Carcinoma of the Lung Flashcards
What is the most common cause of cancer mortality worldwide?
Lung cancer
What type of cancers are associated with mutations of the K-ras gene?
- 25% adenocarcinomas
- 20% large cell carcinomas
- 5% squamous cell carcinomas
In what cancers is overexpression of the Myc gene found?
10-40% of small cell carcinomas
What cancers are mutations in the p53 gene found?
- 80% of small cell carcinomas
- 50% of non-small cell carcinomas
What cancers are mutations in the Rb gene found?
- 80% of small cell cancers
- 25% of non-small cell carcinomas
What determines the histologic subtyping of lung cancer?
Best differentiated component (unless an area of small cell carcinoma is present)
What determines the degree of differentiation grading of lung cancer?
Worst-differentiated component
Histology shows a cancer with a keratin pearl composed of cells with brightly eosinophilic cytoplasm. The pearl is surrounded by concetric layers of cells (“onion skin”). What is the Dx?
Squamous Cell Carcinoma
Shown is a gross specimen of Squamous Cell Carcinoma. Describe the pathogenesis leading from cigarette smoking to cancer. Where are these tumors generally found?
- Smoking
- Cellular Damage
- Regeneration from the pluripotent basal layer
- Squamous metaplasia
- Dysplasia
- Carcinoma in situ
- Invasive tumor
Central portion of the lung
A gross lung specimen reveals a tumor with an irregular border with a tan/gray cut surface and it causes puckering of the overlying pleura. Furthermore, pleural fibrosis was observed. What is the Dx? Where are these tumors generally found?
Adenocarcinoma of the lung; In the periphery
What is the precursor lesion to adenocarcinoma of the lung?
Atypical adenomatous hyperplasia
What are the 4 types of adenocarcinoma of the lung?
- Acinar
- Papillary
- Solid with mucus formation
- Bronchioalveolar
What type of adenocarcinoma is this?
Acinar
Epithelial cells grow along thin fibrovascular cores. What type of adenocarcinoma is this?
Papillary
Several intracytoplasmic droplicts are shown within this adenocarcinoma. What is it?
Solid adenocarcinoma with mucus
A diffusely infiltrating tumor appears solid, glistening and mucoid. What type of adenocarcinoma is it?
Bronchiolalveolar
What is the most common type of adenocarcinoma?
Acinar
What are the two subtypes of bronchiolalveolar carcinoma?
Nonmucinous and mucinous
A lung biopsy reveals atypical cuboidal to low columnar cells proliferating along th existing alveolar wall. What is the growth called? What is the Dx?
Lepidic growth; Nonmucinous bronchioloalveolar carcinoma
A lung biopsy reveals tall columnar cells that grow along the existing alveolar walls. Goblet cells are featured throughout the sample. What is within the columnar cells? What is the Dx?
Mucin; Mucinous bronchioloalveolar carcinoma
Lung biopsy shows poorly differentiated tumors growing in sheets. The cells do not show squamous or glandular differentiation. The cells show prominent nucleoli and ample cytoplasm. What is the Dx? What is unique about the Dx?
Large Cell Carcinoma of the Lung; It is a Dx of exclusion
Histology reveals sheets of small, round, oval, and spindle-shaped cells with scant cytoplasmm. The nuclei are very distinctive and nuceloli are absent. Necrosis is evident. Mitotic rate is very high. What is the Dx? What is the clinical Px? What markers are seen in this sample? What is this cancer associated with?
Small Cell Lung Carcinoma; This cancer has a high rate of metastasis; CD56, synaptophysin, chromogranin; SMOKING
What are some paraneoplastic syndromes associated with small cell lung carcinoma?
Diabetes insipidus, Ectopic adrenocortioctropic hormone syndrome, Eaton-Lambert Syndrome
What is the Rule of Thumb in SCLC measurements in histology?
Diameter of three small resting lymphocytes
What are the two types of carcinoid tumors?
Atypical and typical
What are the differences between typical and atypical carcinoid tumors?
Atypical:
- increased mitoses
- tumor necrosis
- areas of increased cellularity and disorganization of the architecture
- nuclear pleomorphism, hyperchromatism and high nuclear:cytoplasmic ratio
What is the most common lung tumor of childhood?
Bronchial carcinoids
Histology reveals ribbons of tumor cells embedded in a vascular stroma. The cells show eosinophilic, finely granular cytoplasm and nuclei. What is the Dx?
Typical Carcinoid Tumor
Histology reveals a cellular tumor with central necrosis and disorganized architecture. What is the Dx? What are the Syx of this general type of tumor?
Atypical carcinoid tumor; Generally asymptomatic, if showing Syx, hemoptysis, postobstructive pneumonitis, and dyspnea
A tumor protrudes into the lumen of a main bronchus causing postobstructive pneumonia in the distal lung parenchyma. The patient did not know that he had the tumor and did not show any Syx. What is the Dx?
Typical Carcinoid Lung Tumor
A histologic section shows intersecting spindle cells and scattered lymphocytes. The section shows consolidation of the lung parenchyma and loss of architecture. What are the two subtypes of this tumor? What is the Dx?
Fibrohistiocytic and Plasma Cell Granuloma; Fibrohistiocytic Inflammatory Pseudotumor
Histology shows a nodule of tumor spreading within the alveolar spaces. The tumor consists of oval-shaped nodules with central, sclerotic, hypocellular zones and cellular peripheral zones. The tumor cells have abundant cytoplasm. Dx?
Epithelioid Hemangioendothelioma
A histologic section resembles embryonal lung, with a glandular component consisting of poorly differentiated columnar cells arranged in tubules, without mucus secretions. What is the Dx? What is the typical patient profile?
Pulmonary Blastoma; median range 35-43 and most are cigarette smokers
Histologic section reveals a polypoid mass of malignant spindle cells spreading within the lumen of this pulmonary artery. Dx?
Pulmonary Artery Sarcoma
What is the most common primary pulmonary lymphoma?
Extranodal marginal zone B-cell Lymphoma
Histology shows extensively necrotic nodular mass consisting of a cellular lymphoid infiltrate that penetrates a blood vessel. The infiltrate is composed of polymorphous population of small, medium-sized, and large atypical lymphoid cells. What is the Dx?
Lymphomatoid Granulomatosis
What are SCC, adenocarcinoma, and large cell carcinoma characterized as?
“Non-small cell carcinoma”
Why is the distinction betwixt adenocarcinoma and SCC important?
EGFR mutations are more common in adeno. than SCC and therefore they respond to EGFR-related chemoTx
What is the number one predictor of cancer Px?
Tumor stage
What is Pancoast Syndrome?
Tumor (Pancoast tumor) at the apex of the leng extends to involve the eighth cervical and 1st/2nd thoracic nerve leading to shoulder pain that radiates down the arm in an ulnar distribution
What is the most common lung malignancy?
Metastatic tumors
A patient’s lung is seen on CXR containing “cannon ball” lesions. The lung is shown. What is the Dx?
Metastatic carcinoma of the lung
