Lecture 10 Pulmonary Neoplasms Flashcards

1
Q

____ causes 80-90% of all lung cancer. what is the most important carcinogen in it?

A

tobacco smoking; polyaromatic hydrocarbons (accoring to pathoma)

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2
Q

who has a higher risk of developing lung cancer, women or men?

A

women

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3
Q

what is the most common histological subtype of lung cancer?

A

adenocarcinoma

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4
Q

adenocarcinoma most likely arises from ____ cells in the _____ (central or peripheral?) bronchi. it stains ____ positive

A

mucin secreting, peripheral, mucin

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5
Q

the bronchioalveolar subtype of adenocarcinoma is characterized by ____ cells that grow along bronchioles/alveoli. they arise from ___ cells and ____ to smoking

A

columnar;

clara, unrelated

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6
Q

what is the prognosis with bronchioloalveolar carcinoma? CXR shows a ____ infiltrate similar to ____

A

good. hazy, pneumonia

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7
Q

what is the ‘S’ pneumonic?

A

Squamous cell and Small cell carcinoma are Sentrally located, caused by Smoking, and have paraneoplastic Syndromes associated with them.

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8
Q

squamous cell carcinoma presents as a ____ mass arising from the ____.

A

hilar, bronchus

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9
Q

characteristic histological findings of squamous cell carcinoma

A

keratin pearls and intercellular bridges

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10
Q

what are the “C”s of squamous cell carcinoma?

A

cavitation, cigarretes, hyperCalcemia (due to PTHrP)

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11
Q

large cell carcinoma:
central or peripheral?
surgery or chemo?
good or bad prognosis?

A
peripheral, surgery;
bad prognosis (aggressive)
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12
Q

small cell carcinoma: neoplasm of ____ _____ cells which are small dark ___ cells on histology

A

neuroendocrine Kulchitsky, blue

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13
Q

small cell carcinoma can produce ____, causing cushing syndrome. they can also cause ____. they can produce antibodies against ____ channels causing lambert eaton myasthenic syndrome

A

ACTH, SIADH;

presynaptic calcium

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14
Q

what might you see histologically in small cell carcinoma?

A

lot of mitotic activity

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15
Q

bronchial carcinoid tumor: highly ___ lesions that arise in ____ glands in the bronchial wall. characterized by red/pink ___ mass protruding from the bronchial wall

A

vascularized, submucosal;

polyploid

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16
Q

bronchial carcinoid tumor: stains positively to ____ markers such as _____

A

neuroendocrine, chromogranin

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17
Q

diagnosis of bronchial carcinoid tumor is usually made based off of history of frequent ____ or repeated bouts of ___ + bronchoscopy. what’s the prognosis?

A

hemoptysis, pneumonia;

“excellent”

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18
Q

carcinoid syndrome: release of vasoactive amines such as _____ which cause _____ of face and upper body,diarrhea, and _____

A

serotonin; flushing;

wheezing

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19
Q

why shouldn’t you biopsy a carcinoid tumor?

A

severe risk of hemorrhage

20
Q

bronchial carcinoid tumor shows a nest of slightly spindled cells with strippled ____; “ ____ and ____” pattern

A

chromatin; salt, pepper

21
Q

____ is the most common benign tumor of the lung. composed of disorganized elements of tissue normally ____ in the lung

A

hamartoma; present (ie lung tissue and cartilage)

22
Q

hamartoma is characterized by a ____ hard smooth mass with the “____ out”

A

rubber, shell

23
Q

staging system looks at 3 things:

A

TNM:

Tumor size/extension, regional lymph node involvement, metastasis

24
Q

how is small cell carcinoma staged?

A

limited or extensive disease (ie to contralateral hemithorax)

25
see his notes for staging system specifics
not the most high yield
26
presence of metastasis automatically makes the disease stage ___
IV
27
treatment of limited small cell cancer is ____. | what about extensive stage disease?
chemo + RT; | just chemo
28
is hypercalcemia in lung cancer typically due to bony metastasis or due to secretion of PTHrP?
PTHrP (80%)
29
hypoglycmia is due to increased insulin release and is seen typically in what type of lung cancer?
squamous cell
30
large cell carcinoma can contain cells that secrete _____, leading to ____ or clubbing
gonadotropin, gyneocomastia
31
a right apical lung mass or thrombosis from indwelling catheter is usually the cause of _____
SVC syndrome
32
Symptoms of SVC: ___ discoloration and edema of the ____ and ____, JVD.
blue; upper extremity, face
33
Pancoast tumors involve the ___ dermatomes with invasion of the brachial plexus, resulting in ____ and ___ pain along with weakness and atrophy of ___ muscles. can also cause ____ syndrome
C8-T2; shoulder, arm; hand; horner's
34
horner's syndrome causes what 3 symptoms? (better know this or you will be haunted by Dr. Walker); due to involvement of the sympathetic chain and _____ ganglion. does it cause ipsi or contralateral symptoms?
ptosis, miosis, anhidrosis; inferior cervical (stellate); ipsi
35
acanthosis nigricans is brownish hyperpigmentation and is common with _____
bronchial adenocarcinoma
36
what is the most useful diagnostic test in screening for cancer? What is the most useful radiologic test?
sputum cytology; CT
37
look for ____ lesion on CXR or a _____ nodule on CT
"coin"; noncalcified
38
____ determines the diagnosis of lung cancer and determines the cell type
bronchoscopy
39
non-small cell lung cancer: for stage 1 and 2, use ____; | for stage 3, use ____; stage 4 use ____
surgery + adjuvant chemo RT; | chemo + RT; chemo
40
limited disease small cell lung cancer is very responsive to _____; although still low survival :(
chemotherapy + RT
41
extensive stage small cell lung cancer: | _____ irradiation is used to improve quality of life and decrease mets
brain
42
asbestos usually causes _____ and can cause _____
lung cancer; mesothelioma
43
mesothelioma is characterized by pleural _____ or ___
thickening, effusion
44
mesothelioma stains positive for ____ and _____
cytokeratin, calretinin
45
characteristic ____ bodies are seen on histology with mesothelioma
psammoma