Lecture 10 Pulmonary Neoplasms

Question 1

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

Answer 1

tobacco smoking; polyaromatic hydrocarbons (accoring to pathoma)

Question 2

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

Answer 2

women

Question 3

what is the most common histological subtype of lung cancer?

Answer 3

adenocarcinoma

Question 4

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

Answer 4

mucin secreting, peripheral, mucin

Question 5

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

Answer 5

columnar;

clara, unrelated

Question 6

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

Answer 6

good. hazy, pneumonia

Question 7

what is the ‘S’ pneumonic?

Answer 7

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

Question 8

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

Answer 8

hilar, bronchus

Question 9

characteristic histological findings of squamous cell carcinoma

Answer 9

keratin pearls and intercellular bridges

Question 10

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

Answer 10

cavitation, cigarretes, hyperCalcemia (due to PTHrP)

Question 11

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

Answer 11

peripheral, surgery;
bad prognosis (aggressive)

Question 12

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

Answer 12

neuroendocrine Kulchitsky, blue

Question 13

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

Answer 13

ACTH, SIADH;

presynaptic calcium

Question 14

what might you see histologically in small cell carcinoma?

Answer 14

lot of mitotic activity

Question 15

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

Answer 15

vascularized, submucosal;

polyploid

Question 16

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

Answer 16

neuroendocrine, chromogranin

Question 17

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

Answer 17

hemoptysis, pneumonia;

“excellent”

Question 18

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

Answer 18

serotonin; flushing;

wheezing

Question 19

why shouldn’t you biopsy a carcinoid tumor?

Answer 19

severe risk of hemorrhage

Question 20

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

Answer 20

chromatin; salt, pepper

Question 21

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

Answer 21

hamartoma; present (ie lung tissue and cartilage)

Question 22

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

Answer 22

rubber, shell

Question 23

staging system looks at 3 things:

Answer 23

TNM:

Tumor size/extension, regional lymph node involvement, metastasis

Question 24

how is small cell carcinoma staged?

Answer 24

limited or extensive disease (ie to contralateral hemithorax)

Question 25

see his notes for staging system specifics

Answer 25

not the most high yield

Question 26

presence of metastasis automatically makes the disease stage ___

Answer 26

IV

Question 27

treatment of limited small cell cancer is ____.

what about extensive stage disease?

Answer 27

chemo + RT;

just chemo

Question 28

is hypercalcemia in lung cancer typically due to bony metastasis or due to secretion of PTHrP?

Answer 28

PTHrP (80%)

Question 29

hypoglycmia is due to increased insulin release and is seen typically in what type of lung cancer?

Answer 29

squamous cell

Question 30

large cell carcinoma can contain cells that secrete _____, leading to ____ or clubbing

Answer 30

gonadotropin, gyneocomastia

Question 31

a right apical lung mass or thrombosis from indwelling catheter is usually the cause of _____

Answer 31

SVC syndrome

Question 32

Symptoms of SVC: ___ discoloration and edema of the ____ and ____, JVD.

Answer 32

blue; upper extremity, face

Question 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

Answer 33

C8-T2; shoulder, arm;
hand;
horner’s

Question 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?

Answer 34

ptosis, miosis, anhidrosis;
inferior cervical (stellate);
ipsi

Question 35

acanthosis nigricans is brownish hyperpigmentation and is common with _____

Answer 35

bronchial adenocarcinoma

Question 36

what is the most useful diagnostic test in screening for cancer? What is the most useful radiologic test?

Answer 36

sputum cytology; CT

Question 37

look for ____ lesion on CXR or a _____ nodule on CT

Answer 37

“coin”; noncalcified

Question 38

____ determines the diagnosis of lung cancer and determines the cell type

Answer 38

bronchoscopy

Question 39

non-small cell lung cancer: for stage 1 and 2, use ____;

for stage 3, use ____; stage 4 use ____

Answer 39

surgery + adjuvant chemo RT;

chemo + RT; chemo

Question 40

limited disease small cell lung cancer is very responsive to _____; although still low survival :(

Answer 40

chemotherapy + RT

Question 41

extensive stage small cell lung cancer:

_____ irradiation is used to improve quality of life and decrease mets

Answer 41

brain

Question 42

asbestos usually causes _____ and can cause _____

Answer 42

lung cancer; mesothelioma

Question 43

mesothelioma is characterized by pleural _____ or ___

Answer 43

thickening, effusion

Question 44

mesothelioma stains positive for ____ and _____

Answer 44

cytokeratin, calretinin

Question 45

characteristic ____ bodies are seen on histology with mesothelioma

Answer 45

psammoma