Lung neoplasms 2

Question 1

The small cell carcinoma is also called?

Answer 1

Poorly differentiated neuroendocrine /Oat cell

Question 2

explain small cell carcinoma

Answer 2

Aggresive, highly malignant, tumour

Question 3

Why the prognosis is poor for small cell carcinoma

Answer 3

Poor prognosis : due to late presentation ,
usually demonstrates metastasis at initial presentation
Least likely to be cured by surgery

Question 4

The Small cell carcinoma is associated with what?

Answer 4

cigarette smoking

Question 5

small cell carcinoma is common in which gender?

Answer 5

Men

Question 6

The small cell carcinoma is Present as what ?

Answer 6

Hilar or perihilar mass

Question 7

does small cell carcinoma response to chemotherapy?

Answer 7

Yes

Question 8

The small cell carcinoma has the ability to secrete a host of polypeptide hormones such as?

Answer 8

ACTH (adrenocorticotropic H)
ADH

Question 9

The small cell carcinoma is associated with which syndromes

Answer 9

It may associated with Paraneoplastic Syndrome , Cushing syndrome , Eaton- Lambert syndrome] These phenomena are mediated by humoral factors (by hormones or cytokines) secreted by tumor cells or by an immune response against the tumor

Question 10

explain the small cell lung carcinoma gross appearance

Answer 10

Small cell lung carcinoma, gross
Arising centrally in this lung and spreading extensively is a small cell anaplastic (“oat cell”) carcinoma. The cut surface : a soft, lobulated, white to tan appearance. This tumor obstructs the left main bronchus so that the distal lung (↓) is collapsed (atelectatic).
Very aggressive and often metastasize widely before the primary tumor mass in the lung reaches a large size leading to diagnosis.
More amenable to chemotherapy than radiation therapy or surgery, but the prognosis is still poor. Small cell lung carcinomas occur almost exclusively in smokers.

Question 11

explain what happen to superio vena cava because of lung neoplasms

Answer 11

Superior vena cava syndrome: invasion leads to obstruction of venous drainage which leads to dilation of veins in the upper part of the chest and neck resulting in swelling and cyanosis of the face, neck, and arms.

Question 11

explain the small cell lung carcinoma microscopic appearance

Answer 11

Small cell lung carcinoma, microscopic
The small dark-blue cells (resembling rolled oats”) with minimal cytoplasm (high nuclear-to-cytoplasmic ratio) are packed together in sheets and irregular nests.
Cells often show “crush artifact” from handling the specimen.
Mutations inTP53, p16,andRBtumor suppressor genes and anti apoptoticBCL2
gene are often present.
Expresses NE markers such as chromogranin and synaptophysin.
Associated with paraneoplastic syndromes from hormonal effects: ectopic adrenocorticotropic hormone (ACTH) produces Cushing syndrome, and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) leads to hyponatremia

Question 12

Explan the pancoast tumour

Answer 12

Pancoast tumor (superior sulcus tumor): Apical (upper lobe) Bronchogenic carcinoma (could be either squamous or adenocarcinoma) neoplasms may invade the brachial sympathetic plexus to cause severe pain, numbness and weakness in the distribution of the ulnar nerve.Accompanied by destruction of the first and second ribs and thoracic vertebrae. It often coexists with Horner syndrome (ptosis + asymmetrical miosis + anhidrosis)

Question 13

explain the horner syndrome

Answer 13

Horner syndrome: invasion of the cervical thoracic sympathetic nerves and it leads to ipsilateral enophthalmos (displacement of the eyeball within the orbit –eyes goes inside-). miosis, ptosis, and facial anhidrosis. (Anhidrosis is the inability to sweat normally –leads to dryness in –leads to dryness in facial areas-).
The combination of these clinical findings is known as Pancoast syndrome.

Question 14

where is carcinoid tumpur situated

Answer 14

Usually the tumour is situated in a primary bronchus or at the lung periphery

Question 15

explain the appearance of carcinoid tumour

Answer 15

The tumour is a smooth surfaced yellow nodule.

Question 16

Histologically the carcinoid tumour resembles what?

Answer 16

carcinoid tumours of the appendix

Question 17

A small proportion of these tumours metastasise to regional lymph nodes – all are potentially malignant
name that tumour

Answer 17

carcinoid tumours

Question 18

Carcinoid Central tumours tend to block the bronchus in which they arise RESULTING IN .

Answer 18

*
Obstruction
*
Collapse of lung.
*
Pneumonia Infection
*
Bronchiectasis
*
Lung abscess

Question 19

explain the atypical carcinoid tumours

Answer 19

Atypical carcinoid tumours: This sub-group of tumours shows nuclear pleomorphism, mitotic activity and necrosis. Over half eventually metastasised

Question 20

explain the atypical carcinoid microscopic appearance

Answer 20

Atypical carcinoid, microscopic
There is a spectrum of neuroendocrine tumors from well-differentiated carcinoids to aggressive small cell anaplastic carcinoma. The atypical carcinoid shown here lies between. Note the infiltrative border in the right panel, and some cells with greater pleomorphism and hyperchromatism in the left panel. Atypical carcinoids are larger and more aggressive than carcinoids. They can metastasize. They arise in the same locations (bronchi) but are more likely to be peripheral than typical carcinoids.