(17.1) Pulmonary Pathology III (Singh)

Question 1

What is THE most significant risk factor for aquiring lung cancer?

Answer 1

Tobacco use in terms of duration and intensity

Question 2

What is a “pack-year”?

Answer 2

(packs smoked per day) x (years of use)

ex: 1 pack a day for 35 years = 35 pack years

2 packs a day for 30 years = 60 pack years

Question 3

What are other risk factors for aquiring lung cancer?

Answer 3

Radiation

Uranium

Asbestos

Radon

Question 4

What genetic factors can mitigate carcinogen exposure?

Answer 4

P450 polymorphisms

Genes responsible for DNA repair

Question 5

What are the major classifications of lung tumors?

Answer 5

“Small cell” vs. “Non-small cell”

Question 6

What is the origin of squamous-cell carcinoma?

Answer 6

Coming from the respiratory epithelium

Arises from metaplastic adaptive phenomenon

Question 7

What is the origin of small-cell carcinoma?

Answer 7

Neuroendecrine cells

Question 8

What is the origin of adenocarcinoma?

Answer 8

Type II pneumocytes

Question 9

Describe the 4 steps in the progression of pulmonary adenocarcinoma

Answer 9

Normal –> AAH –> AIS –> Adenocarcinoma

Question 10

Atypical adenomatous hyperplasia (AAH)

Size?

Describe appearance:

Answer 10

Less than or equal to 5mm

Dysplastic pneumocytes present along alveoli with some interstitial fibrosis

Question 11

Adenocarcinoma in Situ (AIS)

Size?

Describe appearance:

Answer 11

<3cm

Dysplastic pneumocytes confluently growing along alveoli

Question 12

What is the most common form of lung cancer?

Answer 12

Pulmonary adenocarcinoma

Question 13

How can you tell histologically that a lung biopsy has pulmonary adenocarcinoma?

Answer 13

Histology shows malignant GLANDS invading the lung tissue

Question 14

What is the pathology?

Answer 14

Mucinous adenocarcinoma

Question 15

Why is mucinous adenocarcinoma frequently misdiagnosed?

Answer 15

CAN MIMIC PNEUMONIA on CXR

Question 16

What is the progression of squamous carcinoma?

Answer 16

Normal bronchial epithelium –> Squamous metaplasia –> Squamous carcinoma in situ –> Invasive squamous carcinoma

Question 17

Demographic of squamous carcinoma?

Answer 17

Men

Smokers

Question 18

Where in the lungs does squamous carcinoma occur?

Answer 18

Centrally

Question 19

What are these?

Answer 19

KERATIN PEARLS

Diagnostic for squamous carcinoma

Question 20

What does an orange cytoplasm represent in cytology?

Answer 20

Orange cytoplasm = keratin

That means wer are dealing with squamous carcinoma

Question 21

What is the pathology?

Answer 21

Small cell *neuroendocrine* carcinoma

Question 22

What is one of the newer methods physicians use for “typing” tumors?

Answer 22

Molecular testing

Has implications for how you can treat them

Question 23

Squamous carcinoma is correlated with….

Answer 23

Hypercalcemia

PTH-related peptide

Question 24

What is small cell carcinoma correlated with?

Answer 24

SIADH (Syndrome of inappropriate ADH secretion)

Cushing’s syndrome (secretion of ACTH)

Question 25

How is Horner’s syndrome related to lung oncology?

Answer 25

Superior lung tumor can impinge on nervous system and induce horners

Question 26

What is DIPNECH?

Answer 26

“Diffuse interstitial pulmonary neuroendocrine cell hyperplasia”

Nodules

LESS THAN 5mm

Question 27

What is a carcinoid tumor?

Answer 27

5mm or larger

Metastasize

Indolent

Question 28

What is atypical carcinoid tumor?

Answer 28

(Neuroendocrine tumor grade 2)

As opposed to carcinoids:

• Increased mitotic activity
• Necrosis
• Disordered growth

INCREASE RATE OF METASTASIS

Question 29

5 year survival rates for neuroendocrine tumors

State which has a:

95%

70%

5%

Survival rate

Answer 29

Carcinoid tumors (neuroendocrine carcinoma grade 1) = 95%

Atypical carcinoid tumors (neuroendocrine carcinoma grade 2) = 70%

Small cell carcinoma (neuroendocrine carcinoma grade 3) = 5%

Question 30

Inflammatory myofibroblastic tumors are associated with what mutation?

Answer 30

ALK gene rearrangements

Question 31

What is the demographic for lymphangioleiomyomatosis (LAM)?

Answer 31

Young women

Question 32

What is the associated loss of function mutation associated with lymphangioleiomyomatosis (LAM)?

Answer 32

Loss of function of TSC2

Question 33

What is the difference b/w transudative and exudative fluid?

Answer 33

Transudate = clear fluid

Exudate = high protein content

Question 34

What would cause the following pleural effusion samples?

Left, Center, Right

Answer 34

Left = bloody effusion

Middle = obstructed throacic duct

Right = heart failure

Question 35

What is an empyema?

Answer 35

Inflammatory exudate w/ accumulation of pus in the pleural space

bacterial infection

*Hallmark = Creating loculations which are web-like traps for fluid

Question 36

What is a pneumothorax?

Answer 36

The presence of air or gas in the cavity b/w the lungs and the chest wall, causing collapse of the lung

Question 37

What is a tension pneumothorax?

Answer 37

Injury to the chest wall resulting in a one-way valve allowing air into the pleural space but not OUT

Question 38

What is a hallmark feature on a CXR that is indicative of tension pneumothorax?

Answer 38

Mediastinal shift

Question 39

What is a solitary fibrous tumor?

Answer 39

Benign when small and pedunculated plural tumor

Question 40

What is mesothelioma?

Answer 40

Associated with asbestos exposure

Question 41

What is the special stain used to distinguish adenocarcinoma from mesothelioma?

Answer 41

CALRETININ