Lung cancers

Question 1

What are the histological findings in small cell (oat cell) carcinomas?

Answer 1

• Neoplasm of neuroendocrine Kulchistky cells -> small dark blue cells
• Chromogranin A +ve
• Neuron specific enolase +ve
• Synaptophysin +ve

Question 2

What type of lung cancers are chromogranin A +ve?

Answer 2

• Bronchial carcinoid tumour

- Small cell

Question 3

What type of lung cancer has good prognosis and rare metastases?

Answer 3

Bronchial carcinoid tumor

Question 4

What can the symptoms of bronchial carcinoid tumor be due to?

Answer 4

• Mass effect

- Carcinoid syndrome (flushing, diarrhea, wheezing)

Question 5

What cancers will have neuroendocrine cells?

Answer 5

• Small cell

- Bronchial carcinoid

Question 6

What type of cancer is located peripherally and may produce hCG (gynaecomastia)?

Answer 6

Large cell carcinoma

Question 7

What type of lung cancer produces PTHrP (hypercalcemia, cavitations) and has a hilar mass arising from the bronchus (located centrally)?

Answer 7

Sq cell carcinoma

Question 8

What type of LC has Keratin pearls and intercellular bridges (desmosomes) on histology?

Answer 8

Sq cell carcinoma

Question 9

What types of LC is associated hypertrophic osteoarthropathy (clubbing)?

Answer 9

Adenocarcinoma

Question 10

What type of LC is more common in females than males and is common in non-smokers?

Answer 10

Adenocarcinoma

Question 11

What type of LC has a glandular pattern, stains mucin +ve on histology?

Answer 11

Adenocarcinoma

Question 12

What may be seen in the bronchioalveolar subtype of adenocarcinoma?
On CXR and Histology?

Answer 12

CXR: Hazy infiltrates similar to pneumonia

Histology

• Grows along alveolar septa -> apparent thickening of alveolar walls
• Tall columnar cells containing mucus

Question 13

What mutations may be associated with Adenocarcinoma?

Answer 13

• KRAS
• EGFR
• ALK

Question 14

What can be seen on histology in large cell carcinoma?

Answer 14

Pleomorphic giant cells

Question 15

How may Small cell carcinoma cause Lambert-Eaton myasthenic syndrome?

Answer 15

AntiBs against presynaptic Ca2+ channels

Question 16

How may Small cell cancer effect the Nervous System?

Answer 16

• Lambert-Eaton myasthenic syndrome
• Paraneoplastic myelitis
• Encephalitis
• Subacute cerebellar degeneration

Question 17

Amplification of what genes is comon in Small cell carcinoma?

Answer 17

myc oncogenes

Question 18

What is seen on histology in Large cell carcinoma?

Answer 18

Pleomorphic giant cells

Question 19

What is the more common name for a superior sulcus tumour?

Answer 19

Pancoast tumour

Question 20

What structures can a pancoat tumour compress?

Answer 20

• Recurrent laryngeal nerve -> hoarsness
• Stellate ganglion -> Horner syndrome
• SVC
• Brachiocephalic vein -> BC syndrome (unilateral symptoms)
• Brachial plexus -> shoulder pain, sensorimotor defecits (e.g. atrophy of intrinsic muscles of the hand)
• Phrenic nerve -> hemidiaphragm paralysis (seen on CXR)

Question 21

What are the symptoms of SVC syndrome?

Answer 21

• Facial plethora
• Blantching after fingertip pressure
• Neck (jugular venous distention)
• Upper extremity oedema

Question 22

What may cause SVC syndrome?

Answer 22

• Malignancy (mediastinal mas, Pancoast tumor)

- Thrombosis from indwelling catheters

Question 23

What is the main danger in SVC syndrome?

Answer 23

Raised intracranial pressure

• Headaches, dizziness
• Increased risk of aneurysm / rupture of intracranial arteries