L12- Pulmonary Pathology VI (Specific Lung Cancers) Flashcards
list the 4 common forms of lung adenocarcinoma
- atypical adenomatous hyperplasia (AAH)
- adenocarcinoma in-situ
- minimally invasive adenocarcinoma
- invasive histological types
define atypical adenomatous hyperplasia (AHH)
- precursor lesion
- proliferation of minimally (or slightly) atypical pneumocytes along alveolar septa- measures <5 mm in diameter
- lesions are found adjacent to adenocarcinoma
define adenocarcinoma in-situ (include histology)
(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
define minimally invasive adenocarcinoma
<3cm in total size
<5mm invasive focus
define invasive histologic types
> 5mm invasive focus
-lepidic, acinar, papillary, solid, micropapillary
list the Sxs of adenocarcinoma in-situ
- very productive cough
- pneumonia-like presentation
- ground glass appearance on X-ray
(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
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
list the key histological evidence of adenocarcinoma
- gland formation - morphological differentiation
- mucin production - functional differentiation
- sometimes requires special stain
define the grading of adenocarcinomas
G1- well differentiated, well formed glands; >90%
G2- moderately differentiated, moderately well formed glands, 50-90%
G3- poorly differentiated, poorly formed glands, <5-50%
SCC in lung:
- mostly (peripheral/central)
- mostly (men/women)
- (3) smoking status
1- central > periphery
2- men > women
3- closely aligned with smoking history (acanthosis usually also seen on gross appearance)
SCC in lung:
- first spreads to (1)
- (2) spreading is seen in later stages
- (3) and (4) are local complication / effects
1- hilar lymph nodes
2- extrathoracic spread (later than other histologic types)
3- obstruction, atelectasis, infection
4- central necrosis => cavitation
describe the progression of SCC in the lung
1) squamous metaplasia
2) squamous dysplasia
3) SCC in-situ
4) invasive SCC
list the key histological features of lung SCC
- Keratin Pearls
- intercellular bridges
- individual cell keratinization
Note- existence of each depends and changes with grading of lung SCC
define the grading of SCC in the lung
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
define large cell carcinoma (include histology)
Undifferentiated epithelial malignancy:
- lacks features of SCLC
- no glandular and no squamous differentiation
- pleomorphic / bizarre cells
-poor prognosis, early metastasis
SCLC:
- mostly (central/peripheral)
- (2) relation to smoking Hx
1- central (hilar) > peripheral
2- closely aligned with smoking hx, 99% of cases are associated with cigarette smoking
SCLC:
- (1) first location of metastasis
- (2) usual Tx
1- mediastinal lymph nodes
2- chemotherapy and radiation // NOT typically amenable to surgical resection
describe the histology of SCLC
- 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
SCLC frequently invades (1), usually allowing it to (2).
1- vasculature
2- infitrate and metastasize widely
list the paraneoplastic syndrome of SCLC
- ACTH
- ADH
- gastrin-releasing peptide
- calcitonin
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
1- poor prognosis
2- 9% overall
3- 10%, SCC, adenocarcinoma
4- 3%, SCLC
A carcinoid tumor of the lung is a (1) type tumor arising from (2).
1- neuroendocrine
2- Kulchitsky cells
list the spectrum of carcinoid tumors of the lung
- 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)
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
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
Carcinoid Syndrome is seen in (1)% of all carcinoid tumor patients. It mainly excretes (2), but other neuropeptides include (3).
1- 1%
2- serotonin / 5-HT
3- histamine, bradykinin, PGs
define the episodic attacks from Carcinoid Syndrome
(mostly from 5-HT)
-vasomotor disturbances: flushes, cyanosis
- GI hypermotility: diarrhea, vomiting, cramps
- asthma attacks
describe the histology of Carcinoid tumors
- nested appearance
- uniform round cells
- neuroendocrine nuclear chromatin (‘salt-n-pepper chromatin)
-fine granular cytoplasm
- NO pleomorphism
- NO necrosis
- RARE mitoses, <2/10 hpf
(1) is the common primary malignancy of pleura, peritoneum, or pericardium, strongly associated with (2).
1- mesothelioma
2- asbestos
mesothelioma clinical presentation
- chest pain and or dyspnea
- occasional cough or fatigue
mesothelioma imaging results
- moderate to large pleural effusions
- nodular pleural thickening
-enhanced with PET scan
describe the histology of mesothelioma
(note- has a variety of patterns and mimics other malignancies) Three Primary Patterns: -epithelioid -sarcomatoid -mixed / biphasic
when considering Mesothelioma as a differential diagnosis, the following must be considered
- 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
Mesothelioma:
- (1) typical course and survival rate
- (2) most effective Tx plan
1- progressive and fatal, usually 1-2 yr survival post-diagnosis
2- multi-modality: surgery, radiation, chemotherapy
[innovatice Tx approaches are needed]
Pulmonary Hamartoma:
- (common/rare)
- (2) number of sites and size
- since its usually an incidental finding, (3) is the appearance on CXR
1- common
2- solitary, 3-4 cm diameter
3- rounded, radio-opacity (coin lesion) on CXR
list the conditions that present with a ‘coin lesion’
(a rounded radio-opaque lesion seen on CXR)
- pulmonary harmatoma
- pulmonary Tb
- sarcoidosis
- lung tumor
- metastasis
describe the histology of pulmonary harmatoma
nodules of CT (cartilage, fibrous tissue, fat) along with epithelial clefts
