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Pulmonary Pathology Online

Metastatic Tumours of the Lung

Dr Sampurna Roy MD





Syn:  Secondary Pulmonary Tumour

Lung is one of the most common site of metastasis from internal malignancies.

Spread of cancer to the lung can occur via:

1. Direct extension from contiguous organs ;

2. Lymphatics ;

3. Hematogenous route.

Pathology of metastatic tumors is as follows:

- Discrete masses ("cannonball") or rarely solitary ("coin") lesions are more common in the lower lobes.

- The lesions may be confused with a primary tumour due to intraparenchymal or nodular deposits in the wall of the major bronchus and presenting as a polypoid mass.

- Multiple tumor microemboli (miliary nodules) simulate infectious process of lung.

The lesions are seen in the terminal pulmonary arterial vasculature bed and are commonly bilateral.

- Growth within peribronchial perivascular lymphatics (lymphangitis carcinomatosis) results in severe dyspnea, pulmonary hypertension, often without any abnormality in radiograph.

- Metastatic adenocarcinomas line the alveolar walls in a "lepidic" fashion, resembling bronchioalveolar carcinoma.

- Some metastatic spindle-cell sarcomas grow extensively along bronchi and vessels (pulmonary sarcomatosis) and are suggested as metastases from leiomyosarcoma and metastatic endometrial stromal sarcoma of uterus, after several years or decades of their treatment.

- Rarely, pulmonary metastases may show features of benign leiomyoma, meningioma, thymoma, and giant cell tumor of bone (osteoclastoma).


Further reading:

Histopathologic prognostic factors in resected colorectal lung metastases.

Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer.

Pulmonary metastases in children with solid tumours--own experiences .

A case of prostatic cancer discovered from lung metastatic lesions  .

Pulmonary metastasectomy for osteosarcomas and soft tissue sarcomas .

Pulmonary metastases in children: an analysis of surgical spectrum.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)









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