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Pulmonology > Lung and Pleural Tumors - Gupta > Flashcards

Lung and Pleural Tumors - Gupta Flashcards

1
Q

example of a benign lung tumor

A

Hamartoma

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2
Q

how does hamartoma appear on X-ray?

A

“coin lesion” rounded, well circumscribed, peripheral, solitary

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3
Q

what is the definition of Hamartoma?

A

nodules of mature** connective tissue (often cartilage)

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4
Q

for hamartomas - are they congenital or a neoplasm?

A

evidence supports neoplasm

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5
Q

What is this? and describe it

A

Pulmonary Hamartoma

grey-white glistening nodule grey tinged = cartilage

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6
Q

What is this? describe

A

Harmatoma

lobules of mature, benign cartialge with entrapped benign respiratory epithelium

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7
Q

compare death rates of lung cancer and breast cancer in women

A

more women now die each year from lung cancer than breast cancer in the US

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8
Q

where does lung cancer rank as far as cancer mortality?

A

is most common cause of cancer mortality worldwide

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9
Q

what percentage of lung cancers occur in smokers or ex-smokers?

A

87%

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10
Q

what is the increase risk for lung cancer in 1 ppd smokers? 2 ppd smokers?

A

1 ppd = 10 fold increased risk 2 ppd = 60 fold increased risk

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11
Q

what is the second most common cause of lung cancer in the US? (besides tobacco smoke)

A

Radon

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12
Q

besides radon and cigarettes, what are some other common causes of lung carcinoma?

A

Industrial hazards - radiation, uranium Asbestos Air pollution

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13
Q

what is the relationship between smoking and asbestos exposure for lung cancer? what types of carcinoma?

A

asbestos exposure is synergistic w/ smoking 50-90 times greater risk in asbestos workers who smoke inc risk for adenocarcinoma (bronchiogenic carcinoma) NOT mesothelioma

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14
Q

for primary lung carcinoma, what are the 4 histologic classifications? (the 4 main types of lung cancer)

A

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

Small cell carcinoma

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15
Q

For small cell carcinoma, when does the pt usually present? what treatment options are available? prognosis?

A

Usually presents at an advanced stage - very aggressive, usually have mets before presenting tx options = chemotherapy +/- radiation NOT surgical candidates

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16
Q

for Non-small Cell Carcinoma, what are the treatment options? how does this compare to small cell carcinoma? prognosis?

A

NSCLC is more resistant to traditional chemotherapy than small cell

Tx options: surgery, +/- chemotherapy/radiation

much better prognosis

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17
Q

what is the most common histologic type of lung carcinoma, especially for non-smoker and female smokers

A

adenocarcinoma

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18
Q

where do most adenocarcinomas of the lung usually arise? how can you help remember this?

A

peripherally adenocarcinoma is most common histologic type in female smokers - females smoke filtered cigarettes - have to draw in harder to get puff - gets smoke further more distally into lungs - peripheral

Goljan: filters filter out the big particles, small particles make it deeper down in the bronchial tree - further out to periphery

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19
Q

Adenocarcinoma - what is the appearance (differentiation)? production of what? growth pattern?

A

glandular differentiation

mucin production *

lepidic growth sometimes pneumonia-like consolidation

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20
Q

what is lepidic growth?

A

grows along the alveoli - snaking a long

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21
Q

What is this? and describe

A

Pulmonary Adenocarcinoma - CT

spiculated peripheral mass

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22
Q

what is this? and describe

A

lung adenocarcinoma

peripheral location

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23
Q

What is this? and describe

A

Lung Adenocarcinoma

occasional pneumonia-like consolidation of entire lobe

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24
Q

What is this? and describe

A

Lung Adenocarcinoma

mucin-producing glandular structures

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25
Q

what is this? and describe

A

Lung adenocarcinoma

lepidic pattern shows growth along alveolar septa

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26
Q

what gender does squamous cell carcinoma arise more in? with what modifiable risk factor?

A

males smokers

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27
Q

where are Squamous cell carcinomas typically found

A

centrally located

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28
Q

What are some histologic features of Squamous cell carcinoma?

A

tendency to show central necrosis/cavitation

keratinization / keratin pearls

intercellular bridges

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29
Q

what hormone may be produced by squamous cell carcinoma?

