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RHS- Path > Lung Neoplasms > Flashcards

Lung Neoplasms Flashcards

1
Q

Pathogenesis of lung cancer

A
  • smoking
  • industrial exposure
  • asbestos exposure
    • The latent period before the development of lung cancer is 10 to 30 years.
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2
Q

Molecular Pathogenesis: small cell carcinoma

A

Tumor suppression genes

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

Molecular Pathogenesis: Adenocarcinoma

A

Proto oncogene

  • EGFR mutations
  • KRAS mutations
  • ALK rearrangements

Easiest to treat

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4
Q

Molecular Pathogenesis of Squamous cell carcinoma

A

Tumor suppression genes

  • P53 mutations
  • 3p deletions
  • CDKN2a/p16 mutations
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5
Q

Pathogenesis of lung cancers in non smokers

A
  1. Make up 25% of all lung cancers
  2. More common in women
  3. EGFR mutations seen
  4. KRAS mutations not seen
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6
Q

Symptoms of lung cancer

A
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7
Q

Pancoast tumor

A
  • 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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8
Q

Superior vena cava (SVC) syndrome

A

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

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9
Q

Horner syndrome

A

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

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10
Q

Paraneoplastic syndromes

A

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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11
Q

What type of metastasis is most common in lung cancer

A

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

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12
Q

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
A

Adenocarcinoma

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13
Q

Adenocarcinoma Pathogenesis

A

Pre-invasive lesions:

  1. Atypical adenomatous hyperplasia
  2. Adenocarcinoma in situ

Minimally invasive adenocarcinoma

Invasive adenocarcinoma

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14
Q

What is expressed on IHC for adenocarcinoma

A

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

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15
Q

What’s this

A

Adenocarcinoma

  • Invasive malignant epithelial tumor with glandular differentiation or mucin production by the tumor cells.
  • thyroid transcription factor-1
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16
Q

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
A

Squamous Cell Carcinoma

17
Q

Explain progression of squamous cell carcinoma

A

Squamous metaplasia → Squamous dysplasia →

Squamous cell carcinoma in-situ→Invasive squamous cell carcinoma

18
Q

What is seen on histology of squamous cell carcinoma

A

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

19
Q

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
A

Small cell carcinoma

20
Q

Which paraneoplastic syndromes are seen in small cell carcinoma

A

ACTH, ADH, Gastrin releasing peptide, Calcitonin.

21
Q

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
A

Small cell carcinoma

22
Q

Large cell carcinoma description

A
  • Undifferentiated epithelial malignancy
  • Lacks features of small cell
  • No glandular differentiation
  • No squamous differentiation
  • Pleomorphic and “bizarre” cells
  • Poor prognosis, early metastasis
23
Q

Which lung cancer arise from Kulchitsky cells

A

Carcinoid tumors

24
Q

Carcinoid tumor spectrum

A
  • 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
25
Q

What’s this

A

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

26
Q

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

A

(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

27
Q

Typical carcinoid

A

Nest of uniform cells; regular round nuclei

  • salt and pepper chromatin
  • absent or rare mitoses and little pleomorphism
28
Q

Atypical carcinoid

A
  • 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

29
Q

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

A

Carcinoid syndromev

30
Q

What type of episodic attacks are seen in carcinoid syndrome

A
  • Vasomotor disturbances (flushes, cyanosis)
  • Gastrointestinal hypermotility (diarrhea, cramps, vomiting)
  • Asthma attacks
31
Q

Malignant mesothelioma

A
  • 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
32
Q

What’s seen on imaging studies of malignant mesothelioma

A

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

33
Q

Diagnosis of Pulmonary Hamartoma

A
  • 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.

34
Q

What is seen in serology when diagnosing lung cancer

A 
Liver function tests deranged-
ALP raised- bone and liver metastasis
GGT raised- liver metastasis
Calcium raised- bone metastasis and paraneoplastic syndromes 
Electrolyte abnormalities
35
Q

What is seen on IHC of small cell carcinoma

A

Synaptophysin

Chromogranin

36
Q

What is seen on IHC of squamous cell carcinoma

A

Squamous cell markers positive

37
Q

Which cancer involves Hypercalcemia due to PTHrP

A

Squamous cell carcinoma

38
Q

Which cancer has the worst prognosis

A

Small cell carcinoma

RHS- Path (4 decks)

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