Lung Tumors Flashcards
Most common cancer in males in India
Bronchogenic carcinoma
Bronchogenic carcinoma arises from
Respiratory Epithelial cells - can arise from Bronchi, Bronchioles or Alveoli
Most common risk factor of Bronchogenic carcinoma
Smoking
Risk factors of Bronchogenic carcinoma
Smoking
Exposure to industrial hazards
Air pollution
Genetic mutations
Exposure to industrial hazards in case of Bronchogenic carcinoma includes
Ionising radiation
Uranium mining
As/Cr/Vinyl chloride
Asbestos
Risk of which cancer if an individual in Asbestos exposure for 10-30 years
Bronchogenic carcinoma
Risk of which cancer if individual in Asbestos exposure for 20-45 years
Mesothelioma
Individuals with which polymorphism have high risk of lung cancer
CYP1A1 Polymorphism
Genetic mutations seen in case of Bronchogenic carcinoma
P53
P16
Rb gene
K.Ras
EgFR
Genetic mutations seen in case of Bronchogenic carcinoma
P53
P16
Rb gene
K.Ras
EgFR
Genetic mutations responsible for squamous cell carcinoma of lung
P53 gene
P16 gene
Rb gene
Genetic mutations responsible for adenocarcinoma of lung
K.Ras
EgFR
Genetic mutations responsible for adenocarcinoma of lung
K.Ras
EgFR
Precursor lesions of lung cancer in Squamous carcinoma
Basal cell hyperplasia - Squamous metaplasia - Squamous Dysplasia - Squamous carcinoma in situ - Squamous carcinoma
Precursor lesions of lung Cancer in Adenocarcinoma
Atypical adenomatous hyperplasia - Adenocarcinoma insitu - Minimally invasive Adenocarcinoma - Invasive Adenocarcinoma
Findings in case of Atypical adenomatous hyperplasia
<5mm lesion
Presence of dysplastic pneumocytes
Findings in case of Atypical adenomatous hyperplasia
<5mm lesion
Presence of dysplastic pneumocytes
Findings in case of Adenocarcinoma in situ
Former called BAC
>5mm whereas <3cm lesion
No invasion
Dysplastic pneumocytes +
Findings in case of Adenocarcinoma in situ
Former called BAC
>5mm whereas <3cm lesion
No invasion
Dysplastic pneumocytes +
Findings in case of Minimally Invasive Adenocarcinoma
<3cm lesion
Invasive involvement <5mm - Mucinous or non mucinous
Findings in case of Invasive Adenocarcinoma
<3cm lesion
Invasive involvement <5mm - Mucinous or non mucinous
Findings in case of Invasive Adenomatous
Lesion of any size
Invasive involvement >5mm
Classification of Malignant epithelial lung tumors according to WHO(2015)
Squamous cell cancer
Adenocarcinoma
Large cell carcinoma
Neuroendocrine carcinoma
Mixed carcinoma
Others - Sarcomatoid, Giant cell and Spindle cell carcinoma
Types of Squamous cell carcinoma (Lung cancer)
Keratinizing
Non-keratinizing
Basaloid - >50% basal appearance
Types of Squamous cell carcinoma (Lung cancer)
Keratinizing
Non-keratinizing
Basaloid - >50% basal appearance
Types of adenocarcinoma of lung
Lepidic
Acinar
Papillary
Solid
Types of adenocarcinoma of lung
Lepidic
Acinar
Papillary
Solid
Types of Neuroendocrine carcinoma (Lung cancer)
Small cell carcinoma
Large cell carcinoma
Carcinoid tumor
Differential idiopathic pulmonary Neuroendocrine hyperplasia (DIPNH)
Types of mixed carcinoma (Lung cancer)
Adeno-Squamous carcinoma
Combined small cell carcinoma
Types of mixed carcinoma (Lung cancer)
Adeno-Squamous carcinoma
Combined small cell carcinoma
Full form of NUT
Nuclear protein in testis -: NUT-M1 - present on long arm of chromosome 15
Prognosis of NUT Carcinoma
Aggressive cancer - Bad Prognosis
Immunohistochemistry finding in NUT Carcinoma
Speckled nuclear +
Immunohistochemistry finding in NUT Carcinoma
Speckled nuclear +
Clinical features of Bronchogenic Carcinoma
Cough(Mc)
Long stand smoking history
Weight loss
Hemoptysis
Dyspnea
Chest pain - pleura involvement - lung abscess
Pancoast Tumor
Apical tumor
Involvement of certain structures - Symphathetic nerve plexus
HORNER SYNDROME
MAPEL
Miosis
Anhidrosis
Ptosis
Enophthalmos
Loss of Ciliospinal reflex
HORNER SYNDROME
MAPEL
Miosis
Anhidrosis
Ptosis
Enophthalmos
Loss of Ciliospinal reflex
Diagnosis of Bronchogenic carcinoma
Sputum examination
Bronchoscopy + Biopsy
PET-CT Scan
Which test is most specific in Bronchogenic carcinoma
