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S3B1 Pathology > Lung Tumors > Flashcards

Lung Tumors Flashcards

1
Q

What is the most significant risk factor for developing lung cancer?

A

cigarette smoke

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2
Q

What is the most common lung tumor?

A

adenocarcinoma

most common in men, women & never smokers

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3
Q

In addition to cigarette smoke, what are the most common risk factors associated with lung cancer?

A

Asbestos

Arsenic

Uranium

Ionizing radiation

pollution

pre-existing inflammatory lung disease

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4
Q

What is an adenocarcinoma?

A

invasice epithelial tumor with glandular differentiation and/or mucin production

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5
Q

Adenocarcinmoma most commonly affects whats demographic?

A

non-smoking women

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6
Q

What are the gross features of an adenocarcinoma?

Microscopic organizations?

A
  • Gross
    • peripheral scar with pleural puckering
  • Micro
    • lipedic predominant
    • acinar predominant
    • (micro)papillary predominant
      • ​poor prognosis
    • solid
    • mucinous
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7
Q

What does lipedic predominant mean when describing an adenocarcinoma?

A

you have an invasive adenocarcinoma that is a small part of the lesion & the bulk of the lesion is actually non-invasive (atypical cells hanging onto alveolar septa)

“butterflies on a treebranch”

treebranch is alveolar septa & butterflies are the atypical cells

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8
Q

What type of lung tumor is shown in the provided image?

Identify its characteristic features.

A
  • Bottom right
    • micropapillary variant
    • tufts of papillae
  • Grossly
    • big, white, grey mass that is out toward the periphery
    • dip on right border = puckering
  • all others -
    • glands
    • cribiform (pierced by many small holes)
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9
Q

What are the two associated/precursor lesions to adenocarcinoma?

What do they have in common?

A
  • Atypical adenomatous hyperplasia
  • Adenocarcinoma I-Situ

both entirely lipidic in growth

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10
Q

Describe the features of atypical adenomatous hyperplasia.

A
  • 5mm of less
  • cytologically mildly to moderately atypical pneumocytes admixed with cilliated and goblet cells
    • note cell on the alveolar septa with abundant mucin in cytoplasm
  • diagnosis not made w/o disclaimer b/c cannot varify there is not verify there is not an invasive componenet
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11
Q

Describe the features of adenocarcinoma In-Situ.

A
  • less than 3cm
  • monotonous population of cells with “more atypia than AAH” but still entirely lipedic growth
    • cells that have large nucleus hanging on alveolar septa
  • diagnosis not made on biopsy w/o disclaimer b/c cannot varify there is not verify there is not an invasive componenet
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12
Q

What are the two stains used to diagnose adenocarcinoma?

A
  • TTF-1 (thyroid transcription factor)
    • positive for primary adenocarcinoma of the lung
    • negative for all other adenocarcinoma metastasis to the lung (other than thyroid)
    • example in provided image
  • Napsin A
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13
Q

What two mutations are associated with adenocarcinoma?

A
  • Gain of function mutations involving GF signaling pathways (mutually exclusive)
    • Receptor Tyrosine Kinase (TK) (have a drug for that!)
      • tend to occur in never smokers
        • EGFR
        • ALK
    • KRAS (poor prognostic)
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14
Q

What is squamous cell carcinoma?

It most commonly affects what demographic?

Where do they most common in occur in the lung?

A
  • invasive epithelial tumor characterized by evidence of squamous differentiation
  • Demographic
    • male smokers
  • Location
    • central - sub segmental bronchi
    • peripheral are on the rise
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15
Q

Why is important to differentiate between squamous cell carcinoma & adenocarcinoma?

A
  • bevacizumab - used to treat adenocarcinoma- can cause serious pulmonary hemorrahage in squamous cell carcinoma
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16
Q

Describe the gross growth patterns & appearance of squamous cell carcinoma.

A
  • Appearance
    • grey-white, firm cut surface
    • often centrally necrotic +/- cavitation
  • Growth patterns
    • exophytic endobronchial mass
      • obstruction, atelectasis, infection
    • peribronchiolar spread
      • mediastinal disease
    • nodular intraparanchymal mass
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17
Q

What microscopic findings are characteristic of squamous cell carcinoma?

