head and neck, thyroid, and genitourinary tract.[1][2][3][4][5] These malignancies have a particular propensity for hematogenous spread to the pulmonary parenchyma due to the lung’s extensive vascular network and its role as a first-pass filter for systemic venous blood. Population-based data indicate that synchronous lung metastases most frequently arise from primary lung cancers, colorectal cancers, kidney cancers, pancreatic cancers, and breast cancers.[2] Sarcomas and melanomas also demonstrate a notable tropism for pulmonary metastasis.[1][6][5] The clinical presentation and radiographic features of lung metastases can vary depending on the primary tumor type, but the above cancers consistently account for the majority of cases. References 1. The Epidemiology and Biology of Pulmonary Metastases. Gerull WD, Puri V, Kozower BD. Journal of Thoracic Disease. 2021;13(4):2585-2589. doi:10.21037/jtd.2020.04.28. 2. The Epidemiology of Lung Metastases. Chen H, Stoltzfus KC, Lehrer EJ, et al. Frontiers in Medicine. 2021;8:723396. doi:10.3389/fmed.2021.723396. 3. Lung Metastases. Herold CJ, Bankier AA, Fleischmann D. European Radiology. 1996;6(5):596-606. doi:10.1007/BF00187656. 4. Lung Metastases. Zullo L, Filippiadis D, Hendriks LEL, et al. Nature Reviews. Disease Primers. 2025;11(1):60. doi:10.1038/s41572-025-00642-1. 5. Lung-Seeking Metastases. Stella GM, Kolling S, Benvenuti S, Bortolotto C. Cancers. 2019;11(7):E1010. doi:10.3390/cancers11071010. 6. Molecular Basis of Metastasis. Chiang AC, Massagué J. The New England Journal of Medicine. 2008;359(26):2814-23. doi:10.1056/NEJMra0805239.

8. Contrast enhancement Contrast enhancement less than 15 HU has a very high predictive value for benignity (99%). After a baseline scan, 4 consecutive scans at 1 minute interval are performed. ▫️This applies only for nodules with the following selection criteria: Nodule > 5mm Relatively spherical Homogeneous, no necrosis, fat or calcification No motion or beam hardening artifacts 👇(Figure)👇Baseline scan and scans after contrast enhancement: Benign

7. Solid and Ground-glass components Partly solid + GGO 63%.malignant Nonsolid - only GGO 18% malignant Only solid lesion only 7%.malignant ‌

6. Air Bronchogram sign more commonly seen in malignant pulmonary nodules. most commonly seen in BAC (bronchoalveolar cell carcinoma) and adenocarcinoma. ‌

5. Margin Corona radiata sign spiculated margins: malignant (figure) Lobulated or scalloped margins intermediate probability Smooth margins more likely benign unless metastatic. ‌

4. Shape Signs of benignity: Polygonal shape Three-dimensional ratio > 1.78 Peripheral subpleural location The three-dimensional ratio is measured by obtaining the maximal transverse dimension and dividing it by the maximal vertical dimension. A large three-dimensional ratio indicates that the lesion is relatively flat, which is a benign sign. ‌

3. Growth Stability over 2 years is highly associated with benignity. ‌

2. Size A solitary pulmonary nodule (SPN) is defined as a single intraparenchymal lesion less than 3 cm in size and not associated with atelectasis or lymphadenopathy. A lesion greater than 3 cm in diameter is called a mass. lesions greater than 3 cm are usually malignant. ‌

Calcification Diffuse, central, laminated or popcorn calcifications are benign patterns of calcification. These types of calcification are seen in granulomatous disease and hamartomas. The exception to the rule above is when patients are known to have a primary tumor; For instance: diffuse calcification pattern can be seen in patients with osteosarcoma or chondrosarcoma. The central and popcorn pattern can be seen in patients with GI-tumors and patients who previously had chemotherapy. .

Pulmonary nodule: Benign versus Malignant #approach

#Approach to Lung cyst like lesions ⚪️ Solitary Lesion: Cyst Cavity Bulla Pneumatocele ⚪️ multiple Lesions Lung cysts Cenrilobular emphysema Honeycombing in fibrosis Cystic Bronchiectasis

#wisdom source link

first: Bone Marrow Biopsy second: Bone Marrow Aspiration اكر ابتدا آسبيريشن انجام شود خونريزي ناشي از اون بافت مغز استخوان رو براي بيوبسي ب

indications for Bone Marrow examination (Biopsy & Aspiration) 1. Blasts (immature cells in PBS) 2. Pancytopenia 3. Severe Hypoproliferative (Retic count <0.1% ) 4. nRBC. teardrop ( bone morrow infiltration) 5. Staging malignancy 6. Unexplained severe anemia #Harrison

10 علت اسپلنومگالی massive CML CLL hairy cell leukemia Lymphoma Myelofibrosis Polycythemia vera Autoimmune hemolytic anemia Sarcoidosis Gaucher disease Diffuse splenic hemangioma

۳۴. شدت مارگزیدگی: (خفیف) علایم لوکال خفیف و سیستمیک خفیف (۲ تا ۵ آمپول آنتی‌ونوم) (متوسط) علایم لوکال شدید و سیستمیک خفیف یا موضعی خفیف و سیستمیک شدید و اختلال آزمایشگاهی خفیف (خونریزی بالینی نداره) (۵ تا ۱۰ آمپول) (شدید) علایم لوکال و سیستمیک شدید، اختلال آزمایشگاهی شدید. (۱۰ تا ۲۰ آمپول)

۳۳. مسمومیت حاد با ویتامین دی خوراکی، saline wash و شارکول سوربیتول فایده ندارد، باید کورتون بدیم.