Sputum examination - Cytology
Which test is most specific in Bronchogenic carcinoma
Sputum examination - Cytology
Best diagnosis method in case of Bronchogenic carcinoma
Bronchoscopy + Biopsy - Histopathological exam - Histochemistry
Central lung cancer have strong association with
Smoking
Good prognosis
Central lung cancer have strong association with
Smoking
Good prognosis
Peripheral lung cancer is more common in
Non - smokers
Important microscopical finding of Squamous cell carcinoma 0f lung
Keratin formation
Finding on electron microscopy in Squamous cell carcinoma of lung
Intracellular bridges
Finding on electron microscopy in Squamous cell carcinoma of lung
Intracellular bridges
Immunohistochemistry markers in Squamous cell carcinoma of lung
P63 +ve
P40 +ve
TTF - 1 And NAPSIN -ve
Immunohistochemistry markers in Squamous cell carcinoma of lung
P63 +ve
P40 +ve
TTF - 1 And NAPSIN -ve
Most common lung cancer in southeast Asian countries particulary india
Squamous cell carcinoma of lungs
Most common lung cancer in southeast Asian countries particulary india
Squamous cell carcinoma of lungs
Prognosis of squamous cell carcinoma
Best prognosis
Adenocarcinoma of lung biopsy findings
Presence of gland like structure or Mucir + on biopsy tissues
Adenocarcinoma of lung biopsy findings
Presence of gland like structure or Mucir + on biopsy tissues
Immunohistochemistry markers in Adenocarcinoma of lung
TTF-1 +ve
NAPSIN +ve
P63/P40 -ve
Immunohistochemistry markers in Adenocarcinoma of lung
TTF-1 +ve
NAPSIN +ve
P63/P40 -ve
Most common lung cancer globally
Adenocarcinoma of lung
Which lung cancer is more common in male smokers
Squamous cell carcinoma of lungs
Which lung cancer is more common in females
Adenocarcinoma of lung
Which lung cancer is more common in females
Adenocarcinoma of lung
Location of Adenocarcinoma of lung
Peripheral location
Lung cancer associated with asbestos
Adenocarcinoma of lung
Lung cancer associated with asbestos
Adenocarcinoma of lung
Small cell carcinoma is
High grade neuroendocrine tumor
Small cell carcinoma is
High grade neuroendocrine tumor
Nuclear features in small cell carcinoma
Amount of chromatin increased
Cytoplasm decreased
Nuclear moulding
Salt and pepper chromatin
Azzopardi effect can be seen which lung cancer
Small cell carcinoma
Basophilic staining
Immunohistochemistry markers in small cell carcinoma
Synaptophysin / CD 56 +ve
Chromogranin, BCL-2 overexpression
Immunohistochemistry markers in small cell carcinoma
Synaptophysin / CD 56 +ve
Chromogranin, BCL-2 overexpression
Small cell carcinoma strongly associated with
Smoking
Not seen in Non-smokers
Location of small cell carcinoma of lung
Central in location
Males M.C
Most aggressive type of lung cancer
Small cell carcinoma - Micrometastasis(invisible metastasis)
Most aggressive type of lung cancer
Small cell carcinoma - Micrometastasis(invisible metastasis)
Which lung cancer is highly chemotherapy or radiosensitive
Small cell carcinoma - max response but due to Micrometastasis have worst prognosis
Which lung cancer is highly chemotherapy or radiosensitive
Small cell carcinoma - max response but due to Micrometastasis have worst prognosis
Neurosecretory granules seen in small cell carcinoma secrets
Secrets hormone like substances - Max paraneoplastic syndromes
Paraneoplastic syndromes in small cell carcinoma
ACTH like - Cushing Syndrome
ADH like - SIADH (Syndrome of inappropriate antidiuretic hormone)
Secretion of calcitonin - Hypocalcemia
Paraneoplastic syndromes in small cell carcinoma
ACTH like - Cushing Syndrome
ADH like - SIADH (Syndrome of inappropriate antidiuretic hormone)
Secretion of calcitonin - Hypocalcemia
Diagnosis of Large cell carcinoma is
Diagnosis of exclusion - Keratin X
Glands/mucin X
Neurosecretory granules X
In Large cell carcinoma tumor cell secretes
Estrogen like substances - Gynecomastia
In Large cell carcinoma tumor cell secretes
Estrogen like substances - Gynecomastia
Metastasis of Bronchogenic carcinoma
Adrenal gland
CNS
Liver
