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DT3- EXAM 2 > Lung Tumors Lecture + Cases (6)- Leah* > Flashcards

Lung Tumors Lecture + Cases (6)- Leah* Flashcards

1
Q

Most common lung cancer

A

Adenocarcinoma, doesn’t require history of smoking

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2
Q

Important history questions to ask regarding smoking

A

Pack years + do they inhale

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3
Q

Exposure related risks for lung cancer (4)

A
  • cigarette smoke
  • radiation/ uranium
  • radon (may be in houses; i.e. Basements)
  • asbestos
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4
Q

Type of cancer seen in NON SMOKING FEMALES:

Assc gene and relevance?

A

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)

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5
Q

Three precursor lesions to lung cancer

What cancer does each lesion lead to?

A
  1. Squamous dysplasia/ carcinoma in situ
    (Bronchogenic squamous cell)
  2. Atypical adenomatous hyperplasia/ Adenocarcinoma in situ
    (Adenocarcinoma)
  3. Neuroendocrine cell hyperplasia
    (NE tumors)
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6
Q

Describe squamous dysplasia appearance

A
  • 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

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7
Q

Describe the appearance of atypical adenomatous hyperplasia

How large are these lesions?

A

Thickened alveolar septae (cuboidal cells) with minimal mitoses.

*Often small lesions; incidental finding

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8
Q 
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?
A

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!

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9
Q

Squamous cell ca:
Population effected
Common location
2 sequelae

A

Male smokers
Central/HILAR cavitations (w/ necrosis + cavitation)

Sequelae:

  1. pleural effusions without tumor cells
  2. ^^Ca (tumors secrete PTHRP–paraneoplastic syndrome)
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10
Q

Three buzzwords to describe the Histo for squamous cell:

A
  • intracellular bridges
  • tadpole cells
  • +/- keratin pearls

**but note that “poorly differentiated” forms do exist!

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11
Q

Genes related to squamous cell?

A

P53 + other tumor suppressor or FGFR1***

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12
Q

Adenocarcinoma

  • assc population
  • location of lesions
  • mets?
A
  • non smoking females
  • peripheral lesions
  • mets early, mets widely
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13
Q

Three Histo findings to assc with Adenocarcinoma

1 cell type, 1 pattern, 1 stain

A
  • glands
  • lepidic growth (butterflies= cancer, wire=septae)
  • TTF1 + staining
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14
Q

Progression to Adenocarcinoma

3 stages

A
  1. Mucinous/nonmucinous Adenocarcinoma in situ: 3cm, noninvasive
  2. Microinvasive AC: ~5 mm of invasion
  3. Adenocarcinoma
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15
Q

Describe the two types of Adenocarcinoma in situ + which is most dangerous?

A

Mucinous: columnar cells with mucin; ^^^ spread = DANGER

Nonmucinous: cuboidal cells without much spread

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16
Q

Two genes assc with Adenocarcinoma?

What are their implications?

A

EGFR- nonsmoking females; can treat with TKi = better prognosis (eGFr- Good Females)

KRAS- (KRAzy Smokers) Can’t give TKi= bad prognosis.

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17
Q

Large cell carcinoma:
How do you diagnose?
Two components?

A

Diagnosis of exclusion.

Poorly differentiated cells with squamous + glandular components (bx similar to adenocarcinoma)

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18
Q

Small cell carcinoma:

What is the risk and where are the lesions?

A

Small cell + Squamous cell have Sentral lesions and are caused by Smoking (SSSSSSSSS thumbs up)

Remember: most aggressive, no surgery (too small to see!)

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19
Q

4 buzzwords for small cell carcinoma Histo

A
  1. Salt and pepper chromatin
  2. Absent nucleoli
  3. Nuclear molding and crush artifacts (hug, then break up)
  4. Basophilic vascular walls (Due to DNA in necrotic cells)
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20
Q

Most common gene affected in small cell

A

^^myc amplification.

But can also be tumor suppressors

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21
Q

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?

A

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)

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22
Q

List the Paraneoplastic Syndromes Associated with the following:
Carcinoid tumor (1)
Squamous cell tumor (1)
Small cell (3)

A

Carcinoid: Serotonin storm = Diarrhea, bronchospasm, flushing (Neuroendocrine Tumor)

Squamous cell: PTHRP –> Ca ^^^

Small cell: Cushings// SiADH// lambert Eaton

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23
Q

Four neuroendocrine related lung masses

A
  1. NE hyperplasia
  2. Benign tumorlets (under 5 mm)
  3. Carcinoid (few mitotic figures)
  4. Small cell (lots of mitotic figures)
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24
Q

CD56, synaptophysin, and chromogranin are markers for:

A

NE tumors

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25
Q

Coin lesion composed of cartilage and columnar epi?

A

Hamartoma

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26
Q

Hamartomas: benign or malignant?

Disease assc?

A

Benign; tuberous sclerosis

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27
Q

Lymphangioleiomatosis:

  1. Assc population
  2. Cell type
  3. 2 Histo markers
A
  • Child Bering age females (Sounds like leomyoma!!)
  • Perivascular epithelioid cells
    • for SM and melanocytic markers
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28
Q

Lymphangioleiomyomatosis:
Assc gene?
What can it cause?
What might it need?

A

LOF mutation in TSC2 (tubular sclerosing gene)

  • Can cause spontaneous pneumothorax
  • May require transplant.

*Terrible Sickness of Childbearing women= 2 bad!!
(TCS2)

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29
Q 
Inflammatory myofibroblastic tumor: 
What is it? 
Who gets it?
What causes it? 
Presentation?
A

-Plasma cell granuloma (pseduotumor)
-Kids and young adults
-ALK mutation
ALK = preAdulthood Lung Kancer

Presents with cough +/- hemoptysis, fever, chest pain

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30
Q

Most common site in the body for mets?

