Path Flashcards
1
Q
What percent of coin lesions are malignant?
A
35-49%
2
Q
What percent of coin lesions are benign?
A
51-65%
3
Q
What are the two common cancerous form of coin lesions?
A
Bronchogenic carcinoma
Secondary met
4
Q
What is the common benign form of coin lesions?
A
- Granulomas
- Chronic pneumonia and abscess
5
Q
What organs of the body generally send mets to the lungs? (4)
A
Breast
Stomach
Pancreas
Colon
6
Q
What are hamartomas of the lung? Where in the lung are they found? Are they usually symptomatic?
A
- Benign collection of tissue
- Usually found peripherally
- Usually asymptomatic
7
Q
What is the most common form of primary lung cancer? Is this the same as the most common?
A
Carcinomas of the lung
secondary mets are more common
8
Q
What age group is usually affected with bronchogenic carcinomas?
A
50s and 60s
9
Q
What is the prognosis of bronchogenic carcinomas?
A
15% 5 year survival rate
10
Q
What are the three usual ssx of bronchogenic carcinoma?
A
- cough
- Weight loss
- Dyspnea
11
Q
What are the top 4 causes of pleural exudates?
A
- Microbial invasion
- Cancer
- Pulmonary infection
- Viral pleuritis
12
Q
At what age are pleural exudate concerning for cancer?
A
Greater than 40 y/o
13
Q
What are the three types of pleural effusions, and which ones are usually associated with cancers?
A
Hydrothorax
Hemothorax*
Chylothorax*
14
Q
How do you diagnose lung cancer?
A
Sputum cytology
Fine needle aspiration
15
Q
What percent of patients with lung cancer have paraneoplastic syndrome?
A
1-10%
16
Q
True or false: Lung cancer is generally not resectable
A
True
17
Q
What type of lung cancer is classically associated with paraneoplastic syndrome?
A
SCLC
18
Q
What is the paraneoplastic syndrome caused by increased secretion of ACTH?
A
Cushing’s syndrome
19
Q
What is the paraneoplastic syndrome caused by increased secretion of ADH?
A
SIADH
20
Q
What is the paraneoplastic syndrome caused by increased secretion of 5HT and bradykinin?
A
carcinoid syndrome
21
Q
What are the two chemicals that paraneoplastic carcinomas secrete to produce hypercalcemia?
A
PTH
Prostaglandin E
22
Q
What is the paraneoplastic syndrome caused by increased secretion of calcitonin?
A
Hypocalcemia
23
Q
What is the paraneoplastic syndrome caused by increased secretion of gonadotropin?
A
Gynecomastia
24
Q
What type of lung neoplasm usually causes paraneoplastic syndrome characterized by hypercalcemia
A
Squamous cell CA
25
What is the etiology of Lambert-Eaton syndrome?
increased secretion of autoantibodies against ACh receptors (can be caused by paraneoplastic syndrome)
26
What is the type of neuropathy that can occur with paraneoplastic syndrome?
Peripheral
27
What is the dermatologic symptom commonly caused by paraneoplastic syndrome?
Acanthosis Nigricans
28
What is the hematologic symptom commonly caused by paraneoplastic syndrome?
Leukemoid reaction
29
What is hypertrophic pulmonary osteoarthropathy? What type of lung cancer is this commonly seen in?
A medical condition combining clubbing and periostitis of the small hand joints, especially the distal interphalangeal joints. The condition may occur alone (primary), or it may be secondary to diseases like lung cancer. It is especially associated with non-small cell lung carcinoma.
30
What are the spinal nerves that are commonly affected with a pancoast tumor?
T1
T2
C8
31
What bones are commonly destroyed with a pancoast tumor?
1st and 2nd ribs
32
What type of tumors are pancoast tumors?
Usually squamous cell CA
33
What is the major vascular pathology that a pancoast tumor can cause?
SVC syndrome
34
What percent of lung cancer are smoking related?
90%
35
What is the relation between frequency of CA and pack years?
Linear
36
How many carcinogenic substances are found in cigarettes?
Over 1200
37
What are the industrial hazards that predispose to lung CA?
Asbestos
Ionizing radiation
Roofers
38
What is the element that causes lung cancer?
Ra
39
What are the precursor lesions to lung cancer? (3)
- Squamous dysplasia
- Atypical adenomatous hyperplasia
- Diffuse idiopathic neuroendocrine cell hyperplasia
40
What are the four major types of lung cancer?
Adenocarcinoma
Squamous cell CA
Small cell CA
Large cell CA
41
Which type of carcinoma never is appropriate for surgery:small cell CA or non-small cell?
Small cell
42
Which of the following is the most common: non-small cell, small cell, or combined
Non-small cell
43
What are the two mutations that are found within adenocarcinomas of the lung?
KRAS
| EGFR
44
What is the the most common lung cancer in young, non-smoking females? Is this more common than in smokers?
Adenocarcinomas
Smokers still have it more often
45
What is the growing/metastatic potential of adenocarcinomas of the lung?
Usually grow slowly
| Metastasizes early
46
What are the two forms of adenocarcinoma?
Bronchial derived and bronchoalveolar
47
What is the primary determinant of survival with lung adenoCA?
