Lung Cancer

Question 1

Adenocarcinoma

Answer 1

Location: peripheral

Characteristics: Most common lung cancer in nonsmokers and females. Activating mutations in k-ras common. Associated with hypertrophic osteoarthropathy (clubbing)
Bronchoioloalveolar subtype: CXR often shows hazy infiltrates similar to pneumonia; excellent prognosis

Histology: Bronchoalveolar subtype – grows along alveolar septa –> apparent thickening of alveolar walls

Question 2

Squamous cell carcinoma

Answer 2

Location: central

Characteristics: Hilar mass arising from bronchus; cavitation; cigarettes (linked to smoking); hypercalcemia (produces PTHrP)

Keratin pearls and intercellular bridges

Question 3

Small cell (oat cell) carcinoma

Answer 3

Location: central

Undifferentiated –> very aggressive. May produce ACTH, ADH or antibodies against presynaptic calcium channels. (Lambert-Eaton syndrome). Amplification of myc oncogenes common. Inoperable; treated with chemotherapy

Neoplasm of neuroendocrine Kulchitsky cells: small dark blue cells

Question 4

Large cell carcinoma

Answer 4

Location: peripheral

Characteristics: Highly anaplastic undifferentiated tumor; poor prognosis. less responsive to chemotherapy; removed surgically

Pleomorphic giant cells

Question 5

Bronchial carcinoid tumor

Answer 5

Excellent prognosis; metastasis rare

Symptoms usually use to mass effect; occasionally carcinoid syndrome (serotonin syndrome –> flushing, diarrhea, wheezing)

Nests of neuroendocrine cells; chromogranin positive

Question 6

Mesothelioma

Answer 6

Location: pleural

Characteristics: Malignancy of the pleura associated with asbestosis. Results in hemorrhagic pleural effusions and pleural thickening

Histology: psammoma bodies

Question 7

Pancoast tumor

Answer 7

Carcinoma that occurs in apex of lung may affect cervical sympathetic plexus causing horner’s syndrome

Question 8

Superior vena cava syndrome

Answer 8

An obstruction of SVC that impairs blood drainage from head and upper extremities. Commonly caused by malignancy and thrombosis from indwelling catheters. Medical emergency. Can raise intracranial pressure; if obstruction severe –> headache, dizziness, and increased risk of aneurysm/rupture of cranial arteries