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Current Medical Imaging


ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Mini-Review Article

Rare Pulmonary Tumors and Carcinoma Mimickers; Experience from an Interventional Radiology Unit with Radiologic-pathologic Correlation- A Pictoral Essay

Author(s): Emre Ünal *, Sevtap Arslan *, Gulnar Aghayeva , Yasin Sarıkaya , Türkmen Çiftçi , Sevgen Önder , Devrim Akıncı and Okan Akhan

Volume 17, Issue 10, 2021

Published on: 19 April, 2021

Page: [1183 - 1190] Pages: 8

DOI: 10.2174/1573405617666210420105624

Price: $65


Background: Although imaging findings along with patients’ clinical history may give a clue for the etiology of a pulmonary lesion, the differentiation of benign pulmonary lesions from lung cancer could be challenging.

Objective: The aim of this review article was to increase the awareness of carcinoma mimicking lung lesions.

Methods: This paper was designed to illustrate rare pulmonary tumors and carcinoma mimickers with emphasis on radiologic-pathologic correlation. Pitfalls encountered on CT images and also false positivity of PET-CT scans were also presented.

Conclusion: Several benign pulmonary lesions may grow in size on follow-up and some may show pathologic FDG (18F-fluorodeoxyglucose) uptake, which makes them indistinguishable from lung carcinoma by imaging. In addition, some slow-growing malignant lesions, such as carcinoid, may be false-negative on PET/CT scans.

Keywords: Lung cancer, CT, benign pulmonary tumors, percutaneous transthoracic biopsy, MRI, PET/CT scan.