Clinical stage
48
What is bronchioloalveolar carcinoma? (where does it start, grow)
Uncommon form of adenoCA that arises in terminal broncholoalveolar regions, and grows along preexisting alveolar walls
49
What are the two types of bronchioloalveolar carcinoma?
Mucinous and nonmucinous
50
What is the precursor lesions with bronchioloalveolar carcinoma?
Atypical adenomatous hyperplasia
51
true or false: by definition there is no stromal, vascular, or pleural invasion with bronchioloalveolar carcinoma
True
52
What is the 5 year survival rate with bronchioloalveolar carcinoma?
42%
53
What is the origin (cell) of bronchioloalveolar carcinoma? What is the normal function of these? Where are they usually located?
bronchioloalveolar stem cells
Stem cells at the bronchoalveolar junction, to replenish normal cell types
54
What are the genetic mutations found in bronchioloalveolar carcinoma?
KRAS and others
55
What is lepidic growth pattern, which can be seen in bronchioloalveolar carcinoma?
Growth along the bronchial walls
56
What percent of squamous cell carcinoma is caused by smoking?
98%
57
Where in the lung is squamous cell carcinoma usually found?
near hilum
58
What is the marker that squamous cell CA produces, and can thus be stained for histologically?
Keratina
59
What are the characteristics of the growth and metastasis rate of squamous cell carcinoma?
Grows rapidly, buts mets slowly
60
What are the two major genetic mutations associated with squamous cell carcinoma?
p53 and EGFR
61
What is the progression of squamous cell carcinoma? (4)
metaplasia
Dysplasia
CIS
Invasive CA
62
What are the usual ssx of squamous cell carcinoma? Why?
Hemoptysis
| Obstruction d/t growth along the bronchi
63
What is the respiratory epithelium?
Ciliated pseudostratified
64
What are the two classic histological findings of squamous cell carcinoma?
keratin pearls
| Intercellular bridges
65
What is the most malignant for of all lung cancers?
Small cell carcinoma
66
In what gender is small cell carcinoma more common in?
Men
67
True or false: small cell lung carcinoma is only loosely correlated with smoking
False--9%
68
What are the genetic mutations that take place with small cell lung carcinoma?
c-Myc
| RB1
69
What is the treatment (generally) for SCLC?
Chemotherapy (NOT surgery)
70
What is the 5 year survival rate with SCLC? mean survival time?
5-10%
| 1 year
71
What are the histological characteristics of SCLC?
Little cytoplasm with high mitotic count
72
What is the cellular origin for SCLC?
Neuroendocrine cell
73
What is the stain that highlights keratin?
Papanikoli
74
Where in the lung is SCLC usually found?
Spreading along the bronchi centrally
75
true or false: large cell CA is usually a diagnosis of exclusion
True
76
What are the histological characteristics of large cell carcinomas?
Anaplastic with vesicular nuclei and prominent nucleoli
Undifferentiated
77
What is the metastatic potential with large cell carcinoma?
High
78
What are the secondary pathologies that occur with primary lung cancers?
- Partial obstruction to total atelectasis
- Bronchitis
- Bronchiectasis
79
Where do changes in the lung occur relative to tumors
Distally
80
What are the primary determinants of operability with lung cancer?
Stage
| Cardiopulmonary status
81
What is a pneumonectomy?
Total lung resection
82
What are the 5 common sites of metastases with lung cancer?
1. Lymph nodes
2. Adrenals
3. Liver
4. Brain
5. Bone
83
What are the common CODs with lung cancer, besides the neoplasm itself?
Pneumonia
Lung abscesses
esophago-pleural fistula
84
What is diffuse idiopathic pulmonary neuroendocrine cell hyperplasia?
rare disorder that may be a precursor to typical or atypical carincoids
85
What are tumorlets?
benign, small clusters of hyperplastic neuroendocrine cells
86
What is the chemical that carcinoid tumors secrete? What are the ssx that this causes?
5HT
| Flushing, diarrhea, fibrosis
87
True or false: there is no relationship between the development of carcinoid tumors of the lung and smoking
True
88
What percent of carcinoid tumors of the lung are resectable?
90-95%
89
What are the histological characteristics of carcinoid tumors?
Uniform small cells in rosettes
90
What is the risk of atypical carcinoid tumors?
Progression to SCLC
91
What is the prognosis of atypical carcinoid tumors?
5-10 years survival rate of 87%
92
What is the major benign tumor of the pleura?
Pleural fibroma
93
What is the major malignant tumor of the pleura?
Malignant mesothelioma
94
True or false: pleural tumors are most often metastatic
True
95
What are pleural fibromas? Is there a relationship to asbestos?
Solitary tumor of the pleural made up of fibroblasts
No relation to asbestos
96
What is malignant mesothelioma?
malignant tumor of mesothelial cells of the visceral or parietal pleura, resulting from asbestosis exposure
97
What is the age group that is most commonly affected with malignant mesothelioma?
40-70 y/o
98
What percent of malignant mesothelioma is asbestosis related? How long does this take to present? What is the prognosis (1 year survival)?
90%
25-40 year
50% 1 year survival
99
What are the three patterns of malignant mesotheliomas?
- Epithelioid (resembles adenoCA)
- Sarcomatoid )like fibrosarcoma)
- Combo
100
What are the ssx of malignant mesothelioma?
Chest pain
Dyspnea
Pleural effusion
