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RHS > L12- Pulmonary Pathology VI (Specific Lung Cancers) > Flashcards

L12- Pulmonary Pathology VI (Specific Lung Cancers) Flashcards

1
Q

list the 4 common forms of lung adenocarcinoma

A
  • atypical adenomatous hyperplasia (AAH)
  • adenocarcinoma in-situ
  • minimally invasive adenocarcinoma
  • invasive histological types
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2
Q

define atypical adenomatous hyperplasia (AHH)

A
  • precursor lesion
  • proliferation of minimally (or slightly) atypical pneumocytes along alveolar septa- measures <5 mm in diameter
  • lesions are found adjacent to adenocarcinoma
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3
Q

define adenocarcinoma in-situ (include histology)

A

(formerly bronchoalveolare carcinoma / BAC)
-lacks invasive disease = **lepidic growth

  • dysplastic cells along pre-existing septae
  • often mucinous type – inc in clear cells
  • hyperchromatic cells with inc nucleus-cytoplasm ratio
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4
Q

define minimally invasive adenocarcinoma

A

<3cm in total size

<5mm invasive focus

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5
Q

define invasive histologic types

A

> 5mm invasive focus

-lepidic, acinar, papillary, solid, micropapillary

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6
Q

list the Sxs of adenocarcinoma in-situ

A
  • very productive cough
  • pneumonia-like presentation
  • ground glass appearance on X-ray
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7
Q

(1) is the most common primary lung tumor.
- mostly seen in (2) patients (age, sex, smoking status)
- mostly (peripheral/central)
- (fast/slow) growing
- (5) metastasis properties
- (6) possible association

A 
1- adenocarcinoma 
2- women <45 y/o, never smokers
3- peripheral > central
4- slow growth
5- wide spread at early stage
6- association with scar
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8
Q

list the key histological evidence of adenocarcinoma

A
  • gland formation - morphological differentiation
  • mucin production - functional differentiation
  • sometimes requires special stain
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9
Q

define the grading of adenocarcinomas

A

G1- well differentiated, well formed glands; >90%

G2- moderately differentiated, moderately well formed glands, 50-90%

G3- poorly differentiated, poorly formed glands, <5-50%

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10
Q

SCC in lung:

  • mostly (peripheral/central)
  • mostly (men/women)
  • (3) smoking status
A

1- central > periphery
2- men > women
3- closely aligned with smoking history (acanthosis usually also seen on gross appearance)

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11
Q

SCC in lung:

  • first spreads to (1)
  • (2) spreading is seen in later stages
  • (3) and (4) are local complication / effects
A

1- hilar lymph nodes
2- extrathoracic spread (later than other histologic types)
3- obstruction, atelectasis, infection
4- central necrosis => cavitation

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12
Q

describe the progression of SCC in the lung

A

1) squamous metaplasia
2) squamous dysplasia
3) SCC in-situ
4) invasive SCC

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13
Q

list the key histological features of lung SCC

A
  • Keratin Pearls
  • intercellular bridges
  • individual cell keratinization

Note- existence of each depends and changes with grading of lung SCC

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14
Q

define the grading of SCC in the lung

A

G1- well differentiated, prominent keratinization and intercellular bridges

G2- moderately differentiated, reduced number of keratin pearls, difficult to find intercellular bridges, tumor necrosis

G3- poorly differentiated, virtually no intercellular bridges and keratin pearls

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15
Q

define large cell carcinoma (include histology)

A

Undifferentiated epithelial malignancy:

  • lacks features of SCLC
  • no glandular and no squamous differentiation
  • pleomorphic / bizarre cells

-poor prognosis, early metastasis

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16
Q

SCLC:

  • mostly (central/peripheral)
  • (2) relation to smoking Hx
A

1- central (hilar) > peripheral

2- closely aligned with smoking hx, 99% of cases are associated with cigarette smoking

17
Q

SCLC:

  • (1) first location of metastasis
  • (2) usual Tx
A

1- mediastinal lymph nodes

2- chemotherapy and radiation // NOT typically amenable to surgical resection

18
Q

describe the histology of SCLC

A
  • round, scant cytoplasm, finely granular chromatin
  • fragile, crush artifacts, nuclear molding, extensive necrosis
  • frequent mitoses
  • diffuse sheets of tumor cells that are 3x the size of mature/resting lymphocytes
  • hyperchromatic nuclei, large nuclear:cytoplasm ratio, inconspicuous nucleoli
19
Q

SCLC frequently invades (1), usually allowing it to (2).

