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Respiratory II Exam 1 > lung neoplasias > Flashcards

lung neoplasias Flashcards

1
Q

Benign and borderline neoplasms uncommon in lung

A

Pulmonary hamartoma (benign)
Diffuse pulmonary lymphangioleiomyomatosis (borderline)
Inflammatory myofibroblastic tumor (borderline)

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2
Q

Metastatic neoplasms are very common

A

in lung

First capillary bed found by tumor cells circulating in systemic venous blood

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3
Q

Epithelial lung malignancies

A

Most common cause of cancer death, USA & world
Most who develop lung cancer-DIE FROM IT
1 year survival is 44% (5 year survival 17%)
Vast majority are epithelial neoplasms, i.e. carcinomas (90-95%)
Carcinoids are 5% of primary lung tumors

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4
Q

Pulmonary Hamartoma - characterized by

A

popcorn calcifications

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5
Q

Diffuse Pulmonary Lymphangioleiomyomatosis (LAM)

A

neoplastic perivascular epithelioid cells (PEC)

Leads to cystic emphysematous lung appearance
Dyspnea +/- recurrent spontaneous pneumothoraces

Usually in young woman
Tumor cells have estrogen and progesterone receptors

tuberous sclerosis associated

RX – Estrogen withdrawal (blockers, androgens, oophorectomy)
mTOR inhibitors being evaluated
Lung transplantation is the only definitive treatment, but can recur post transplant

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6
Q

Inflammatory Myofibroblastic Tumor

A

Rarely metastasizing proliferation of spindle-shaped myofibroblasts

Occurs throughout the body, including lungs

15 congenital cases described (endobronchial location)

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7
Q

Lung Cancer Epidemiology

A

Second most common cancer in both genders in the USA*

Leading cause of cancer deaths in both genders

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8
Q

Summary of adverse effects of smoking

A

Chronic bronchitis, emphysema
Myocardial infarction
Systemic atherosclerosis

(peptic ulcer)

Lung cancer (11% of heavy users)
Oral cancer
Pharyngeal cancer
Laryngeal cancer
Esophageal cancer
Pancreatic cancer
Cervical cancer
Renal cancer
Bladder cancer
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9
Q

carcinogenic cigarette components

A

polycyclic aromatic hydrocarbons- carcinogenesis (targets lung, larynx)

phenol– tumor promotion
nitrosamine– carcinogenesis

4-aminobiphenyl, 2-naphthylamine (–> blader cancer)

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10
Q

Environmental lung cancer risk factors

A

Radiation (uranium miners, atomic bombs, nuclear plant disasters)
Asbestos (20% of asbestos related deaths; mesothelioma)
Radon in uranium miners (radioactive gas)
Polycyclic hydrocarbons (burning fossil fuels)
Silica, bis-ether, nickel, arsenic, chromium, mustard gas

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11
Q

Molecular Genetics

- mutations in lung cancer

A

EGFR and KRAS mutations appear to be mutually exclusive*
Can successfully use EGFR inhibitors in EGFR+ adenocarcinomas

Squamous CC: del3p, CDKN2A/ p16, TP53, RB, EGFR

AdenoCA: TP53, EGFR, KRAS

Small CC: TP53, RB, del3p

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12
Q

Lung CancerSigns and Symptoms

A

Pain, hemoptysis, weight loss, underlying chronic lung disease symptoms

Local direct effects related to endobronchial growth
atelectasis, bronchiectasis & infections (abscesses)

Direct extension into mediastinum/chest wall and other structures

  • superior vena caval syndrome
  • pericarditis and pleuritis

Metastatic disease symptoms
- nodes involved in 50%

Paraneoplastic/endocrine syndromes

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13
Q

hoarseness can suggest

A

involvement of the recurrent laryngeal nerve (lung cancer squishing it?)

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14
Q

Pancoast tumor

A

apical lung tumor with pain in distribution of ulnar nerve and Horner syndrome (enophthalmos, ptosis, miosis, and anhidrosis)

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15
Q

Paraneoplastic Syndromes

A

ADH (hyponatremia)
ACTH (Cushing syndrome)

PTHrp (hypercalcemia) ** Remember - seen more with squamous cell carcinoma! ** [think this when no sign of boney metastases]

Calcitonin (hypocalcemia)
Gonadotropins (gynecomastia, etc.)
Serotonin, VIP, bradykynins, etc. (carcinoid syndrome with diarrhea and flushing)
Lambert-Eaton myasthenic syndrome (Abs to neuronal Ca++ channel)
Peripheral neuropathy
Dermopathies (acanthosis nigricans)
Hypertrophic pulmonary osteoarthropathy
Hematologic abnormalities (leukemoid reaction)
Hypercoagulable state (Trousseau syndrome)

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16
Q

Guidelines for Lung Cancer Screening

A

Annual LDCT (low dose CT scan) be offered
smokers or former smokers between 55 and 74 years old
have smoked for at least 30 pack-years

