B4-080 CBCL Approach to a Lung Nodule Flashcards
well differentiated neuroendocrine tumors
carcinoid tumor
tobacco related neuroendocrine tumors
2
large cell and small cells
- mitoses < 2 per 2 mm
- no necrosis
typical carcinoid
- mitoses 2-10 per 2 mm
- or necrosis
atypical carcinoid
- mitoses > 10 per 2 mm
- cytologic features of SCLC
small cell carcinoma
- mitoses >10 per 2 mm
- cytologic features of NSCLC
large cell NET
chemotherapy is first line for […] and second line for […]
first: large and small cell
second: typical/atypical carcinoid
usually found in lung or GI tract
NET
- well differentiated
- 2% of lung neoplasms
- metastatic potential 5-20%
typical carcinoid
- intermediate grade
- <1% of lung neoplasms
- metastatic potential 30-40%
atypical carcinoid
- high grade variant of large cell lung cancer
- 3% of lung neoplasms
large cell NET
- high grade
- 15-20% of lung cancers
SCLC
functional NETs may present with
3
- carcinoid syndrome
- cushing syndrome
- acromegaly, hypercalcemia, hypoglycemia
carcinoid syndrome
3 symptoms
wheezing, cutaneous flushing, diarrhea
clinical presentation for large cell NET
4 symptoms
cough
hemoptysis
chest pain
dyspnea
- present with cough, hemoptyisis, dyspnea, chest pain, wheezing, hoarseness
- SVC syndrome
- may have paraneoplastic syndromes
small cell lung cancer
typical carcinoid
atypical carcinoid
Large cell NET
small cell
used to differentiate carcinoids vs. large/small cell
cannot distinguish typical vs atypical
Ki67
more Ki67 indicates
high grade NET
small or large cell
least aggressive type of cancer with uniform, round to oval tumor cells
carcinoid
workup for carcinoid tumor includes
3
- 24 hr urine for 5 HIAA
- chromogranin A level
- sometimes somatostatin receptor
has the poorest prognosis
small cell carcinoma
the diagnosis of carcinoid syndrome includes
3 symptoms
flushing
diarrhea
bronchospasm
ptosis, miosis, ipsilateral anhidrosis
horner’s syndrome
can be due to pancoast tumor
has revolutionized the way many cancers are treated, including small cell lung cancer
immunotherapy
small cell lung cancer
number one cancer killer of women in US
lung cancer
diarrhea, facial flushing, asthmatic symptoms
carcinoid tumor
test for definitive diagnosis of cancer
tissue diagnosis is necessary
CT guided biopsy of lesion
altered mental status
hyponatremia
lung mass in upper lobe
SIADH
paraneoplastic syndrome
sympathetic ganglia invasion due to cancer may cause
horner’s syndrome
ptosis, miosis, ipsilateral anhidrosis
horner’s
apical lung tumors may cause impingement of what surrounding structures?
3
- brachial plexus
- recurrent laryngeal nerve
- sympathetic chain
a mass effect on the brachial plexus could cause
upper extremity weakness
a mass effect on the reccurent laryngeal nerve could cause
hoarse voice
a mass effect on the sympathetic chain could cause
horner’s syndrome
carcinoid syndrome is caused by increased
serotonin
carcinoid syndrome is usually apparent after
metastasis, usually to liver
what laboratory finding is most likely with carcinoid syndrome?
elevated 5-HIAA in urine
shows some advantage in the treatment of low grade carcinoid tumors
drug
everolimus
carcinoid tumors are most commonly in the
anatomic location
GI tract
carcinoid tumors typically arise from the […] cells of the GI tract
enterochromaffin
syndrome caused by excessive serotonin release via GI tumors
carcinoid syndrome
generally, metastasis to the […] is required for carcinoid syndrome to occur
liver
neurosecretory granules
necrotic debris
high mitotic count
small cell carcinoma
obstructing mass of a bronchus
carcinoid tumor
first line treatment for carcinoid tumors
surgical resection
first line treatment for small cell lung cancer
combination chemotherapy
treatment to control flushing and diarrhea
long acting octreotide therapy
metabolite of serotonin that can be detected in urine
5-HIAA
synthetic octapeptide analog of somatostatin
octreotide
used to treat pancreatic secretory tumors and carcinoid syndrome
octreotide
glucose intolerance
coarsening of facial hair
macroglossia
thickened fingers
fatigue
sweating
sign of
excessive growth hormone synthesis (acromegaly)
associated with carcinoid tumor
altered mental status
convulsive episodes
hyponatremia
SIADH
small cell lung cancer
may manifest with SIADH, cushings, or pancost tumor
small cell carcinoma
may manifest with hypercalcemia, hypoglycemia, acromegaly
carcinoid tumor
weight gain
abdominal striae
moon facies
poor wound healing
facial plethora
cushing syndrome
high mitotic rate
large cells with nucleoli
necrosis
neuroendocrine differentiation
large cell neuroedocrine tumor