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CARDIOTHORACIC
CORE LECTURES
ADEGBOYE V.O.
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TUMOURS OF THE LUNG
AND MEDIASTINUM
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Topics of Discussion
TUMOURS OF THE LUNG:
PRIMARY MALIGNANT &
BENIGN. SECONDARY METASTATIC.
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MALIGNANT LUNG.
1-BRONCHIAL GLAND TUMOURS.
2-LUNG CANCERS.
3- METASTATIC.
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BENIGN TUMOURS.
1- ORIGIN
UNKNON!H"#$"%$"'T(#"%$"
)'C*("# +(** .2-E,%(*"* +(**)!,",*$" &,*/,).
3-M()0(#$"*!#$"' L,$"'
L($/$"
-O%(#)!$4+)" "))+"%(0
*/$,0 %))4('5"6%$" (%+
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PRESENTATION AND
DIAGNOSIS OF BENIGNTUMOURS.M)% ")/$,%$"%+',(#,(#"**/ *+"%(0 '
+5#"/ 6067.
F(8 (60#6+"* A#(
)/$,%$"%+:((+%) #6+"*++*4)6.
D(6%( 0"76)) 9 T))4( . C5#"/)$(%$() +"#"+%(#)%+ $)% %$() 6%),(++.
S*%"#/ P4*$6"#/ 604*( SPN; -$)%+"**(6767' ,#(
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MAMAGEMENT OF LESIONS
POSITIVE (676%/ ") % (
()%"*)(0: (5+)6! *467
+6)(#
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BRONCHIAL GLAND
TUMOURS. USED TO BE CALLED BRONCHIAL
ADENOMA SUGGESTING BENIGNITY NOT BENIGN
FIVE DISPARATE TUMOURS.
1-B#6+"* C"#+60
2-A0(60 C/)%+ CA.
3-M4+"(,0(#$0 C".
-B#6+"* $4+4) 7*"60 "0(6$".
?-P*($#,+ $5(0 %4$4#
B#6+"* 7*"60
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Bronchi! Crcinoi".
A** #6+"* 7*"60 %4$4#)
"#)( #$ 0(#(6% +(**).
BRONCHIALCARCINOID-@? OF THIS GROUP.
-$"6)%($ # *"#
#6+4): )/$,%$)
)%#4+%6 & 6*"$"%6.
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S#$p%o$s of Bronchi!
Crcinoi". C47-'D/),6(" &
H"($,%/))3'C"#+60
S/60#$( 2-3. N% )((6 8% ,(#,(#"**()6.
S"$( +*6+"* ("%4#() ")
APUD "$6( ,#(+4#)#4,%"( 0(+"#5/*"%(;T4$4#)
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Di&nosis
C/%*7/ #6+"* #4)67*8 /(*0.
FNAC=F#(6 )(+%60(#6+"%( (%8((6 #6+"*+"#+60 "60 )$"** +(** +" 6 +")().
B#6+)+,/ & ,)/ "($##"7('
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TREAMENT.
RESECTION: E60)+,+
B#6+%$/ F#$"* #()(+%6 R"0%(#",/ C($%(#",/.
R",0*/ "%"* 0)(")(. C"#+60 )/60#$( ()% %#("%(0
/ #()(+%6 %4$4#.
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LUNG CANCER
? *467 %4$4#)
"#( $"*76"6%.M"#%/ +"6 (
+*"))(0 6%: )> +(**
+"9"0(6 +"9 *"#7(+(** +"9 )$"** +(** +".
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CLINICAL PRESENTION.
? SYMPTOMATIC. 2 )/$,%$) ,#$"#/ %4$4#.
32 )/$,%$) $(%")%"%+),#("0. 3 )/)%($+ )/$,%$)8% *))'
$"*")('"6#(5" ;
H7 "
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PRESENTATION
CONTNS. S/$,%$) "60 )76) 0(,(60 6:
H/)%*7+"* 6067)
I6%#6)+ %4$4# *7/.-7#8%#"%(' ,"#"6(,*")%+ )/60#$()
A6"%$+ *+"%6
S%"7( ,#()(6%"%6
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HISTOLOG' AND
PRESENTATION S CELL CA AND SM CELL CA-
CENTRALLY LOCATED.!BRONCHIAL OCCLUSIONSUMPTOMS.
ADENO CA & LARGE CELL CA ASYMPTOMATIC ,(#,(#"*
604*( # ,"#(%"* ,*(4#"* # +()%8"** 6
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PULMONAR'MANIFESTATION. FROM BRONCHUS AND LUNG INVOLVEMENT.
COUGH-?'BRONCHIALIRRITATION. DYSPNOEA-?-'BRONCHIAL
OCCLUSION'EFFUSION- PERIPHERALLESION9
HEEJING-LESS ?'PARTIALOBTRUCTION PRO BRONCHUS.
HAEMOPTYSIS-2?-. STREAKY
CENTRALLY LOCATED TUMOURS. PNEUMONIC SYMPTOMS. LUNG ABCESS.