A drawback of LDCT is the overdiagnosis of benign nodules.
Average nodule detection rate with LDCT is 20%
> 90% of nodules found in this screening are benign

17
Q

Squamous cell carcinoma histology

A

look for pink keratinization of the cytoplasm, intercellular bridges (desmosomes between the squamous cells)

adenocarcinoma– tumor forms glands

small cell carcnioma- smaller cells, very little cytoplasm, pushed against each other (nuclear molding), salt and pepper nuclei

Large cell– no glands, no intercellular bridges, no nuclear molding

18
Q

Squamous Cell Carcinoma

A 
Central, endobronchial growth, some peripheral
Precursor lesions (Metaplasia, Dysplasia, CIS)

May have hypercalcemic paraneoplastic syndrome
(parathyroid hormone-related protein - PTHrp)

19
Q

squamous cell carcinoma cytology

A

papa nicholau stain
orange color- karatinization

strap cells-

squamous pearl- layers of squamous cells maturing

20
Q

Adenocarcinoma

A

Most common cancer in women and nonsmokers
Tend to be more peripheral
Precursor lesion: atypical adenomatous hyperplasia
Mucin production common

TTF1 positive (thyroid transcription factor)

may be related to scarring: Scar Carcinoma

21
Q

Adenocarcinoma Histologic Grading

A 
Well differentiated (Low Grade)
Moderately differentiated (Intermediate Grade)
Poorly differentiated (High Grade)

Mucinous adenocarcinoma- tons of mucin production with malignant tissues floating in it.

22
Q

Adenocarcinoma cytology

A

“zellballen” with vacuoles

can look like a signet ring

23
Q

Adenocarcinoma in Situand Microinvasive Carcinoma

A

may be unifocal, multifocal, lobar or diffuse (pneumonia-like consolidation that can cause asphyxia)

Adenocarcinoma in situ (bronchioloalveolar carcinoma)
- less than 3 cm with growth along alveolar septa, no invasion by who definition

Microinvasive (minimally invasive) carcinoma
- less than 3 cm with same appearance but with less than 5 mm of invasive component

May spread aerogenously

24
Q

Large Cell Carcinoma

A

Central or peripheral

Small percentage actually large cell neuroendocrine

25
Q

Neuroendocrine Proliferations and Tumors

A

Lung epithelia contain pulmonary neuroendocrine cells (Kulchitsky cells)

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia appears to be precursor lesion

Types: tumorlets (MEN 1), carcinoids, atypical carcinoids (MEN 2), small cell, large cell

26
Q

bronchial carcinoid histology

A

nests of neuroendocrine cells

27
Q

Small Cell Carcinoma

A

99% smokers
Central growth
Neuroendocrine

Azzopardi effect (blue staining of vessels by tumor DNA)

Very aggressive, respond to chemoRx, surgery used less
Paraneoplastic syndromes

28
Q

International Staging System for Lung Cancer

A

Tis- carcinoma in situ

T1- less than 3 cm, no pleural or mainstem bronchus involvement

T2- 3-7 cm or involvement of mainstem bronchus 2 cm from carina, visceral pleural involvement, or lobar atelectasis

T3- > 7 cm or with involvement of parietal pleura, chest wall, diaphragm, prenic nerve, mediastinal pleura

T4- invasion of hte mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, or carina or separate tumor nodules in a different ipsilateral lobe

29
Q

Lung and Metastatic Disease

A

Metastasizes to:
Regional nodes, adrenals, liver, brain, bone

Receives hematogenous and lymphatic metastases from:
Breast, GI, sarcomas, melanoma, etc.

*** Mucinous lung primaries also spread aerogenously within lung

30
Q

Pleural Effusions

A

transudate- low protein, LDH, cholesterol (CHF, cirrhosis, nephrotic syndrome)

exudate- high protein, cholesterol, LDH (pneumonia, pneumonitis, cancer, infarcts, autoimmune, lymphatic blockage)

  • Serous: CHF or hypoalbuminemia
  • Serosanguinous or sanguinous: Malignancy, trauma, rickettsia, coagulopathies, aortic dissection, etc.
  • Purulent (empyema): Infection
  • Chylous: Lymphatic obstruction (cancer, trauma, superior vena cava syndrome)
  • Malignant (neoplastic): associated with malignant cells
31
Q

Pleural Neoplasms

A

Metastatic are most common (esp. lung & breast)

Primary:

-Solitary (Localized) Fibrous Tumor

-Malignant Mesothelioma- Don’t forget! Not as common as lung CA with asbestos
Express calretenin, mesothelin, WT-1

32
Q

Mesothelioma histology

A

Pulmonary adenocarcinoma -short, plump microvilli

Mesothelioma - microvilli are numerous, long, and slender

Respiratory II Exam 1 (12 decks)

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