Lec 8 Lung tumors I

Question 1

Peak incidence of lung tumors:

Answer 1

50s-60’s

presented in late stages

Question 2

Diagnostic techniques for lung cancer:

Answer 2

-Chest X ray
-sputum cytology
-bronchial biopsy
-trans bronchial biopsy
-transcutaneous needle biopsy
-open lung biopsy (invasive)

Question 3

Primary Lung tumors:

Answer 3

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

Question 4

Etiology of lung cancer:

Answer 4

1)smoking- squamous and small cell carcinoma 90%
2)Occupational hazards
3)scarring in lung tissue

Question 5

Genetic mutation of lung cancers:

Answer 5

**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

Question 6

Clinical manifestations:

Answer 6

**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

Question 7

Gross appearance:

Answer 7

Central masses: carcinoma in situ with endobronchial growth: squamous and small cell CA

-Periphral nodules: consolidative pleural involvment:
adenocarcinomas and large cell carcinomas

Question 8

NSCLC:

1)squamous cell carcinoma:

male: female affects who the most, location

Answer 8

-Male>female
-smoker associated
-Central, may show cavitation —– bronchoscope
-P40 and CK5/6

Question 9

2)Adenocarcinoma:

most common in who, location, growth speed, mutations are:

Answer 9

-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

Question 10

Histology of squamous cell CA:

formation of what, spreads to what?, associated with?

Answer 10

-squamous differentiation and keratin formation
-spreads to local and regional lymph nodes

-metasases later than small cell
-may be associated with hypercalcemia

Question 11

2 histologic types of Adenocarcinoma:

Answer 11

1)Invasive:
-Acinar
-Papillary
-mucinous
-solid

2)Adenocarcinoma in situ
-localized nodule or multifocal
-growth along alveolar walls

Question 12

3) large cell carcinoma:

Answer 12

-poorly differentiated tumors
-aka poorly differentiated squamous cell CA or adenocarcinoma
-poor prognosis

Question 13

Small cell carcinoma: SCLC

general features

Answer 13

male>female
smoker dominant
arises from neuroendocrine cells

Question 14

SCLC cytology:

Answer 14

-Crush artifact
-nuclear molding

Question 15

SCLC features:

Answer 15

location- central
spreads widely in lung
aggressive with necrosis
metastizes early
most frequent type with ectopic hormones

responsive to chemotherapy

Question 16

SCLC histology:

Answer 16

small blue cells
azzopardi effect
positive for TTF-1

Question 17

spread of lung cancer can be:

Answer 17

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

Question 18

Local effects of cancer:

Answer 18

Central- cough, wheezing, hemoptysis
periphral- incidental hemoptysis or pneumonia

Question 19

regional invasion;

Answer 19

Recurrent pharyngeal nerve: vocal cord paralysis

Phrenic nerve: diaphragmatic paralysis

esophagus: bronchoesophageal fistula

Chest wall invasion: pain and pleural effusion

Question 20

Invasion of upper lobe:

Answer 20

right upper lobe invasion– superior vena cava syndrome

Apical tumor– pain and destruction of first and second rib+ vertebra

cervical sympathetic plexus— horner syndrome

Question 21

paraneoplastic syndrome: hyper calcemia

Answer 21

:hypercalcemia:
caused by PTHrP production- squamous cell CA
-kidney stones
-constipation and fatigue if moderate
-coma and arrythmias is severe

Question 22

Paraneoplastic syndrome: Cushing syndrome

Answer 22

due to ectopic ACTH production

patient presents with:
-fluid retention
-increased facial hair
-moon like face

SCLC related

Question 23

paraneoplastic syndromes: Digital clubbing

Answer 23

-can result from hypertrophic osteoarthropathy

Question 24

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paraneoplastic syndromes: neuromuscular disorders

Answer 24

myasthenic syndromes
neuropathy and polymyositis
seen in SCLC

Question 25

Paraneoplastic syndromes: migratory thrombophlebitis

Answer 25

Common cause of DIC in adenocarcinoma

Question 26

Lung hamartoma- benign lung lesion

Answer 26

Most common

-Coin lesoin on X ray
-abscess but benign

Question 27

Metastatic lung tumors show:

Answer 27

-Multiple discrete nodules (cannon ball)
-single nodules
-lymphaginitis carcinomatosa
-pleural effusion

Question 28

Malignant mesotholemia gross:

Answer 28

-starts as pleural fibrosis and palque

-later as gelatinous yellowish white tumor ensheathing the lung.

poor prognisis

Question 29

Malignant mesotholemia casued by:

Answer 29

inactivation of multiple supperssor genes: p53,RB,BAP1