A

The lung!! Cannonball lesions, usually in periphery

31
Q

To where do lung cancers met?

A

those “Bitches Laugh At Premature Babies + Little Kids!!!”

  • brain
  • liver
  • adrenal (#1)
  • pericardium
  • breasts
  • lung (other one)
  • kidney
32
Q

Lambert Eaton:
Assc cancer and Ab
Treatment that fails
Where is the weakness?

A
  • CaC Ab; small cell
  • no response to AchEi (differentiates it from MG)
  • proximal arm and leg weakness
33
Q

Two cancers that often cause SVC syndrome?

What is the danger here?

A

Lymphomas and carcinomas

Risk CIRCULATORY COLLAPSE

34
Q

How do pancoasts tumors cause horners?

A

They compress the superior cervical ganglia near the lung apex

35
Q

Most common cause of pleural tumors

A

Mets from lung or breast (Secondary tumors)

36
Q

Local growth of fibrous tissue on the visceral pleura?

Benign or melignant?

A

Solitary fibrous tumor! (Typically benign & w/o pleural effusion)

37
Q

Solitary fibrous tumor

2 Histo findings; 2 stains

A
  • Collagen/reticulin whorls
  • Spindle cells
  • CD34+ ; keratin -
38
Q

SOB, pain, flu like sx, pleural effusion with malignant cells……

What do these findings point to?

A

Malignant mesothelioma!!!!

39
Q

Who most commonly gets mesotheliomas?

What are two stains?

A

Males exposed to amphibole asbestos
(2nd most common cause is idiopathic)

  1. CD34 -
  2. Keratin +
40
Q

Relationship between mesothelioma and smoking?

A

Not. There isn’t one. Smoking doesn’t cause mesotheliomas.

41
Q

Gross appearance of mesotheliomas

A

Grey patches and lower lobe and diaphragm

42
Q

Three types of mesothelioma

A

Epithelioid, sarcomatoid, biphasic

43
Q

Epithelioid mesothelioma consists of polyhedral cells in ________

A

Cords/nests

44
Q

Sarcomatoid mesothelioma findings

A

Spindle cells
(Storiform/ fascicle pattern)
Calretinin +

45
Q

What is seen on EM of mesothelioma?
Two stains?

A

Long microvilli; these ARENT seen in adenocarcinomas.

CK5-6

46
Q

Where does mesothelioma met? (4)

A

Nodes, liver, diaphragm/ lung parenchya, etc.

47
Q

Gene assc with mesothelioma?

A

CDK/ INK on chrom 9

48
Q

Describe the prevalence of lung cancers

A

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)

49
Q

Glands + Lepidic Pattern + TTF1 =

A

adenocarcinoma

50
Q

Small cuboidal cells, uniform nucleoli, palisading pattern, little mitoses

What markers would be assc?

A

carcinoid

Synaptophysin; chromagranin

51
Q

Small cells in salt + pepper pattern without nucleoli

A

small cell = synaptophysin

52
Q

Intracellular bridges, keratin pearls, tad pole cells;

What stains would be +?

A

squamous cell

Ck5/6 and p63

53
Q

polyhedral cells in cords and nests;

What the tumor and what stain would be +

A

epithelioid mesothelioma

Ck5,6

54
Q

spindle cells in a storiform pattern; what stain would be +?

A

sarcomatoid mesothlioma –> calreticulin

or solitary fibrous tumor –> for CD34

55
Q

pseudotumor

A

inflammatory myofibroblastic tumor

56
Q

tumor + for CD34 marker, with collagen and reticulin whorls

A

solitary fibrous tumor

57
Q

hamartoma: two tissues

A

cartilage and columnar epi

58
Q

perivascular epithelioid cells

A

Lymphangioleiomyomatosis

59
Q

tumor with both glandular and squamous components

A

large cell carcinoma

60
Q

Stain to identify poorly differentiated squamous cell ca? (2)

A

CK5/6 and p63 will be POSITIVE.

TTF1 will be NEGATIVE.

61
Q

1 lung cancer in women?

A

adenocarcinoma

62
Q

Most common malignant cause of pleural effusion

A

Bronchogenic carcinomas

63
Q

Where can mesothelioma be found?

A

Pleural, pericardial, peritoneal, scrotal cavities

All have mesothelial linings

64
Q

Which type of mesothelioma has the better prognosis?

Which is most common?

A

Epithelioid is far better than sarcomatoid. It’s also more common.

65
Q

Chrysotile is another word for?

A

Serpentine asbestos fibers

66
Q

Virus assc with mesothelioma

A

Simian virus 40

67
Q

What’s a carcinoma?

What’s a sarcoma?

A

Carcinoma- epithelial tumors

Sarcomas- soft tissue tumors

68
Q

“Subpleural” is another word for?

A

Peripheral –> THINK ADENOCARCINOMA

69
Q

Puckering pleura means?

A

Subpleural mass is fibrosed and involving the pleura = bad/late stage

70
Q

1 site lung cancer mets

A

Adrenals

71
Q

What do you see in small cell but not carcinoid?

A

Lots of necrosis and mitotic figures

72
Q

Less than ““2 mitoses/10 something field”” =

A

Carcinoid

73
Q

Carcinoid

A

Benign tumorlet

74
Q

What is azoopardi phenomenon?

A

Perivascular Basophilic appearance –> one of the small cell findings

DT3- EXAM 2 (19 decks)

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