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Pathology > Lung 3 > Flashcards

Lung 3 Flashcards

1
Q

T or F
metastatic tumors are more
common than primary tumors.

A

Tru

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2
Q

In the primary tumors, 90% of the tumors in the

lungs are actually

A

Carcinomas

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3
Q

The rest of the tumors in the lungs would be

A

carcinoids,

mesenchymal tumors, and other rare tumors.

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4
Q

is currently the most frequently
diagnosed major cancer and the most common
cause of cancer mortality worldwide.

A

Lung cancer

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5
Q

Lung cancer is generally a disease of older adults,
occurring most often between ages ________, with a peak incidence
between________________

A

55
and 84 years

65 and 74 years.

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6
Q

Only __ of all cases occur before the age of 40

A

2%

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7
Q

is the most common risk
factor that has an established association with
lung cancer

A

Cigarette smoking

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8
Q

T or F

there is a nearly linear correlation between the
frequency of lung cancer and pack-years of
cigarette smoking.

A

T

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9
Q

other factors that interact with smoking to predispose individuals to this deadly disease

A

acquired mutations, genetic makeup of the individual

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10
Q

T or F

women are
more susceptible to carcinogens in tobacco than
men.

A

T

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11
Q

industrial hazards which increase the risk of developing lung cancer

A

asbestos,
arsenic, chromium, uranium, nickel, vinyl
chloride and mustard gas

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12
Q

T or f

High-dose ionizing radiation is carcinogenic

A

T

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13
Q

weakly radioactive, but lung cancer
rates among nonsmoking _____ miners are
four times higher than those in the general
population

A

Uranium

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14
Q

Asbestos workers who do not smoke
have a______ greater risk of
developing lung cancer

A

five-fold

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15
Q

asbestos + smoke

A

55-fold greater risk

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16
Q

Chronic exposure to air particulates in smog may cause

A

lung irritation, inflammation, and repair, and
you will recall that chronic inflammation and repair
increases the risk of a variety of cancers

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17
Q

is a ubiquitous radioactive gas that has been linked

epidemiologically to increased lung cancer in uranium miners.

A

Radon gas

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18
Q

T or F

Most of the mutations are acquired.

A

T

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19
Q

Smoking-related carcinomas of the lung arise by

A

a stepwise accumulation of
oncogenic “driver” mutations that result in the neoplastic transformation of pulmonary
epithelial cells

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20
Q

Receptor Tyrosine Kinases

A
  1. EGFR – 10-15%
  2. ALK – 3-5%
  3. ROS1 – 1%
  4. MET – 2-5%
  5. RET – 1-2%
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21
Q

most common (Receptor tyrosine kinases)

A

EGFR

ALK

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22
Q

Positive KRAS is associated with

A

poor prognosis

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23
Q

Serine/Threonine kinases

A

BRAF
P13K
KRAS

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24
Q

Oncogenic gain of function mutations

A

Adenocarcinomas

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25
Q

is the most

common subtype in never-smokers

A

adenocarcinomas

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26
Q

Chromosome deletions of tumor

suppressor loci

A

SQUAMOUS CELL CARCINOMAS

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27
Q

site for CDKN2A gene, associated

with P16 mutation

A

3P9P

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28
Q

site of TP52 gene; associated with
TP53 mutations and p53 protein
overexpression

A

17p

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29
Q

a gene encoding the

fibroblast growth factor receptor tyrosine kinase.

