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Pulmonology - OMS 2 > Lung Cancer - pathology > Flashcards

Lung Cancer - pathology Flashcards

1
Q

95% of lung tumors are _______ (which type).

A

carcinoma (CA of epithelial cells)

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2
Q

Which type of lung cancer kills more people than colon, breast and prostate combined?

A

lung

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3
Q

how do you calculate risk of lung CA for cigarrette smokers?

A

2 pack/day for 20 yrs = 60 x risk than non-smokers

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4
Q

4 environmental risk factors for lung CA

other than smoking

A
  1. asbestos
  2. uraniam (radiation)
  3. arsenic, chromium, nickle
  4. vinyl chloride (plastics)

possibly air pollution &. mustard gas (WWI vets) & indoor air pollution

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5
Q

Lung CA classifications

in order of prevalence

A
  1. adenocarcinoma (50%)
  2. Squamous cell (20%)
  3. Small cell (15%)
  4. Large cell (2%)

large cell are undifferentiated

tumors may be a mixture of these

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6
Q

Which 2 types of lung cancer are centrally located?

A
  1. Small cell
  2. Squamous

Sentrally located

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7
Q

Loss of TP53 & CDKN2A or amplification of FGFR1 will lead to which type of lung cancer?

A

squamous cell

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8
Q

Adenocarcinoma is formed due to a gain-of-fxn mutation of EGFR, ALK & which 2 others?

these lead to un-checked growth factor production

A
  1. MET
  2. RET
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9
Q

Lung CA in Never Smokers almost never have _____ mutations & less ______ mutations.

A
  • KRAS
  • TP53
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10
Q

4 MC metastases of Lung CA

outside of the chest cavity

A
  1. adrenals (50%)
  2. liver
  3. brain
  4. bone

lymphatic and hemogenous spread

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11
Q

dysplastic

A

abnormal cell (increased cytosol, nuclear enlargement, hyperchromasia)

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11
Q

dysplastic

A

abnormal cell (increased cytosol,

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12
Q

Lung carcinomas commonly metastasize to which 4 organs/tissues?

within the chest cavity

A
  1. pleura
  2. pericadium
  3. mediastinum
  4. lymph nodes (50%)
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13
Q

atypical adenomatous hyperplasia

A

small lesions (<5mm) w/dysplastic celll lining alveolar walls

may lead to adenocarcinoma in situ

looks like interstitial fibrosis
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14
Q

define adenocarcinoma in situ

1-5% of lung adenocarcinomas

A

small solitary lesion <3 mm
neoplastic cells grow along preexisting alveolar walls (NO INVASION…(in situ = “in place”; it stays in place))

(excision = 100% survival rate)

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15
Q

2 MC types of adenocarcinoma in situ?

(in situ = “in place”; it stays in place)

A
  1. nonmucinous
  2. mucinous
(left: non-mucinous; right mucinous)
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16
Q
A

non-mucinous adenocarcinoma in situ

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17
Q
A

mucinous adenocarcinoma in situ

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18
Q

Which lung cancer is associated with fetoprotein thyroid transciption factor-1?

A

adenocarcinoma

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19
Q

Which lung cancer is invasie/malignant epithelial tumor w/glandular differentiation and/or mucin production?

A

adenocarcinoma

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20
Q

what are the 4 patterns of adenocarcinoma?

A
  1. acinar
  2. lepidic
  3. papillary
  4. solid w/mucin
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21
Q

why are mucinous adenocarcinomas difficult to excise?

A

spread aerogenously –> satellite tumors

(multiple nodules or entire lobe)

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22
Q
A

well-differentiated adenocarcinoma
obvious gland formation

(pink within gland=mucin, inset is a postive stain for TTF-1)

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23
Q

Where in the lungs does squamous cell carcinoma arise?

A

bronchus

24
Q

Squamous cell carinoma arises from respiratory epithelium which differentiates into ________.

