EXAM #2: PATHOLOGY OF THE LUNG

Question 1

What are the most common malignant lesions of the lung?

Answer 1

Metastasis from a different organs to the lung

Question 2

What is the most common BENIGN lesion of the lung?

Answer 2

Granuloma i.e.

• TB
• Fungus (Histoplasmosis)

Question 3

What are the most common sites that metastesize to the lung?

Answer 3

1) Breast
2) Stomach
3) Pancreas
4) Colon

Question 4

How do mets to the lung appear?

Answer 4

Multiple “cannonball” lesions

Question 5

How does a pulmonary hamartoma appear on imaging?

Answer 5

“Coin lesion”

*This is a benign lesion of normal lung tissue (and cartilage) that is disorganized)

Question 6

What are the vast majority of primary lung tumors?

Answer 6

Carcinoma i.e. neoplasia arising from the epithelium

Question 7

What are the top four causes of pleural exudate?

Answer 7

1) Microbial invasion
2) Cancer*
3) Pulmonary infarction
4) Viral pleuritis

Especially if “blood-tinged exudate”

Question 8

What is Lambert Eaton Syndrome?

Answer 8

Muscle weakness due to autoantibodies vs. Ca++ channels on motor end plates

Note that this is differentiated from myasthenia gravis in that it gets BETTER with activity

Question 9

What type of lung cancer causes the majority of paraneoplastic sydromes?

Answer 9

Small cell lung cancer (neuroendocrine)

Question 10

What lung cancer is hypercalcemia most commonly associated with?

Answer 10

Squamous cell carcinoma

*B/c is produces PTHrP

Question 11

What are the sequelae of a Pancoast tumor?

Answer 11

1) Horner Syndrome
2) Brachial plexus dysfunction

*This is a tumor, typically of squamous cell etiology, that is located in the apex of the lung

Question 12

Aside from smoking, what other exposures are associated with lung cancer?

Answer 12

1) Asbestos
2) Industrial hazards
3) Aromatic hydrocarbons

Question 13

What are the four major types of lung cancer?

Answer 13

NSCLC:

1) Adenocarcinoma
2) Squamous cell carcinoma
3) Large cell carcinoma

4) Small cell carcinoma

Question 14

What is never indicated for small cell lung cancer?

Answer 14

Surgery

Question 15

What is the most common type of lung cancer?

Answer 15

Adenocarcinoma i.e. glandular

Question 16

What gene mutations are associated with adenocarcinoma? What are these three mutations associated with?

Answer 16

1) KRAS in smokers
2) EGFR in individuals of Asian descent
3) ALK (anaplastic lymphoma kinase) in nonsmokers and younger patients

Question 17

Where does adenocarcinoma typically develop?

Answer 17

Periphery i.e. most common to involve the pleura

Question 18

What are the two forms of adenocarcinoma?

Answer 18

1) Bronchial

2) Bronchioalveolar

Question 19

What is unique about bronchioalveolar adenocarcinoma (BAC)?

Answer 19

• Uncommon but best prognosis

- Cancer grows on walls of alveoli and bronchioles

Question 20

What does BAC arise from?

Answer 20

Bronchioalveolar stem cells

Question 21

Describe the progression of SCC.

Answer 21

1) Metaplasia
2) Dysplasia
3) CIS
4) Invasive carcinoma

Question 22

What genetic mutations are associated with SCC?

Answer 22

• p53

- EGFR

Question 23

Histologically, what is pathognomonic for SCC?

Answer 23

Keratin pearls and intercellular bridges

Question 24

What mutations are associated small cell lung cancer?

Answer 24

• c-MYC

- Rb1

Question 25

What is the treatment of choice for small cell lung cancer?

Answer 25

Chemotherapy

Question 26

What histological finding is pathognomonic for small cell carcinoma?

Answer 26

“Oat cell carcinoma”

Question 27

Where does small cell carcinoma arise?

Answer 27

Centrally

Question 28

How is the diagnosis of large cell carcinoma described?

Answer 28

Diagnosis of exclusion

Question 29

How are the large cells in large cell carcinoma described?

Answer 29

Undifferentiated i.e. no mucin, no glands, no keratin pearls…etc.

Question 30

What are the concerning staging elements for lung cancer?

Answer 30

1) Larger than 3cm
2) Invasion of adjacent structures
3) Contralateral lymph nodes

*Also, note that Mets= stage 4

Question 31

What are the most common sites of metastases of primary lung cancer?

Answer 31

1) LN
2) Adrenal gland
3) Liver
4) Brain
5) Bone

Question 32

What causes carcinoid syndrome? What are the symptoms?

Answer 32

5-HT secretion from a carcinoid tumor causing:

1) Diarrhea
2) Flushing
3) Bronchoconstriction
4) Cyanosis

Question 33

What are the major benign and malignant pleural tumors?

Answer 33

Benign= fibroma–most made up of collagen

Malignant= mesothelioma