Lung Cancer

Question 1

describe the pathogenesis of small cell carcinoma

Answer 1

• myc amplification
• p53
• pRB
• 3p deletion

Question 2

describe the pathogenesis of non-small cell carcinoma

Answer 2

• 3p deletion
• p16/CDKN2a
• adenocarcinoma: KRAS, EGFR
  
  • signet ring adenocarcinoma, non-smokers: ALK

Question 3

describe peripheral vs. central tumors

Answer 3

• peripheral: may be clinically silent
• central tumors (hilar):
  
  • obstruction = partial or total
  • infection = pneumonia, abscess, bronchiectasis
  • resorption atelectasis

Question 4

describe clinical features of lung cancer

Answer 4

• cough, weight loss, hemoptysis, dyspnea
• pulmonary osteoarthropathy (clubbing)
• hoarseness, chest pain
• pericardial and pleural effusion

Question 5

lung cancer can lead to ____ syndrome due to obstruction

Answer 5

lung cancer can lead to superior vena cava (SVC) syndrome due to obstruction

• blood flow accumulation in upper part → swelling of the face, neck and upper part of the body and arms

Question 6

lung cancer can lead to ____ where the cervical sympathetic plexus is damaged

what are clinical features of this?

Answer 6

lung cancer can lead to Horner syndrome where the cervical sympathetic plexus is damaged

• ipsilateral enophthalmos, ptosis, miosis, anhidrosis (PAM)

Question 7

describe clinical features of a pancoast tumor

Answer 7

• pancoast tumor:
  
  • apical neoplasm
  • T1, T2 destruction → wasting of hand muscles, pain in arms (ulnar nerve)
  • Horner syndrome
  • compression of blood vessels → edema
  • recurrent laryngeal nerve paralysis
  • esophagus involvement → dysphagia
  • thoracic duct obstruction → chylothorax

Question 8

hypercalcemia (increased PTH) is seen in _____

Answer 8

hypercalcemia (increased PTH) is seen in squamous cell carcinoma

Question 9

Cushing’s syndrome (increased ACTH secretion) is seen in ____

Answer 9

Cushing’s syndrome (increased ACTH secretion) is seen in small cell carcinoma

Question 10

SIADH leading to hyponatremia is seen in ____

Answer 10

SIADH leading to hyponatremia is seen in small cell carcinoma

Question 11

Lambert-Eaton syndrome is seen in _____

Answer 11

Lambert-Eaton syndrome is seen in small cell carcinoma

Question 12

describe the metastasis of lung cancer

Answer 12

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• lymph node matastases most common
• adrenal (50%)
  
  • very rarely Addison’s (insufficiency)
• liver (30-50%)
• brain (20%)
• bone (15-20%)

Question 13

____ metastasize quickly; virtually all ___ metastasize at time of diagnosis

Answer 13

small cell carcinoma metastasize quickly; virtually all SCC metastasize at time of diagnosis

• tx = chemo +/- radiation therapy

Question 14

____ is the precursor lesion to adenocarcinoma

Answer 14

atypical adenomatous hyperplasia (AAH) is the precursor lesion to adenocarcinoma

Question 15

describe what is seen in the image

Answer 15

atypical adenomatous hyperplasia (AAH)

Question 16

____ lacks invasive disease (lepidic growth)

Answer 16

adenocarcinoma in-situ lacks invasive disease (lepidic growth)

Question 17

describe what is seen in the image

Answer 17

Question 18

___ is the most common primary lung tumor, as well as the most common in women that have never smoked

Answer 18

adenocarcinoma is the most common primary lung tumor, as well as the most common in women that have never smoked

Question 19

___ is more peripherally located (as opposed to centrally)

Answer 19

adenocarcinoma is more peripherally located (as opposed to centrally)

Question 20

describe the grading of adenocarcinoma (ratio of glands to solid elements)

Answer 20

Question 21

describe squamous cell carcinoma

Answer 21

Question 22

describe the progression of squamous cell carcinoma

Answer 22

• progression:
  
  • squamous metaplasia → squamous dyaplasia → squamous cell carcinoma in-situ → invasive sq. cell carcinoma

Question 23

describe the histologic evidence of squamous differentiation

Answer 23

• keratin pearls
• intercellular bridges
• individual cell keratinization

Question 24

describe what is seen in the image

Answer 24

squamous cell carcinoma

arrow = keratin pearl formation

Question 25

describe the grading of squamous cell carcinoma

Answer 25

Question 26

describe large cell carcinoma

Answer 26

* undifferentiated epithelial malignancy * lacks features of small cell * no glandular differentiation * no squamous differentiation * poor prognosis, early metastasis

Question 27

describe what is seen in the image

Answer 27

**large cell carcinoma**

Question 28

describe a small cell carcinoma

Answer 28

small cell carcinoma = neuroendocrine cell origin

Question 29

describe the histology of small cell carcinoma

Answer 29

* round, scant cytoplasm, finely granular chromatin, fragile, crush artifacts, nuclear molding, extensive necrosis * frequent mitoses

Question 30

describe the image

Answer 30

**small cell carcinoma**

Question 31

describe features of small cell carcinoma

Answer 31

Question 32

describe the importance of accurate typing of primary lung neoplasms (treatment)

Answer 32

Question 33

describe EGFR, ALK and KRAS analysis

Answer 33

* the rationale is that KRAS mutations are associated with poor response to EGFR inhibitor treatment and should be therefore avoided as the patients do not respond

Question 34

describe a carcinoid tumor of the lung

Answer 34

* neuroendocrine tumor of the lung * arises from Kulchitsky cells

Question 35

describe features of a carcinoid tumor of the lung

Answer 35

Question 36

Answer 36

Question 37

describe malignant mesothelioma

Answer 37

* primary malignancy of pleura, peritoneum or pericardium, **strongly associated with asbestos** * patients present with chest pain and/or dyspnea; occasionally with cough or fatigue * imaging studies show moderate to large unilateral pleural effusion, nodular pleural thickening, enhancement with PET

Question 38

describe histological findings in mesothelioma

Answer 38

* mesothelioma can assume a variety of histological patterns and thus mimic other malignancies * 3 primary patterns are: * epithelial * sarcomatoid * mixed (biphasic)

Question 39

describe what is seen in the image

Answer 39

**mesothelioma**

Question 40

Answer 40

**epithelial mesothelioma**

Question 41

Answer 41

**mixed mesothelioma**

Question 42

describe what is seen in the image

Answer 42

**intercellular bridges seen in squamous cell carcinoma**

Question 43

describe what is seen in the image

Answer 43

**well-differentiated neuroendocrine cells (nests) seen in carcinoid tumor**

Question 44

describe what is seen in the image

Answer 44

**chromogranin (neuroendocrine origin) stained slide shows a carcinoid tumor**