Lung neoplasms

Question 1

is a disorganized admixture of tissues indigenous to that site eg Cartilage, blood vessels, glands, inflammatory cells, mesenchymal tissue, fat in various proportions. cartilage, smooth muscle fibers & slits lined by epithelium (constituents of the bronchus).
One word

Answer 1

Hamartoma

Question 2

Radiograph appearance of hamartoma

Answer 2

Coin lesion

Question 3

Macroscoy appearance of hamartoma

Answer 3

Macroscopy : Well-circumscribed, spherical, small (1 to 4 cm), discrete solid lesion with yellowish pale cut surface.

Question 4

what is choristoma

Answer 4

Choristoma a mass composed from normal tissues but in ectopic location .eg pancreatic islets in liver or stomach.
These masses are usually discovered at the routine medical examinations by coincidence and it is not related to any 2 symptoms.

Question 5

explain the gross appearance of hamartoma

Answer 5

They are firm and discrete and often have calcifications recognizable on radiography. Most are small (<2 cm).
Clonal expansion of cells with 6p21 or 12q14–q15 chromosomal alterations.

Question 6

List the different diagnosis for hamartoma

Answer 6

The differential diagnosis includes granuloma, small primary carcinoma, solitary metastasis, or hamartoma

Question 7

explain the microscopic appearance of hamartoma

Answer 7

This pulmonary hamartoma microscopically is composed of benign elements:
cartilage () on the right that is jumbled with a fibrovascular stroma and scattered bronchial glandular structures () on the left.
The cartilaginous nature of this mass causes it to bounce off a biopsy needle like a ping-pong ball.
A hamartoma is a neoplasm in an organ that is composed of tissue elements normally found at that site but growing in a haphazard mass

Question 8

Most lung tumour are malignant or benign?

Answer 8

Malignant

Question 9

Primary lung cancer is a common disease but ————- are the most common lung carcino,a seen in clinical practice.

Answer 9

Metastatic tumours

Question 10

List the primary lung tumours and their percentage of occurance

Answer 10

95 % are carcinomas
5% Carcinoids
Mesenchymal malignancies (fibrosarcoma, leiomyomas)
Lymphomas

Question 11

List the non-small cell lung carcinoma

Answer 11

Squmous cell carcinoma
Adenocarcinoma, including bronchioloalveolar carcinoma
Large cell carcinoma

Question 12

List the combined patterns in lung tumours

Answer 12

Mixed squamous cell carcinoma and adenocarcinoma
Mixed squamous cell carcinoma and SCLC

Question 13

List the carcinoid tumours

Answer 13

Benign cancer arising from endocrine cell

Question 14

Explain the atypical adenomatous hyperplasia :AAH

Answer 14

Small lesion
Characterised by dysplastic pneumocytes lining alveolar walls that are mildly fibrotic

Question 15

Explain adenocarcinoma in situ, AIS

Answer 15

Used to be called bronchioalveolar carcinoma
Lesion 3 cm or less
omposed entirely of dyplastic cells growing along, preexisting alveolar septa without rupturing it . (Atypical glandular cells line the alveoli (along the basement memrabe-hyperplasia)
Lepidic growth pattern but once invasive (>3cm) it forms desmiplasia
No features of necrosis or invasion

Question 16

explain minimally invasive adenocarcinoma of lungs (MIA)

Answer 16

Lesion <or eqaully to 3 cm
Describe small solitary adenocarcinomas with either pure lepidic growth for predominant lepidic growth with </= 5 mm of stromal invasion

Question 17

what is bronchoalveolar carcinoma

Answer 17

subtype of adenocarcinoma having absence of stromal, vascular or pleural invasion with growth of the tumor along the pre-existing alveolar septa.

Question 18

Tumour cells of bronchoalveolar carcinoma present in what?

Answer 18

Alveoli and tend to have aerogenous spread q.

Question 19

Tumors cells are present in the alveoli and tend to have aerogenous spreadQ. whay?

Answer 19

to involvement of the airways, the patient usually dies by suffocation (not by metastatic spreadQ).

Question 20

clinical features of bronchoalveolar carcinoma

Answer 20

Clinical features: Cough is the most common symptom in these patients which is followed by weight loss and dyspnea. They also have anorexia, fatigue, hemoptysis, and chest pain.

Question 21

Metastasis of Bronchoalveolar carcinoma causes involves what?

Answer 21

Metastasis of the cancer causes involvement of adrenal (most commonly) followed by liver, brain and bone.

Question 22

Intrathoracic spread of bronchoalveolar carcinoma causes what?

Answer 22

Intrathoracic spread of the cancer causes enlargement of lymph nodes (hilar, mediastinal, bronchial and tracheal),
pleural involvement,
hoarseness (recurrent laryngeal nerve invasion),
dysphagia (esophageal obstruction),
diaphragmatic paralysis (phrenic nerve paralysis),
Horner syndrome and
superior vena cava (SVC) syndrome

Question 23

List Paraneoplastic syndromes associated with Bronchogenic Cancer

Answer 23

1.
Endocrinological syndrome

2.
Lambert eaton syndrome: Due to autoantibodies against neuronal calcium channel
3.
Acanthosis nigricans: Hyperpigmentation of axillary region.
4.
Hypertrophic pulmonary osteoarthropathy having clubbing and periosteal new born formation.

Question 24

list Endocrinological syndrome

Answer 24

a. Cushing syndrome (Due to ACTH)
b. Syndrome of inappropriate ADH secretion (SIADH) [Due to anti-diuretic hormone]
c. Hypercalcemia: Due to parathyroid hormone related peptide (PTH related peptide).
d. Hypocalcemia: Due to calcitonin
e. Gynecomastia: Due to gonadotropins

Question 25

The stepwise accumulation of oncogenic driver mutation results to what?

Answer 25

stepwise accumulation of oncogenic ‘driver’ mutations resulting in neoplastic transformation of pulmonary epithelial cells.

Question 26

Commonly divided into non-small cell (including adenocarcinoma, squamous cell carcinoma, other types) and small cell carcinoma based on behaviour and prognosis.
TRUE OR FALSE

Answer 26

TRUE

Question 27

The molecular features present depend on the histologic tumour type:
explain the adenocarcinoma

Answer 27

Adenocarcinoma: Most common type in never-smokers, although it is also associated to a lesser extent with smoking. A third of adenocarcinomas have oncogenic gain-of-function mutations involving growth factor receptor signalling pathways that can be targeted by specific inhibitors e.g. tyrosine kinase receptors (EGFR, ALK, ROS1) or their downstream molecules (KRAS – usually in smokers)

Question 28

The molecular features present depend on the histologic tumour type:
explain Squamous cell carcinoma

Answer 28

o Squamous cell carcinoma: Highly associated with smoking and has diverse genetic aberrations. Most haveTP53 mutations, often as an early event, and may also have FGFR1 amplification

Question 29

The molecular features present depend on the histologic tumour type:
explain small cell carcinoma

Answer 29

o Small cell carcinoma: Almost always smoking-related and the highest mutational burden, with inactivation of both TP53 and RB. May also have MYC amplification* Precursor lesions: There are morphologic precursor epithelial lesions which do not necessarily all progress to cancer