A

squamous cell dysplasia (lose cilia)

(leads to CIS = carcinoma in situ –> breaks thru the lamina propria)

25
Q

squamous cell carcinoma may be identified via

A

cytology smear of sputum

(screening for caner of cancer that arise from bronchi)

26
Q
A

Goblet cell hyperplasia

27
Q
A

Basal cell (reserve cell) hyperplasia

goblet cell hyperplasia before this & squamous cell hyperplasia after

28
Q
A
squamous cell
29
Q
A
squamous cell
30
Q
A
31
Q
A
32
Q

Dx? Why?

A
  1. squamous cell LC
  2. grayish white & firm

note how it comes from the bronchus

33
Q
A
  • squamous cell LC
  • well-differentiated nests of neoplastic epithelium (blue: whirling “keratin pearls”), fibroblasts (desmoplastic response), keratin
34
Q

Which tumor is most likely associated w/neuroendocrine progenitor cells in the bronchial epithelium?

A

small cell carcinoma

35
Q

Which type of lung cancer is commonly a/wectopic hormone production?

A

small cell carcinoma

36
Q

Most aggresive type of lung CA?

A

small cell carcinoma

metastasize early, non-surgical

37
Q

Dx? why?

A
  • small cell LC
  • sheets of hyperchromatic neoplastic cells (high N/C ratio) & areas of necrosis (yellow arrow)

no glands, mucous or keratin

38
Q

Dx? Why?

A
  • small cell carcinoma
  • round-oval tumor cells: hyperchromatic (nigh N/C ratio
39
Q

DX? why?

A
  • large cell carcinoma
  • sheet of tumor cells having large, optically clear (vesicular) nuclei with prominent nucleoli + moderate cytoplasm
40
Q

Which lung cancer is a dx of exclusion?

A

large cell

41
Q

TNM staging stands for

A
  • Tumor (size)
  • Nodes (spread to nodes)
  • Metastasis

metastasis most important

42
Q
A

bronchial carcinoid tumor

inside the lumen

43
Q
A

Typical carcinoid tumor

  1. Uniform in appearance with small round basophilic nuclei
  2. trabecular (cord-like) arrangement.
  3. Rosette formation: tumor cells are arranged around blood vessels (yellow arrow)

looks like normal tissue = “organoid” appearance.

44
Q

2 paraneoplastic syndromes associated w/small cell carcinoma?

A
  1. SIADH (increased ADH)
  2. cushing (increased ACTH)
45
Q

paraneoplastic syndrome a/w squamous cell carcinoma

A

hypercalcemia (PTH & PTH related peptide)

46
Q

What staging factor automatically makes lung cancer stage IV?

A

any distant metastases

doen’t matter how far

47
Q

MC site of metastatic tumors

A

lung

malignant. tumors invade veins first –> systemic

48
Q

MC metastatic lung tumor pattern

A

multple well-circumscribed nodules throughout lung

49
Q
A

metastatic carcinoma

aka “cannon ball” lesion

50
Q

age of mesothelioma manifestation

A

25-45 yo

80% = asbestos-related
51
Q

What are the 3 types of mesothelioma?

A
  1. epithelioid
  2. sarcomatoid
  3. biphasic
52
Q

mesothelioma prognosis

A

2 years

53
Q
A

Lung encased by a dense gray-white mesothelioma

restrictive lung diz

54
Q
A
  • biphasic mesothelioma
  • Slit-like glandular structures lined by epitheliod cells (yellow arrows)
  • Stroma between the glandular structures has a sarcomatoid appearance w/cellular proliferation of atypical spindle-shaped cells (red).

Mesotheliomas spread widely throughout the pleural cavity, and are usual

55
Q
A
  • Epitheliod mesothelioma
  • plump epithelial-like cells having abundant cytoplasm.

looks like adenocarcinoma; check for CEA and calretinin to distinguish

56
Q

Immunohistochemical staining is used to distinguish adenocarcinoma from epithelial mesothelioma (they look similar on histo). What are each positive for?

A
  • Adenocarcinomas: carcinoembryonic antigen (CEA)
  • Mesotheliomas: calretinin
57
Q
A

Biphasic mesothelioma stained for calretinin

(the epitheliod component is strongly positive (dark brown), while the sarcomatoid component is less so)

Pulmonology - OMS 2 (28 decks)

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