Etiologies, some of the benign etiologies
include granuloma from a previous maybe fungal
infection. The most common systemic fungus,
Histoplasma. Hamartomas and slowly
resolving local pneumonias. Hamartomas are
a big one. What’s a hamartoma? A benign
lesion and it is overgrowth of the cell, but
it’s indigenous to that organ, correct?
Whereas if it was more ectopic, what do you
call that? You call that a heterotopic rest
or you call that a choristoma. Keep that in
mind. You know, your exams and boards love
such questions. Benign.
Clinical presentation, incidental findings
is benign lesions, asymptomatic. Diagnosis?
Biopsy. Well, watch and wait, and hopefully
that’s good enough.
Lung nodules and cancer. We’ll take a
look at that. Which favours benign and that
which favours malignancy. Pretty much, what
we’ve already kind of talked about.
If it’s benign, no growth. Malignancy,
Increased proliferation. Benign, less
than 1 cm. Malignant, larger.
Benign, calcified. Malignancy, we have
what’s known as spiculated calcification.
It looks like the nodule, but then it looks
like there’s spicules coming out from it
and that’s not good. Or even non-calcified
Benign, non-smoker. One big exception?
Good, adenocarcinoma. Smoker, many of them.
Including small or squamous.
Benign, no associated pleural effusion.
If it’s malignant, we talked about it being?
Good, haemorrhagic like, invading chest wall.
Benign, not glucose avid on PET scan. What
does that mean? Big time. Positive emission
tomography. This revolutionised the way in
which we handle cancers and how we interpret
it. Cancer, as we talked about earlier, favours
a particular type of pathway in biochemistry
and it’s not anaerobic, it’s not aerobic,
it’s right in the middle. It’s called
Warburg. Amazing. Even if that cancer is accepting,
we had this discussion earlier, let us now
bring it up one more time. This cancer, even
if it is receiving and it’s being supplied
by proper amounts of blood, still wishes and
prefers tocreate quite or to undergo
quite a bit of fermentation. So therefore,
there’s going to be increased lactate dehydrogenase
activity. That’s a seriously malignant issue.
If it’s a benign ideology, the Warburg effect,
the Warburg pathway is not the way that it
goes and therefore in terms its consumption
of glucose, its consumption and really the
production of lactate dehydrogenase is just
not going to be there. So, your PET scan is
going to be negative for benign. That’s
huge for us. If it’s positive, you’re
thinking about malignancy.