Lung Neoplasms

Question 1

A 23-year-old man presents with cavitary lung nodules and a vocal polyp. He has a history of hoarseness as a child. What is the diagnosis?

Answer 1

Recurrent respiratory papillomatosis with lung involvement, most likely squamous cell cancer

Question 2

Hamartomas are the most common benign neoplasms in adults and are generally solitary nodules. Computed tomography scans show a characteristic combination of calcifications and/or fat.

Question 3

A 36-year-old patient with unresolving right middle lobe pneumonia of 2 months’ duration presents for evaluation. Chest CT scan shows a right middle lobe alveolar infiltrate with air bronchograms. What is the next step?

Answer 3

CT-guided lung biopsy. The biopsy showed complete replacement of lung architecture by monomorphic small lymphoid cells with positive immunohistochemistry for mucosa-associated lymphoid tissue–type lymphoma.

Question 4

Interior mediastinal masses— four Ts:
Thymoma
Teratoma Intrathoracic Thyroid Terrible lymphoma

Answer 4

Mediastinal teratomas tend to be cystic.

Question 5

What neoplastic syndromes are associated with thymoma?

Answer 5

Pure red cell aplasia, myasthenia gravis, and hypogammaglobulinemia

Question 6

What neoplastic syndromes are associated with thymoma?

Answer 6

Pure red cell aplasia, myasthenia gravis, and hypogammaglobulinemia

Question 7

Differential diagnosis of solitary pulmonary nodules—

Answer 7

CASH PLEASe:
Cancer
Abscess
Solitary metastasis
Hamartoma
Pseudotumor
Lymphoma
Echinococcus
Actinomyces
Sequestration

Question 8

Hamartomas:
- Benign but can grow
slowly
- Fat visible on CT scan in
about 60%
- Most often found in men
> 50 years of age
- Popcorn calcification seen in about 25%

Question 9

What is appropriate management when a solitary, pure ground-glass nodule > 5 mm is found on chest CT scan?

Answer 9

Initial follow-up at 3 months and then annual surveillance for at least 3 years.

Question 10

Which type of lung cancer is most frequently associated with paraneoplastic syndromes?

Answer 10

Small cell lung cancer

Question 11

Hypertrophic pulmonary osteoarthropathy resolves completely with treatment of the primary cancer.

Question 12

Which of the following paraneoplastic syndromes is appropriately matched with the corresponding antibodies?
Lambert–Eaton myasthenia syndrome— Anti-Yo antibodies

Cerebellar degeneration—Voltage- gated channel antibodies

Limbic encephalitis—Anti- Hu antibodies

Answer 12

Limbic encephalitis—Anti- Hu antibodies

Question 13

The diagnosis of pleural neoplasm is established with proper history, imaging, tissue specimens, and histopathology with immunohistochemical staining.

Question 14

Which of the following statements about MPM is false?
A. There is a synergistic effect between asbestos exposure and smoking.

B. Serum biomarkers are not useful as a screening tool.

C. There is a long latency period between exposure to asbestos and development of symptoms.

D. Treatment is rarely curative.

Answer 14

The correct answer is A. There is no synergy between asbestos exposure and smoking in MPM.

Question 15

Treatment of MPM is rarely curative. However, multimodal treatment regimens combining surgery, radiation therapy, and chemotherapy may offer a significant increase in survival for subgroups of patients with mesothelioma.

Question 16

Which of the following parameters places the patient at high risk for surgical complications?
A. 77 years old
B. Chronic obstructive
pulmonary disease
with hypercapnia
C. Able to climb three
flight of stairs
D. VO2 max 30% of predicted

Answer 16

D. VO2 max < 35% of predicted places the patient at very high risk for surgery.

Question 17

VO2 max < 10 mL/kg/min or 35% of predicted indicates a high risk of mortality and long-term disability.

Question 18

If % PPO FEV1 and % PPO DLCO values are both > 60%, the patient is considered at low risk for surgical complications and no further tests are indicated.