LUNG 3 2024 Flashcards
Recall that many chemicals (procarcinogens) are
converted into carcinogens via activation by
highly polymorphic P-450 monooxygenase
enzyme system
Asbestos
The latent period before the development
of lung cancer
10-30 yrs
Cancers in nonsmokers are more likely to have
_______ and almost never have_______;
EGFR mutations; KRAS
mutations
Preceded by atypical proliferation of terminal
bronchiolar epithelium
pulmonary fibrosis
Most common cause of granuloma
tuberculolus infection
Most occur in _____because of more air. M. tuberculosis thrive well in
aerated environment
upper lobe
o Stains that can tell us that the tumor is
epithelial in origin
o Carcinomas are generally positive for
keratins (adenocarcinomas, squamous cell carcinomas, small cell carcinomas)
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 \_\_\_\_\_\_\_\_
TTF-1
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 ________
NAPSIN A
o Markers for squamous differentiation
p63 and P40
dx where you
cannot really tell whether they are adenocarcinoma or squamous cell carcinoma;
Waste basket diagnosis
Other markers that could be used to differentiate
the different common histologic variants of
pulmonary carcinoma
TTF-1, CD56. CK5/6 34BE12
adenocarcinoma types:
Mucin secreting
Micropapillary pattern
Lepidic pattern
A positive TTF-1 and a negative CK5/6
most
likely an adenocarcinoma primary to the lungs
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)
34βE12
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
Napsin A
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
p63
markers for small cell carcinoma
TTF-1, CD56
OTHER MARKERS FOR NEUROENDOCRINE
DIFFERENTIATION
SYNAPTOPHYSIN & CHROMOGRANIN
Grown significantly (bronchus obstruction) →
atelectatic lung/lobe (depends on the
involvement) → pneumonic process = pain,
sputum production → later stages =
weight loss
is a pain
experienced in the distribution in the
ulnar nerve
Pancoast tumor
tumor type of cushing syndrome
small cell, carcinoid
tumor type of hypercalcemia
squamous cell carcinoma
Antidiuretic hormone (ADH), inducing \_\_\_\_\_\_\_\_due to inappropriate ADH secretion
hyponatremia
Adrenocorticotropic hormone
(ACTH), producing
cushing syndrome
Parathormone, parathyroid
hormone-related peptide,
prostaglandin E, and some
cytokines, all implicated in the
hypercalcemia often seen with lung
cancer
muscle weakness is
caused by autoantibodies (possibly elicited by
tumor ionic channels) directed to the neuronal
calcium channel
LAMBERT-EATON MYASTHENIC
SYNDROME
Dermatologic abnormalities, including
ACANTHOSIS NIGRICANS
Hematologic abnormalities, such as
Leukemoid reactions
Hypercoagulable states, such
s Trousseau
syndrome (deep vein thrombosis and
thromboembolism)
A peculiar abnormality of connective tissue called
hypertrophic pulmonary osteoarthropathy,
associated with clubbing of the fingers
tumor classification percentage:
adenocarcinoma
50%
tumor classification percentage:
Squamous cell carcinoma
20%
tumor classification percentage:
small cell carcinoma
15%
tumor classification percentage:
large cell carcinoma
2% (outside the umbrella of neuroendocrine tumors
very poorly
differentiated carcinoma that usually assume
a sarcomatoid feature
sarcomatoid carcinoma
squamous + adenocarcinoma
14%
small cell + squamous cell
5%
are those that retain
basaloid features instead of producing
the squamous features
are those that retain
basaloid features instead of producing
the squamous features
are difficult to
differentiate with small cell carcinoma
because they do not form the keratin.
nonkeratinizing
For neuroendocrine tumors, there are
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)
Compared with squamous cell cancers, these lesions
are usually more peripherally located and tend to be
smaller.
adenocarcinoma
Adenocarcinomas grow in various patterns, including
acinar, lepidic, papillary, micropapillary, and
solid.
In the poorly differentiated forms, this is where
difficulty in differentiating ______________ occur
Squamous Cell
Carcinomas
sometimes are
very well-differentiated that they assume/form
just like your alveoli which we call
Lepidic type
of Carcinoma.
very typical adenocarcinoma wherein you
have irregular glandular structures and
angulations of the glands which means that we
have
invasion of the stroma.
a protein first identified in the thyroid that
is required for normal lung development.
Thyroid Transcription Factor 1
o To differentiate Primary Pulmonary
Adenocarcinoma from a Metastatic Colonic
Adenocarcinoma, we usually use
CDX2
CDX2 (-) for
Primary pulmonary adenocarcinoma
CDX2(+) for
metastatic colonic adenocarcinoma
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.
solid
solid adenocarcinoma are mostly positive for
TTF1 and Napsin
commonly in the form of point
mutations and homozygous deletions are seen in
50% of cases.
TP53 Mutations
KRAS and EGFR Mutations are also important in
atypical and adenomatous hyperplasia
EGFR Mutations are mutually exclusive of KRAS
mutations and occur significantly higher in:
Adenocarcinomas from east Asians rather
than non-Asians;
In women than in men;
In never-smokers than ever-smokers.
occur in never-smokers or light-smokers, in younger
patients and in patients that lack mutations of EGFR,
KRAS and TP53.
ALK translocation
