Lung and Pleural Tumors - Gupta Flashcards
example of a benign lung tumor
Hamartoma
how does hamartoma appear on X-ray?
“coin lesion” rounded, well circumscribed, peripheral, solitary
what is the definition of Hamartoma?
nodules of mature** connective tissue (often cartilage)
for hamartomas - are they congenital or a neoplasm?
evidence supports neoplasm
What is this? and describe it
Pulmonary Hamartoma
grey-white glistening nodule grey tinged = cartilage
What is this? describe
Harmatoma
lobules of mature, benign cartialge with entrapped benign respiratory epithelium
compare death rates of lung cancer and breast cancer in women
more women now die each year from lung cancer than breast cancer in the US
where does lung cancer rank as far as cancer mortality?
is most common cause of cancer mortality worldwide
what percentage of lung cancers occur in smokers or ex-smokers?
87%
what is the increase risk for lung cancer in 1 ppd smokers? 2 ppd smokers?
1 ppd = 10 fold increased risk 2 ppd = 60 fold increased risk
what is the second most common cause of lung cancer in the US? (besides tobacco smoke)
Radon
besides radon and cigarettes, what are some other common causes of lung carcinoma?
Industrial hazards - radiation, uranium Asbestos Air pollution
what is the relationship between smoking and asbestos exposure for lung cancer? what types of carcinoma?
asbestos exposure is synergistic w/ smoking 50-90 times greater risk in asbestos workers who smoke inc risk for adenocarcinoma (bronchiogenic carcinoma) NOT mesothelioma
for primary lung carcinoma, what are the 4 histologic classifications? (the 4 main types of lung cancer)
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Small cell carcinoma
For small cell carcinoma, when does the pt usually present? what treatment options are available? prognosis?
Usually presents at an advanced stage - very aggressive, usually have mets before presenting tx options = chemotherapy +/- radiation NOT surgical candidates
for Non-small Cell Carcinoma, what are the treatment options? how does this compare to small cell carcinoma? prognosis?
NSCLC is more resistant to traditional chemotherapy than small cell
Tx options: surgery, +/- chemotherapy/radiation
much better prognosis
what is the most common histologic type of lung carcinoma, especially for non-smoker and female smokers
adenocarcinoma
where do most adenocarcinomas of the lung usually arise? how can you help remember this?
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
Adenocarcinoma - what is the appearance (differentiation)? production of what? growth pattern?
glandular differentiation
mucin production *
lepidic growth sometimes pneumonia-like consolidation
what is lepidic growth?
grows along the alveoli - snaking a long
What is this? and describe
Pulmonary Adenocarcinoma - CT
spiculated peripheral mass
what is this? and describe
lung adenocarcinoma
peripheral location
What is this? and describe
Lung Adenocarcinoma
occasional pneumonia-like consolidation of entire lobe
What is this? and describe
Lung Adenocarcinoma
mucin-producing glandular structures
what is this? and describe
Lung adenocarcinoma
lepidic pattern shows growth along alveolar septa
what gender does squamous cell carcinoma arise more in? with what modifiable risk factor?
males smokers
where are Squamous cell carcinomas typically found
centrally located
What are some histologic features of Squamous cell carcinoma?
tendency to show central necrosis/cavitation
keratinization / keratin pearls
intercellular bridges
what hormone may be produced by squamous cell carcinoma?
PTHrP
What is this? and describe
Squamous Cell Lung Carcinoma
large centrally situated mass
What is this? and describe
Squamous Cell Lung Carcinoma
large tumor that obliterates entire central portion of lung and shows an area of cavitation
What is this? and describe
Squamous Cell Lung Carcinoma
keratin pearls also note the distinct borders of surrounding cells - squamous cells
define a large cell carcinoma
located where? differentiation?
undifferentiated non-small cell carcinoma often peripherally located no glandular or squamous differentiation
describe how large cell carcinoma appears on microscopy - comment on nucleus and chromatin
large nuclei with prominent nucleoli and vesicular (clumpy) chromatin look anaplastic - variation of size and shape
what is the prognosis of Large cell carcinoma?
poor
What is this? and describe
Large Cell Lung Carcinoma
large cells w/ prominent nucleoli no glandular or squamous differentiation is evident
define small cell carcinoma. what does it have a strong association with?
High-grade neuroendocrine carcinoma
strong relationship to smoking
what is the likelihood of small cell carcinoma to metastasize?
small cell carcinomas exhibit aggressive growth with widespread metastases
small cell carcinoma of lung - how sensitive is it to chemo or radiation?
small cell carcinomas are more chemo/radiosensitive than non small cell carcinomas
What are the histologic features of small cell carcinoma?
small cells w/ scant cytoplasm and granular chromatin nuclear molding, abundant mitotic bodies, crush artifact
what paraneoplastic syndromes or hormones may be produced by small cell carcinoma of the lung? (3)
ADH
ACTH
Lambert-Eaton syndrome
What is this? and describe
Small Cell Lung Carcinoma
Central tumor with infiltrative growth into surrounding lung
What is this? and describe
Small Cell Lung Carcinoma
small cells w/ scant cytoplasm and crush artifact
what immuno stains can be done for small cell lung carcinoma?
chromogranin and synaptophysin
define carcinoid tumor of lung (primary malignant tumor)
low-grade neuroendocrine carcinoma
what percentage of all lung tumors do carcinoid tumors comprise? which population does it predominantly affect?
