LUNG 3 2024

Question 1

Recall that many chemicals (procarcinogens) are

converted into carcinogens via activation by

Answer 1

highly polymorphic P-450 monooxygenase

enzyme system

Question 2

Asbestos

The latent period before the development
of lung cancer

Answer 2

10-30 yrs

Question 3

Cancers in nonsmokers are more likely to have

_______ and almost never have_______;

Answer 3

EGFR mutations; KRAS

mutations

Question 4

Preceded by atypical proliferation of terminal

bronchiolar epithelium

Answer 4

pulmonary fibrosis

Question 5

Most common cause of granuloma

Answer 5

tuberculolus infection

Question 6

Most occur in _____because of more air. M. tuberculosis thrive well in
aerated environment

Answer 6

upper lobe

Question 7

o Stains that can tell us that the tumor is
epithelial in origin
o Carcinomas are generally positive for

Answer 7

keratins (adenocarcinomas, squamous cell carcinomas, small cell carcinomas)

Question 8

o Positive for MAJORITY of 
adenocarcinomas of the lungs
o Positive also in the thyroid tissue
normally
o Positive in obviously malignant lesion 
forming glands in the lungs
Most adenocarcinomas PRIMARY to the 
lungs is usually positive for \_\_\_\_\_\_\_\_

Answer 8

TTF-1

Question 9

Sometimes since it can also be positive for thyroid tumors metastasizing to the
lungs, if you have history of thyroid cancer in the patient and you need to rule out metastasis coming from the thyroid, you have to do ________

Answer 9

NAPSIN A

Question 10

o Markers for squamous differentiation

Answer 10

p63 and P40

Question 11

dx where you

cannot really tell whether they are adenocarcinoma or squamous cell carcinoma;

Answer 11

Waste basket diagnosis

Question 12

Other markers that could be used to differentiate
the different common histologic variants of
pulmonary carcinoma

Answer 12

TTF-1, CD56. CK5/6 34BE12

Question 13

adenocarcinoma types:

Answer 13

Mucin secreting
Micropapillary pattern
Lepidic pattern

Question 14

A positive TTF-1 and a negative CK5/6

Answer 14

most

likely an adenocarcinoma primary to the lungs

Question 15

General marker for adenocarcinoma,
not automatically primary to the lungs, adjunct
marker if you do not have more specific TTF-1 or
napsin (not always available)

Answer 15

34βE12

Question 16

o It is present in the cytoplasm of Type II
pneumocytes and alveolar macrophages
o Highly sensitive marker for
adenocarcinomas of the lungs (around 80%)
o It is also seen in other adenocarcinomas like
renal cell carcinomas and variants of
papillary thyroid carcinomas

Answer 16

Napsin A

Question 17

 Less specific and can be seen staining
some of the adenocarcinomas
 Not usually strong and diffused
PATHO20: LUNG 3.1 (Pulmonary Tumors)
5
Group#14: CANONO, P.T., MULLA, S., TUMALA, R.J., UDARBE, K.M., VILLANUEVA, A.L., VILLARBA, A.L., VITAL, C.N.
LECTURE ¦ BOOK ¦ RECORDING ¦ TRIVIA/FACTS ¦ OLD TRANSES ¦ EMPHASIS
 If there is a problem with this, it is
combined with CK5/6

Answer 17

p63

Question 18

markers for small cell carcinoma

Answer 18

TTF-1, CD56

Question 19

OTHER MARKERS FOR NEUROENDOCRINE

DIFFERENTIATION

Answer 19

 SYNAPTOPHYSIN & CHROMOGRANIN

Question 20

Grown significantly (bronchus obstruction) →
atelectatic lung/lobe (depends on the
involvement) → pneumonic process = pain,
sputum production → later stages =

Answer 20

weight loss

Question 21

is a pain
experienced in the distribution in the
ulnar nerve

Answer 21

Pancoast tumor

Question 22

tumor type of cushing syndrome

Answer 22

small cell, carcinoid

Question 23

tumor type of hypercalcemia

Answer 23

squamous cell carcinoma

Question 24

Antidiuretic hormone (ADH), inducing  \_\_\_\_\_\_\_\_due to inappropriate ADH 
secretion

