乐播传媒 Curriculum Pathway for Lung Cancer: Sample Content

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PRETEST

A 67-year-old woman is determined to have a solitary pulmonary nodule in the right lower lobe.

As you review the imaging study, which of the following findings would suggest that a malignant etiology is more likely?

Popcorn calcification of the lesion
Laminar texture of the nodule
Stippled calcification of the nodule
Diameter of the nodule <2 cm

Answer | Commentary

C. Stippled calcification of the nodule

Popcorn calcification, diffuse calcification, central calcification, and laminated calcification are associated with nonmalignant causes of lung nodules. Popcorn calcifications are caused by hamartomas, whereas diffuse, central, and laminated calcification patterns indicate a granulomatous infectious or inflammatory etiology, such as TB or histoplasmosis (choice C is correct; choices A, B, and D are incorrect).

Stippled and eccentric calcification patterns are more concerning for a malignant etiology.

The size of the nodule does not necessarily correlate with its underlying etiology. SCLC is commonly a metastatic disease by the time it is diagnosed, given its aggressive nature. Only 30% of patients receive diagnosis at limited stage. Treatment recommendations differ based on stage at presentation. All patients with SCLC receive induction chemotherapy (standard is cisplatin plus etoposide) for 2 to 4 cycles, and then benefit is reassessed. No benefit has been shown for administering more than 6 cycles. For patients with limited stage, survival benefit is achieved by adding radiotherapy (choice D is correct; choice B is incorrect).

Note that for patients with TNM stage I disease, surgical resection has shown some survival benefit and should be considered in those circumstances.