Lec 8 Lung tumors I Flashcards
Peak incidence of lung tumors:
50s-60’s
presented in late stages
Diagnostic techniques for lung cancer:
-Chest X ray
-sputum cytology
-bronchial biopsy
-trans bronchial biopsy
-transcutaneous needle biopsy
-open lung biopsy (invasive)
Primary Lung tumors:
95% NSCLC
M:F 2:1
5% are bronchial carcinoids and bronchial gland tumors:
-rare mesenchymal tumors and lymphomas
-Hamartoma: Most common benign primary tumor
Etiology of lung cancer:
1)smoking- squamous and small cell carcinoma 90%
2)Occupational hazards
3)scarring in lung tissue
Genetic mutation of lung cancers:
**4)Genetic mutations **
-Inactivation of supressor gene on chr.3p and later mutations in TP53
-Activating mutations EGFR,KRAS,ALK,ROS1, HER2 or c-MET in adenocarcinoma
-RB mutation in small cell carcinoma
-p16/CDKN2A inactivation in NSCLC’s
Clinical manifestations:
**Central or endobronchial tumor growth: **(small cell carcinoma)
-cough, hemoptysis,wheeze,stridor, dyspnea and post productuve pneumonitis.
periphral tumor growth: (adenocarcinomas)
Chest pain,cough, dyspnea, pneumonia like symptoms
Gross appearance:
Central masses: carcinoma in situ with endobronchial growth: squamous and small cell CA
-Periphral nodules: consolidative pleural involvment:
adenocarcinomas and large cell carcinomas
NSCLC:
1)squamous cell carcinoma:
male: female affects who the most, location
-Male>female
-smoker associated
-Central, may show cavitation —– bronchoscope
-P40 and CK5/6
2)Adenocarcinoma:
most common in who, location, growth speed, mutations are:
-most common in females
-Least associated with smoking
-periphral
-slow growing but widely metastatic
-3p deletion and KRAS mutation in AAH
-TTF-1 positive by IHC
Histology of squamous cell CA:
formation of what, spreads to what?, associated with?
-squamous differentiation and keratin formation
-spreads to local and regional lymph nodes
-metasases later than small cell
-may be associated with hypercalcemia
2 histologic types of Adenocarcinoma:
1)Invasive:
-Acinar
-Papillary
-mucinous
-solid
2)Adenocarcinoma in situ
-localized nodule or multifocal
-growth along alveolar walls
3) large cell carcinoma:
-poorly differentiated tumors
-aka poorly differentiated squamous cell CA or adenocarcinoma
-poor prognosis
Small cell carcinoma: SCLC
general features
male>female
smoker dominant
arises from neuroendocrine cells
SCLC cytology:
-Crush artifact
-nuclear molding
SCLC features:
location- central
spreads widely in lung
aggressive with necrosis
metastizes early
most frequent type with ectopic hormones
responsive to chemotherapy
SCLC histology:
small blue cells
azzopardi effect
positive for TTF-1
spread of lung cancer can be:
1)local (minority) (like in squamous cell CA)
pleura, pericaridum, mediastinum, nerves vessles
2)lymphnode metastasis (also in squamous cell CA)
-regional lymph node , bronchial, trachial, mediastinal
3)distant (most of cancers)
adrenal (>50%), liver, brain,bone
Local effects of cancer:
Central- cough, wheezing, hemoptysis
periphral- incidental hemoptysis or pneumonia
regional invasion;
Recurrent pharyngeal nerve: vocal cord paralysis
Phrenic nerve: diaphragmatic paralysis
esophagus: bronchoesophageal fistula
Chest wall invasion: pain and pleural effusion
Invasion of upper lobe:
right upper lobe invasion– superior vena cava syndrome
Apical tumor– pain and destruction of first and second rib+ vertebra
cervical sympathetic plexus— horner syndrome
paraneoplastic syndrome: hyper calcemia
:hypercalcemia:
caused by PTHrP production- squamous cell CA
-kidney stones
-constipation and fatigue if moderate
-coma and arrythmias is severe
Paraneoplastic syndrome: Cushing syndrome
due to ectopic ACTH production
patient presents with:
-fluid retention
-increased facial hair
-moon like face
SCLC related
paraneoplastic syndromes: Digital clubbing
-can result from hypertrophic osteoarthropathy
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paraneoplastic syndromes: neuromuscular disorders
myasthenic syndromes
neuropathy and polymyositis
seen in SCLC
Paraneoplastic syndromes: migratory thrombophlebitis
Common cause of DIC in adenocarcinoma
Lung hamartoma- benign lung lesion
Most common
-Coin lesoin on X ray
-abscess but benign
Metastatic lung tumors show:
-Multiple discrete nodules (cannon ball)
-single nodules
-lymphaginitis carcinomatosa
-pleural effusion
Malignant mesotholemia gross:
-starts as pleural fibrosis and palque
-later as gelatinous yellowish white tumor ensheathing the lung.
poor prognisis
Malignant mesotholemia casued by:
inactivation of multiple supperssor genes: p53,RB,BAP1
