Chapter 13: Lecture lung part 2

Question 1

Moving on from infectious diseases, tuberculosis is a very important one. What is it caused by?

Answer 1

Mycobacteria

Question 2

Is tuberculosis contagious?

Answer 2

Yes! very!

Question 3

Where is tuberculosis common (geographically)?

Answer 3

In Afrika, in The Netherlands we keep it contained to identify which patients have it, and minimize the risk of infecting others

Question 4

After how many years can someone with tuberculosis die?

Answer 4

A couple of years (before treatment was available)

Question 5

What is the hallmark of tuberculosis

Answer 5

Granuloma and giant cells, with necrosis, formed by Langerhans cells

(Macrophages activated by IFN-γ differentiate into the “epithelioid histiocytes” that aggregate to form granulomas; some epithelioid cells may fuse to form giant cells.)

Question 6

Protection against infection is done be mechanical (1), immunological (2) and fagocytical (3) mechanisms. What are these mechanisms?

Answer 6

1. Mechanical: mucociliairy transport, coughing reflex
2. Immunological: IgA secretion in bronchial mucus, Humoral and cellular immune respons (BALT)
3. Phagocytosis: alveolar macrophages, neutrophillic granulocyte

Question 7

What causes that one patient becomes sick because of an infection and the other doesn’t?

Answer 7

The dose and the pathogenicity virulence of the pathogen, and the host’s health state (however, in regard to corona, it is still very unclear why some patients have mild, and others have severe symptoms)

Question 8

How was the corona virus through the pathology department mostly investigated?

Answer 8

Post-mortem, with autopsy

Question 9

Is there diffuse alveolar damage in COVID-10 patients?

Answer 9

Yes

Question 10

The lecturer told us about a study with covid that he did, what did he find?

Answer 10

Profound inflammatory changes in all areas of the brain, but no virus! So there is an inflammatory respons that influences the brain

Question 11

If we would make a graph, where on the x-axis there is a timeline (1930s-2010s), and on the y-axis the amount of death rates for lung and bronchitis. How would this graph look?

Answer 11

You would see a high increase of amount of deaths, reaching it’s peak at 1990s, but then a decrease. This correlates with the smoking habits of the population (for illustration see p64 of the lecture)

Question 12

Lung cancer comes in 4th in place (of incidences) of all cancers (for both males/females). Still it is the most important cause of death in The Netherlands. How?

Answer 12

Because the mortality is high(er than the others such as breast, skin and prostate)

Question 13

What is the main risk factor of lung cancer?

Answer 13

Smoking

Question 14

Lung cancer can present in many ways and can look very different. What are some histologic classifications that are/can be made? (don’t learn by heart)

Answer 14

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, neuroendocrine carcinoma, mixed carcinomas, other unusual morphologic variants (sarcomatoid/spindle/giant) This is for illustration

Question 15

What is the order of most - least frequent primary malignant epithelial lung tumors?

Answer 15

• 50-60%: Adenocarcinoma - 25-30%: Squamous cell carcinoma - 10-15%: Small cell carcinoma - 1-5%: Carcinoid - 10%: Large cell carcinoma (you have to know the first three / should be able to recognize them)

Question 16

How does a papillary adenocarcinoma look like? you only need to know what an adenocarcinoma looks like, these are just for illustration

Answer 16

Question 17

How does a acinar adenocarcinoma look like?

Answer 17

(top right:

1. lepicidic (not discussed)
2. papillary adenocarcinoma)

(forms glandular structures)

Question 18

How does a micro papillary adenocarcinoma look like?

Answer 18

(top right:

1. lepicidic (not discussed)
2. papillary adenocarcinoma
3. acinar adenocarcinoma
4. micropapillary adenocarcinoma)

Question 19

Where does squamous cell carcinoma occur, and because of what?

Answer 19

In the central part of the lung, at the main bronchus, and 98% are smokers

Question 20

How does a squamous cell carcinoma look like under the light/electron microscopy?

Answer 20

Large lesions may undergo central necrosis, giving rise to cavitation. The preneoplastic lesions that antedate, and usually accompany, invasive squamous cell carcinoma are well characterized

Question 21

What (sub)type are small cell carcinoma?

Answer 21

neuroendocrine carcinoma

Question 22

Why is it important to recognize small cell carcinoma?

Answer 22

Because it has very different treatment than e.g. squamous, it is more aggressive (2-4 months to live without treatment)

Question 23

How is small cell lung cancer treated?

Answer 23

Chemotherapie, most patients don’t survive well on surgery (5 year survival is 2%) (cause is also >98% smoking)

Question 24

In 2004 there was a ground-breaking study that showed that a subgroup of patients with non-small-cell lung cancer have specific mutations in the EGFR gene. What do these mutations lead to?

Answer 24

Increased growth factor signaling and confer susceptibility to the inhibitor

Question 25

How can the mutation in the EGFR gene be used as a treatment?

Answer 25

Tyrosine-kinase inhibitors can be administered (and there is a clinical responsiveness!)

Question 26

If we would make a graph where an x amount of mutations is shown per cancer, we would see that lung cancer has the highest amount of mutations. Why is that?

Answer 26

Substances in sigarettes bind/damage the DNA, causing for more mutations

Question 27

What you need to know is that squamous cell can be identified under the microscope, because…

Answer 27

There is squamous cell differentiation

Question 28

What you need to know is that adenocarcinoma cell can be identified under the microscope, because…

Answer 28

There is adenoma cell differentiation

Question 29

What is the hallmark of interstitial lung disease? A. Increased mucin production B. Stiffening of the lung C. Lymphadenopathy D. Mastcelldegranulation

Answer 29

B. Stiffening of the lung

Question 30

Which of the mentioned diseases is a restrictive lung disease: A. Asbestosis B. Chronic bronchitis C. Emphysema D. Asthma

Answer 30

A. Asbestosis

Question 31

True/false: PDL1 expression on tumor cells as a predictor for response to checkpoint inhibitor therapy

Answer 31

True