Lung Cancer

Question 1

What is an alternative name for small cell carcinoma?

Answer 1

oat cell carcinomas

Question 2

Are most lung carcinomas small cell or non-small cell?

Answer 2

non-small cell (80%)

Question 3

What are some of the key histologic features of small cell carcinoma?

Answer 3

• densely packed “small blue” tumor w/ cells ~3 times the size of a small, resting lymphocyte
• round/ovoid nucleus
• scant cytoplasm
• finely dispersed chromatin
• inconspicuous nuceloli
• high mitotic activity (dark purple)
• presence of necrosis

Question 4

Small cell carcinoma involves an inactivation of ___ and ___ in 100% of cases.

Answer 4

p53; RB

Question 5

Order the neuroendocrine tumors from least malignant to most malignant.

Answer 5

typical bronchial carcinoid < atypical bronchial carcinoid < small cell carcinoma

Question 6

When does carcinoid syndrome occur, and what are the symptoms?

Answer 6

It occurs rarely with bronchial carcinoid tumors. It involves intermittent diarrhea, flushing, and cyanosis.

Question 7

may be associated with inappropriate PTH secretion causing elevated calcium

Answer 7

squamous cell carcinoma

Question 8

What are the key histological features of squamous cell carcinoma?

Answer 8

intercellular bridges and keratinization (bright orange keratinized cells on PAP stain)

Question 9

What are the main mutations associated with squamous cell carcinoma?

Answer 9

• p53**
• FGFR

(EGFR and KRAS = very rare)

Question 10

Which type of lung cancer is more frequent in women?

Answer 10

adenocarcinoma

Question 11

What is the most common type of lung cancer in non-smokers?

Answer 11

adenocarcinoma

Question 12

What is the main distinguishing feature of adenocarcinoma?

Answer 12

spiculated lung mass with central scarring

Question 13

How can you tell an adenocarcinoma is an adenocarcinoma?

Answer 13

gland forming, or mucus containing, or TTF-1 positive

Question 14

What are the precursor lesions of an adenocarcinoma?

Answer 14

atypical adenomatous hyperplasia (AAH) –> adenocarcinoma in situ (AIS) –> minimally invasive adenocarcinoma

Question 15

What are the 4 subtypes of adenocarcinoma?

Answer 15

• acinar
• papillary
• solid
• mucinous

Question 16

What are the driver mutations in ADC?

Answer 16

• EGFR mutations

- ALK gene fusions

Question 17

What is the targeted therapy available for carcinomas with EGFR mutation?

Answer 17

Erlotinib (EGFR inhibitor)

Question 18

What is the targeted therapy available for carcinomas with ALK mutation?

Answer 18

Crizotinib (ALK inhibitor)

Question 19

What is the targeted therapy available for carcinomas with KRAS mutation?

Answer 19

no specific targeted therapy available!

Question 20

A pleural tumor is almost always metastatic, except for…

Answer 20

solitary fibrous tumor (localized fibrous tumor of the pleura, LFTP)

Question 21

What is the origin of mesothelioma (in the lung)?

Answer 21

pleura (spreads widely in pleural space, invasive by contiguous spread or diffuse seeding of pleural space)

Question 22

What are the cytogenetic abnormalities associated with mesothelioma?

Answer 22

deletions in chromosomes 1p, 3p, 6q, 9p, 22q

Question 23

What are the different histologic types of mesothelioma, and which is the most common?

Answer 23

• epithelioid (most common)
• sarcomatoid
• mixed

Question 24

What is the typical clinical presentation of mesothelioma?

Answer 24

• chest pain
• dyspnea
• recurrent pleural effusion

Question 25

How is large cell undifferentiated carcinoma diagnosed?

Answer 25

diagnosis of exclusion