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P&T Block 3 Pulm & GI > L61 > Flashcards

L61 Flashcards

1
Q

Name the 3 main types of lung cancers

A

Small cell
Non-small cell:
- Squamous cell
- Adenocarcinoma (most likely to get this if a non-smoker)

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2
Q

What are the 2 genetic targets commonly mutated in adenocarcinoma?

A

EGFR
EML4-ALK
Impt to note b/c therapy targets. Other lung cancers are too diverse in the causative mutations to be targeted

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3
Q

What is the precursor lesion for:
Adenocarcinoma in situ
Small cell

A

Atypical adenomatous hyperplasia = AAH (non-invasive) -> in situ (non-invasive) -> invasive
*No in situ lesion for small cell cancers b/c too aggressive to have a precursor lesion

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4
Q

Adenocarcinoma

  • Describe the cells
  • Cell markers expressed
A

Neoplasic cells are glandular (acinar pattern) or mucin producing (or both)
TTF-1 = thyroid transcription factor
- Not used as treatment target, only for dx

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5
Q

Describe the most prevalent growth patterns of adenocarcinoma

A

**Peripheral
Can also be:
- Central (arising from bronchus)
- Pna-like = filling air spaces (grows along alveolar walls)

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6
Q

If an adenocarcinoma is invasive, what are the 5 histo patterns it can form?

A 
Acinar - glands
Papillary
Mucinous
Solid - since solid adenos are so uncommon, you must make sure these tumors either make mucin or are TTF 1 +
Micropapillary
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7
Q

Adenocarcinoma in situ has no risk for mets b/c non-invasive. What is this tumor’s:

  • Spread
  • 2 subtypes
A

Lepidic spread - tumor cells like scales on alveolar septa
1. Mucinous - more likely to have invasive component
Vs
2. Non-mucinous

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8
Q

When you say adenocarcinoma in situ is multifocal, what does that mean?

A
  1. Aerogenous spread - mucinous subtype likely to fill alveolar spaces and look more like pna
  2. Field effect = pre-cancerous AAH involves a lot of the lung so multiple in situ tumors occur
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9
Q

What kind of tumor is a bronchioloalveolar carcinoma?

- Mucinous vs non

A

Adenocarcinoma in situ

  • Mucinous = lepidic growth pattern
  • Non-mucinous = spreads along alveolar surfaces
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10
Q

If you see ground glass appearance on CT in a confined lesion, which of these is on your differential:

  1. AAH
  2. Adenocarcinoma in situ
  3. Invasive adenocarcinoma
A

1 & 2 b/c confined lesion = non-invasive

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11
Q

Do you need to be able to tell AAH from adenocarcinoma in situ on histo?

A

NO

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12
Q

Squamous carcinoma

  • Central or peripheral?
  • Describe tumor characteristic
A

Central - might fill airway

Cavitary

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13
Q

3 main features of squamous carcinoma on histo

A
  1. Solid tumor - “pavement like” with cells that have lots of cytoplasm
  2. Keratin pearls
  3. Intercellular bridges = desmosomes on cancer cells
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14
Q

What are the squamous cell precursor lesions

A

**Remember, normally there is no squamous epithelium in the resp tract - so this is more often a response to injury (smoking)
Squamous metaplasia
Squamous dysplasia - some malignant characteristics
Squamous in situ - malignant except for hasn’t invaded yet: irregular nuclei, varying cell size
Invasive

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15
Q

A peripheral nodule is most likely what type of lung cancer?

A

Adenocarcinoma

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16
Q

How treat small cell carcinoma: surg or chemo or both?

A

Chemo not surg

17
Q

Small cell carcinoma - peripheral or central?

A

Central

** Think: the smoking cancers are more likely to be central b/c that is where smoke would hit first when inhaled

18
Q

4 major attributes of small cell carcinoma on histo

A
  1. Endocrine differentiation
    - Neurosecretory granules: synaptophysin & chromogranin
  2. Small cells that are mostly nucleus w/o nucleoli (why stain blue) = salt and pepper
  3. High mitotic rate
  4. Necrosis common
19
Q

What are the 4 neuroendocrine tumors of the lung?

A

Typical carcinoid
Small cell
Atypical carcinoid
Large cell

20
Q

Describe the appearance of carcinoid tumor on histo, What’s different about atypical carcinoid?

A

Look like small blue cell tumors but not as high grade - more likely to be benign
- Lots of cytoplasm
- Uniform nuclei
Atypical is more intermediate behavior - more mitotic figures, less likely for 10 year survival

21
Q

Describe the typical carcinoid pt

A

Young (

22
Q

Carcinoid:

  • Central vs peripheral
  • In what tissue layer
  • Hetero or homogenous
A

Central but may also be peripheral
Submucosal - under resp epi
Homogenous - no necrosis or cavitation

23
Q

Will carcinoid tumors stain for chromogranin or synaptophysin?

A

YES - neuroendocrine tumors

24
Q

What is carcinoid syndrome?

A 
Carcinoids in the gut or met to the liver increase vasoactive amines 
Symptoms:
- Diarrhea
- Flushing
- Cyanosis
25
Q

Is carcinoid syndrome common with bronchial carcinoids?

A

Not common but if do have one, symptoms:

- Obstruction of bronchus

26
Q

If another tumor mets to the lung, what will the cancer in the lung look like?

A

Multiple peripheral mets
Pleural mets common
“Cannonball” lesions of mets

P&T Block 3 Pulm & GI (31 decks)

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