A
  • keratinization
    • keratin pearls
    • dyskeratosis
  • intracellular bridges (desmasomes)
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18
Q

What are associated/precursor lesions of squamous cell carcinoma?

A
  • squamous metaplasia
  • increasing degrees of squamous dysplasia
  • squamous cell carcinoma in-situ (found adjacent to invasive tumor)
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19
Q

What pathology is shown in the provided images?

A

Squamous cell carcinoma

  • Upper middle image
    • mass spreading along peri-bronchiolar area
  • Bottom right
    • classic cavitation
  • Bottom middle
    • intercellular bridges
  • top right
    • keratin pearls
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20
Q

What stains are used to diagnose squamous cell carcinoma?

A
  • Positive
    • P40
    • P63
  • Negative
    • TTF-1
    • Napsin A
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21
Q

What mutation is associated with sqamous cell carcinoma?

A

highest TP53 mutations of all histologic types

22
Q

What is large cell carcinoma?

How is it diagnosed?

A

undifferentiated non-small cell carcinoma that lacks morphologic & immunohistochemical evidence of other differentiated forms of lung cancer

Diagnosis of exclusion

23
Q

What are the microscopic characteristics of large cell carcinoma?

A
  • micro
    • large nuclei
    • prominent nucleoli
    • moderate amount of cytoplasm
    • no pearls, bridges, glands or mucin
24
Q

What stains are diagnostic for large cell carcinoma?

A
  • Diagnostic - nothin’
    • no TTF-1
    • no Napsin A
    • no p40
    • no p63
25
Q

What lung tumor is shown in the provided image?

A

large cell carcinoma

large cell with large nuclei & prominent nucleoli

26
Q

What is the most aggressive lung tumor?

A

small cell carcinoma

99% of cases occur in smokers

27
Q

What is the progenitor cell for small cell carcinoma?

What is the staging classification for small cell caricinoma?

A
  • from neuroendocrine progenitor cells
  • Staged
    • Limited (confined to one side of the thorax & regional nodes)
    • Extensive
28
Q

What are the gross characteristics of small cell carcinoma?

A
  • central or peripheral
    • resections not often seen b/c surgery is rarely performed
29
Q

What are the microscopic characteristics of small cell carcinoma?

A
  • “relatively” small cells
    • scant cytoplasm
    • nuclear molding (take shape of one adjacent to it)
      • finely granular “salt & pepper” chromatin (b/c neuroendocrine)
      • inconspicous nucleoli
    • lots of mitotic activity
    • extensive necrosis
    • crush artifact
    • azzopardi effect
      • spilled chromatin ends up in blood vessels & makes them look blue
30
Q

What tumor is shown in the provided histological slides?

A
  • Center
    • very little cytoplasm
    • “salt & pepper” chromatin
    • nuclei molding to cell next to it
  • Bottom left
    • classic necrosis
  • Right
    • upper right corner: classic necrosis
    • azzopardi effect (blue line in middle)
31
Q

What stains are used to diagnose small cell carcinoma?

What are electron microscopy findings?

A
  • Positive
    • Chromogranin (highly specific, low sensitivity)
    • Synaptophysin
    • +/- TTF-1 (when lung primaries)
  • Electron microscopy
    • dense core neurosecretory granules
    • shown in the provided image?
32
Q

What type of imaging technique is used in the provided photo & what type of tumor is depicted?

A

Electron microscopy

small cell carcinoma (neuroendocrine neoplasm)

33
Q

What type of tumore looks like large cell carcinoma but is positive for chromogranin and has dense core neurosecretory granules in electron microscopy?

A

large cell neuroendocrine carcinomas

34
Q

Where do lung cancers most frequently metastasize to?

A

adrenal glands (image)

liver

brain

bone

35
Q

What lymph nodes are most commonly involved with lung carcinoma?

A

bronchial

tracheal

mediastinal

36
Q

What is the clinical presentation of lung carcinomas?

