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Advanced Pulmonology > Lung Cancer Pathology > Flashcards

Lung Cancer Pathology Flashcards

1
Q

What are the two main classifications of lung cancer?

A

Non-Small Cell Lung Carcinoma (NSCLC) and Small Cell Lung Carcinoma (SCLC)

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2
Q

List the subtypes of Non-Small Cell Lung Carcinoma.

A

Adenocarcinoma, Squamous cell carcinoma, Large cell carcinoma

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3
Q

What is the primary histological feature of squamous cell carcinoma?

A

Pink-orange cells with abundant cytoplasm, can be keratinizing or non-keratinizing

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4
Q

Which lung cancer subtype often shows glandular differentiation?

A

Adenocarcinoma

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5
Q

Name a common mutation in adenocarcinoma of the lung.

A

EGFR activation mutation

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6
Q

What is a hallmark characteristic of small cell carcinoma?

A

High nuclear-to-cytoplasmic ratio, fine chromatin, mitoses, and necrosis

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7
Q

What are common risk factors for lung cancer?

A

Tobacco smoke, asbestos, ionizing radiation, air pollution

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8
Q

Which cancers are most associated with heavy smoking?

A

Squamous cell carcinoma and Small cell carcinoma

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9
Q

Describe the importance of TTF-1 in lung cancer diagnosis.

A

TTF-1 is positive in adenocarcinoma, used in immunohistochemistry (IHC)

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10
Q

What is PD-L1 used for in lung cancer?

A

As a biomarker for suitability for immunotherapy (immune checkpoint inhibitors - Pembrolizumab)

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11
Q

What type of testing is standard for targeted therapy in lung cancer?

A

Molecular testing for mutations like EGFR, ALK, ROS1

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12
Q

What is an oncogenic driver mutation?

A

Mutation that promotes tumor growth, e.g., EGFR, ALK in lung cancer

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13
Q

Which neuroendocrine tumors can arise in the lungs?

A

Typical Carcinoid, Atypical Carcinoid, Small Cell Carcinoma, Large Cell Neuroendocrine Carcinoma

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14
Q

What defines a typical carcinoid tumor?

A

Low nuclear-to-cytoplasmic ratio, salt-and-pepper chromatin, rare mitoses

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15
Q

What distinguishes atypical carcinoid from typical carcinoid?

A

Increased mitoses, necrosis, and cytologic atypia in atypical carcinoid

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16
Q

What are common metastatic tumors to the lung?

A

Colon cancer, breast cancer

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17
Q

What is malignant mesothelioma?

A

Primary pleural tumor, associated with asbestos exposure

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18
Q

What is the precursor lesion for squamous cell carcinoma?

A

Squamous dysplasia or carcinoma in situ

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19
Q

What is the purpose of immunohistochemistry (IHC) in lung cancer?

A

To identify protein markers for differentiating tumor types

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20
Q

Which protein is typically positive in squamous cell carcinoma?

A

p40 or p63

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21
Q

What biomarker indicates a likely response to EGFR inhibitors?

A

EGFR mutation

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22
Q

What testing method is used to detect translocations like ALK?

A

Fluorescence in Situ Hybridization (FISH)

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23
Q

What is an example of a targeted therapy in lung cancer?

A

Tyrosine kinase inhibitors (e.g., Erlotinib for EGFR mutation)

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24
Q

Describe the role of ALK in lung cancer.

A

ALK translocation acts as a driver mutation, treatable with specific inhibitors

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25
Q

What is a solitary fibrous tumor?

A

A rare pleural tumor, distinct from mesothelioma

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26
Q

Which lung tumor is most aggressive and typically fatal?

A

Small cell carcinoma

27
Q

Describe the histology of small cell carcinoma.

A

Nuclear molding, high mitotic rate, small cells with little cytoplasm

28
Q

What kind of mutation is ROS1 in lung cancer?

A

Translocation driving tumor growth, treatable with targeted therapies

29
Q

What type of testing detects a large array of mutations at once?

A

Next Generation Sequencing (NGS)

30
Q

Which tumor marker is useful for diagnosing mesothelioma?

A

Calretinin and WT-1 in IHC

31
Q

What is the importance of CDKN2A and TP53 in lung cancer?

