Lec 24 Lung Cancer Path Flashcards
What is field cancerization?
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
WHat are risks for lung cancer?
- tobacco smoking!!
- industrial hazards
- air pollution
- molecular genetics
What is precursor lesion to squamous cell carcinoma?
squamous dysplasia and carcinoma in situ
What is precursor lesion to adenocarcinoma?
atypical adenomatous hyperplasia
Who gets lung carcinoma?
- age 40-70; peak in 50s/60s
What is typical clinical presentation of lung cancer?
asymptomatic/incidental
local disease
disseminated disease
paraneoplastic syndromes
What type of cells do lung tumors derive from?
90% epithelial tumors
some mesothelial tumors
What type of neoplasms are epithelial tumors of lung? percentage of each?
90-95% carcinomas
5% carcinoids
What are 3 types of non small cell carcinoma?
- squamous cell carcinoma
- adenocarcinoma
- large cell carcinoma
What is most common type of lung carcinoma?
adenocarcinoma = 35-40%
What types of lung cancer are centrally located?
- squamous cell
- small cell
What types of lung cancer are peripherally located?
- adenocarcinoma
- large cell carcinoma
Who gets squamous cell carcinoma?
men; smokers
What are symptoms of squamous cell carcinoma?
bronchial obstruction; pneumonitis; atelectasis
What is progression of squamous carcinoma?
get squamous metaplasia –> dysplasia and carcinoma in situ –> invasive carcinoma
What are characteristics of squamous cell carcinoma?
- central tumors
- extensive necrosis w/ cavitation of tumor
- metastasize late
- hypercalcemia = classic paraneoplastic syndrome
What lung carcinoma tends to undergo necrosis and cavitate?
squamous cell carcinoma
What do you see microscopically in squamous cell carcinoma?
- sheets of cells w/ keratin
- clusters/islands of tumor cells w/ pink cytoplasm
- keratin pearls
- intercellular bridges
What type of cells is adenocarcinoma thought to arise from?
type 2 pneumocytes
What is classical person w/ adenocarcinoma?
non smoking female w/ EGFR mutation of asian descent
What 2 mutations of adenocarcinoma particularly seen in non-smokers?
- EGFR
- EML4-ALK
What is progression of adenocarcinoma?
atypical adenomatous hyperplasia –> adenocarcinoma in situ –> minimally invasive adenocarcinoma –> invasive adenocarcinoma
What is atypical adenomatous hyperplasia?
small area of proliferation moderately atypical type 2 pneumocytes or clara cells lining alveolar walls
absent other significant inflammation
What is adenocarcinoma in situ?
tumor cells growing along existing alveolar septa aka lepidic growth
greater than 5 mm size
non-mucinous
What is difference in prognosis adenocarcinoma in situ vs conventional adenocarcinoma?
much better prognosis adenocarcinoma in situ = close to 100% 5 yr survival
What do you see radiographically with adenocarcinoma in situ?
ground glass (as opposed to solid)
What is minimally invasive adenocarcinoma?
adenocarcinoma w/ lepidic pattern and < 5 mm invasion in any only focus
usually non-mucinous
solitary and discrete
What are characteristics of adenocarcinoma?
- glands or papillary structures
- mucin
What do you see grossly w/ adenocarcinomas?
- associated w/ pleural puckering
What is large cell carcinoma? features?
undifferentiated malignant epithelial tumor
large nuclei; moderate amount of cytoplasm; peripheral
What are characteristics of small cell carcinoma
- high grade neuroendocrine carcinoma
- usually smokers; very aggressive w/ early mediastinal lymph node involvement
What paraneoplastic syndromes associated with small cell lung cancer?
- ADH [hyponatremia]
- ACTH [cushings]
- Lamber Eaton
What do you see on micro w/ small cell lung cancer?
small to medium size round cells; minimal cytoplasm; hyperchromatic
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?
squamous cell carcinoma
Usually peripheral; less linked to smoking.
What type of cancer?
adenocarcinoma
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?
small cell lung cancer
What do neurosecretory granules suggest?
type of neuroendocrine tumor –> small cell or carcinoid tumor
Who gets carcinoid tumors?
younger; equal for sexes; 20-40% are nonsmokers
What is carcinoid syndrome?
intermittent attacks of diarrhea; flushing; cyanosis
usually only see in metastatic disease
What do you see histologically w/ carcinoid tumors?
organoid, trabecular, palisading, ribbon arrangement of cells
moderate eosinophilic cytoplasm; nuclei w/ finely granular chromatin
What are typical vs atypical carcinoids?
typical = fewer tahn 2 mitoses and lack necrosis atypical = 2-10 mitoses; + foci of necrosis
What is prognosis typical vs atypical carcinoid?
typical = > 90% survive atypical = 30-50% survive
What is superior vena cava syndrome?
gradual compression of SVC
usually due to lung cancer
What is pancoast tumor?
- tumor in apex of lung
- get Horners + hoarseness from recurrent laryngeal nerve paralysis
Are tumors of pleura more commonly primary or metastatic?
more commonly metastatic
What are risks for mesothelioma?
usually due to amphibole asbestos exposure; develop after long latency 20+ yrs from time of exposure
What is morphology of mesothelioma?
early lesions start as multiple small nodules coalesce into confluent thick “rind”
diffuse involvement of mesothelial surfaces
What is prognosis of mesothelioma?
majority die in 18 months