A

Amplification of FGFR1

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30
Q

virtually always smoking related and has the

highest mutational burden among lung cancers

A

● SMALL CELL CARCINOMA

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31
Q

Acquisition of RB loss of function mutations

A

Small cell carcinoma

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32
Q

Non-small cell carcinomas are your

A

adenocarcinoma and squamous cell

carcinoma

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33
Q

is seen even in histologically normal lung epithelium, suggesting that this also is a critical early event

A

Loss of chromosome 3p

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34
Q

Small cell carcinoma

A

TP53 and RB activation
Acquisition of RB loss of function mutations
Transformation of non-small cell carcinoma to small cell carcinoma
Loss of chromosome 3p
○ Amplification of MYC gene family

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35
Q

mutations in lung cancer (never-smokers)

A

EGFR mutations

TP53 mutations

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36
Q

Four types of morphologic precursor epithelial

lesions are recognized:

A 
○ Atypical adenomatous hyperplasia
○ Adenocarcinoma in situ
○ Squamous dysplasia and carcinoma in
situ
○ Diffuse idiopathic pulmonary
neuroendocrine cell hyperplasia
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37
Q

T or F

Currently it is not possible to distinguish
between precursor lesions that progress and
those that remain localized or regress.

A

T

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38
Q

Tumor classification (Adenocarcinoma)

A

Lepidic, acinar, micropapillary, papillary, solid

Invasive mucinous adenocarcinoma

Minimally invasive adenocarcinoma (nonmucinous, mucinous)

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39
Q 
Tumor classification 
(squamous cell carcinoma)
A

Keratinizing, nonkeratinizing, basaloid

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40
Q 
Tumor classification 
(Neuroendocrine tumors)
A 
Small cell carcinoma
Combined small cell carcinoma
Large cell neuroendocrine carcinoma
Combined large-cell neuroendocrine carcinoma
Carcinoid tumor (typical, atypical)
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41
Q 
Tumor classification
(Other uncommon types)
A 
Large cell carcinoma
Adenosquamous carcinoma
Sarcomatoid carcinoma
Lymphoepthelioma-like carcinoma and NUT carcinoma
Salivary gland-type tumors
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42
Q

mixtures of histologic patterns,

even in the same cancer

A

○ squamous cell carcinoma and
adenocarcinoma (14%)
○ small cell and squamous cell carcinoma
(5%)

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43
Q

Epithelium of Atypical adenomatous hyperplasia

A

cuboidal, and there is mild interstitial fibrosis.

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44
Q

ATYPICAL ADENOMATOUS HYPERPLASIA is A small precursor lesion (≤5 mm) characterized
by________ lining alveolar
walls that are mildly fibrotic.

A

dysplastic pneumocytes

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45
Q

formerly called bronchioloalveolar carcinoma

A

ADENOCARCINOMA IN-SITU

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46
Q

ADENOCARCINOMA IN-SITU
lesion that is_____ in size and is
composed entirely of _______ growing
along pre-existing alveolar sept

A

less than 3 cm

dysplastic cells

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47
Q

T or F
In adenocarcinoma in-situ, The cells have more dysplasia than atypical
adenomatous hyperplasia and may or may not
have intracellular mucin

A

T

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48
Q

Most common form of lung cancer in women

and men

A

adenocarcinomas

49
Q

is an invasive malignant epithelial tumor with glandular differentiation or mucin production by the tumor cells

A

Adenocarcinomas

50
Q

poorly differentiated
type of adenocarcinoma. It is already difficult to
differentiate with the squamous cell carcinoma.
Hence, we usually end up diagnosing it just like
non-small cell carcinoma.

A

Solid adenocarcinoma

51
Q

Lung carcinomas may arise in the

A 
peripheral lung (more often adenocarcinomas) or in the central/hilar region (more often squamous cell
carcinomas)
52
Q

They vary histologically from well-differentiated
tumors with obvious glandular elements (Fig.
15.43A), to papillary lesions resembling other
papillary carcinomas, to solid masses with only
occasional mucin-producing glands and cells

A

adenocarcinomas

53
Q

In adenocarcinoma, The majority express ___________, a protein first identified in the
thyroid that is required for normal lung
development.

A

thyroid transcription

factor-1 (TTF-1)

54
Q

For _________, we usually request for TTF-1 as an immunohistochemical stain to mark that
this is a adenocarcinoma instead of squamous
cell carcinoma

A

solid patterns

55
Q

At the periphery of the tumor there is often a ___ pattern of spread, in which the tumor
cells “crawl” along normal-appearing alveolar
septa.

