Lung Cancer Flashcards
This patient with a heavy smoking history, weight loss, cough, and a mediastinal mass with evidence of metastases (supraclavicular node elargement) has
small cell lung cancer (SCLC), also known as oat cell carcinoma.
the most common form of cancer in both nonsmokers and the total population (especially women).
Adenocarcinoma
histologically characterized by glandular differentiation (gland formation, mucin production)
tumor cells often show abundant cytoplasm
eccentrically placed nuclei.
Mucin + stain.
Arises in the periphery of the lung.
Adenocarcinoma
Symptoms (fever, night sweats)
typically presents with cervical lymphadenopathy and can cause a mediastinal mass. Microscopy demonstrates Reed-Sternberg cells in a background of inflammatory cells.
Hodgkin lymphoma
Reed-Sternberg cells (large cell with multilobed nucleus or multiple nuclei, prominent nucleoli, abundant cytoplasm, and an “owl’s eye” appearance)
typically arises centrally and is composed of polygonal cells with eosinophilic cytoplasm and distinct borders.
Squamous cell carcinoma
*Well-differentiated squamous cell carcinomas show keratin pearls and intercellular bridges on light microscopy.
Histopathology shows smallround/oval cells with scant cytoplasm, hyperchromatic (blue) nuclei, and granular chromatin; abundant mitoses are also usually seen.
Immunohistochemical stains are frequently positive for neuroendocrine markers (chromogranin, synaptophysin, neural cell adhesion molecule [CD56]).
Adenocarcinoma
the most common benign lung tumors.
They present as asymptomatic peripherally located “coin lesion” in patients 50-60 years old.
These tumors are composed of disorganized cartilage, fibrous and adipose tissue.
Hamartomas
Lung ____ often contain islands of mature hyaline cartilage, fat, smooth muscle and clefts lined by respiratory epithelium.
hamartomas
It almost always arises at the lung periphery and has a characteristic distribution along the alveolar septae without vascular or stromal invasion.
On chest x-ray it appears as a peripheral mass or as a pneumonia-like consolidation.
Bronchioloalveolar carcinoma
*a variant of adenocarcinoma.
can lead to paraneoplastic hypercalcemia (due to tumor secretion of parathyroid hormone-related protein).
squamous cell carcinoma
SIADH is characterized by hyponatremia,
decreased ____ & ____
serum osmolality
urine osmolality >100
SIADH is characterized by _____,
decreased serum osmolality,
decreased urine osmolality >100
hyponatremia
List the most common paraneoplastic syndrome of Small Cell Carcinoma of the lungs?
& the others
SIADH (ADH)
Cushing syndrome (ACTH) Labert Eaton (ABs–Calcium channels)
Clinical associations:
Clubbing
Hypertrophic osteoarthropathy
Adenocarcinoma
Clinical associations:
Hypercalcemia
Necrosis &
cavitation
Squamous Cell Carcinoma
Clinical associations:
Cushing syndrome
SIADH
Lambert-Eaton syndrome
Small Cell Carcinoma
- Lambert-Eaton (progressive proximal muscle weakness, often in the legs).
Clinical associations:
Gynecomastia
Galactorrhea
Large cell carcinoma
Giant cells
Lung tumor secretes Prolactin
Large cell carcinoma
Peripheral Lung tumors (2)
Adenocarcinoma
Large cell carcinoma
Central Lung tumors (2)
Squamous Cell Carcinoma
Small Cell Carcinoma
(Sentral)
It typically presents with wheezing due to bronchial obstruction and occasionally also causes episodic diarrhea, flushing, bronchospasm
Bronchial Carcinoid Tumor
of the lung
Associated mutations:
epidermal growth factor receptor (EGFR)
ALK gene rearrangements
KRAS mutation (smokers mostly)
Adenocarcinoma
patient with an extensive smoking history who now has hemoptysis and shoulder pain likely has
lung cancer
caused by a tumor at the lung apex. Such tumors often arise in the superior sulcus (groove formed by the subclavian vessels). The apical location allows for extensive local tumor spread.
Pancoast syndrome
Pancoast syndrome (Superior sulcus lung tumor) can cause Horner syndrome occurs due to involvement of the \_\_\_\_\_\_ ganglia. Symptoms include ipsilateral ptosis, miosis, and anhydrosis.
cervical sympathetic ganglia
Pancoast syndrome (Superior sulcus lung tumor) can cause ____ may be due to compression of subclavian vessels.
upper extremity edema
Pancoast syndrome (Superior sulcus lung tumor) can cause \_\_\_\_\_. It occurs due to involvement of the Lower brachial plexus.
Shoulder pain radiating toward the axilla and scapula (most common presenting symptom)
*atrophy of hand muscles, and pain in the distribution of C8, T1, and T2 nerve roots.
Pancoast syndrome (Superior sulcus lung tumor) Other associated symptoms include \_\_\_\_, weakness, and muscle atrophy.
arm paresthesia
*C8, T1, and T2 root invasion of mass
Pancoast syndrome (Superior sulcus lung tumor) can cause Spinal cord compression and ____ can result from tumor extension into the intervertebral foramina
paraplegia
Pericardial effusions are characterized by dyspnea, distended neck veins, distant heart sounds, and particularly _____ if tamponade is present
pulsus paradoxus (decrease in systolic blood pressure >10 mm Hg during inspiration).
Mucinous forms can produce copious amounts of watery sputum (bronchorrhea).
Whcich Lung cancer?
Adenocarcinoma
typically presents with a cavitary lesion in the upper lungs, often associated with hilar adenopathy. Histology demonstrates caseating granulomas with multinucleated giant cells.
Pulmonary tuberculosis
associated with smoking and typically arises centrally within a bronchial lumen. Histopathology demonstrates invasive squamous cells with intercellular bridges and keratin pearls.
Squamous cell lung cancer
The most aggressive type of lung cancer, typically occurs in patients with a history of heavy smoking.
Small Cell Carcinoma
Squamous cell is associated, but not as aggresive
show evidence of neuroendocrine differentiation.
These tumors stain for neuroendocrine markers, such as neural cell adhesion molecule (CD56), neuron-specific enolase, chromogranin, and synaptophysin.
Small cell carcinomas
Normal bronchi are lined mainly by pseudostratified ____ cells that propel inhaled particles toward the oropharynx
ciliated columnar
*Can progress to squamous cell then to Squamous cell carcinoma
Signs and symptoms include facial swelling, conjuctival edema, distended collateral veins, headache, and dyspnea.
Extrinsic compression of the superior vena cava by a mediastinal mass (ex: bronchiogenic carcinoma) can cause _____, with impaired venous return from the upper body.
superior vena cava syndrome
Headache, dizziness, and/or confusion (cerebral edema and elevated intracranial pressure)
Cough and/or dyspnea due to laryngeal edema and/or direct compression of trachea by the mass
