Lung Tumors Lecture + Cases (6)- Leah* Flashcards
Most common lung cancer
Adenocarcinoma, doesn’t require history of smoking
Important history questions to ask regarding smoking
Pack years + do they inhale
Exposure related risks for lung cancer (4)
- cigarette smoke
- radiation/ uranium
- radon (may be in houses; i.e. Basements)
- asbestos
Type of cancer seen in NON SMOKING FEMALES:
Assc gene and relevance?
This doesn’t only apply to Adenocarcinoma; but it frequently describes Adenocarcinoma.
Linked to EGFR gene.
(EGFR): Every Good Female Rejects cigarettes!
Means they can be treated with Tyrosine kinase inhibitors (better prognosis)
Three precursor lesions to lung cancer
What cancer does each lesion lead to?
- Squamous dysplasia/ carcinoma in situ
(Bronchogenic squamous cell) - Atypical adenomatous hyperplasia/ Adenocarcinoma in situ
(Adenocarcinoma) - Neuroendocrine cell hyperplasia
(NE tumors)
Describe squamous dysplasia appearance
- Full thickness of atypical epi cells w/ ^ mitosis in the bronchial epi
- DOESNT invade BM.
*once it invade the BM, it is then squamous cell carcinoma
Describe the appearance of atypical adenomatous hyperplasia
How large are these lesions?
Thickened alveolar septae (cuboidal cells) with minimal mitoses.
*Often small lesions; incidental finding
Small cell vs non small cell: Which mets more often? Which is surgically resected? Which is treated with chemo? Which is 100% related to smoking?
More mets- small cell
Surgical resection- non small cell
Chemo/radiation- small cell
100% smoking- small cell
*way to remember the surgery thing…..
Pretend that small cells are super small so surgeons cannot see them! Can’t cut them out if they cannot see them!
Squamous cell ca:
Population effected
Common location
2 sequelae
Male smokers
Central/HILAR cavitations (w/ necrosis + cavitation)
Sequelae:
- pleural effusions without tumor cells
- ^^Ca (tumors secrete PTHRP–paraneoplastic syndrome)
Three buzzwords to describe the Histo for squamous cell:
- intracellular bridges
- tadpole cells
- +/- keratin pearls
**but note that “poorly differentiated” forms do exist!
Genes related to squamous cell?
P53 + other tumor suppressor or FGFR1***
Adenocarcinoma
- assc population
- location of lesions
- mets?
- non smoking females
- peripheral lesions
- mets early, mets widely
Three Histo findings to assc with Adenocarcinoma
1 cell type, 1 pattern, 1 stain
- glands
- lepidic growth (butterflies= cancer, wire=septae)
- TTF1 + staining
Progression to Adenocarcinoma
3 stages
- Mucinous/nonmucinous Adenocarcinoma in situ: 3cm, noninvasive
- Microinvasive AC: ~5 mm of invasion
- Adenocarcinoma
Describe the two types of Adenocarcinoma in situ + which is most dangerous?
Mucinous: columnar cells with mucin; ^^^ spread = DANGER
Nonmucinous: cuboidal cells without much spread
Two genes assc with Adenocarcinoma?
What are their implications?
EGFR- nonsmoking females; can treat with TKi = better prognosis (eGFr- Good Females)
KRAS- (KRAzy Smokers) Can’t give TKi= bad prognosis.
Large cell carcinoma:
How do you diagnose?
Two components?
Diagnosis of exclusion.
Poorly differentiated cells with squamous + glandular components (bx similar to adenocarcinoma)
Small cell carcinoma:
What is the risk and where are the lesions?
Small cell + Squamous cell have Sentral lesions and are caused by Smoking (SSSSSSSSS thumbs up)
Remember: most aggressive, no surgery (too small to see!)
4 buzzwords for small cell carcinoma Histo
- Salt and pepper chromatin
- Absent nucleoli
- Nuclear molding and crush artifacts (hug, then break up)
- Basophilic vascular walls (Due to DNA in necrotic cells)
Most common gene affected in small cell
^^myc amplification.
But can also be tumor suppressors
What type of tumor is a carcinoid tumor?
Who gets carcinoid tumors?
What’s the Histo pattern?
What are two differences between typical and atypical carcinoids?
Neuroendocrine Tumor
Middle aged smokers (under 40) both sexes
Small cells with uniform nucleoli and typically no mitoses
Typical carcinoids: no necrosis, less mitosis
Atypical carcinoids: necrosis, more mitosis (still not lots)
List the Paraneoplastic Syndromes Associated with the following:
Carcinoid tumor (1)
Squamous cell tumor (1)
Small cell (3)
Carcinoid: Serotonin storm = Diarrhea, bronchospasm, flushing (Neuroendocrine Tumor)
Squamous cell: PTHRP –> Ca ^^^
Small cell: Cushings// SiADH// lambert Eaton
Four neuroendocrine related lung masses
- NE hyperplasia
- Benign tumorlets (under 5 mm)
- Carcinoid (few mitotic figures)
- Small cell (lots of mitotic figures)
CD56, synaptophysin, and chromogranin are markers for:
NE tumors
Coin lesion composed of cartilage and columnar epi?
Hamartoma
Hamartomas: benign or malignant?
Disease assc?
Benign; tuberous sclerosis
Lymphangioleiomatosis:
- Assc population
- Cell type
- 2 Histo markers
- Child Bering age females (Sounds like leomyoma!!)
