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Pulm > Lec 24 Lung Cancer Path > Flashcards

Lec 24 Lung Cancer Path Flashcards

1
Q

What is field cancerization?

A

idea that entire upper aero-digestive tract is damaged by carcinogens in cigarette smoke

at risk for head/neck, esophagus, lung cancer

tumors can arise anywhere in that field

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2
Q

WHat are risks for lung cancer?

A
  • tobacco smoking!!
  • industrial hazards
  • air pollution
  • molecular genetics
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3
Q

What is precursor lesion to squamous cell carcinoma?

A

squamous dysplasia and carcinoma in situ

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4
Q

What is precursor lesion to adenocarcinoma?

A

atypical adenomatous hyperplasia

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5
Q

Who gets lung carcinoma?

A
  • age 40-70; peak in 50s/60s
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6
Q

What is typical clinical presentation of lung cancer?

A

asymptomatic/incidental
local disease
disseminated disease
paraneoplastic syndromes

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7
Q

What type of cells do lung tumors derive from?

A

90% epithelial tumors

some mesothelial tumors

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8
Q

What type of neoplasms are epithelial tumors of lung? percentage of each?

A

90-95% carcinomas

5% carcinoids

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9
Q

What are 3 types of non small cell carcinoma?

A
  • squamous cell carcinoma
  • adenocarcinoma
  • large cell carcinoma
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10
Q

What is most common type of lung carcinoma?

A

adenocarcinoma = 35-40%

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11
Q

What types of lung cancer are centrally located?

A
  • squamous cell

- small cell

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12
Q

What types of lung cancer are peripherally located?

A
  • adenocarcinoma

- large cell carcinoma

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13
Q

Who gets squamous cell carcinoma?

A

men; smokers

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14
Q

What are symptoms of squamous cell carcinoma?

A

bronchial obstruction; pneumonitis; atelectasis

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15
Q

What is progression of squamous carcinoma?

A

get squamous metaplasia –> dysplasia and carcinoma in situ –> invasive carcinoma

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16
Q

What are characteristics of squamous cell carcinoma?

A
  • central tumors
  • extensive necrosis w/ cavitation of tumor
  • metastasize late
  • hypercalcemia = classic paraneoplastic syndrome
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17
Q

What lung carcinoma tends to undergo necrosis and cavitate?

A

squamous cell carcinoma

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18
Q

What do you see microscopically in squamous cell carcinoma?

A
  • sheets of cells w/ keratin
  • clusters/islands of tumor cells w/ pink cytoplasm
  • keratin pearls
  • intercellular bridges
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19
Q

What type of cells is adenocarcinoma thought to arise from?

A

type 2 pneumocytes

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20
Q

What is classical person w/ adenocarcinoma?

A

non smoking female w/ EGFR mutation of asian descent

21
Q

What 2 mutations of adenocarcinoma particularly seen in non-smokers?

A
  • EGFR

- EML4-ALK

22
Q

What is progression of adenocarcinoma?

A

atypical adenomatous hyperplasia –> adenocarcinoma in situ –> minimally invasive adenocarcinoma –> invasive adenocarcinoma

23
Q

What is atypical adenomatous hyperplasia?

A

small area of proliferation moderately atypical type 2 pneumocytes or clara cells lining alveolar walls

absent other significant inflammation

24
Q

What is adenocarcinoma in situ?

A

tumor cells growing along existing alveolar septa aka lepidic growth

greater than 5 mm size
non-mucinous

25
Q

What is difference in prognosis adenocarcinoma in situ vs conventional adenocarcinoma?

A

much better prognosis adenocarcinoma in situ = close to 100% 5 yr survival

26
Q

What do you see radiographically with adenocarcinoma in situ?

A

ground glass (as opposed to solid)

27
Q

What is minimally invasive adenocarcinoma?

A

adenocarcinoma w/ lepidic pattern and < 5 mm invasion in any only focus

usually non-mucinous
solitary and discrete

28
Q

What are characteristics of adenocarcinoma?

A
  • glands or papillary structures

- mucin

29
Q

What do you see grossly w/ adenocarcinomas?

A
  • associated w/ pleural puckering
30
Q

What is large cell carcinoma? features?

A

undifferentiated malignant epithelial tumor

large nuclei; moderate amount of cytoplasm; peripheral

31
Q

What are characteristics of small cell carcinoma

A
  • high grade neuroendocrine carcinoma

- usually smokers; very aggressive w/ early mediastinal lymph node involvement

32
Q

What paraneoplastic syndromes associated with small cell lung cancer?

A
  • ADH [hyponatremia]
  • ACTH [cushings]
  • Lamber Eaton
33
Q

What do you see on micro w/ small cell lung cancer?

A

small to medium size round cells; minimal cytoplasm; hyperchromatic

34
Q

Appears as a hilar mass and frequently results in cavitation; clearly linked to smoking; incidence greatly increased in smokers; may be marked by inappropriate parathyroid hormone (PTH)-like activity

Which type of cancer?

A

squamous cell carcinoma

35
Q

Usually peripheral; less linked to smoking.

What type of cancer?

A

adenocarcinoma

36
Q

Undifferentiated tumor; most aggressive bronchogenic carcinoma; least likely form to be cured by surgery; usually already metastatic at diagnosis; often associated with ectopic production of corticotrophin (ACTH) or antidiuretic hormone (ADH}; incidence greatly increased in smokers

What type of cancer?

A

small cell lung cancer

37
Q

What do neurosecretory granules suggest?

A

type of neuroendocrine tumor –> small cell or carcinoid tumor

38
Q

Who gets carcinoid tumors?

A

younger; equal for sexes; 20-40% are nonsmokers

39
Q

What is carcinoid syndrome?

A

intermittent attacks of diarrhea; flushing; cyanosis

usually only see in metastatic disease

40
Q

What do you see histologically w/ carcinoid tumors?

A

organoid, trabecular, palisading, ribbon arrangement of cells

moderate eosinophilic cytoplasm; nuclei w/ finely granular chromatin

41
Q

What are typical vs atypical carcinoids?

A 
typical = fewer tahn 2 mitoses and lack necrosis
atypical = 2-10 mitoses; + foci of necrosis
42
Q

What is prognosis typical vs atypical carcinoid?

A 
typical  = > 90% survive
atypical = 30-50% survive
43
Q

What is superior vena cava syndrome?

A

gradual compression of SVC

usually due to lung cancer

44
Q

What is pancoast tumor?

A
  • tumor in apex of lung

- get Horners + hoarseness from recurrent laryngeal nerve paralysis

45
Q

Are tumors of pleura more commonly primary or metastatic?

A

more commonly metastatic

46
Q

What are risks for mesothelioma?

A

usually due to amphibole asbestos exposure; develop after long latency 20+ yrs from time of exposure

47
Q

What is morphology of mesothelioma?

A

early lesions start as multiple small nodules coalesce into confluent thick “rind”

diffuse involvement of mesothelial surfaces

48
Q

What is prognosis of mesothelioma?

A

majority die in 18 months

Pulm (24 decks)

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