1-5% of all lung tumors affects the relatively young (5th decade - age is only a number I guess)
where are carcinoid tumors most often located
central (endobronchial) or peripheral
how do carcinoid tumors present?
hemoptysis and dyspnea or discovered incidentally
what is the prognosis of carcinoid tumor? buzzword? 5 year survival?
good prognosis
indolent
5 yr survival 87% or more
what is this? and describe
carcinoid tumor
endobronchial circumscribed tumor homgenous in appearance, no necrosis or hemorrhage or shit
what is this? and describe
carcinoid tumor
nests of bland cells w/ granular chromatin low grade
What is this? describe
Carcinoid Tumor
dense core granules are evidence of neuroendocrine differentiation
what system is used to define prognosis of lung carcinoma? define the components of this system
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
where does lung carcinoma most often mets to? (4)
adrenal, liver, brain, bone
(also hilar lymph nodes)
which stage of lung carcinoma has best survival? worst?
stage I (localized tumors with no nodal or distant mets) has significant better survival than stage IV (distant mets)
for lung carcinoma, what are 2 genetic alterations we want to look for?
KRAS and EGFR
KRAS mutation - prognosis and population most often arise in
bad in an already grim picture
25% of adenocarcinomas arising in smokers
what populations do EGFR mutations most often occur in?
non-smokers, females, Asians
what do lung adenocarcinomas containing EGFR mutation respond to? pharm shit
novel tyrosine kinase inhibitors
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?
Bevacizumab can cause hemorrhage in squamous cell carcinoma (this is more pharm, but she mentioned it)
what kind of cancer is associated with ALK mutation
mucinous adenocarcinoma
what are 4 sites of involvement in the local effects of lung cancer spread? what are their consequences in each site?
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
What paraneoplastic syndrome is caused by squamous cell carcinoma? what hormone is released and what is the result?
PTH-related peptide –> hypercalcemia
what 3 paraneoplastic syndromes are associated with small cell lung carcinoma? what hormones are released and what is the result?
1) SIADH –> hyponatremia
2) ACTH –> Cushing’s
3) antibodies to voltage gated calcium channels –> Lambert-Eaton syndrome
what is Lambert-Eaton’s syndrome
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
what is a pancoast tumor?
carcinoma that occurs in the apex of the lung
what are 2 common side effects of a pancoast tumor?
1) Horner’s syndrome - impinging on the cervical sympathetic chain, inhibiting it –> ipsilateral ptosis, miosis, anhidrosis
2) SVC syndrome
lungs are the most common site of metastatic tumors - how do they usually get there? what do they look like?
via blood or lymphatics usually multiple well-circumscribed nodules ‘cannon balls’
for mets to the lungs, where are the common sites of origin? (5)
lung
breast
colon
melanoma
sarcomas
What is this? describe
Metastatic involvement of the lung
multiple well-circumscribed “cannonball” nodules
what is a primary malignant tumor of the pleura?
mesothelioma
are primary or secondary (metastatic) pleural tumors more common?
secondary are more common by far
what are the 2 most common sites of origin for secondary mets tumors to the pleura?
lung and breast
what is the most common cause of primary malignant tumors of the pleura
asbestos
what type of tumor is most common from asbestos exposure?
adenocarcinoma (bronchogenic carcinoma according to Muthiah)
mesothelioma from asbestos only carries a 7-10% lifetime risk w/ heavy exposure
how does smoking and asbestos exposure relate to risk for mesothelioma
there is no increased risk from smoking
what are the presenting symptoms of mesothelioma? what is the course of this disease?
chest pain, dyspnea, effusions
rapid course - 50% die within 1 year
what is treatment possibilities for mesothelioma
aggressive surgery, chemo/radiotherapy sometimes prolongs survival
what is this? describe
Malignant Pleural Mesothelioma
diffusely thickens pleura with characteristic “rind-like” encasement of lung
what are the 3 histologic types of mesothelioma? what do they resemble? which is most common?
1) Epitheliod (most common) - can resemble metastatic adenocarcinoma
2) Sarcomatoid - resemble sacromas
3) biphasic - mixture of epitheliod and sarcomatoid patterns
What is this? describe
Malignant Pleural Mesothelioma
epitheliod type of mesothelioma can show tubules that mimic glandular structure seen in adenocarcinoma
what histochemical stains are used to differentiate mesothelioma from adenocarcinoma? which one is used for which?
Hyaluronic acid - mesothelioma
Mucin - adenocarcinoma
what immunohistochemical stains are used to differentiate mesothelioma from adenocarcinoma? which one is used for which?
Calretinin - mesothelioma
Carcinoembryonic antigen (CEA) - adenocarcinoma
what is the caveat for calretinin stain used for mesothelioma
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
what is the appearance on electron microscopy of mesothelioma vs adenocarcinoma?
mesothelioma - long slender microvilli
adenocarcinoma - stubby microvillous rootlets
what color are we looking for in the calretinin immunohistochemistry stain for malignant mesothelioma? *
tumor cells stain positively - brown color