Answer 24

hyponatremia

Question 25

Adrenocorticotropic hormone | (ACTH), producing

Answer 25

cushing syndrome

Question 26

Parathormone, parathyroid hormone-related peptide, prostaglandin E, and some cytokines, all implicated in the

Answer 26

hypercalcemia often seen with lung | cancer

Question 27

muscle weakness is caused by autoantibodies (possibly elicited by tumor ionic channels) directed to the neuronal calcium channel

Answer 27

LAMBERT-EATON MYASTHENIC | SYNDROME

Question 28

Dermatologic abnormalities, including

Answer 28

ACANTHOSIS NIGRICANS

Question 29

Hematologic abnormalities, such as

Answer 29

Leukemoid reactions

Question 30

Hypercoagulable states, such

Answer 30

s Trousseau syndrome (deep vein thrombosis and thromboembolism)

Question 31

A peculiar abnormality of connective tissue called

Answer 31

hypertrophic pulmonary osteoarthropathy, | associated with clubbing of the fingers

Question 32

tumor classification percentage: | adenocarcinoma

Answer 32

50%

Question 33

tumor classification percentage: | Squamous cell carcinoma

Answer 33

20%

Question 34

tumor classification percentage: | small cell carcinoma

Answer 34

15%

Question 35

tumor classification percentage: | large cell carcinoma

Answer 35

2% (outside the umbrella of neuroendocrine tumors

Question 36

very poorly differentiated carcinoma that usually assume a sarcomatoid feature

Answer 36

sarcomatoid carcinoma

Question 37

squamous + adenocarcinoma

Answer 37

14%

Question 38

small cell + squamous cell

Answer 38

5%

Question 39

are those that retain basaloid features instead of producing the squamous features

Answer 39

are those that retain basaloid features instead of producing the squamous features

Question 40

are difficult to differentiate with small cell carcinoma because they do not form the keratin.

Answer 40

nonkeratinizing

Question 41

For neuroendocrine tumors, there are

Answer 41

``` o Small cell carcinomas o Combination of small cell and medium cell and even the large cell type o Large cell neuroendocrine carcinoma o Carcinoid tumor (typical and atypical) ```

Question 42

Compared with squamous cell cancers, these lesions are usually more peripherally located and tend to be smaller.

Answer 42

adenocarcinoma

Question 43

Adenocarcinomas grow in various patterns, including

Answer 43

acinar, lepidic, papillary, micropapillary, and | solid.

Question 44

In the poorly differentiated forms, this is where | difficulty in differentiating ______________ occur

Answer 44

Squamous Cell | Carcinomas

Question 45

sometimes are very well-differentiated that they assume/form just like your alveoli which we call

Answer 45

Lepidic type | of Carcinoma.

Question 46

very typical adenocarcinoma wherein you have irregular glandular structures and angulations of the glands which means that we have

Answer 46

invasion of the stroma.

Question 47

a protein first identified in the thyroid that | is required for normal lung development.

Answer 47

Thyroid Transcription Factor 1

Question 48

o To differentiate Primary Pulmonary Adenocarcinoma from a Metastatic Colonic Adenocarcinoma, we usually use

Answer 48

CDX2

Question 49

CDX2 (-) for

Answer 49

Primary pulmonary adenocarcinoma

Question 50

CDX2(+) for

Answer 50

metastatic colonic adenocarcinoma

Question 51

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.

Answer 51

solid

Question 52

solid adenocarcinoma are mostly positive for

Answer 52

TTF1 and Napsin

Question 53

commonly in the form of point mutations and homozygous deletions are seen in 50% of cases.

Answer 53

TP53 Mutations

Question 54

KRAS and EGFR Mutations are also important in

Answer 54

atypical and adenomatous hyperplasia

Question 55

EGFR Mutations are mutually exclusive of KRAS | mutations and occur significantly higher in:

Answer 55

 Adenocarcinomas from east Asians rather than non-Asians;  In women than in men;  In never-smokers than ever-smokers.

Question 56

occur in never-smokers or light-smokers, in younger patients and in patients that lack mutations of EGFR, KRAS and TP53.

Answer 56

ALK translocation