Pathology 4

Question 1

lung tumors=

Answer 1

benign and primary malignant neoplasms

Question 2

pleural tumors=

Answer 2

benign and malignant neoplasms

Question 3

most malignant lesions in lung are:

Answer 3

-mets from other cancers = CANNON BALL LESIONS

Question 4

most common benign lesons?

Answer 4

• granulomas

- chronic pneumonia and abscess

Question 5

pulmonary hamartoma

Answer 5

• common BENIGN tumor
• PERIPHERAL
• asymptomatic and slow growing
• can appear as a “coin lesion”

Question 6

• Majority of primary (bronchogenic) lung tumors are:

- peak incidence:

Answer 6

• carcinomas
• 50s and 60s

MALES=FEMALES

Question 7

Lung cancer symptoms:

Answer 7

• COUGH
• WL
• DYSPNEA

Question 8

bloody pleural efusion in patient >40yrs… thikn?

Answer 8

cancer

Question 9

non-inflam plueral effusions:

Answer 9

• hydrothorax=serous fluid; usually caused by cardiac failure
• hemothorax=blood in pleural space; usually ruptured aneurysm, vascular trauma, or cancer
• chylothorax=lymphatic obstruction; thoracic duct injury

Question 10

Paraneoplastic syndromes

Answer 10

• common with lung cancers
• ex) squamous cell carcinoma = hypercalcemia (PTH, prostaglandin E)
• ex) small cell carcinoma - neuroendocrine cells so more syndromes (cushings, inappropriate ADH secretion, carcinoid…)

Question 11

Other lung cancer systemic manifestations:

Answer 11

1) lambert-eaton myasthenic syndrome= muscle weakness due to autoantibodies
2) peripheral neuropathy=purely sensory
3) acanthosis nigricans=dermatologic
4) leukemoid reactions=hematologic
5) hypertrophic pulmonary osteoarthropathy = clubbing of fingers

Question 12

Pancoast tumor

Answer 12

• UPPER LOBES
• grows directly into brachial plexus
• arm pain
• Horners syndrome (8th nerve screwed) possible
• superior vena cava syndrome

Question 13

Horners syndrome

Answer 13

(pancoast tumor)

• enophthalmos
• ptosis of upper eyelid
• miosis
• anhidrosis

Question 14

most important factor in cancers?

Answer 14

-SMOKING

Question 15

most common mutation in lung cancers?

Answer 15

-p53

Question 16

precursor lesions to lung cancer:

Answer 16

• squamous dysplasia and carcinoma in situ
• atypical adenomatous hyperplasia
• diffuse idiopathic neuroendocrine cell hyperplasia

Question 17

TUmor classification -

Answer 17

1) adenocarcinoma - More females
2) squamous cel carcinoma -more males
3) small cell carcinoma - more females
4) large cell carcinoma - more males

Question 18

treatment of cancer is based on?

Answer 18

-classifications

so we have:

• nonsmall cell carcinomas (adeno, squamous, large) 70-75%
• small cell
• some other combined patterns

Question 19

adenocarcinomas

Answer 19

• most common
• increasing incidence
• gland formaton–> mucin production (MUCIN = MORE AGGRESSIVE)
• frequent desmoplastic response

-MOST COMMON LUNG CANCER IN WOMEN, YOUNGER PATIENTS AND NON-SMOKERS (SMOKERS STILL COMMONLY GET THIS)

Question 20

adenocarcinomas - genes involved:

Answer 20

-KRAS and EGFR mutations

Question 21

Adenocarcinoma

Answer 21

• PERIPHERAL with scars sometimes

- slow growing and mets early

Question 22

2 froms of adenocarcinoma

Answer 22

• bronchial derived

- brochioloalveolar - origin=bronchioloalveolar stem cell; lepidic growth patter (no invasion- but grows along walls)

Question 23

Bronchioloalveolar -

-precursor lesions:

Answer 23

-atypical adenomatous hyperplasia (AAH) - monoclonal

Question 24

squamous cell carcinoma

Answer 24

• CLOSE CORRELATION WITH SMOKING
• CENTRAL ( IN OR NEAR HILUS)
• MEN!!v
• produced KERATIN!!!!!!

-grows rapid and mets slowly

Question 25

squamous cell carcinoma- genes

Answer 25

hgih frequency of p53 mutation and EGFR overexpression

Question 26

adeno vs squamous cell ca?

Answer 26

- adeno grows more slowly but mets early | - squamous grows rapidly but mets slowly

Question 27

Squamous cell Ca - clinical features:

Answer 27

- bloody sputum - cough - obstruction symptoms - pneumonia reccurent - atelectasis

Question 28

Squamous cell Ca- related syndromes:

Answer 28

- superior vena cava syndrome | - pancoast tumor

Question 29

squamous cell Ca -histology==

Answer 29

intercellular bridges | keratin pearl formation!

Question 30

small cell ca-

Answer 30

MOST MALIGNANT - more males - SMOKING!!!!!!! - highly aggressive- rapid growing early mets - surgery not helpful - CHEMO IS CHOICE -paraneoplastic syndromes!!!!!!

Question 31

small cell carcin - genes

Answer 31

c-MYC | -RB1

Question 32

small cell Ca- histology:

Answer 32

- little cytoplasm | - OAT CELL CARCINOMA - round to oval cells

Question 33

LArge cell Ca-

Answer 33

DIAGNOSIS OF EXCLUSION - UNDIFFERENTIATED - poor prognosis - many variants - GIANT CELLS

Question 34

secondary patholgoy due to lung cancer:

Answer 34

- changes occur distal to tumor! - partial obstruction= focal emphysema - complete obstruction = atelectasis - severe bronchitis, bronchiectasis, pulmoanry abscess - post obstructive pneumonia

Question 35

MOST AGGRESSIVE?

Answer 35

SMALL CELL

Question 36

MOST FAVORABLE?

Answer 36

-bronchioalveolar

Question 37

most common mets?

Answer 37

- LN most!! - adrenal - liver - brain - bone

Question 38

lugn cancer causes of death:

Answer 38

- PNEUMONIA - lung abscess - bleeding - esophago-pleural fistula - met effects on other organs

Question 39

neuroendocrine prognosis?

Answer 39

-pretty good - 90-95% curable via surgery

Question 40

carcinoid syndrome:

Answer 40

- intermittent: diarrhea, flushing, bronchoconstriction, cyanosis - SEROTONIN PRODUCTION -GREAT SURVIVAL for TYPICAL