A

PTHrP

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30
Q

What is this? and describe

A

Squamous Cell Lung Carcinoma

large centrally situated mass

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31
Q

What is this? and describe

A

Squamous Cell Lung Carcinoma

large tumor that obliterates entire central portion of lung and shows an area of cavitation

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32
Q

What is this? and describe

A

Squamous Cell Lung Carcinoma

keratin pearls also note the distinct borders of surrounding cells - squamous cells

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33
Q

define a large cell carcinoma

located where? differentiation?

A

undifferentiated non-small cell carcinoma often peripherally located no glandular or squamous differentiation

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34
Q

describe how large cell carcinoma appears on microscopy - comment on nucleus and chromatin

A

large nuclei with prominent nucleoli and vesicular (clumpy) chromatin look anaplastic - variation of size and shape

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35
Q

what is the prognosis of Large cell carcinoma?

A

poor

36
Q

What is this? and describe

A

Large Cell Lung Carcinoma

large cells w/ prominent nucleoli no glandular or squamous differentiation is evident

37
Q

define small cell carcinoma. what does it have a strong association with?

A

High-grade neuroendocrine carcinoma

strong relationship to smoking

38
Q

what is the likelihood of small cell carcinoma to metastasize?

A

small cell carcinomas exhibit aggressive growth with widespread metastases

39
Q

small cell carcinoma of lung - how sensitive is it to chemo or radiation?

A

small cell carcinomas are more chemo/radiosensitive than non small cell carcinomas

40
Q

What are the histologic features of small cell carcinoma?

A

small cells w/ scant cytoplasm and granular chromatin nuclear molding, abundant mitotic bodies, crush artifact

41
Q

what paraneoplastic syndromes or hormones may be produced by small cell carcinoma of the lung? (3)

A

ADH

ACTH

Lambert-Eaton syndrome

42
Q

What is this? and describe

A

Small Cell Lung Carcinoma

Central tumor with infiltrative growth into surrounding lung

43
Q

What is this? and describe

A

Small Cell Lung Carcinoma

small cells w/ scant cytoplasm and crush artifact

44
Q

what immuno stains can be done for small cell lung carcinoma?

A

chromogranin and synaptophysin

45
Q

define carcinoid tumor of lung (primary malignant tumor)

A

low-grade neuroendocrine carcinoma

46
Q

what percentage of all lung tumors do carcinoid tumors comprise? which population does it predominantly affect?

A

1-5% of all lung tumors affects the relatively young (5th decade - age is only a number I guess)

47
Q

where are carcinoid tumors most often located

A

central (endobronchial) or peripheral

48
Q

how do carcinoid tumors present?

A

hemoptysis and dyspnea or discovered incidentally

49
Q

what is the prognosis of carcinoid tumor? buzzword? 5 year survival?

A

good prognosis

indolent

5 yr survival 87% or more

50
Q

what is this? and describe

A

carcinoid tumor

endobronchial circumscribed tumor homgenous in appearance, no necrosis or hemorrhage or shit

51
Q

what is this? and describe

A

carcinoid tumor

nests of bland cells w/ granular chromatin low grade

52
Q

What is this? describe

A

Carcinoid Tumor

dense core granules are evidence of neuroendocrine differentiation

53
Q

what system is used to define prognosis of lung carcinoma? define the components of this system

A

TNM staging

T - tumor size, visceral pleura or mainstem bronchus involvement, distance from carina, invasion of structures outside of lung

N - lymph nodes mets

M - distant metastases

54
Q

where does lung carcinoma most often mets to? (4)

A

adrenal, liver, brain, bone

(also hilar lymph nodes)

55
Q

which stage of lung carcinoma has best survival? worst?

A

stage I (localized tumors with no nodal or distant mets) has significant better survival than stage IV (distant mets)

56
Q

for lung carcinoma, what are 2 genetic alterations we want to look for?

A

KRAS and EGFR

57
Q

KRAS mutation - prognosis and population most often arise in

A

bad in an already grim picture

25% of adenocarcinomas arising in smokers

58
Q

what populations do EGFR mutations most often occur in?

A

non-smokers, females, Asians

59
Q

what do lung adenocarcinomas containing EGFR mutation respond to? pharm shit

A

novel tyrosine kinase inhibitors

60
Q

why is it important to get the diagnosis right as to what type of lung cancer you have? there is a anti-lung cancer drug that can cause hemorrhage in a certain type of lung cancer, what is it?