A

These tumor suppressors are often inactivated in lung tumors

32
Q

What type of lung tumor originates from the neuroendocrine system?

A

Neuroendocrine tumors like small cell carcinoma and carcinoids

33
Q

What are the subtypes of neuroendocrine tumors in the lung?

A

Typical carcinoid, Atypical carcinoid, Small cell carcinoma, Large cell neuroendocrine carcinoma

34
Q

What role does asbestos play in lung disease?

A

Risk factor for mesothelioma and other lung cancers

35
Q

What defines malignant mesothelioma histologically?

A

Infiltrative growth pattern, epithelioid and spindle cell types

36
Q

How does immunohistochemistry aid in lung cancer diagnosis?

A

Helps identify protein markers for different tumor types

37
Q

What does positive p40 or p63 indicate?

A

Indicates squamous cell carcinoma in lung tumors

38
Q

Which type of carcinoma is commonly found in nonsmokers?

A

Adenocarcinoma

39
Q

What mutation in lung cancer is treatable with tyrosine kinase inhibitors?

A

EGFR mutation

40
Q

What genetic change is often seen in small cell carcinoma?

A

Loss of function mutations in TP53, RB genes

41
Q

Which subtype of lung carcinoma is linked to neuroendocrine granules?

A

Small cell carcinoma (identified by synaptophysin and chromogranin)

42
Q

What does FISH testing detect in lung cancer?

A

Detects specific translocations such as ALK

43
Q

What is a characteristic of adenocarcinoma in situ?

A

Localized, lepidic growth pattern without invasion

44
Q

What is the difference between mucinous and non-mucinous adenocarcinoma?

A

Mucinous has mucin-secreting cells, non-mucinous does not

45
Q

Describe the significance of PD-L1 in lung cancer.

A

Biomarker for immune checkpoint therapy eligibility

46
Q

What is a common precursor lesion for adenocarcinoma?

A

Atypical adenomatous hyperplasia

47
Q

Which lung tumor has a high mitotic rate and is usually fatal?

A

Small cell carcinoma

48
Q

What is the main treatment strategy for EGFR-mutated lung cancers?

A

EGFR tyrosine kinase inhibitors (erlotinib)

49
Q

What type of chromatin is seen in carcinoid neuroendocrine tumors?

A

Salt and pepper chromatin

50
Q

What are the precursor lesions for squamous cell carcinoma?

A

Squamous dysplasia and carcinoma in situ

51
Q

Which lung cancer subtype often metastasizes from other organs?

A

Metastatic tumors, common from colon and breast cancer

52
Q

What immunohistochemical marker is used to identify adenocarcinoma?

A

TTF-1 positivity in IHC

53
Q

What is the primary cell feature in squamous cell carcinoma?

A

Keratinization or intercellular bridges in the cells

54
Q

How does ALK mutation affect lung cancer treatment?

A

Makes cancer susceptible to ALK inhibitors

55
Q

Describe the growth pattern of mesothelioma.

A

Infiltrative with epithelioid or spindle cells, affects pleura

56
Q

What is the purpose of molecular testing in lung cancer?

A

Identify driver mutations for targeted therapy

57
Q

What is one characteristic of well-differentiated neuroendocrine tumors?

A

Organized, organoid growth with rare mitoses

58
Q

What is the treatment for PD-L1 positive lung cancer?

A

Immune checkpoint inhibitors like pembrolizumab

59
Q

What are typical histologic features of adenocarcinoma?

A

Gland formation and mucin production

60
Q

What biomarker is useful for mesothelioma diagnosis?

A

Calretinin positivity in IHC

61
Q

What is the common molecular alteration in non-smoking lung cancer?

A

EGFR or ALK mutations

62
Q

What is the most common histologic type in lung cancer?

A

Adenocarcinoma, especially in non-smokers

63
Q

What mutation is less common in adenocarcinomas related to smoking?

A

TP53 mutations are less frequent in non-smoker adenocarcinoma

64
Q

What is the precursor to high-grade neuroendocrine carcinoma?

A

Neuroendocrine cell hyperplasia

Advanced Pulmonology (5 decks)

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