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NON PULMONAR'
THORACIC MANIFESTATION PRIMARY TUMOUR INVASIONOF
CONTIGUOUS STRUCTURES.
ENLARGED TUMOUR BEARING
LYMPH NODES COMPRESSION OF
)TRUTURES. D,#"7$'+()% 8"**',#(6+
6(#
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PARANEOPLASTIC
S'NDROME OCCUR ITH OTHER TUMOURS BUT
MOST FREUENT ITH LUNG CA.
ESPECIALLY ! S CELL CA AND SM
CELL CA. MAY BE FIRST INDICATION OF
DISEASE LEADING TO EARLY
DIAGNOSIS.
HYPERTROPHIC PULMONARYOSTEOARTHROPATHY
ROLIFERATING PERIOSTITIS' END OF
LONG BONES.
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PARANEOPLASTIC
S'NDROME CONTNS I6",,#,#"%( ADH SECRETION ! IN
*467 +".H7()% 8% )$ +(** +". H/,(#+"*+($"
M/,"%+ 6(4#*7+ )/60#$($6); $)% +$$6 1 "
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METASTATIC
S'MPTOMS CNS: MOST COMMOM "#( )/$,%$)
6+#(")(0 6#"+#"6"* ,#())4#(
("0"+(' 6"4)("'
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DIAGNOSIS OF LUNG
CANCER HISTORY AND PHYSICAL
EAMINATION: SMOKING'
OCCUPATIONSMOKINGASBESTOS MULTIPLICATION
EFFECT;9 T LOSS OF
ADVANCED DISEASE.
SPUTUM CYTOLOGY@2.?OVERAL YIELD MORE ITH
MULTIPLE SPECIMENS.
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DIAGNOSIS CONTNS
CHEST RADIOGRAPHY
CT =MRI FNAB
TRANSTHORACIC!FLUOROSCOPIC OR CT GUIDED ITH
INCREASED YIELD INEPERIENCED HANDS..
BRONCHOSCOPY
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OTHER DIAGNOSTIC
METHODS CERVICAL MEDISTINOSCOPY
LEFT ANTERIOR
MEDIASTINOTOMY. SCALENE NODE BIOPSY
THORACOSCOPY.
THORACOTOMY.
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TREATMENT
SURGERYS; FOR LOCALISED
DISEASE.
CHEMOTHERAPYC%;- #METASTATIC DISEASE.
RADIOTHERAPY R%;-LOCAL
CONTROL.
C% +$6(0 8% R% (%%(# %"6
(%(# "*6( # "0
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TREAMENT CONTNS
SM CELL CA FREUENLY
0))($6"%(0 "% %$( ,#()(6%"%6
)4#7(#/ ) 6% #)% *6( (5+(,% 6 8(**
)(*(+%(0 +")().
O%(#) ! N6-)$ +(** +"%#("%$(6%
0(,(60 6 )%"7( 0)(")(. S4#
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MEDIASTINALTUMOURS MEDIASTINAL BORDERS:
MEDIASTINAL COMPARTMENTS
INITIALLY NO 3ANTEROSUPERIOR9
MIDDLE9 AND POSTERIOR.
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PRIMAR' TUMOURS
PRESENT AS MYRIADS OF
SYMPTOMS AND SIGNS.
NATURAL HISTORY!ASYMPTOMATIC TO BENIGN
SLO GROTH ITH MINIMAL
SYMPTOMS TO AGGRESSIVE'
INVASIVE NEOPLASM
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FRE(UENC' OF
MASSES NEUROGENIC-2
THYMOMAS-1
PRIMARY CYSTS-1@ LYMPHOMAS -13
GERM CELLS -1
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LOCATION OF
TUMOURS ANTEROSUPERIOR-?
POSTERIOR 2?
MIDDLE ---1
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COMMONEST
MASSES)% !oc%ions. ANTEROSUPERIOR:T/$+'L/$,
$"'G(#$ +(**' C"#+6$".
POSTERIOR: N(4#7(6+' C/)%).
MIDDLE:C/)%) "60 L/$,$").
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MALIGNANT
NEOPLASM 2?-2 OF MASSES.
FREUENCY
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CLINICAL FEATURES.
? TO ? SYMTOMATIC AT
PRESENTATION.
B(676 ? ")/$,%$"%+ "%,#()(6%"%6.
1? M"*76"6% ")/$,%$"%+
"% ,#()(6%"%6.
C*0#(6 ? )/$,%$"%+ "%
,#()(6%"%6 # "
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C!inic! f*%ur*s con%nS
COMMON : C()% ,"6'(
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DIAGNOSIS
HISTORY AND PHYSICALEAMINATION.
C RAY PA AND LATERAL. CT ITH CONTRAST
ROUTINE. INVASIVENESS CAN BE
STUDIED BY CT =MRI FNAB UNDER CT OR ECHO
GUIDIANCE.INCREASE YIELD.
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DIAGNOSIS+OTHERS.
MEDIASTINAL USS! ECHO
IODINE 131 SCAN FOR
THYROID. FDG POSITRON EMISSION.
POOL DATA AND APPLY
TREATMENT AS APPROPRIATE..