Pathology of Lung Cancer

Question 1

What are the methods for diagnosis of Lung masses?

Answer 1

CXR
Spiral CT
MRI
Sputum cytology
Bronchial lavage, brushing
Biopsy

Question 2

What are the most common causes of Coin lesions in the lung?

Answer 2

Granulomas

Chronic Pneumonia and abcess

Question 3

What is the most common malignant cancer of the lung?

Answer 3

Metastatic CA

Question 4

What are the top 4 causes of Pleural Exudates?

Answer 4

Microbial Invasion
Cancer
Pulmonary Infarction
Viral Pleuritis

Question 5

What are the most common Paraneoplastic syndromes from lung cancer?

Answer 5

Cushing Syndrome
Innapropriate ADH
Carcinoid Syndrome
Hypercalcemia
Hypocalcemia
Gynecomastia

Question 6

What are Systemic manifestations of Lung cancer?

Answer 6

Lambert Eaton myasthenic Synd: muscle weakness
Peripheral neuropathy: sensory only
Acanthosis Nigricans: dermatologic
Leukemoid reactions: hematologic 
Hypertrophic Pulmonary
Osteopathy: clubbing

Question 7

What is a Pancoast Tumor?

Answer 7

Direct growth of tumor from lung apex into brachial plexus
8th cervical thoracic nerves
Horner synd: enopthalmous, ptosis, miosis, and anhidrosis

Question 8

What causes Superior VC Syndrome?

Answer 8

Tumor inpinges on Superior VC.

Causes blood to back up into the upper body

Question 9

What are common risk factors for lung cancer?

Answer 9

SMOKING(2nd hand too)
Asbestos exposure
Industrial hazards
Aromatic Hydrocarbons
Radon
Molecular Genetics

Question 10

What are the different types of Non-small cell CA?

Answer 10

AdenoCA
Squamous cell CA
Large Cell CA

Question 11

Waht are the most common gene mutations seen in AdenoCA?

Squamous cell CA?

Answer 11

KRAS and EGFR mutations

p53, RB1, p16

Question 12

What are the 2 types of AdenoCA?

Answer 12

Bronchial Derived and Bronchioloalveolar

Question 13

What is bronchoalveolar CA?

Answer 13

Grows along pre-existing Alveolar Walls, preserves architecture, lepidic
Mucinous and non-mucinous

Question 14

What is the progression seen in Squamous cell CA?

Charicteristics?

Answer 14

Metaplasia > Dysplasia > CIS > Invasive CA
Produces Keratin(pearls)

Question 15

What are the Mutations associated with Small Cell CA?

Answer 15

c-MYC and RB1

Question 16

How is Small Cell CA treated?

Answer 16

Chemo works well against rapidly dividing cells. mean survival is 1 year.

Question 17

What stain is used in Identifying Sq Cell CA?

Answer 17

Papanicolaou (pumpernickle?) stain turns keratin red.

Question 18

What is charicteristic of Large Cell CA?

Answer 18

Anaplastic(large, irregular looking cells)
Undifferentiated cells
Poor prognosis, metastasizes early

Question 19

What are secondary pathologies related to lung cancer?

Answer 19

Change occurs distal to the tumor
Partial obstruction: focal emphasema(total: atelectasis)
Severe bronchitis, bronchiectasis, pulmonary abcess
Post obstructive Pneumonia

Question 20

What are the most common causes of death in Lung Cancer?

Answer 20

Pneumonia
Lung abcess
Bleeding 
Esophago-pleural fistula
Effects of metastases on other organs

Question 21

What are the different Neuroendocrine Tumors associated with lung cancer?

Answer 21

.

Question 22

What are the different pleural tumors?

Answer 22

Benign- pleural fibroma (benign mesothelioma)

Malignant- Malg. Mesothelioma

Question 23

What are the 3 patterns of Malignant Mesothelioma?

Answer 23

Epitheliod (like adenoCA, most common)
Sarcomatoid(like fibrosarcoma)
Combination (biphaic)