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MHD VI: Pulm > 11.30: Pulm IV > Flashcards

11.30: Pulm IV Flashcards

1
Q

What is a hamartoma?

A

Most common benign tumor of the lung

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2
Q

What is the Most common benign tumor of the lung?

A

Hamartoma

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3
Q

What is most common primary malignant tumor of lungs?

A

95% are carcinomas

- Carcinoma is an epithelial, malignant tumor

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4
Q

Prevalence of lung cancers?

A
  • 2nd most common tumor in men and women
  • # 1 in men is prostate
  • # 1 women breast
  • ***However, lung cancer is most common cause of death in both men and women
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5
Q

Most common etiology of lung cancer?

A
  • Smoking
  • Average smoker 10 x greater risk
  • Heavy smoker 60 x greater risk
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6
Q

What do most smoking related cancers have in common?

A

P53 abnormalities

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7
Q

Factors outside of tobacco increasing risk of lung cancer?

A
  1. High dose ionizing radiation
  2. Asbestos
  3. Radon from air pollution
  4. Genetic Predisposition
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8
Q

What is 2 compartment model of lung cancer pathogenesis?

A
  • Smokers are more likely to damage upper airways and are more likely to get SQC or SCLC
  • Non smokers more likely to get ADC in terminal respiratory unit
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9
Q

What is SQC?

A

“Squamous cell carcinoma”

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10
Q

What is SCLC?

A

Small cell carcinoma

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11
Q

Which cancers are smokers most likely to get?

A
  1. SCLC

2. SQC

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12
Q

Which type of lung cancer are non smokers more likely to get?

A

ADC: “Adenocarcinoma”

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13
Q

Key mutations leading to ADC?

A
  1. EGFR

2. Kras

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14
Q

In which organ is direct association between smoking and carcinoma not shown?

A
  • Breast

- Correlative evidence in most others

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15
Q

Break down of lung carcinoma types?

A
  1. Small cell carcinoma (SCC) 20%
  2. Non SCC 80%
    a. Adenocarcinoma: “ADC” 40%
    b. Squamous cell: “SQC” 30%
    c. Large cell/other: 10%
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16
Q

Which type of lung cancer more responsive to surgical therapy?

A
  • Non small cell carcinomas

* **SCCs are not responsive to surgery as it is systemic in metastasis by time it is discovered

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17
Q

Treatment of two main types of lung cancer?

A

SCC: radiation as likely inoperable and systemic
NSCC: Surgery

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18
Q

What is the function of PTH?

A
  • Elevate serum Ca

- SQC can be associated with inappropriate PTH secretion

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19
Q

Who is at high risk for SQC?

A
  1. Men

2. Smokers

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20
Q

How is SQC characterized in morphology?

A

Any of the following:

  1. Intercellular bridges
  2. Keratinization
  3. Diffuse P63/40 immunoreactivity
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21
Q

Where is SQC usually located?

A
  • Large, Centrally based mass in thorax
  • 70 - 90 % lymph node involvement
  • 7% spread outside thorax
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22
Q

What happens in SQC grows too large?

A
  • Outstips vascular supply to become necrotic w/ cavitating center
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23
Q

What is metaplasia?

A

Movement from one epithelium type to another

24
Q

Progression of precursor lesions for SQC?

A
  1. Squamous metaplasia
  2. Mild Dysplasia, moderate, severe
  3. Carcinoma in situ: full thickness with all layers involved and basement membrane intact
  4. Invasion characterized by intercellular bridges and keratinization
25
Q

What is Invasion characterized by intercellular bridges and keratinization characteristic of?

A

SQC

26
Q

Most common genetic abnormality with SQC?

A
  1. p53 mutation
27
Q

Which tumor has highest frequency of P53 mutation?

A

SQC

28
Q

Who is ADC seen in?

A
  • Women > men
  • More often in non smokers
  • More often located in periphery
29
Q

Progression of precursor lesions in ADC?

A
  1. AAH “Atypical adenomatous Hyperplasia”
  2. AIS “Adenocarcinoma in situ”
  3. MIA “Minimally invasive Adenocarcinoma”
30
Q

What must tumor have to be ADC?

A

EITHER…..

  1. Gland forming
  2. Contain intracellular mucin
  3. TTF1 positive
31
Q

What is irregular spiculated mass indicative of?