Bones
LN
Paraneoplastic syndromes seen in Squamous cell carcinoma
Hypercalcemia
Paraneoplastic syndromes seen in Squamous cell carcinoma
Hypercalcemia
Paraneoplastic syndromes seen in Small cell carcinoma
Cushing’s Syndrome
SIADH
Paraneoplastic syndromes seen in Adenocarcinoma of lungs
Clubbing
DIC/Trosseau sign/NBTE
Lambert Eaton Syndrome
Small cell carcinoma
Autoantibodies against pre synaptic calcium cells
Treatment of Squamous cell carcinoma of lungs
Nivolimab
Treatment of Squamous cell carcinoma of lungs
Nivolimab
Treatment of Adenocarcinoma of lung
Bivacizumab
Gefitinib
Erlotinib
Treatment of Adenocarcinoma of lung
Bivacizumab
Gefitinib
Erlotinib
Type of pleural Tumors
Primary
Secondary (Metastasis)
Type of pleural Tumors
Primary
Secondary
Types of Primary pleural Tumors
Solitary fibrous tumor (Benign mesothelioma)
Malignant Mesothelioma
Types of Primary pleural Tumors
Solitary fibrous tumor (Benign mesothelioma)
Malignant Mesothelioma
Most common cause of Secondary pleural Tumors
Lung cancer
Breast cancer
Most common cause of Secondary pleural Tumors
Lung cancer
Breast cancer
Chromosome involved in Solitary fibrous tumor
Chromosome 12 inversion - NAB2 STAT6 Fusion gene
Chromosome involved in Solitary fibrous tumor
Chromosome 12 inversion - NAB2 STAT6 Fusion gene
Immunohistochemistry marker of Solitary fibrous tumor
CD34 +
Immunohistochemistry marker of Solitary fibrous tumor
CD34 +
Risk factors of Malignant mesothelioma
Asbestos (MC) - Amphibole
Radiation exposure
Smoking no association
Risk factors of Malignant mesothelioma
Asbestos (MC) - Amphibole
Radiation exposure
Smoking no association
If History of Asbestos exposure + Smoking there is more chances of which cancer
Bronchogenic carcinoma
If History of Asbestos exposure + Smoking there is more chances of which cancer
Bronchogenic carcinoma
Asbestos exposure is common in which industries
Insulation industries
Malignant mesothelioma is seen after how much year with asbestos exposure
25-45 year
Clinical features of Malignant mesothelioma
Elderly patients (50-60 yrs)
Chest pain
Dyspnea
Pleural effusion
Right lung»_space; left
Clinical features of Malignant mesothelioma
Elderly patients (50-60 yrs)
Chest pain
Dyspnea
Pleural effusion
Right lung»_space; left
Types of Malignant mesothelioma on the basis Microscopic findings in biopsy
Epitheloid type (MC) - 60%
Sarcomatoid type - 20%
Mixed/Biphasic type - 15-20%
On Biopsy Epitheloid type structure
Tubule like structure - Resembles like Adenocarcinoma of lung
Electron microscopy finding in case of Adenocarcinoma of lung
Small microvilli and non branching
Electron microscopy finding in case of Malignant mesothelioma
Villi big in size and branching seen
Immunohistochemistry markers of Malignant mesothelioma
Calretinin ++
WT1 ++
CK5/6 ++
MOC31 –
Best immunohistochemistry marker in Malignant mesothelioma
Calretinin
Best immunohistochemistry marker in Malignant mesothelioma
Calretinin
Pulmonary hamartoma is what type of neoplasm
True neoplasm
Pulmonary hamartoma is what type of neoplasm
True neoplasm
What happens in Pulmonary hamartoma
Respiratory epithelium entrapped into nodules of mesenchymal tissue
Most common mesenchymal tissues involved in Pulmonary hamartoma
Connective tissue
Fat cells
Smooth cells
Cartilage
Translocation seen in Pulmonary hamartoma
t(3;12)
Incidental finding on Xray and CT scan in Pulmonary hamartoma
Popcorn calcification
Incidental finding on Xray and CT scan in Pulmonary hamartoma
Popcorn calcification
Treatment of Pulmonary hamartoma
Surgical excision
Inflammatory myofibroblastic tumor is common in
Childrens
Inflammatory myofibroblastic tumor is common in
Childrens
Which gene activates in Inflammatory Myofibroblastic tumor
ALK gene
Clinical features of Inflammatory myofibroblastic tumor
Fever in children
Cough
Hemoptysis
Grossly findings in Inflammatory Myofibroblastic tumor
Peripheral firm mass - Ca
Microscopical findings in Inflammatory Myofibroblastic tumor
Spindle shaped cells(Myoblasts or Myofibroblasts)
+
Lymphocytes/Plasma cells