A

lepidic

56
Q

Tumors (≤3 cm) with a small invasive
component (≤5 mm) associated with scarring
and a peripheral lepidic growth pattern are
called

A

microinvasive adenocarcinoma

57
Q

variant
where the major component shows papillary
growth pattern, often with complex secondary
and tertiary branching structure. The tumor cells
are arranged in multiple layers around true
fibrovascular cores.

A

Papillary adenocarcinoma of lung

58
Q

tend to spread
aerogenously, forming satellite tumors; thus,
these are less likely to be cured by surgery.

A

Mucinous adenocarcinomas

59
Q

Mucinous adenocarcinomas may present as a solitary nodule or as multiple nodules, or an entire lobe may be consolidated by tumor, mimicking _______

A

lobar pneumonia

60
Q

a variant where
the major tumor component consists of solid
sheets and lacks other recognizable patterns of
adenocarcinoma such as lepidic, acinar, papillary, or micropapillary growth.

A

Solid adenocarcinoma

61
Q

T or F

squamous cell carcinoma is more common in men and is strongly associated with smoking

A

T

62
Q

are often antedated
by squamous metaplasia or dysplasia in the
bronchial epithelium, which then transforms to
carcinoma in situ

A

Squamous cell carcinomas

63
Q

When it is associated with smoking, it starts as
______ in the bronchi associated gene
mutation and eventually it develops into a n
invasive cancer

A

dysplasia

64
Q

Squamous cell carcinoma has a different growth pattern. It can protrude into the lumen of the bronchus and can cause obstruction of the airway. Whatever is obstructed would have

A

secondary atelectasis

65
Q

T or F

Squamous cell carcinoma can invade the lung parenchyma

A

T

66
Q

How to differentiate adenocarcinoma vs Squamous cell carcinoma

A

Through biopsy

67
Q

Aside from production of keratin pearls, another
thing that can guide you to the differentiation or
identification of Squamous Cell Carcinoma
differentiation would be the presence of your

A

intercellular bridges

68
Q

they are present in well
differentiated or at least differentiated squamous
epithelium

A

desmosomes

69
Q

Squamous Cell Carcinoma s are associated with
your ____and ___ for poorly differentiated
Squamous Cell Carcinoma

A

p63; p40

70
Q

oat cell

A

Small cell carcinoma

71
Q

T or F

Majority of the Small Cell Carcinoma are highly
malignant and there’s a very strong relationship
to cigarette smoking.

A

T

72
Q

Most of these tumors arise in the bronchi and

there is no known preinvasive phase.

A

small cell carcinoma

73
Q

T or F

Among the malignant lung CA, small cell carcinoma is the most
aggressive and you have a really high mitotic count.

A

T

74
Q

This is also the tumor associated with extensive necrosis

A

Small cell carcinoma

75
Q

In small cell carcinoma, cytoplasm is ____

A

very scanty

76
Q

what pattern is present in the nuclei of small cell carcinoma

A

chromatin (salt and pepper)

77
Q

crushed
hyperchromatic cells wherein you can no longer
see them as individual cells.

A

crushing artifacts (very fragile)

78
Q

Basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells

A

Azzopardi effect (small cell carcinoma)

79
Q

electron microscopy

for small cell carcinoma shows

A

dense-core
neurosecretory granules, about 100 nm in
diameter, in two-thirds of cases of small cell
carcinoma.

80
Q

suggest that Small cell carcinoma
originates from neuroendocrine progenitor cells,
which are present in the lining bronchial
epithelium.

