CVPR Week 5: Basics of lung cancer Flashcards
Histologic classifications of malignant epithelial lung tumors
Small cell or Non-small cell
Histological classifications of small cell lung cancer
3 listed
- Classical small cell carcinoma
- Large cell neuroendocrine
- Combined
Histological classifications of Non-small cell lung cancer
3 listed
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
Types of adenocarcinoma
Bronchoalveolar carcinoma
Adenocarcinoma cancer type
Non-small cell lung
Combined cancer type
Small cell lung
Large cell neuroendocrine cancer type
Small cell lung
Squamous cell carcinoma cancer type
Non-small cell lung
Classical small cell carcinoma cancer type
Small cell lung cancer
Large cell carcinoma cancer type
Non-small cell lung cancer
Bronchoalveolar carcinoma cancer type
Adenocarcinoma of Non-small cell lung cancer
Why is this system no longer clinical significant?
- No longer clinically sufficient to only distinguish small cell vs Non-small cell
- Because a minority of adenocarcinomas will have treatable genetic alterations
- Therefore it is necessary to know if a given tumor is adenocarcinoma, so molecular testing can be performed
More classifications of malignant epithelial lung tumors
Small cell carcinoma: Neuroendocrine differentiation
Neuroendocrine differentiation (cells that receive neuronal input and subsequently release hormones)
Non-Small cell carcinoma:
- Squamous cell carcinoma
- Adenocarcinoma
- Combined adenosquamous
- Large cell carcinoma
- Large cell neuroendocrine carcinoma
- Large cell non-neuroendocrine carcinoma
Mesothelioma
Epithelioid (not truly epithelial)
Derived from visceral/parietal pleura (mesothelial layer)
Small cell carcinoma synonyms
- Small cell neuroendocrine carcinoma
- “Oat cell” carcinoma (old terminology)
Small cell carcinoma risk factors
Highly associated with smoking (“if the patient never smoked, it’s not small cell)
Small cell carcinoma location
Usually occurs centrally near large airways
Small cell carcinoma: How is Neuroendocrine differentiation shown?
- Cytoplasmic neurosecretory granules
- these stain with synaptophysin, chromogranin (immunohistochemical stains)
- This is how we “prove” the tumor has neuroendocrine differentiation
Small cell carcinoma properties of growth
- grows fast
- metastisizes early
- usually late stage at the time of discovery
Small cell carcinoma treatment
Treated differently than Non-small cell carcinoma
- Usually not resectable (can and do resect if low-stage, but usually not detected until late stage)
- Different chemotherapy regimen (vs. non-small cell carcinoma)
Small cell carcinoma Histological features
6 listed
High nuclear:cytoplasmic ratio (scant cytoplasm)
frequent necrosis and mitoses
Crush artifact
+ for synaptophysin
+ for chromogranin (IHC)
- for squamous cell markers
Identify cancer type and features
5 listed
Small cell carcinoma
Small
Identify cancer type and histological features
6 listed
High nuclear:cytoplasmic ratio (scant cytoplasm)
frequent necrosis and mitoses
Crush artifact
+ for synaptophysin
+ for chromogranin (IHC)
- for squamous cell markers
Squamous cell carcinoma risk factors
Highly associated with smoking (similar to small cell CA, but association not quite as strong as small cell carcinoma
Squamous cell carcinoma location
most commonly centrally located around large airways
Squamous cell carcinoma histological features
6 listed
- Keratinization (“pink stuff”, keratin “pearls”)
- Intercellular bridges (can be difficult to see)
- Abundant, dense cytoplasm
- No gland formation (unless mixed subtype, e.g. “Adenosquamous carcinoma”)
- for neuroendocrine markers (Chromo, synapto)
- for squamous markers
What is this?
squamous metaplasia
Identify cancer type and histological features
6 listed
squamous cell carcinoma
- Keratinization (“pink stuff”, keratin “pearls”)
- Intercellular bridges (can be difficult to see)
- Abundant, dense cytoplasm
- No gland formation (unless mixed subtype, e.g. “Adenosquamous carcinoma”)
- for neuroendocrine markers (Chromo, synapto)
- for squamous markers
Identify cancer type and histological features
6 listed
Squamous cell carcinoma
- Keratinization (“pink stuff”, keratin “pearls”)
- Intercellular bridges (can be difficult to see)
- Abundant, dense cytoplasm
- No gland formation (unless mixed subtype, e.g. “Adenosquamous carcinoma”)
- for neuroendocrine markers (Chromo, synapto)
- for squamous markers
Adenocarcinoma Risk factors
3 listed
- Most common cancer in never-smokers
- Not highly associated with smoking (but smoking does increase risk)
- Most common lung malignancy in women
Adenocarcinoma location
- Usually occurs peripherally (vs small cell and squamous cell which ten to occur centrally)
Adenocarcinoma properties of growth
Grows slower than squamous cell but metastasizes earlier
Adenocarcinoma histological features
5 listed
- Abundant cytoplasm that is foamy (vs the dense cytoplasm of squamous cell carcinoma) and often contains mucin
- Will usually show Gland formation
- Multiple histologic patterns: acinar (gland-forming), papillary, lepidic (bronchioloalveolar), solid
- Can be challenging to distinguish from a metastasis
- Primary lung is usually + for TTF-1 (IHC)
Adenocarcinoma treatment
2 listed
- Can have treatable molecular aberrations, therefore must distinguish from other non-small cell carcinomas
- Most common alterations in the genes EGFR and ALK
Identify cancer type and histological features
6 listed
adenocarcinoma
Identify cancer type and histological features
6 listed
Adenocarcinoma
Mesothelioma caveat
- Not truly epithelial (“epithelioid”) so this is NOT a carcinoma
- Is derived from the pleura of lung (visceral or parietal)
- Pleura derived from embryonic mesoderm (epithelial surfaces are derived from embryonic ectoderm)
Pleura of the lung embryological origin
Pleura derived from embryonic mesoderm (epithelial surfaces are derived from embryonic ectoderm)
Mesothelioma derived from
Derived from pleura of lung (visceral or parietal)
Mesothelioma risk factors
2 listed
- Associated with asbestos exposure
- Smoking exposure synergistic with asbestos exposure
Mesothelioma histological features
- The epithelioid variant can be difficult to distinguish from adenocarcinoma
- Sarcomatoid variant mimics many types of sarcoma
Identify cancer type and histological features
Identify cancer type and histological features
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Lung metastases
Need to watch lecture cause this PDF sucked
