Pathology of Lung Cancer

Question 1

What is the worst type of lung cancer to get?

Answer 1

Small cell carcinoma

Question 2

Squamous cell carcinoma

Answer 2

Most are centrally located
Often cavitate
Resemble normal squamous epithelium with keratin formation and intercellular bridges
Can be well, moderately, or poorly differentiated
Epithelium adjacent to invasive tumor often shows metaplasia, dysplasia, and carcinoma in situ
Easy to get sample (usually)
Smokers

Question 3

Adenocarcinoma

Answer 3

Most are located peripherally, can be central
Most common type in non-smokers
Peripheral tumors associated with pleural puckering
Characterized by gland formation and/or mucin production

Question 4

How can you tell between squamous and adenocarcinoma by histology (in general)?

Answer 4

Squamous: keratin
Adeno: glands, maybe mucin

Question 5

Adenocarcinoma in situ

Answer 5

Also called bronchiolo-alveolar carcinoma

Growth of tumor cels along the surface of alveolar walls and resp bronchioles

Question 6

For adenocarcinoma, how much invasion is okay before you get metastasis?

Answer 6

5 mm or less

Question 7

Small cell carcinoma

Answer 7

Predominately central
Highly malignant
Usually disseminated at time of presentation
Characterized by cells with small oval hyperchromatic nuclei and scanty cytoplasm
Neuroendocrine differentiation of tumor cells

Question 8

Large cell carcinoma

Answer 8

Often peripheral
Large polygonal cells with vesicular nuclei and often predominant nuclei
No specific differentiation on LM
Probably cases of poorly differentiated adenocarcinoma or squamous cell carcinoma

Question 9

P40 and TTF-1 immunohistochem signals for

1. Squamous cell
2. Adeno
3. Small cell

Answer 9

1. +, -
2. -, +
3. -, +

Question 10

Definition
1. EGFR
2. ALK
And what tumor type they’re relevant for

Answer 10

1. Epidermal growth factor receptor (if positive, give TKI)
2. Anaplastic lymphoma kinase
   Depending on which one of these adenocarcinoma is positive for, will impact which drugs to give

Question 11

4 main places that the lung metastasizes to

Answer 11

Adrenals
Liver
Brian
Bone

Question 12

2 main prognostic factors

Answer 12

Stage
Cell type (small cell or non-small cell)

Question 13

5 year survival for lung cancer

Answer 13

Between 5 and 15%

Question 14

TNM staging

Answer 14

T: extent of local disease
N: lymph node status
M: distant metastatic disease

Question 15

Metastatic tumor to the pleura usually comes from which 2 places

Answer 15

Lung

Breast

Question 16

Malignant mesothelioma

Answer 16

Primary neoplasm of the pleural
Associated with asbestos exposure
Encases the whole lung and invades the thoracic wall structures
Associated with recurrent or persistent pleural effusion and severe chest pain
Poor prognosis