A

occurrence of
neurosecretory granules; the expression of
neuroendocrine markers such as
chromogranin, synaptophysin, and CD56;
and the ability of some of these tumors to
secrete hormones (e.g., parathormone-related
protein, a cause of paraneoplastic
hypercalcemia)

81
Q

they are made up of large cells, and the cells that you see are undifferentiated

A

Large cell carcinoma

82
Q

You should do immunohistochemical staining
first before you proceed to a Large cell
carcinoma diagnosis because

A

they are usually
negative for your markers:
○ adenocarcinoma - TTF-1, napsin A
○ squamous cell carcinoma - p40, p63

83
Q

has molecular
features similar to those of small cell carcinoma,
but is comprised of tumor cells of larger size

A

large cell

neuroendocrine carcinoma

84
Q

T or F

Any type of lung carcinoma may extend to the
pleural surface and then spread within the pleural cavity or into the pericardium

A

T

85
Q

Metastases to the

________ can be found in most cases

A

bronchial, tracheal, and mediastinal nodes

86
Q

Distant spread of lung carcinoma occurs through

both ______ and ________pathways

A

lymphatic; hematogenous

87
Q

may be the first manifestation of an

underlying occult pulmonary lesion.

A

Metastasis

88
Q

No organ or tissue is spared, but the a_____, for obscure reasons, are involved in
more than half of the cases.

A

adrenal glands

89
Q

liver

A

30-50%

90
Q

brain

A

20%

91
Q

bone

A

20%

92
Q

Anterior mediastinum

A 
Thymoma
Parathyroid tumors
Teratoma
Metastatic carcinoma
Lymphoma
Thyroid lesions
93
Q

Posterior mediastinum

A 
Neurogenic tumors
Lymphoma
Metastatic tumor
Bronchogenic cyst
gastroenteric hernia
94
Q

Middle mediastinum

A

bronchogenic cyst
pericardial cyst
lymphoma

95
Q

partial obstruction

A

focal emphysema

96
Q

90% total obstruction

A

atelectasis

97
Q

Impaired drainage of the

airways

A

Severe suppurative or Ulcerative bronchitis

or bronchiectasis

98
Q
  • sometimes call attention

to an otherwise silent carcinoma.

A

pulmonary abscess

99
Q

Superior Vena Cava Syndrome - compression

or invasion of the superior vena cava can cause ________

A

venous congestion and edema of the head and

arm and, ultimately, circulatory compromise

100
Q

extension into the

pericardium and pleura

A

pericarditis and pleuritis

101
Q

○ Apical lung cancers in the superior pulmonary sulcus
○ Invade the neural structures around the
trachea, including the cervical sympathetic plexus

A

Pancoast tumors

102
Q

Produce a group of clinical findings that includes severe pain in the distribution
of the ulnar nerve and Horner syndrome (enophthalmos, ptosis,
miosis, and anhidrosis) on the same side as the lesion

A

Pancoast tumors

103
Q

Involvement of central airways

A

cough

104
Q

hemorrhage from tumor in airways

A

hemoptysis

105
Q

extension of tumor into mediastinum, pleura, or chestwall

A

chest pain

106
Q

airway obstruction by tumour

A

Pneumonia, abscess, lobar collapse

107
Q

tumor obstruction; accumulation of cellular lipid in foamy macrophages

A

lipoid pneumonia

108
Q

tumor spread into pleura

A

Pleural effusion

109
Q

recurrent laryngeal nerve invasion

A

hoarseness

110
Q

esophageal invasion

A

dysphagia

111
Q

phrenic nerve invasion

A

diaphragm paralysis

112
Q

chest wall invasion

A

rib destruction

113
Q

SVC compression by tumor

A

SVC syndrome

114
Q

sympathetic ganglia invasion

A

horner syndrome

115
Q

pericardial involvement

A

pericarditis, tamponade

116
Q

backpain

A

bone metastases

117
Q

headache, hemiparesis, cranial nerve damage,

and seizures

A

brain metastases

118
Q

We usually proceed with _________ to determine metastasis

A

bone scanning,

PETscan

119
Q

are very sensitive to
chemotherapy and radiotherapy this is
secondary to having very young tumor cells and
you have a lot of tumor cell undergoing
metastasis hence they are very sensitive to
radiation

A

small cell carcinomas

Pathology (31 decks)

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