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Y2S1-CVS-Pathology > Lung cancer > Flashcards

Lung cancer Flashcards

1
Q

What is the only example of a benign lung neoplasm?

A

Pulmonary hamartoma

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2
Q

What is pulmonary hamartoma?

A
  • The most common benign tumor of the lungs, AKA pulmonary chondroma (as this tumor has a lot of cartilage)
  • A hamartoma is a normal component of the organs and tissues but arranged in a disorganized way, it arises due to the disorganization of cells where often cartilage is found in places where it should not be and its division will give rise to more disorganized cells leading to a hamartoma
  • Usually asymptomatic and found accidently as a coin lesion
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3
Q

Where in the lungs does hamartoma occur?

A

At the periphery

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4
Q

Which tumors occur at the periphery of the lungs?

A

1) Pulmonary hamartoma

2) Pulmonary chondroma

3) Bronchioalveolar atypical adenomatous hyperplasia

4) Adenocarcinoma in situ

5) Adenocarcinoma

6) Large cell carcinoma

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5
Q

Which tumors occur at the center of the lungs?

A

1) Squamous dysplasia

2) Squamous cell carcinoma

3) Small cell lung carcinoma

4) The most common type of typical carcinoid

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6
Q

What is the pulmonary chondroma of carney?

A
  • It is a syndrome found in young females which involves 3-types of tumors:

1) Chondroma in lungs

2) Tumor in the GIT (GIST)

3) Tumor in the ganglia or the adrenal glands (paraganglioma)

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7
Q

What is the difference between hamartoma and pulmonary chondroma of carney?

A

1) Hamartoma occurs in males while Carney’s triad occurs in young females

2) Hamartoma contains cartilage, fat, and smooth muscle cells, while carney has cartilage only

3) Hamartomas have a single tumor, while in Carney’s there are multiple tumors

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8
Q

What are some examples of pre-invasive lung neoplasms?

A

1) Squamous dysplasia

2) Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)

3) Bronchial atypical adenomatous hyperplasia

4) Adenocarcinoma in situ

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9
Q

What is squamous dysplasia?

A
  • It is a disordered proliferation of the cells where they acquire cancerous morphological features, but are unable to invade the surrounding tissues (with three grades: mild, moderate, and severe)
  • It is a central lesion of the large airways, which is associated with obstructive lung disease (chronic bronchitis and bronchiectasis “cells change continuously due to inflammation then metaplasia then dysplasia”) and smoking (as smoking causes a change of the pseudostratified cells into squamous)
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10
Q

What are the types of squamous dysplasia lesions?

A

1) Flat

2) Nodular

3) Polypoid

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11
Q

Describe the pathological progression of squamous dysplasia

A
  • Squamous cells are found in the trachea and bronchi via some sort of metaplasia

1) Hyperplasia of the basal cells of the pseudostratified cells

2) Squamous Metaplasia

3) Dysplasia, which will lead to squamous cell carcinoma

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12
Q

What is diffuse idiopathic pulmonary neuroendocrine cell hyperplasia?

A

1) Diffuse = Occurs in multiple places in the lungs (multifocal)

2) Idiopathic: No known cause

3) Neuro-endocrine cells: These cells are present throughout our body (especially in the lung and the GIT), and respond to neural stimulation by releasing hormones, in this cancer those type of cells will proliferate in the lungs without a nervous stimulation

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13
Q

Describe the pathophysiology of the DIPNECH

A
  • The neuro-endocrine cells will increase without nervous stimulation
  • Once they cross the basement membrane they become a tumor (less than 5mm), if it becomes greater than 5mm it will turn into a carcinoid tumor
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14
Q

What is bronchioalveolar atypical adenomatous hyperplasia?

A

1) atypical: not similar to the normal alveolar epithelium

2) hyperplasia: increase in number

3) Adenomatous: which means that if left untreated it will continue to divide and proliferate becoming an adenocarcinoma (the most common type of lung cancer)

  • It is a precursor to adenocarcinoma in situ and invasive adenocarcinoma, that arises from progenitor cells, Clara cells, and type-2 pneumocytes
  • It has no nodule, and it is multifocal with a Tan lesion at the periphery of the lungs (centri-acinar)
  • It is <5mm in size
  • The alveolar walls are thickened by fibrosis and lined by an interrupted proliferation of the tumor cells (Lepidic growth pattern along the alveolar septa)
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15
Q

From which types of lung cells do Bronchioalveolar atypical adenomatous hyperplasia arise?

A

1) Progenitor cells

2) Clara cells

3) Type-2 pneumocytes

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16
Q

What is adenocarcinoma in situ?

A

1) In situ: it does not spread “not invasive”

  • It is a precursor for adenocarcinoma with two types mucinous and non-mucinous
  • It has a single nodule at the periphery of the lungs that is 5-30mm in size
  • The alveolar walls are thickened by fibrosis lined by uninterrupted proliferation of the tumor cells in a lepidic growth pattern
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17
Q

From which type of lung cells do adenocarcinoma arise?