A
  • Clinical course
    • cough, cheest pain, weight loss, dyspnea, hemoptysis, pleural effusion, SVC syndrome
    • Horner symdrome
37
Q

What is Horner Syndrome & what causes it?

A
  • Pancoast tumor (in the apices of the lung)
    • direct extension into sympathetic cervical ganglia
  • Symptoms
    • miosis, ptosis, anhidrosis (no sweating), enophtaimos (eye looks sunken back in head)
    • ulnar pain
38
Q

Cushing syndrome is associated with what type of underlying cancer?

What is its causal mechanism?

A
  • small cell carcinoma of the lung
  • Causal Mechanism
    • ACTH or ACTH-like substance
39
Q

Syndrome of Inappropriate antidiuretic hormone secretion is associated with what type of underlying cancer?

What is its causal mechanism?

A
  • Underlying cancer
    • Small cell carcinoma
    • intracranial neoplasm
  • Causal Mechanism
    • antidiuretic hormone or atrial natruietic hormone
      • hyponatrimia
      • hypoosmolality
      • increased urine osmolality
40
Q

Hypercalcemia is associated with what type of underlying cancer?

What is its causal mechanism?

A
  • Underlying cancer
    • squamous cell carcinoma of the lung
  • Mechanism
    • parathyroid hormone-related protein (PTHRP)
    • TGF-alpha
    • TNF
    • IL-1
41
Q

What is the treatment for adenocarcinoma that block angiogenesis by inhibiting VEGF?

A

bevacizumab

42
Q

What are carcinoid tumors?

Typing features?

A

they are basically low-grade neuroendocrine

  • dense coronary secretory grandules
  • positive for chromogranin & synaptophysin
  • salt & pepper chromatin
43
Q

What demographic is most commonly affected by lung carcinoid tumors?

Where are they located within the lung?

Clinical presentation?

Treatment?

A
  • Demographic
    • usually <40 yr
    • most common pediatric lung tumor
  • Location
    • central or peripheral
    • typically confined to bronchus
  • Clinical presentation
    • hemoptysis
    • infection distal to tumor
  • Treatment
    • removal usually curative, but atypical are more aggressive
44
Q

What is the gross appearance of carcinoid tumors of the lung?

A
  • Gross characteristics
    • Grey-yellow cut surface
    • polypoid
    • mucosal covered
    • intraluminal masses
45
Q

What are the characteristic microscopic findings of carcinoid tumors of the lung?

A
  • small uniform cells
  • central nuclei
  • moderate amount of fine granular cytopllasm (salt & pepper)
  • distinct “organoid” architecture
    • nests, ribbons, rosette-like arrangements
  • prominent fibrovascular stroma
46
Q

What lung tumor is shown in the provided images?

A

Carcinoid tumor of the lung

  • Upper left
    • notice how bright golden-yellow it is
  • Upper right
    • classic one poking out into the bronchus
  • Bottom right
    • cells with salt & pepper chromatin
    • quite a bit of cytoplasm
    • nested growth pattern
47
Q

How are typical & atypical carcinoid tumors differentiated?

Why does this a matter?

A
  • mitotic activity
  • necrosis
  • Typical (less mitotic activity & less necrosis) - typically curable
  • Atypical (more mitotic activity & more necrosis)
48
Q

What is a pre-canacer lesion associated with carcinoid tumors?

A

diffuse neuroendocrine cell hyperplasia

49
Q

What stains are used to diagnose carcinoid tumors?

What findings would you expect to see with electron microscopy?

A
  • Positive
    • Serotonin
    • Chromogranin
    • Synaptophysin
    • +/- TTF-1
  • Electron microscopy
    • dense core neurosecretory granules
50
Q

What is a pulmonary hamartoma?

How are they often discovered?

A
  • <3-4 cm benign connective tissue with epithelial clefts
    • cartilage most common, cellular fibrous tissue, fat
    • ciliated or non-ciliated columnar epithelium (probably not lesional)

incidental “coin lesion” on X-ray

51
Q

What type of lung tumor is shown in the provided image?

A

Pulmonary Hamartoma

52
Q

What is a lymphangiomyomatosis?

What demographic is most commonly affected?

A

S3B1 Pathology (7 decks)

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