Graphical Abstract
Ananthakrishnan L, Sharma N, Kanne JP. Wegener’s granulomatosis in the chest: high-resolution CT findings. AJR Am J Roentgenol 2009; 192(3): 676-82.
[] [PMID: 19234263]
Furuya K, Yasumori K, Takeo S, et al. Lung CT: Part 1, Mimickers of lung cancer-spectrum of CT findings with pathologic correlation. AJR Am J Roentgenol 2012; 199(4): W454-63.
[] [PMID: 22997395]
Giménez A, Franquet T, Prats R, Estrada P, Villalba J, Bagué S. Unusual primary lung tumors: a radiologic-pathologic overview. Radiographics 2002; 22(3): 601-19.
[] [PMID: 12006690]
Aydin M, Akkoyunlu ME, Yakar F, Ergul N, Sezer M. Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener’s granulomatosis. Rev Esp Med Nucl Imagen Mol 2014; 33(1): 32-5.
[PMID: 23680478]
Lin KH, Chang CP, Liu RS, Wang SJ. F-18 FDG PET/CT in evaluation of pulmonary sclerosing hemangioma. Clin Nucl Med 2011; 36(5): 341-3.
[] [PMID: 21467848]
Reichert M, Bensadoun ES. PET imaging in patients with coal workers pneumoconiosis and suspected malignancy. J Thorac Oncol 2009; 4(5): 649-51.
[] [PMID: 19395909]
Baha A, Yildirim F, Kokturk N, Akdemir UO, Demircan S, Turktas H. 18F-FDG uptake in focal organising pneumonia mimicking bronchial carcinoma. Clin Respir J 2016; 10(6): 740-5.
[] [PMID: 25689088]
Beslic S, Zukic F, Milisic S. Percutaneous transthoracic CT guided biopsies of lung lesions; fine needle aspiration biopsy versus core biopsy. Radiol Oncol 2012; 46(1): 19-22.
[] [PMID: 22933975]
Connor S, Dyer J, Guest P. Image-guided automated needle biopsy of 106 thoracic lesions: a retrospective review of diagnostic accuracy and complication rates. Eur Radiol 2000; 10(3): 490-4.
[] [PMID: 10757002]
Siegelman SS, Khouri NF, Scott WW Jr, et al. Pulmonary hamartoma: CT findings. Radiology 1986; 160(2): 313-7.
[] [PMID: 3726106]
Bateson EM. An analysis of 155 solitary lung lesions illustrating the differential diagnosis of mixed tumours of the lung. Clin Radiol 1965; 16: 51-65.
[] [PMID: 14249223]
Hochhegger B, Marchiori E, dos Reis DQ, et al. Chemical-shift MRI of pulmonary hamartomas: initial experience using a modified technique to assess nodule fat. AJR Am J Roentgenol 2012; 199(3): W331-4.
[] [PMID: 22915423]
Park KY, Kim SJ, Noh TW, et al. Diagnostic efficacy and characteristic feature of MRI in pulmonary hamartoma: comparison with CT, specimen MRI, and pathology. J Comput Assist Tomogr 2008; 32(6): 919-25.
[] [PMID: 19204455]
Jiang L, Huang Y, Tang Q, et al. 18F-FDG PET/CT characteristics of pulmonary sclerosing hemangioma vs. pulmonary hamartoma. Oncol Lett 2018; 16(1): 660-5.
[] [PMID: 29930720]
Shin SY, Kim MY, Oh SY, et al. Pulmonary sclerosing pneumocytoma of the lung: CT characteristics in a large series of a tertiary referral center. Medicine (Baltimore) 2015; 94(4): e498.
[] [PMID: 25634202]
Im JG, Kim WH, Han MC, et al. Sclerosing hemangiomas of the lung and interlobar fissures: CT findings. J Comput Assist Tomogr 1994; 18(1): 34-8.
[] [PMID: 8282879]
Wang QB, Chen YQ, Shen JJ, et al. Sixteen cases of pulmonary sclerosing haemangioma: CT findings are not definitive for preoperative diagnosis. Clin Radiol 2011; 66(8): 708-14.
[] [PMID: 21529795]
Jin HY, Park TS. Pulmonary pleomorphic adenoma: report of a rare case. Korean J Intern Med (Korean Assoc Intern Med) 2007; 22(2): 122-4.
[] [PMID: 17616030]
Takeuchi E, Shimizu E, Sano N, Yamaguchi T, Yanagawa H, Sone S. A case of pleomorphic adenoma of the lung with multiple distant metastases--observations on its oncogene and tumor suppressor gene expression. Anticancer Res 1998; 18(3B): 2015-20.
[PMID: 9677459]
Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002; 20(3): 750-62.
[] [PMID: 12358356]
Sirajuddin A, Raparia K, Lewis VA, et al. Primary pulmonary lymphoid lesions: Radiologic and pathologic findings. Radiographics 2016; 36(1): 53-70.
[] [PMID: 26761531]
Au V, Leung AN. Radiologic manifestations of lymphoma in the thorax. AJR Am J Roentgenol 1997; 168(1): 93-8.
[] [PMID: 8976927]
Kinsely BL, Mastey LA, Mergo PJ, et al. Pulmonary mucosa-associated lymphoid tissue lymphoma: CT and pathologic findings. AJR Am J Roentgenol 1999; 172(5): 1321-6.
[] [PMID: 10227510]
Lee IJ, Kim SH, Koo SH, et al. Bronchus-associated lymphoid tissue (BALT) lymphoma of the lung showing mosaic pattern of inhomogeneous attenuation on thin-section CT: a case report. Korean J Radiol 2000; 1(3): 159-61.
[] [PMID: 11752947]
Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics 2010; 30(1): 269-91.
[] [PMID: 20083598]
Perry C, Herishanu Y, Metzer U, et al. Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma. Eur J Haematol 2007; 79(3): 205-9.
[] [PMID: 17662066]
Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Pneumoconiosis: comparison of imaging and pathologic findings. Radiographics 2006; 26(1): 59-77.
[] [PMID: 16418244]
