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Term 4 - RHS : Pulmonary path > Path 5 (lung Neoplasms ) > Flashcards

Path 5 (lung Neoplasms ) Flashcards

1
Q

Pathogenesis of lung cancer

A

-smoking
-industrial exposure and air pollution
-asbestos exposure (uranium exposure as well )

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2
Q

Small cell carcinogen Pathogenesis

A

• Rb mutations
• P53 mutations
• 3p deletions (~90%)
• Myc amplifications

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3
Q

Adenocarcinoma Pathogenesis

A

• EGFR mutations
• KRAS mutations
• ALK rearrangements
• ROS1 mutations
-Non smokers

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4
Q

Squamous cell carcinoma Pathogenesis

A

-P53 mutations
-3p deletions
-CDKN2a/p16 mutations
-FGFR1 amplifications

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5
Q

Pancoast tumour

A

• Wasting of hand muscles, pain in arms (ulnar nerve)
• Horner syndrome
• Compression of blood vessels à Edema
• Recurrent laryngeal nerve paralysis
• Esophagus involvement -dysphagia
• Thoracic duct obstruction - chylothorax
-apical neoplasm - invasion of brachial or cervical sympathetic plexus

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6
Q

SVC syndrome

A

Venous congestion and edema of the head and arm

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7
Q

Horner syndrome

A

-cervical sympathetic plexus damaged
-ipsilateral enophtalmos , ptosis , miosis , anhidrosis

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8
Q

Paraneoplastic syndromes

A

• Earliest manifestation of occult (hidden) neoplasm

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9
Q

Squamous cell carcinoma - paraneoplastic syndromes

A

-hypercalcemia (parathyroid hormone related peptide )

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10
Q

Small cell carcinoma - paraneoplastic syndromes

A

-Cushings syndrome
-syndrome of inappropriate ADH secretion
-Myasthenic like syndrome ( lambert Eaton syndrome )

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11
Q

Adenocarcinoma clinical features

A

-women and non smokers
- over 45 years of age
-more peripheral
-grow slowly

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12
Q

Adenocarcinoma- pre invasive lesions

A

-Adenocarcinoma in situ
-atypical adenomatous hyperplasia with cuboidal epithelium and mild interstitial fibrosis
-lipidic pattern
-ground glass appearance

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13
Q

Minimally invasive Adenocarcinoma

A

-Size < 3 cm
-stromal invasion < 5mm
-no pleural or lymph vascular invasion

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14
Q

Invasive carcinoma

A

-Stromal invasion
-pleural/lymphovascular invasion
-different histological types
-majority express TTF1

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15
Q

Squamous cell carcinoma clinical features

A

-central
- more in men
-smoking history
-Spreads to hilar lymph nodes
• Extra-thoracic spread is later than other histologic types
• Obstruction, atelectasis, infection
• Central necrosis - CAVITATION
• Progression: Squamous metaplasia -Squamous dysplasia -Squamous cell carcinoma in-situ-Invasive squamous cell carcinoma

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16
Q

Squamous cell carcinoma histo

A

Keratin pearls
Squamous cell differentiation

17
Q

Small cell carcinoma

A

-central > peripheral
-smoking
Paraneoplastic syndrome
-frequent vascular invasion
-early metastasis

18
Q

Small cell carcinoma histo

A

-round ,scant cytoplasm , finely granular chromatin ,fragile ,crush artifacts ,nuclear molding ,extensive necrosis
-azzopardj effect
-frequent mitosis
-chromagranin A dye

19
Q

Large cell carcinoma

A

• Undifferentiated epithelial malignancy
• Lacks features of small cell
• No glandular differentiation
• No squamous differentiation
• Pleomorphic and “bizarre” cells
-poor prognosis

20
Q

Carcinoid tumors

A

-neuroendocrine tumor of the lung
-arises from kulchitsky

21
Q

Carcinoid tumor , typical variant

A

-centrally located
-polyploid growth
-40 y/o age range
-obstruction,cough ,hemoptysis ,infection
-localized ,but can metastize to lymph nodes
-resectable and good prognosis

22
Q

Typical carcinoid histo

A

-regular round nuclei
-salt and pepper chromatin
-absent or rare mitosis and little pleomorphism

23
Q

Atypical carcinoid

A

-Higher militia rate and small Foci of necrosis
-higher incidence of lymph node and distant metastasis and typical carcinodes

24
Q

Carcinoid syndrome

A

-neuropeptides secreted into systemic circulation leading to symptoms
-serotonin , histamine ,bradykinin ,PGs
-episodic attacks :
-vasomotor disturbances (flushes and cyanosis )
-GI hypermotility
-asthma attacks

25
Q

Malignant mesothelioma

A

-malignancy of the pleura , peritonitis or pericardium
-asbestosis risk factor
-

26
Q

Malignant mesothelioma clinical features

A

-chest pain
-dyspnea
-cough/ fatigue

27
Q

Diagnosis of malignant mesothelioma

A

-moderate to large unilateral pleural effusion
-nodular pleural thickening
-enhancement with PET scan

28
Q

Mesothelioma histo

A

-biphasic
-sarcomatoid
-epitheliod

29
Q

Pulmonary Hamartoma

A
  • appears as rounded radio-opacity (coin lesion ) on chest x ray
    Histo : Nodules of connective tissue (cartilage/ fibrous tissue/ fat) along with epithelial clefts.

Term 4 - RHS : Pulmonary path (5 decks)

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