A

1) Mucinous: arises from goblet cells

2) Non-mucinous: Arises from Clara cells and type-2 pneumocytes

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18
Q

What is meant by lepidic growth pattern?

A

The growth of abnormal cells along the alveolar septa without invading the stroma or pleura

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19
Q

What is the difference between adenocarcinoma in situ and bronchoalveolar atypical adenomatous hyperplasia?

A

1) AIS is larger in size by 5-30mm compared to below 5mm in the case of AAH

2) AIS can be mucin-producing in case it arises from the goblet cells other than that they are non-mucin-producing

3) AAH has an interrupted lepidic growth while AIS has an uninterrupted lepidic alveolar growth

4) AAH has no nodule while AIS has a nodule

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20
Q

What are the different types of invasive lung neoplasm?

A

1) Adenocarcinoma

  • Most common
  • Most common in women and in never smokers who are below 45 years old

2) Squamous cell carcinoma (Sq.CC)

  • Strongest associated with smoking, and more common in men

3) Small cell carcinoma (SCLC “subtype of neuroendocrine carcinoma”)

  • Strong association with smoking

4) Large cell carcinoma

21
Q

How did adenocarcinoma replace small cell carcinoma as being the most common?

A

As tobacco companies created alternatives for cigarettes with smaller amounts of nicotine enabling us to inhale the smoke deep into our alveoli

  • It affects females and never smokers more frequently, unknown etiology
22
Q

Which lung cancer occurs in females and in never-smokers?

A

Adenocarcinoma

23
Q

What are the risk factors of lung carcinoma?

A

1) Sex: More in females

2) Cigarette smoking

  • 90% of lung cancers occur in smokers and those who recently quit

2) E-Cigarettes

3) IQOS (I Quit Ordinary Smoking)

4) Environmental factors

  • Pollution
  • Industrial asbestos, ionizing radiation
  • Vitamin-A deficiency (needed to maintain the epithelium and if not it can lead to metaplasia)

5) Heredity

6) Pre-existing lung diseases (IPF, Asbestosis, Chronic bronchitis, Bronchiectasis)

24
Q

Describe the pathogenesis of lung cancer

A
  • Smoking-related carcinomas of the lungs arise stepwise by the accumulation of mutations
  • Activation of Oncogenes:

1) Activation of K-RAS oncogene usually in adenocarcinoma, mucin secreting, and female smokers (K-RASSSSS, MUCCCCIN, SSSSSMOKER, SSSSSET)

2) Overexpression of EGFR (epidermal growth factor receptor), usually in adenocarcinoma in non-smoker females (women are responsible for the growth of a child “mnemonic”)

3) EML4-ALK fusion gene, in adenocarcinoma, young, non-smoker males

  • Inhibition of tumor suppressor genes

1) Mutation of the p53 tumor suppressor gene

2) Mutation/deletion of the RB gene (mainly in SCLC)

25
Q

What is the pre-invasive lesion of adenocarcinoma?

A

1) Bronchoalveolar atypical adenomatous hyperplasia

2) Adenocarcinoma in situ

  • It originates from the bronchioalveolar stem cells (BASCs)
26
Q

Describe the morphology of adenocarcinoma

A

1) Gross: Small irregular mass at the periphery, with a greyish-white and glistening mucus

2) Microscopic:

  • Cancer formed of glands (could be mucinous “K-RAS” or nonmucinous)
  • Minimally invasive if <3cm, which is predominantly lepidic with an excellent prognosis
  • Invasive ADC, tumor of any size with an area of invasion of more than 5mm, the pattern can be lepidic, acinar, solid, etc
27
Q

What is the cellular origin of lung squamous cell carcinoma?

A

Bronchial epithelium then will lead to squamous metaplasia,

28
Q

Describe the morphology of squamous cell carcinoma

A

1) Gross:

  • Centrally hilar located in the major bronchi
  • Grey-white, firm-hard, and large lesions that may undergo central necrosis “cavitation”

2) Microscopic

  • Polygonal cells
  • Keratinization (based on this we will have different grades of SqCC)
  • Intercellular bridges
29
Q

What is the pathogenesis of developing SqCC?

A

1) Basal cell hyperplasia

2) Squamous hyperplasia

3) Mild dysplasia

4) Moderate dysplasia

5) Severe dysplasia

6) Invasiveness and metastasis

30
Q

What is the cell origin of small-cell lung carcinoma?

A
  • Neuroendocrine cells
  • Unknown pre-invasive cancer, related to cancer
  • Increased with tobacco and the inactivation of TP53 and RB1
30
Q

Necrosis and cavitation are seen in which lung cancer?