Mirsadraee M. Anthracosis of the lungs: etiology, clinical manifestations and diagnosis: a review. Tanaffos 2014; 13(4): 1-13.
[PMID: 25852756]
Kim HY, Im JG, Goo JM, et al. Bronchial anthracofibrosis (inflammatory bronchial stenosis with anthracotic pigmentation): CT findings. AJR Am J Roentgenol 2000; 174(2): 523-7.
[] [PMID: 10658734]
Canbaz F, Kefeli M, Sahin Z, Basoglu T. Anthracotic solitary pulmonary nodule imitating lung malignancy on F-18 FDG PET/CT imaging. Clin Nucl Med 2011; 36(10): 955-6.
[] [PMID: 21892061]
Matsumoto S, Miyake H, Oga M, Takaki H, Mori H. Diagnosis of lung cancer in a patient with pneumoconiosis and progressive massive fibrosis using MRI. Eur Radiol 1998; 8(4): 615-7.
[] [PMID: 9569334]
Ogihara Y, Ashizawa K, Hayashi H, et al. Progressive massive fibrosis in patients with pneumoconiosis: utility of MRI in differentiating from lung cancer. Acta Radiol 2018; 59(1): 72-80.
[] [PMID: 28361545]
Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics 2006; 26(1): 41-57.
[] [PMID: 16418242]
Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003; 97(4): 934-59.
[] [PMID: 12569593]
Zwiebel BR, Austin JH, Grimes MM. Bronchial carcinoid tumors: assessment with CT of location and intratumoral calcification in 31 patients. Radiology 1991; 179(2): 483-6.
[] [PMID: 2014296]
Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC. Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR Am J Roentgenol 1998; 170(5): 1369-73.
[] [PMID: 9574618]
Wartski M, Alberini JL, Leroy-Ladurie F, et al. Typical and atypical bronchopulmonary carcinoid tumors on FDG PET/CT imaging. Clin Nucl Med 2004; 29(11): 752-3.
[] [PMID: 15483502]
Lee JW, Lee KS, Lee HY, et al. Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. AJR Am J Roentgenol 2010; 195(4): 916-22.
[] [PMID: 20858818]
Akira M, Yamamoto S, Sakatani M. Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses. AJR Am J Roentgenol 1998; 170(2): 291-5.
[] [PMID: 9456931]
Erdoğan Y, Özyürek BA, Özmen Ö, et al. The evaluation of FDG PET/CT scan findings in patients with organizing pneumonia mimicking lung cancer. Mol Imaging Radionucl Ther 2015; 24(2): 60-5.
[] [PMID: 26316470]
Tateishi U, Hasegawa T, Seki K, Terauchi T, Moriyama N, Arai Y. Disease activity and 18F-FDG uptake in organising pneumonia: semi-quantitative evaluation using computed tomography and positron emission tomography. Eur J Nucl Med Mol Imaging 2006; 33(8): 906-12.
[] [PMID: 16568202]
Martinez F, Chung JH, Digumarthy SR, et al. Common and uncommon manifestations of Wegener granulomatosis at chest CT: radiologic-pathologic correlation. Radiographics 2012; 32(1): 51-69.
[] [PMID: 22236893]
Kuhlman JE, Hruban RH, Fishman EK. Wegener granulomatosis: CT features of parenchymal lung disease. J Comput Assist Tomogr 1991; 15(6): 948-52.
[] [PMID: 1939773]
Lee KS, Kim TS, Fujimoto K, et al. Thoracic manifestation of Wegener’s granulomatosis: CT findings in 30 patients. Eur Radiol 2003; 13(1): 43-51.
[] [PMID: 12541109]
Ito K, Minamimoto R, Yamashita H, et al. Evaluation of Wegener’s granulomatosis using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Ann Nucl Med 2013; 27(3): 209-16.
[] [PMID: 23242952]
Ozmen O, Tatci E, Gokcek A, et al. Integration of 2-deoxy-2-[18F] fluoro-D-glucose PET/CT into clinical management of patients with Wegener’s granulomatosis. Ann Nucl Med 2013; 27(10): 907-15.
[] [PMID: 24037685]
Garg MK, Sharma M, Gulati A, et al. Imaging in pulmonary hydatid cysts. World J Radiol 2016; 8(6): 581-7.
[] [PMID: 27358685]
Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. Radiographics 2000; 20(3): 795-817.
[] [PMID: 10835129]
Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to toe. Radiographics 2003; 23(2): 475-94.
[] [PMID: 12640161]
Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114(1): 1-16.
[] [PMID: 19931502]
Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J 2003; 21(6): 1069-77.
[] [PMID: 12797504]
Kant S, Saheer S, Prakash V, Hasan G, Jabeed P, Husain N. Bilateral nodular pulmonary tuberculomas simulating metastatic disease. BMJ Case Rep 2011; 2011: bcr1120103539.
Prakash V, Kant S, Mishra AK, Verma AK, Shukla S, Yadav S. Pulmonary actinomycosis masquerading as a malignant lung tumor. CHRISMED. J Health Sci 2015; 2(3): 298.
Martinez S, Heyneman LE, McAdams HP, Rossi SE, Restrepo CS, Eraso A. Mucoid impactions: finger-in-glove sign and other CT and radiographic features. Radiographics 2008; 28(5): 1369-82.
[] [PMID: 18794313]
Torrisi JM, Schwartz LH, Gollub MJ, Ginsberg MS, Bosl GJ, Hricak H. CT findings of chemotherapy-induced toxicity: what radiologists need to know about the clinical and radiologic manifestations of chemotherapy toxicity. Radiology 2011; 258(1): 41-56.
[] [PMID: 21183492]

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