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21. CPR Exam 1 > 21. Pulmonary Path 3 > Flashcards

21. Pulmonary Path 3 Flashcards

1
Q

Lung tumors are 90-95% carccinomas. Lung cancer is the most frequently dianosed cancer in the world. Due to radiation, uranium, asbestos, radon and most importantly?

A

Smoking cigarettes/tobacco (females)

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2
Q

Carcinogen exposure may be mitigated by genetic variation in patients such as genes responsible for DNA repair and what types of polymorphisms in the liver?

A

CYP450

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3
Q

Adenocarcinomas account for 38%, SCC account for 20% and small cell neuroendocrine carcinoma acounts for 14%. Adenocarcinomas are derived from type 2 pneumocytes via what gene/ pathway mutation (GOF)?

A

EGFR-RAS pathway activation

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4
Q

Squamous cell carcinoma of the lung is when a basal cell makes a squamous cell instead of making respiratory ciliated cells d/t constant irritation, commonly due to loss of CDKN2A, SOX2, TP53**, or?

A

NOTCH alterations

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5
Q

Small cell carcinomas occur when neuroendocrine cells differentiate to become cancer, via TP53 loss and what other common mutation which is seen in retinoblastomas?

A

RB1 loss* (100% of small cell) - MYC amplification

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6
Q

Which cancer is known as a two hit cancer, which can occur along other cancers, lets say SCC causes the known out of RB?

A

Small cell carcinoma

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7
Q

Progression of pulmonary adencarcinomas occur in stages. The tissue starts as normal, first seen is atypical type II pneumocytes (enlarged), classified as?

A

Atypical adenomatous hyperplasia (AAH)

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8
Q

From AAH what can be seen next? which only spreads on the surface of the alveoli.

A

Adenocarcinoma in situ (AIS)

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9
Q

From AIS, what is formed, forming a solid mass turmor which is able to grow outside of the alveoli? (most common lung cancer in the ABSENCE of smoking)

A

Adenocarcinoma

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10
Q

Atypical adenomatous hyperplasia AAH are dysplastic pneumocytes present along alveoli with some interstitial fibrosis, what must the size of the tumor be under for this stage?

A

Less than or equal to 5mm

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11
Q

Adeoncarcinoma in situ AIS formerly known and bronchioloalveolar carcinoma (BAC), is when dysplastic pneumocytes confluently are growing along the alveoli, what size mus tthe tumor be to for this stage?

A

Less than 3cm

picket fence histo

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12
Q

Pulmonary adenocarcinoma can arise from precursors or develop outright, MC lung malignancy in smokers and nonsmokers, histology shows malignant?

A

GLANDS invading the lung tissue-invasive peripheral lung

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13
Q

What is a variant of adenocarcinoma, are solitary or multiple nodules of tall cells within alveoli-can MIMIC pneumonia?

A

Mucinous adenocarcinoma

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14
Q

The progression of SCC is as follows:
1) Ciliated respiratory normal bronchial epi
2) squamous metaplasia seen as horizontal laying cells
3) squamous carcinoma in situ (dark purple w thickened epithelium)
4)

A

Invasive squamous carcinoma

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15
Q

SCC are more common in men and strongly associated with smoking (MCC lung cancer associated with smoking), the cancer usually occurs where in the lobe?

A

centrally- in the airways

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16
Q

SCC is seen as cauliflower mass (grey/white) firm neoplastic tissue, associated with paraneoplastic syndrome of hypercalcemia, and WHAT is most important on histo?

A

Keratin pearls : dark pink swirls***

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17
Q

Recognizing SCC on cytology is imporant, what is the color of keratin in the cytoplasm?

A

Orange cytoplasm!! = SCC

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18
Q

What type of lung cancer is almost always associated with smoking, high rate of metastasis early to LN, brain, renal and does respond to chemo but comes back?

A

Small cell neuroendocrine carcinoma

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19
Q

Small cell carcinoma has small cells with fine blue nuclear chromatin, scant cytoplasm, characteristic necrosis and nuclear?

A

MOLDING (poorly differentiated, nuclear molding) (basophilic staining of vascular walls = azzopardi effect)

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20
Q

Small cell carcinoma is important to identify for treatment purposes, because what if it spread to LN already, or if there is a specific?

A

chemotherapy used ***-it is different for small cell

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21
Q

As mentioned earlier, Squamous cell carcinoma causes hypercalcemia by releasing a PTH related peptide (paraneoplastic). What are two secretions that can occur paraneoplatically with small cell carcinoma?

A

SIADH (syndrome of inappropriate ADH sec.)

Cushing’s (secretion of ACTH)

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22
Q

What type of anatomic tumor in the upper lobe of the lung hits the cervical plexus, causing horner’s syndrome (enophthalmos, ptosis, miosis, anihidrosis on that side of the face)? (also paresis of hand and arm)

A

Pancoast Tumor (apical lung cancer)

23
Q

tumors 3cm or less with no stromal invasion=

A

adenocarcinoma in situ

24
Q

tumors 3cm or less with no stromal invasion=

A

adenocarcinoma in situ

25
Q

If the tumor is in central airways, it will present as a cough, or if there is hemorrhage from tumor in the airway you will see hemoptysis, what if someone has chest pain?