A

1- vasculature

2- infitrate and metastasize widely

20
Q

list the paraneoplastic syndrome of SCLC

A
  • ACTH
  • ADH
  • gastrin-releasing peptide
  • calcitonin
21
Q

Lung Cancer in general:

  • (good/poor) prognosis
  • (2)% 5 yr survival rate
  • SCC, adenocarcinomas have (3)% 5 yr survival rate
  • SCLC has (4)% 5 yr survival rate
A

1- poor prognosis
2- 9% overall
3- 10%, SCC, adenocarcinoma
4- 3%, SCLC

22
Q

A carcinoid tumor of the lung is a (1) type tumor arising from (2).

A

1- neuroendocrine

2- Kulchitsky cells

23
Q

list the spectrum of carcinoid tumors of the lung

A
  • DIPNECH: diffuse pulmonary neuroendocrine cell hyperplasia
  • carcinoid tumorlets, <5mm
  • carcinoid tumor, typical variant
  • carcinoid tumor, atypical variant (necrosis and or elevated mitotic count > 2/10 hpf)
24
Q

Carcinoid Tumors of Lung:

  • (central/peripheral) location
  • (2) age group most affected
  • (3) type growth
  • (4) Sxs / local complications
  • (5) metastasis properties
  • (6) prognosis
  • (7) Tx
A

1- central
2- 40 y/o age range
3- polyploid growth
4- obstruction, cough, hemoptysis, infection
5- localized, but can metastasize to lymph nodes
6- good prognosis
7- resectable tumor

25
Q

Carcinoid Syndrome is seen in (1)% of all carcinoid tumor patients. It mainly excretes (2), but other neuropeptides include (3).

A

1- 1%
2- serotonin / 5-HT
3- histamine, bradykinin, PGs

26
Q

define the episodic attacks from Carcinoid Syndrome

A

(mostly from 5-HT)
-vasomotor disturbances: flushes, cyanosis

  • GI hypermotility: diarrhea, vomiting, cramps
  • asthma attacks
27
Q

describe the histology of Carcinoid tumors

A
  • nested appearance
  • uniform round cells
  • neuroendocrine nuclear chromatin (‘salt-n-pepper chromatin)

-fine granular cytoplasm

  • NO pleomorphism
  • NO necrosis
  • RARE mitoses, <2/10 hpf
28
Q

(1) is the common primary malignancy of pleura, peritoneum, or pericardium, strongly associated with (2).

A

1- mesothelioma

2- asbestos

29
Q

mesothelioma clinical presentation

A
  • chest pain and or dyspnea

- occasional cough or fatigue

30
Q

mesothelioma imaging results

A
  • moderate to large pleural effusions
  • nodular pleural thickening

-enhanced with PET scan

31
Q

describe the histology of mesothelioma

A 
(note- has a variety of patterns and mimics other malignancies)
Three Primary Patterns:
-epithelioid
-sarcomatoid
-mixed / biphasic
32
Q

when considering Mesothelioma as a differential diagnosis, the following must be considered

A
  • metastasis from other sites: breast, lung, stomach, kidney, pancreas, ovary, etc
  • other primary pleural tumors: angiosarcoma, epithelioid hemangioendothelioma, synovial sarcoma
  • lymphoma, CLL (chronic lymphocytic leukemia), melanoma
33
Q

Mesothelioma:

  • (1) typical course and survival rate
  • (2) most effective Tx plan
A

1- progressive and fatal, usually 1-2 yr survival post-diagnosis

2- multi-modality: surgery, radiation, chemotherapy
[innovatice Tx approaches are needed]

34
Q

Pulmonary Hamartoma:

  • (common/rare)
  • (2) number of sites and size
  • since its usually an incidental finding, (3) is the appearance on CXR
A

1- common
2- solitary, 3-4 cm diameter
3- rounded, radio-opacity (coin lesion) on CXR

35
Q

list the conditions that present with a ‘coin lesion’

A

(a rounded radio-opaque lesion seen on CXR)

  • pulmonary harmatoma
  • pulmonary Tb
  • sarcoidosis
  • lung tumor
  • metastasis
36
Q

describe the histology of pulmonary harmatoma

A

nodules of CT (cartilage, fibrous tissue, fat) along with epithelial clefts

RHS (35 decks)

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