- Perivascular epithelioid cells
- for SM and melanocytic markers
Lymphangioleiomyomatosis:
Assc gene?
What can it cause?
What might it need?
LOF mutation in TSC2 (tubular sclerosing gene)
- Can cause spontaneous pneumothorax
- May require transplant.
*Terrible Sickness of Childbearing women= 2 bad!!
(TCS2)
Inflammatory myofibroblastic tumor: What is it? Who gets it? What causes it? Presentation?
-Plasma cell granuloma (pseduotumor)
-Kids and young adults
-ALK mutation
ALK = preAdulthood Lung Kancer
Presents with cough +/- hemoptysis, fever, chest pain
Most common site in the body for mets?
The lung!! Cannonball lesions, usually in periphery
To where do lung cancers met?
those “Bitches Laugh At Premature Babies + Little Kids!!!”
- brain
- liver
- adrenal (#1)
- pericardium
- breasts
- lung (other one)
- kidney
Lambert Eaton:
Assc cancer and Ab
Treatment that fails
Where is the weakness?
- CaC Ab; small cell
- no response to AchEi (differentiates it from MG)
- proximal arm and leg weakness
Two cancers that often cause SVC syndrome?
What is the danger here?
Lymphomas and carcinomas
Risk CIRCULATORY COLLAPSE
How do pancoasts tumors cause horners?
They compress the superior cervical ganglia near the lung apex
Most common cause of pleural tumors
Mets from lung or breast (Secondary tumors)
Local growth of fibrous tissue on the visceral pleura?
Benign or melignant?
Solitary fibrous tumor! (Typically benign & w/o pleural effusion)
Solitary fibrous tumor
2 Histo findings; 2 stains
- Collagen/reticulin whorls
- Spindle cells
- CD34+ ; keratin -
SOB, pain, flu like sx, pleural effusion with malignant cells……
What do these findings point to?
Malignant mesothelioma!!!!
Who most commonly gets mesotheliomas?
What are two stains?
Males exposed to amphibole asbestos
(2nd most common cause is idiopathic)
- CD34 -
- Keratin +
Relationship between mesothelioma and smoking?
Not. There isn’t one. Smoking doesn’t cause mesotheliomas.
Gross appearance of mesotheliomas
Grey patches and lower lobe and diaphragm
Three types of mesothelioma
Epithelioid, sarcomatoid, biphasic
Epithelioid mesothelioma consists of polyhedral cells in ________
Cords/nests
Sarcomatoid mesothelioma findings
Spindle cells
(Storiform/ fascicle pattern)
Calretinin +
What is seen on EM of mesothelioma?
Two stains?
Long microvilli; these ARENT seen in adenocarcinomas.
CK5-6
Where does mesothelioma met? (4)
Nodes, liver, diaphragm/ lung parenchya, etc.
Gene assc with mesothelioma?
CDK/ INK on chrom 9
Describe the prevalence of lung cancers
Declining along with smoking but still #1 cause cancer deaths
2nd most common in terms of incidence (breast and prostate are leading)
Closely assc to cigarette smoking (esp squamous and small cell)
Glands + Lepidic Pattern + TTF1 =
adenocarcinoma
Small cuboidal cells, uniform nucleoli, palisading pattern, little mitoses
What markers would be assc?
carcinoid
Synaptophysin; chromagranin
Small cells in salt + pepper pattern without nucleoli
small cell = synaptophysin
Intracellular bridges, keratin pearls, tad pole cells;
What stains would be +?
squamous cell
Ck5/6 and p63
polyhedral cells in cords and nests;
What the tumor and what stain would be +
epithelioid mesothelioma
Ck5,6
spindle cells in a storiform pattern; what stain would be +?
sarcomatoid mesothlioma –> calreticulin
or solitary fibrous tumor –> for CD34
pseudotumor
inflammatory myofibroblastic tumor
tumor + for CD34 marker, with collagen and reticulin whorls
solitary fibrous tumor
hamartoma: two tissues
cartilage and columnar epi
perivascular epithelioid cells
Lymphangioleiomyomatosis
tumor with both glandular and squamous components
large cell carcinoma
Stain to identify poorly differentiated squamous cell ca? (2)
CK5/6 and p63 will be POSITIVE.
TTF1 will be NEGATIVE.
1 lung cancer in women?
adenocarcinoma
Most common malignant cause of pleural effusion
Bronchogenic carcinomas
Where can mesothelioma be found?
Pleural, pericardial, peritoneal, scrotal cavities
All have mesothelial linings
Which type of mesothelioma has the better prognosis?
Which is most common?
Epithelioid is far better than sarcomatoid. It’s also more common.
Chrysotile is another word for?
Serpentine asbestos fibers
Virus assc with mesothelioma
Simian virus 40
What’s a carcinoma?
What’s a sarcoma?
Carcinoma- epithelial tumors
Sarcomas- soft tissue tumors
“Subpleural” is another word for?
Peripheral –> THINK ADENOCARCINOMA
Puckering pleura means?
Subpleural mass is fibrosed and involving the pleura = bad/late stage
1 site lung cancer mets
Adrenals
What do you see in small cell but not carcinoid?
Lots of necrosis and mitotic figures
Less than ““2 mitoses/10 something field”” =
Carcinoid
Carcinoid
Benign tumorlet
What is azoopardi phenomenon?
Perivascular Basophilic appearance –> one of the small cell findings
