Apical neoplasm – Invasion of brachial or cervical sympathetic plexus Wasting of hand muscles, pain in arms (ulnar nerve) Horner syndrome Compression of blood vessels→Edema Recurrent laryngeal nerve paralysis Esophagus involvement → dysphagia Thoracic duct obstruction → chylothorax

Lung Neoplasms Flashcards by Hannah Gabriella

Pathogenesis of lung cancer

smoking
industrial exposure
asbestos exposure
• The latent period before the development of lung cancer is 10 to 30 years.

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Molecular Pathogenesis: small cell carcinoma

Tumor suppression genes

Rb mutations
P53 mutations
3p deletions (~90%)

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Molecular Pathogenesis: Adenocarcinoma

Proto oncogene

EGFR mutations
KRAS mutations
ALK rearrangements

Easiest to treat

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Molecular Pathogenesis of Squamous cell carcinoma

Tumor suppression genes

P53 mutations
3p deletions
CDKN2a/p16 mutations

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Pathogenesis of lung cancers in non smokers

Make up 25% of all lung cancers
More common in women
EGFR mutations seen
KRAS mutations not seen

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Symptoms of lung cancer

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Pancoast tumor

Apical neoplasm – Invasion of brachial or cervical sympathetic plexus
Wasting of hand muscles, pain in arms (ulnar nerve)
Horner syndrome
Compression of blood vessels→Edema
Recurrent laryngeal nerve paralysis
Esophagus involvement → dysphagia
Thoracic duct obstruction → chylothorax

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Superior vena cava (SVC) syndrome

due to compression – venous congestion and edema of the head and arm

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Horner syndrome

Cervical sympathetic plexus damaged→Ipsilateral enophthalmos, ptosis, miosis, anhidrosis

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Paraneoplastic syndromes

Symptom complexes that occur in patients with cancer that cannot be readily explained by local or distant spread; or by elaboration of hormones by tumor cells

• Hypercalcemia (Parathyroid hormone-related peptide)- Squamous cell
carcinoma
• Cushing’s syndrome (ACTH) (bilateral adrenal hyperplasia)→Small cell
carcinoma
• Syndrome of inappropriate ADH secretion (hyponatremia) → Small cell
carcinoma
• Myasthenic like syndrome (Lambert-Eaton syndrome)→Small cell carcinoma

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What type of metastasis is most common in lung cancer

Lymph node metastases most common
• Adrenal (50%): very rarely Addison’s disease (insufficiency)
• Liver (30-50%)

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Which cancer is this:

primary lung tumor; in women and non-smokers
• < 45 years of age
• Peripheral > central location
• Grow slowly
• Metastasis widely at an early stage

Adenocarcinoma

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Adenocarcinoma Pathogenesis

Pre-invasive lesions:

Atypical adenomatous hyperplasia
Adenocarcinoma in situ

Minimally invasive adenocarcinoma

Invasive adenocarcinoma

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What is expressed on IHC for adenocarcinoma

Majority express TTF- 1 (thyroid transcription factor-1)

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What’s this

Adenocarcinoma

Invasive malignant epithelial tumor with glandular differentiation or mucin production by the tumor cells.
thyroid transcription factor-1

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Which cancer is this:

Central > peripheral
Men > women
Closely aligned with smoking history
Spreads to hilar lymph nodes
Extra-thoracic spread is later than other histologic types
Obstruction, atelectasis, infection
Central necrosis → CAVITATION

Squamous Cell Carcinoma

Explain progression of squamous cell carcinoma

Squamous metaplasia → Squamous dysplasia →

Squamous cell carcinoma in-situ→Invasive squamous cell carcinoma

What is seen on histology of squamous cell carcinoma

Keratin pearls; intercellular bridges and individual cell keratinization- squamous differentiation

Which cancer is this:

Neuroendocrine origin
Central (hilar) > peripheral
Closely aligned with smoking history
Early metastasis to mediastinal lymph nodes
Typically, not amenable to surgical resection
Responds to chemo/ radiation therapy

Small cell carcinoma

Which paraneoplastic syndromes are seen in small cell carcinoma

ACTH, ADH, Gastrin releasing peptide, Calcitonin.

Which cancers histology is described as the following:

Round, scant cytoplasm, finely granular chromatin, fragile, crush artifacts, nuclear molding, extensive necrosis,
Azzopardi effect- basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells
Frequent mitoses

Small cell carcinoma

Large cell carcinoma description

Undifferentiated epithelial malignancy
Lacks features of small cell
No glandular differentiation
No squamous differentiation
Pleomorphic and “bizarre” cells
Poor prognosis, early metastasis

Which lung cancer arise from Kulchitsky cells

Carcinoid tumors

Carcinoid tumor spectrum

Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH)
Carcinoid tumorlets (< 5 mm)
Carcinoid tumor, typical variant
Carcinoid tumor, atypical variant: necrosis and or elevated mitotic count > 2 / 10 high power fields

What’s this

Carcinoid growing as a spherical, pale mass (arrow) protruding into the lumen of the bronchus and histologic appearance demonstrating small, rounded, uniform nuclei and moderate cytoplasm

Most carcinoids originate in main bronchi and grow in one of two patterns:

(1) An obstructing polypoid, spherical, intraluminal mass (2) A mucosal plaque penetrating the bronchial wall to fan out in the peribronchial tissue—the so-called “collar-button” lesion

Typical carcinoid

Nest of uniform cells; regular round nuclei - salt and pepper chromatin - absent or rare mitoses and little pleomorphism

Atypical carcinoid

* Display a higher mitotic rate and small foci of necrosis | * These tumors have a higher incidence of lymph node and distant metastasis than typical carcinoids

Which cancer is described by neuropeptides (serotonin, histamine, bradykinin, prostaglandins) being secreted into systemic circulation and causes episodic attacks?

Carcinoid syndromev

What type of episodic attacks are seen in carcinoid syndrome

* Vasomotor disturbances (flushes, cyanosis) * Gastrointestinal hypermotility (diarrhea, cramps, vomiting) * Asthma attacks

Malignant mesothelioma

* Primary malignancy of pleura, peritoneum or pericardium. * Risk factor: Exposure to asbestosis * Clinical features: Patients present with chest pain and/or dyspnea; occasionally with cough or fatigue * Histology: biphasic (mixed), sarcomatoid, epithelioid

What’s seen on imaging studies of malignant mesothelioma

moderate to large unilateral pleural effusion, nodular pleural thickening, enhancement with PET scan

Diagnosis of Pulmonary Hamartoma

* Mostly solitary, 3 – 4 cm in diameter * Appears as a rounded, radio-opacity (coin lesion) on chest x-ray Histology: Nodules of connective tissue (cartilage/ fibrous tissue/ fat) along with epithelial clefts.

What is seen in serology when diagnosing lung cancer

``` Liver function tests deranged- ALP raised- bone and liver metastasis GGT raised- liver metastasis Calcium raised- bone metastasis and paraneoplastic syndromes Electrolyte abnormalities ```

What is seen on IHC of small cell carcinoma

Synaptophysin | Chromogranin

What is seen on IHC of squamous cell carcinoma

Squamous cell markers positive

Which cancer involves Hypercalcemia due to PTHrP

Squamous cell carcinoma

Which cancer has the worst prognosis

Small cell carcinoma