A

it means the tumor has extended into the mediastinum, pleura or chest wall

26
Q

Diffuse interstitial pulmonary neuroendocrine cell hyperplasia (DIPNECH) is similar to RB-ILD seen in younger patients with a mosaic pattern. High res CT scan can detect the nodules - nests of NE cells in interstitum, and are usually what size?

A

VERY small, less than 5mm (hyperplasia leads to tumorlets)

27
Q

What type of tumor is 5mm or larger (how to differentiate from DIPNECH), it can metastasize and are considered neuroendocrine carcinoma grade 1 = low grade carcinoma?

A

Carcinoid Turmor

28
Q

Any Carcinoid tumors can cause carcinoid syndrome which are intermittent attacks of diarrhea, cyanosis, and ?

A

flushing (d/t serotinin - 5hydroindoleacetic acid)

29
Q

What type of neuroendocrine tumor is a grade 2, and as opposed to carcinoid tumors, they have increased mitotic activity, NECROSIS, and disordered growth?

A

Atypical carcinoid tumor

30
Q

Atypical carcinoid tumors have an increased rate of metastiasis and a lower survival, but still better than?

A

small cell carcinoma

31
Q

Tumor cells associated with carinoids (not atypical) with be small, rounded and uniforme with moderate amounts of?

A

Cytoplasm

32
Q

Carcinoid tumors grade 1 has 95% 5 year survival, atypical carcinoid grade 2 have 70% and small cell carcinoma (NE grade 3) have a?

A

5% 5 year survival rate

33
Q

What type of lung tumor has coin lesions on CT scan, is benign, firm marble with smooth edge looking, which on high power can see cartilage, fat, SM, and respiratory epithelium?

A

Hamartoma

34
Q

Lypmhangioleiomyomatosis (LAM) occurs mostly in young women and is assocaited with loss of funtion of tumor suppressor?

A

TSC2 (linked to tuberous sclerosis- presenting condition)

35
Q

LAM have proliferation of cells creating/ around cystic spaces, made of perivascular epitheliod cells (PEC-oma) and may present with ***?

A

Spontaneous Pneumothorax

36
Q

LAM can be seen as small nests of dark purple tumor cells on high mag hist, and are modified smooth muscle cells which are posistve for what markers?

A

Melanoma markers like HMB45

37
Q

What tumors are rare, more common in children with no gender preference, present with fever cough chest pain and hemoptysis?

A

Inflammatory myofibroblastic tumor

38
Q

Inflammatory myofibroblastic tumor are grey/white round well defined single peripheral masses with calcium deposits, can see proliferation of fibroblasts, myofibroblasts and what other two cells?

A

lymphocytes and plasma cells

39
Q

Inflammatory myofibroblastic tumor have what type of mutation, so treatment is with the mutation inhibitor?

A

ALK mutation

40
Q

Pleural consists visceral pleura directly on top of the lung and parietal pleura which lines the thoracic cavity, in between both layers is?

A

pleural spave with slight negative pressure

41
Q

What is the most common site of metastatic neoplasms with ‘cannonball lesions’ scattered throughout beginning at the periphery?

A

THE LUNGS

42
Q

Pleural effusions can either be transudative of exudative, what is the difference?

A

Transudate: d/t inc. hydrostatic pressure in HF, nephrotic syndrome, cirrhosis
Exudate: inflammatory: infection or malignancies

43
Q

What type of effusion might come from a patient with metastatic breast carcinoma involving the pleura?

A

Bloody effusion (thin)

44
Q

What type of effusion might come from a patient with bronchogenic carcinoma (mass lesion) that obstructed the thoracic duct?

A

Milky chylous effusion***

45
Q

What type of effusion might come from a patient with heart failure?

A

Serous transudative effusion (straw yellow)

46
Q

What is inflammatory exudatte with accumulation of pus in the pleural space typically due to bacterial infection?

A

empyema

47
Q

Empyema is notorious for creating loculations - web- like traps for fluid, the fluid will be thick and yellow with smears showing?

A

neutrophils and bacteria **more common on right side)

48
Q

What occurs primarily (idiopathically) due to rupture of subpleural blebs in young patients or secondarily due to cystic infections, cycstic tumors, + pressure ventilation, or trauma?

A

Pneumothorax (air in the pleural space)

49
Q

What occurs due to injury to the chest wall resulting in a one way valve allowing air into the pleural spae but not out WITH tracheal / mediastinal shift away from lung?

A

Tension pneumothorax

50
Q

The main difference between primary and tension pneumothorax is that in primary the pleural cavity pressure is less than atmospheric pressure but in tension?

A

the pleural cavity pressure is greater the atmospheric pressure (insert needle to make an exit for inward air)

51
Q

What type of tumor is benign when small and pedunculated mass attached to pleural surface, larger ones may behave like sarcomas?

A

Solitary fibrous tumor

52
Q

Solitary fibrous tumors have whorls of reticulin and collagen fibers with spindle cells and staghorn vessels, what kind of mass?

A

circumscribed pleural based mass pedunculated from neighboring lung tissue

53
Q

What is a pleural tumor associated with asbestos exposure used commercially for insulation, shipyard work and construction workers?

A

mesothelioma

54
Q

mesothelioma has 3 variants : *epitheliod (60%) sarcomatoid and mixed, can look like adenocarcinomas but there is a special stain used to differentiate it called?

A 
Calretinin positive (also + for cytokeratin proteins)
and will have ferruginous bodys/asbestos bodies!!

21. CPR Exam 1 (26 decks)

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