Lec 24 Lung Cancer Path

Question 1

What is field cancerization?

Answer 1

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

Question 2

WHat are risks for lung cancer?

Answer 2

• tobacco smoking!!
• industrial hazards
• air pollution
• molecular genetics

Question 3

What is precursor lesion to squamous cell carcinoma?

Answer 3

squamous dysplasia and carcinoma in situ

Question 4

What is precursor lesion to adenocarcinoma?

Answer 4

atypical adenomatous hyperplasia

Question 5

Who gets lung carcinoma?

Answer 5

• age 40-70; peak in 50s/60s

Question 6

What is typical clinical presentation of lung cancer?

Answer 6

asymptomatic/incidental
local disease
disseminated disease
paraneoplastic syndromes

Question 7

What type of cells do lung tumors derive from?

Answer 7

90% epithelial tumors

some mesothelial tumors

Question 8

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

Answer 8

90-95% carcinomas

5% carcinoids

Question 9

What are 3 types of non small cell carcinoma?

Answer 9

• squamous cell carcinoma
• adenocarcinoma
• large cell carcinoma

Question 10

What is most common type of lung carcinoma?

Answer 10

adenocarcinoma = 35-40%

Question 11

What types of lung cancer are centrally located?

Answer 11

• squamous cell

- small cell

Question 12

What types of lung cancer are peripherally located?

Answer 12

• adenocarcinoma

- large cell carcinoma

Question 13

Who gets squamous cell carcinoma?

Answer 13

men; smokers

Question 14

What are symptoms of squamous cell carcinoma?

Answer 14

bronchial obstruction; pneumonitis; atelectasis

Question 15

What is progression of squamous carcinoma?

Answer 15

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

Question 16

What are characteristics of squamous cell carcinoma?

Answer 16

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

Question 17

What lung carcinoma tends to undergo necrosis and cavitate?

Answer 17

squamous cell carcinoma

Question 18

What do you see microscopically in squamous cell carcinoma?

Answer 18

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

Question 19

What type of cells is adenocarcinoma thought to arise from?

Answer 19

type 2 pneumocytes

Question 20

What is classical person w/ adenocarcinoma?

Answer 20

non smoking female w/ EGFR mutation of asian descent

Question 21

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

Answer 21

• EGFR

- EML4-ALK

Question 22

What is progression of adenocarcinoma?

Answer 22

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

Question 23

What is atypical adenomatous hyperplasia?

Answer 23

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

absent other significant inflammation

Question 24

What is adenocarcinoma in situ?

Answer 24

tumor cells growing along existing alveolar septa aka lepidic growth

greater than 5 mm size
non-mucinous

Question 25

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

Answer 25

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

Question 26

What do you see radiographically with adenocarcinoma in situ?

Answer 26

ground glass (as opposed to solid)

Question 27

What is minimally invasive adenocarcinoma?

Answer 27

adenocarcinoma w/ lepidic pattern and < 5 mm invasion in any only focus usually non-mucinous solitary and discrete

Question 28

What are characteristics of adenocarcinoma?

Answer 28

- glands or papillary structures | - mucin

Question 29

What do you see grossly w/ adenocarcinomas?

Answer 29

- associated w/ pleural puckering

Question 30

What is large cell carcinoma? features?

Answer 30

undifferentiated malignant epithelial tumor large nuclei; moderate amount of cytoplasm; peripheral

Question 31

What are characteristics of small cell carcinoma

Answer 31

- high grade neuroendocrine carcinoma | - usually smokers; very aggressive w/ early mediastinal lymph node involvement

Question 32

What paraneoplastic syndromes associated with small cell lung cancer?

Answer 32

- ADH [hyponatremia] - ACTH [cushings] - Lamber Eaton

Question 33

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

Answer 33

small to medium size round cells; minimal cytoplasm; hyperchromatic

Question 34

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?

Answer 34

squamous cell carcinoma

Question 35

Usually peripheral; less linked to smoking. What type of cancer?

Answer 35

adenocarcinoma

Question 36

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?

Answer 36

small cell lung cancer

Question 37

What do neurosecretory granules suggest?

Answer 37

type of neuroendocrine tumor --> small cell or carcinoid tumor

Question 38

Who gets carcinoid tumors?

Answer 38

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

Question 39

What is carcinoid syndrome?

Answer 39

intermittent attacks of diarrhea; flushing; cyanosis usually only see in metastatic disease

Question 40

What do you see histologically w/ carcinoid tumors?

Answer 40

organoid, trabecular, palisading, ribbon arrangement of cells moderate eosinophilic cytoplasm; nuclei w/ finely granular chromatin

Question 41

What are typical vs atypical carcinoids?

Answer 41

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

Question 42

What is prognosis typical vs atypical carcinoid?

Answer 42

``` typical = > 90% survive atypical = 30-50% survive ```

Question 43

What is superior vena cava syndrome?

Answer 43

gradual compression of SVC | usually due to lung cancer

Question 44

What is pancoast tumor?

Answer 44

- tumor in apex of lung | - get Horners + hoarseness from recurrent laryngeal nerve paralysis

Question 45

Are tumors of pleura more commonly primary or metastatic?

Answer 45

more commonly metastatic

Question 46

What are risks for mesothelioma?

Answer 46

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

Question 47

What is morphology of mesothelioma?

Answer 47

early lesions start as multiple small nodules coalesce into confluent thick "rind" diffuse involvement of mesothelial surfaces

Question 48

What is prognosis of mesothelioma?

Answer 48

majority die in 18 months