B4.080 - Carcinoid of the Lung

Question 1

Patients with carcinoid syndrome may receive what treatment to best control symptoms of flushing and diarrhea?

Answer 1

The best treatment to control flushing and diarrhea is a long-acting octreotide therapy.

Question 2

Answer 2

Small cell carcinoma. There are islands of small deeply basophilic cells and areas of necrosis.

Question 3

Answer 3

large cell carcinoma

shows no evidence of squamous or glandular differentiation

Question 4

Molecular profiling of an individual’s lung cancer is now considered ‘standard of care’. Results of the gene profiling of a tumor may result in treatment with a targeted agent specific for that genetic lesion. The results of molecular profiling show a tumor expressing an ALK mutation. This finding is typically found in a lung cancer patient with which of the followinghistologies?

Answer 4

adenocarcinoma

Question 5

what is typically the first line treatment for extensive stage small cell lung cancer in an asymptomatic patient?

Answer 5

Combination chemotherapy.

First line treatment for small cell lung cancer is combination chemotherapy, typically cisplatin and another agent. Radiation therapy may be used to palliate symptoms, particularly if the patient presents with an SVC syndrome or brain metastases, but is not used as up front therapy for small cell lung cancer. Targeted agents are not used in patients with small cell lung cancer. Surgery is very rarely used in small cell lung cancer with limited disease, and is not recommended routinely in patients with extensive disease.

Question 6

A 40-year-old man has had an increasing cough with hemoptysis for 2 weeks. On physical examination, his temperature is 38.2°C. A chest radiograph shows an area of consolidation in the right upper lobe. His condition improves with antibiotic therapy; however, the cough and hemoptysis persist for 2 more weeks. A chest CT scan shows right upper lung atelectasis. Bronchoscopic examination shows an obstructive mass filling the bronchus of the right upper lobe. Which of the following neoplasms is most likely to produce these findings?

Answer 6

Carcinoid tumor.

Most carcinoids of the lungs present with an obstructing mass of a bronchus. Many are resectable, and follow a benign course.

Question 7

describe characteristics of squamous cell and small cell cancer and their typical labs

Answer 7

Small cell lung cancer and squamous cell lung cancer tend to occur in a central location. Squamous cell cancers are known for the development of hypercalcemia, and small cell lung cancer may be associated with paraneoplastic syndromes.

Question 8

Answer 8

small cell lung cancer

Question 9

A 55-year-old man with a long history of smoking presents with increasing chest pain, bloody sputum, and weight loss over the past 3 months. A high-resolution CT scan reveals a mass circumscribing the right main bronchus, extending into its lumen. Histologic examination of an open-lung biopsy shows a neoplasm with abundant neurosecretory granules consistent with neuroendocrine tumor. Of note, the mitotic count was high, and necrosis of the lesion was extensive. What is the most appropriate diagnosis?

Answer 9

small cell

Question 10

For non-small cell cancer of the lung, mutations in EGFR, ALK, ROS, and MET may be associated with which lung cancer?

Answer 10

Adenocarcinomas may exhibit gain-of-function mutations in multiple genes that code for receptor tyrosine kinases including those listed.

Question 11

Answer 11

bronchial carcinoid

Question 12

hallmarks of small cell carcinoma

Answer 12

Hallmarks of small cell cancer include neurosecretory granules, necrotic debris and an increase in the number of mitoses.

Question 13

Answer 13

Well-differentiated squamous cell carcinoma showing keratinization (arrow)

Question 14

what is horners syndrome

Answer 14

Ptosis, miosis, ipsilateral anhidrosis. This may be a case of Horner’s syndrome. These findings occur when a patient’s tumor invades the sympathetic ganglia.

Question 15

Answer 15

Gland-forming adenocarcinoma; inset shows thyroid transcription factor 1 (TTF-1) expression, as detected by immunohistochemistry.

Question 16

The highest frequency of TP53 mutations is associated with which of the following lung cancer histologies?

Answer 16

Squamous cell carcinoma shows the highest frequency of TP53 mutations.

Question 17

A 64-year-old man, who is a chain-smoker, sees his physician because he has had a cough and a 5- kg weight loss over the past 3 months. Physical exam shows clubbing.

He is afebrile. A chest radiograph shows no hilar adenopathy, but there is cavitation within a 3-cm lesion near the right hilum. Laboratory studies are unremarkable except for a calcium level of 12.3 mg/dL, phosphorus concentration of 2.2 mg/dL, and albumin level of 3.9 g/dL. Bronchoscopy shows a lesion almost occluding the right main stem bronchus. A biopsy is performed. Based on the pathologist’s report and further testing, including chest and abdomen CT and bone scans, the patient is told that a surgical procedure with curative intent will be attempted. Which of the following neoplasms is most likely to be present in this patient?

Answer 17

Squamous cell carcinoma.

Of all the lung cancers, squamous cell carcinoma is the most likely to cause paraneoplastic hypercalcemia. Also, there is a strong association with cigarette smoking in squamous cell cancer. Adenocarcinomas, bronchioloalveolar carcinomas, and large cell carcinomas tend to produce peripheral masses and generally are not associated with paraneoplastic syndromes.

Question 18

name the cancer and the molecular profiling

Answer 18

adenocarcinoma

EGFR, ALK, ROS, MET, RET, KRAS

mucin positive

Question 19

what is an ECOG status of 4

Answer 19

The patient is completely disabled, incapable of any self-care, totally confined to bed, consistent with an ECOG status of 4.

Question 20

classic features of carcinoid

Answer 20

The classic features include diarrhea, facial flushing and asthmatic symptoms.

Question 21

Mrs. Walker presents to the emergency room with confusion. Her son brings her in, as he stopped to see her on his way home from church and found her sitting on the floor in a confused state. O2 saturation was 98%. MRI of the brain showed no mass lesions, no abnormalities. A chest x-ray shows a 4 cm mass in the left upper lobe of the lung. A CBC was obtained, all within normal limits. Serum chemistries were remarkable for a Na of 119 MMOL/L (Range: 137-147 MMOL/L) All other chemistries were normal. What is the most likely cause of the hyponatremia in this patient?

Answer 21

SIADH, a paraneoplastic syndrome.

Question 22

A 53-year-old woman with a history of cigarette smoking presents with a 3-month history of chest pain, cough, and mild fever. A chest x-ray reveals a peripheral subpleural mass in the left upper lobe. What is the most LIKELY diagnosis?

Answer 22

adenocarcinoma more likely to be peripheral

Question 23

describe squamous cell histo

Answer 23

Characterized by presence of keratinization and or intercellular bridges.

Question 24

A 71-year-old man complains of shortness of breath, hoarseness, productive cough, and bloody sputum of 2 weeks in duration. Recently, he experienced a significant loss of appetite and weight loss. Physical examination shows pallor and cachexia. A chest x-ray reveals a mass at the right lung apex. Fine needle aspiration of the mass shows a neoplastic process with prominent keratin pearls. What is the appropriate histologic diagnosis?

Answer 24

squamous cell carcinoma

keratin pearls!!!