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Pathology > Lung Pathology > Flashcards

Lung Pathology Flashcards

1
Q

What gene encodes p16

A

CDKN2A

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2
Q

Is lung SqCC or adenocarcinoma most strongly associated with cigarette smoking

A

Squamous cell

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3
Q

What percentage of lung adenocarcinoma in caucasians are EGFR mutant. What group is higher than this

A

10-15%
Asian women

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4
Q

What percentage of lung adenocarcinoma have KRAS mutation

A

30%

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5
Q

How commonly is small cell lung cancer smoking associated

A

Almost always

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6
Q

What major tumour suppressor proteins are almost always mutated in small cell lung cancer

A

Rb, p53.

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7
Q

Where are SqCC vs adenoCa more likely to be located in the lung

A

Peripheral; adenocarcinoma
Central; SqCC

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8
Q

What is a lepidocrocite pattern of spread? Which type of lung cancer shows this pattern?

A

Tumour cells appearing to crawl along normal spaces, in this case alveolar septa. Common in adenocarcinoma.

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9
Q

What subtypes of lung adenocarcinoma tends to form satellite lesions

A

Mucinous adenocarcinoma. Therefore less likely cured with surgery.

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10
Q

What are pathological features that are required for diagnosis of large cell lung cancer

A

Diagnosis of exclusion. Negative TTF-1, p40 (and others).

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11
Q

What are common neurological consequences of pancoast tumours

A

Horners syndrome
Pain in distribution of ulnar nerve

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12
Q

What are the most common sites of metastasis of lung cancer at initial diagnosis

A

Adrenal (>50%)
Liver 30-50%
Brain 20%
Bone 20%

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13
Q

What does an activating mutation of KRAS mean prognostically in the absence of treatment

A

Worse prognosis

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14
Q

What are the non-carcinoma neuroendocrine tumours of the lung, and how are they classified

A

Carcinoid.
-Typical: less than 2 mitosis per 10 high power field
-atypical 2-10 mitosis.

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15
Q

What is the classical carcinoid syndrome

A

Intermittent:
Diarrhoea
Flushing
Cyanosis

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16
Q

What are the most common anterior mediastinal tumours (6)

A

Thymoma
Teratoma
Lymphoma
Thyroid
Parathyroid
Metastatic carcinoma
Robbins pg 724

17
Q

What are the most common posterior mediastinal tumours

A

Lymphoma
Metastatic (usually lung)
Neurogenic (schwannoma, neurofibromas)
Bronchogenic cyst
Gastrointestinal hernia

18
Q

What is a commonly benign pleural tumour. What are it’s morphological features

A

Solitary fibrous tumour
-dense fibrous tissue, interspersed spindle cells resembling fibroblasts
-CD34+, STAT6+, keratin- (opposite of mesothelioma)
-rarely malignant; pleomorphism, mitotic activity, necrosis, large size >10cm

19
Q

What tumour suppressor gene is lost in 80% of mesothelioma

A

CDKN2A (p16)

20
Q

What is the lifetime risk of mesothelioma in individuals heavily exposed to aspestos

A

7-10%

21
Q

Morphologically what are the two main subtypes of mesothelioma

A

Epithelioid
Sarcomatoid

22
Q

What is the common immunohistochemistry profile for mesothelioma

A

Keratin proteins
WT-1+
Calretinin+
Cytokeratin 5/6+
Claudin4-
Sarcomatoid subtype less commonly has this profile

23
Q

Which immunotherapy drugs target PD-1

A

Pembbrolizumab
Nivolumab

24
Q

Which immunotherapy drugs target PD-L1

A

Durvalumab
Atezolizumab

25
Q

What is the difference between PD-1 and PD-L1

A

PD-L1 is what tumour cells can express to interact with PD-1 on immune T-cells to stop the immune cell killing the cancer cell

26
Q

What are the 5 histological patterns of lung adenocarcinoma, and what grade is each associated with

A

LAMPS
Low: Lepidic
Intermediate: papillary, acinar
High: micropapillary, solid

27
Q

What is the definition of lung adenocarcinoma in situ

A

Lesion <3cm
No invasion
Usually lepidic pattern

28
Q

Is lung adenocarcinoma or SqCC more likely to metastasise. What are the most common sites

A

Adenocarcinoma more likely
Brain>bone>liver>adrenal

29
Q

How are EGFR point mutations tested for in lung cancer

A

PCR/ NGS

30
Q

How is ALK mutation tested for in lung cancer

A

Abnormality is generally rearrangement
Initial IHC for over expression
Confirmation with FISH

31
Q

What are the criteria for invasion of lung adenocarcinoma

A

1) Histological pattern other than lepidic
2) desmoplastic stroma
3) pNI or LVI
4) spread through air spaces

32
Q

What is the IHC pattern of mucinous adenocarcinoma of the lung

A

CK7+
CK20 +/-
TTF1 +/-
CDX2 +/-

33
Q

What is the prognosis of mucinous lung adenocarcinoma in comparison to other adenocarcinoma types

A

Worse prognosis

34
Q

What is the microscopic appearance of lung mucinous adenocarcinoma

A

Goblet or columnar cells
Abundant intracellular mucin
Cytologically bland

35
Q

What is the parthenogenesis of lung SqCC

A

Irritant/ carcinogen exposure
Hyperplasia
Squamous metaplasia
Squamous dysplasia
SqCC in situ
SqCC

36
Q

What should be stained when assessing for pleural invasion

A

Elastin (EVG)

37
Q

What are examples of mesynchymal tumours that can arise in the lung

A

Hamartoma
PEComa
Solitary fibrous tumour

Pathology (16 decks)

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