Lung Tumors

Question 1

80% of lung cancers occur in who, and what are the most common types?

Answer 1

• active smokers

- small cell & squamous

Question 2

What are the 3 genes associated with lung cancer?

Answer 2

• activation of KRAS

- inactivation of p53 & Rb

Question 3

broncho-alveolar carcinoma is the precursor for which type of carcinoma?

Answer 3

Adenocarcinoma

Question 4

neuroendocrine cell hyperplasia is the precursor for what type of carcinoma?

Answer 4

small cell carcinoma

Question 5

A patient presents with a hilar, friable spherical mass that is occluding the lumen of the main bronchus. On cut section it is yellowish-white and has foci of necrosis and hemorrhage producing cavities. What could be your diagnosis?

Answer 5

• small cell carcinoma

- squamous cell carcinoma

Question 6

a patient presents with a grayish mucoid mass in a peripheral bronchiole. What could be your diagnosis?

Answer 6

adenocarcinoma

Question 7

A patient with a history of smoking tobacco presents with a mass occluding a large bronchus. On microscopic examination, keratin pearls were seen. On staining, CK5/6 was positive. What is your diagnosis?

Answer 7

Squamous cell carcinoma

Question 8

Keratinization and glandular appearance in characteristic to what type of carcinoma?

Answer 8

adenosquamous carcinoma

Question 9

a patient with a positive TTF-1 stain may have what type of carcinoma?

Answer 9

adenocarcinoma

Question 10

If a patient has an undifferentiated tumor that lacks cytologic features from all other types of carcinomas, what could u diagnose it as?

Answer 10

large cell carcinoma

Question 11

A patient with paraneoplastic syndrome (ectopic hormone production) and positive chromogranin, NSE, and synaptophysin may have what type of carcinoma?

Answer 11

small cell carcinoma

Question 12

What are the first lymph nodes that are gonna get affected?

Answer 12

Hilar lymph nodes the mediastinal then cervical then supraclavicular and lastly para-aortic

Question 13

what are other sites the may get affected?

Answer 13

liver
adrenals
bones
brain

Question 14

What are the most common local symptoms?

Answer 14

cough
chest pain
dyspnea
haemoptysis

Question 15

What diseases occur with ectopic hormone production in paraneoplastic syndrome?

Answer 15

• ACTH: Cushing’s
• ADH: Hyponatremia
• Parathormone: Hypercalcemia
• Calcitonin: Hypocalcemia
• Gonadotropins: Gynecomastia
• Serotonin: Carcinoid syndrome

Question 16

What other types of paraneoplastic syndromes are there?

Answer 16

• neuromuscular: polymyositis, myopathy and peripheral neuropathy
• skeletal: clubbing
• cutaneous: acanthuses nigricans
• cardiovascular: Trousseau’s syndrome
• haematologic: abnormal coagulation

Question 17

What are the 2 neuroendocrine tumors?

Answer 17

small cell & carcinoid tumor

Question 18

a 32 year old patient presented with a collar-button like mass at the major bronchus, on cut section is was yellow tan in color. What is your diagnosis and what microscopic features could be found?

Answer 18

• Carcinoid tumor
• Micro: cuboidal cells forming ribbons separated by fibrous septa
  finely granular cytoplasm
  salt & pepper chromatin

Question 19

Secondary tumors that look like canon-balls at the periphery of the lung may be caused by what?

Answer 19

Metastatic tumors

Question 20

Asbestos bodies are found in which tumor, what does this tumor look like grossly?

Answer 20

• malignant mesothelioma (primary pleural tumor)

- thick layer of soft gelatinous greyish pink tumor tissue

Question 21

where do secondary epithelial tumors metastasize to?

Answer 21

• via lymohatics: breast & lung

- haematogenously: ovaries