A

Bevacizumab can cause hemorrhage in squamous cell carcinoma (this is more pharm, but she mentioned it)

61
Q

what kind of cancer is associated with ALK mutation

A

mucinous adenocarcinoma

62
Q

what are 4 sites of involvement in the local effects of lung cancer spread? what are their consequences in each site?

A

1) tumor obstruction of airway –> pneumonia, abscess, collapse
2) recurrent laryngeal n invasion –> hoarseness
3) SVC compression –> SVC syndrome
4) sympathetic ganglion invasion –> Horner syndrome

63
Q

What paraneoplastic syndrome is caused by squamous cell carcinoma? what hormone is released and what is the result?

A

PTH-related peptide –> hypercalcemia

64
Q

what 3 paraneoplastic syndromes are associated with small cell lung carcinoma? what hormones are released and what is the result?

A

1) SIADH –> hyponatremia
2) ACTH –> Cushing’s
3) antibodies to voltage gated calcium channels –> Lambert-Eaton syndrome

65
Q

what is Lambert-Eaton’s syndrome

A

an autoimmune disease that is characterized by muscle weakness in the limbs - due to the antibodies blocking the voltage gated calcium channels at the presynaptic nerve terminals at the NM junction

66
Q

what is a pancoast tumor?

A

carcinoma that occurs in the apex of the lung

67
Q

what are 2 common side effects of a pancoast tumor?

A

1) Horner’s syndrome - impinging on the cervical sympathetic chain, inhibiting it –> ipsilateral ptosis, miosis, anhidrosis
2) SVC syndrome

68
Q

lungs are the most common site of metastatic tumors - how do they usually get there? what do they look like?

A

via blood or lymphatics usually multiple well-circumscribed nodules ‘cannon balls’

69
Q

for mets to the lungs, where are the common sites of origin? (5)

A

lung

breast

colon

melanoma

sarcomas

70
Q

What is this? describe

A

Metastatic involvement of the lung

multiple well-circumscribed “cannonball” nodules

71
Q

what is a primary malignant tumor of the pleura?

A

mesothelioma

72
Q

are primary or secondary (metastatic) pleural tumors more common?

A

secondary are more common by far

73
Q

what are the 2 most common sites of origin for secondary mets tumors to the pleura?

A

lung and breast

74
Q

what is the most common cause of primary malignant tumors of the pleura

A

asbestos

75
Q

what type of tumor is most common from asbestos exposure?

A

adenocarcinoma (bronchogenic carcinoma according to Muthiah)

mesothelioma from asbestos only carries a 7-10% lifetime risk w/ heavy exposure

76
Q

how does smoking and asbestos exposure relate to risk for mesothelioma

A

there is no increased risk from smoking

77
Q

what are the presenting symptoms of mesothelioma? what is the course of this disease?

A

chest pain, dyspnea, effusions

rapid course - 50% die within 1 year

78
Q

what is treatment possibilities for mesothelioma

A

aggressive surgery, chemo/radiotherapy sometimes prolongs survival

79
Q

what is this? describe

A

Malignant Pleural Mesothelioma

diffusely thickens pleura with characteristic “rind-like” encasement of lung

80
Q

what are the 3 histologic types of mesothelioma? what do they resemble? which is most common?

A

1) Epitheliod (most common) - can resemble metastatic adenocarcinoma
2) Sarcomatoid - resemble sacromas
3) biphasic - mixture of epitheliod and sarcomatoid patterns

81
Q

What is this? describe

A

Malignant Pleural Mesothelioma

epitheliod type of mesothelioma can show tubules that mimic glandular structure seen in adenocarcinoma

82
Q

what histochemical stains are used to differentiate mesothelioma from adenocarcinoma? which one is used for which?

A

Hyaluronic acid - mesothelioma

Mucin - adenocarcinoma

83
Q

what immunohistochemical stains are used to differentiate mesothelioma from adenocarcinoma? which one is used for which?

A

Calretinin - mesothelioma

Carcinoembryonic antigen (CEA) - adenocarcinoma

84
Q

what is the caveat for calretinin stain used for mesothelioma

A

it will stain both malignant and benign mesothelial cells

need to know history and other features to know ahead of time if it is malignant or not

85
Q

what is the appearance on electron microscopy of mesothelioma vs adenocarcinoma?

A

mesothelioma - long slender microvilli

adenocarcinoma - stubby microvillous rootlets

86
Q

what color are we looking for in the calretinin immunohistochemistry stain for malignant mesothelioma? *

A

tumor cells stain positively - brown color

Pulmonology (31 decks)

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