A

Squamous cell carcinoma

  • Cavity can also be due to lung abscess, and tuberculosis
31
Q

Describe the morphology of small cell carcinoma

A

1) Gross: Centrally located mass, which extends into the lung parenchyma

2) Microscopically:

  • Small
  • Scant cytoplasm
  • Indistinct Cell border
  • “Salt & Pepper chromatin”
  • No nucleoli
  • Necrosis
  • Due to the very high proliferation rate the DNA can be released and deposited in nearby blood vessels (Azzopardi effect “bluish staining of the blood vessels”)
32
Q

When taking a biopsy of the neuroendocrine cells, what will you find?

A

They can secrete hormones in the blood, if you check the hormone level from the gland directly you will find it to be low

33
Q

What is the paraneoplastic syndrome?

A
  • It is a group of symptoms that cannot be explained by:

1) Direct spread of cancer in the tissue

2) Distant spread of cancer to other tissues

3) Production of substances by the cancer cell

34
Q

What is large cell carcinoma?

A

Undifferentiated malignant epithelium tumors, which lack cytologic features of neuroendocrine carcinoma, showing no sign of squamous cell differentiation

  • Diagnosed by exclusion as it does not share the characteristics of any other lung cancer
35
Q

Describe the morphology of large cell carcinoma

A

1) Large nuclei

2) Clear cell border

3) Clear nuclei

36
Q

What are the types of neuro-endocrine proliferations and tumors?

A

1) DIPNECH (precursor of typical carcinoid tumors)

2) Carcinoid tumors (typical and atypical)

3) Small cell lung carcinoma

4) Large cell neuro endocrine carcinoma

37
Q

Describe the morphology of the carcinoid tumors

A

1) Typical carcinoids:

  • Size is below 5mm
  • NO Necrosis
  • <2 mitosis/ 2mm^2

2) Atypical carcinoid:

  • Higher mitotic rate (2-10 mitosis/ 2mm^2)
  • Small foci of necrosis
  • Whenever you see in a microscopic picture large areas of necrosis or VERY active mitosis -> this is small cell lung carcinoma
38
Q

Where do the carcinoid tumors arise from?

A

They arise from the main bronchus:

  • Obstructs the polyploid intraluminal mass
  • Mucosal plaque penetrating the bronchial wall (collar-button lesion)
39
Q

What hormones is produced by the carcinoid tumor cells? and what are the three important symptoms of that?

A

1) Serotonin

2) Histamine

Symptoms are FWD:

1) Flushing
2) Wheezing
3) Diarrhea

40
Q

What are the secondary changes that occurs due to the tumor?

A

1) Obstruction of a major bronchus lumen (emphysema if partial, atelectasis and infection if complete)

2) Ulcerative bronchitis, bronchiectasis, and lung abscess

3) Compression/Invasion of the superior vena cava (superior vena cava syndrome)

41
Q

What are the ways by which lung cancer can spread?

A

1) Direct:

  • Airspaces
  • Pleural spaces
  • Apical neoplasm (Pancoast tumors, where the cancer is anatomically close to the brachial plexus and cervical sympathetic nerves, if it invades the brachial plexus it will cause severe pain in the distribution of the ulnar nerve, if it invades the cervical sympathetic it will cause Horner’s syndrome (characterized by ptosis, miosis, anhidrosis)

2) Blood (Liver, bone, and brain)

3) Lymphatic: (hilar lymph nodes)

42
Q

Which tumor produces ACTH and ADH?

A

Small Cell Carcinoma

43
Q

Which tumor causes hypercalcemia?

A

Squamous Cell Tumors

44
Q

What are the investigations done for lung cancers?

A

1) X-Rays

2) Sputum Cytology

3) Bronchoscopy: (BAL & Biopsy)

4) CT scan

  • For example, a ground glass nodule no more than 3cm is AIS
  • If the same as above + Solid component which less than 5mm = MIA
  • Lepidic predominates in Adenocarcinoma
45
Q

What is mesothelial neoplasm (malignant mesothelioma)?

A

It is a rare tumor that arises from the parietal or visceral pleura, found less commonly in the pericardium and peritoneum

46
Q

What are the risk factors of mesothelial neoplasm?

A

1) Smoking

2) Strong relation with asbestos

47
Q

Mesothelial neoplasm is associated with which mutated genes?

A
  • Mutation of:

1) BAP1

2) P16

48
Q

Describe the morphology of mesothelial neoplasm?

A

1) Gross: Tumors being in a localized area and spreads over time (yellow-white firm tumor)

2) Microscopically:

  • Epitheloid variant (Neoplastic cells are round, with nuclei having a prominent nucleoli, and a moderate amount of eosinophilic cytoplasm)
  • Sarcomatoid variant (the neoplastic cells are spindle growing in a fibrous stroma)
  • Biphasic variant

Y2S1-CVS-Pathology (12 decks)

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