A

ADC

32
Q

What is AAH?

A

“Atypical adenomatous Hyperplasia”

  • Less than 5mm
  • Well demarcated
  • Lined by cuboidal to low columnar epithelium
  • Mild atypia
  • **Incidental finding, not pathological
33
Q

What is AIS?

A

“Adenocarcinoma in situ”

  • 3cm or less
  • Growth along pre existing structures but do not invade
  • Alveolar architecture is preserved
34
Q

What is MIA?

A

“Minimally invasive Adenocarcinoma”

  • 3 cm or less
  • INVASIVE focus > 5mm
  • NO invasion into pleura, lymphatics or vessels
35
Q

Main driver mutation in ADC?

A
  1. EGFR mutation
    - Females, asians, on smokers
    - Tyrosine kinase receptor becomes always active triggering proliferation
    - Can be inhibited
  2. kRAS
    - Confer resistance to EGFR therapy
    - No targeted therapy: poor outcome
  3. ALK
36
Q

Characteristics of large cell carcinoma?

A
  1. Undifferentiated
  2. Poor prognosis: 5 year survival 2-3%
  3. Metastasize early to liver, adrenal, brain
37
Q

Oat is oat cell carcinoma?

A

Another name for SCC

38
Q

Another name for SCC?

A

Oat cell carcinoma

39
Q

Characteristics of SCC?

A
  • Rapidly growing, high grade, neuroendocrine tumor
  • Strongly associated with smoking
  • High, fast metastasis
  • Leads to paraneoplastic syndromes
  • Rarely resectable: radio/chemotherapy
  • 2 year survival of 5-8%
40
Q

Histologic characteristics of SCC?

A 
 Densely packed “small blue” tumor
 size 3 x of small, resting lymphocyte
 Round to ovoid nucleus
 Scant cytoplasm
 Finely dispersed chromatin
 High mitotic activity
 Necrosis present
41
Q

Genetic components of SCC?

A
  • 100% show inactivation of P53 and RB
42
Q

What is bronchial carcinoid?

A
  • Low grade malignant neuroendocrine tumor
  • Rarely metastatic
  • Good surgical prognosis
43
Q

Most common clinical features of lung cancer?

A
  1. Cough
  2. Weight Loss
  3. Chest pain
  4. Dyspnea
44
Q

Downstream features of lung cancer?

A

 Pneumonia, abscess –tumor obstruction of airway
 Pleural effusion-tumor spread into the pleura
 Pericardial tamponade- pericardial involvement
 Hoarseness- recurrent laryngeal nerve invasion
 Dysphagia- esophageal invasion
 Diaphragm paralysis-phrenic nerve involvement
 Rib destruction-chest wall invasion

45
Q

How does lung cancer cause hoarseness?

A

Impingement upon recurrent laryngeal nerve

46
Q

What is superior vena cava syndrome?

A

Obstruction of SVC resulting in facial swelling, cyanosis, and dilation of head and neck veins

47
Q

What is pancoast tumor?

A
  • Apically located tumor that can dester 1st/2nd rib

- May show horner syndrome

48
Q

What is horner’s syndrome?

A
  • ***Due to sympathetic plexus involvement
    1. Ptosis
    2. Miosis
    3. Anhydrosis
49
Q

What are paraneoplastic syndromes?

A
  • Cancer symptoms that cannot be explained by spread of cancer or its elaboration of hormones
  • *EG: Tumor not in adrenal area producing adrenal hormones
50
Q

What is cushing’s?

A

Paraneoplastic syndrome with excess ADH expression

51
Q

What is hydrothorax?

A

Fluid in pleural space from CHF

52
Q

What is chylothorax?

A

Lymphatic fluid in pleural space

53
Q

Most common malignant pleural tumor?

A
  • Mesothelioma
  • Related to asbestos
  • 25 - 50 year latent period
  • Rarely survive > 1 year
54
Q

Genetic component of mesothelioma?

A
  1. P16 deletion

2. NF2 deletion

55
Q

Clinical presentation of mesothelioma?

A
  1. Chest pain
  2. Dyspnea
  3. Recurrent pleural effusion
56
Q

Most common malignant tumor of lung?

A

Metastasis from other area

MHD VI: Pulm (20 decks)

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