Pathology- tumor of the lung

Question 1

What is the most common benign lung tumor?

Answer 1

hamartoma also called coin lesion

Question 2

What does the benign hamartoma consist of:

Answer 2

mature cartilage with fat, fibrous tissue, and blood vessels.

Question 3

Though this benign lung tumor is called a “hamartoma”, what is it truly?

Answer 3

a benign neoplasm

Question 4

What lesion is demonstrated in this image:

Answer 4

lung coin lesion or hamartoma

Question 5

What is the most important cause of cancer-related deaths in industrialized countries?

Answer 5

carcinoma of the lung

Question 6

Which cancer accounts for about one-third of cancer deaths in men, and has become the leading cause of cancer deaths in women as well?

Answer 6

lung carcinoma

Question 7

Which lung lesion the presence of a popcorn-like pattern of calcification?

Answer 7

Coin Lesion - Hamartoma

Question 8

Which carcinomas are by far the most common primary tumors arising in women, in never-smokers, and in individuals younger than 45 years of age?

Answer 8

adenocarcinomas

Question 9

Carcinomas of the lung begin as lesions that typically are firm and gray-white.

• They may arise as intraluminal masses, invade the bronchial mucosa, or form large bulky masses pushing into adjacent lung

Answer 9

small; parenchyma.

note the masses invading from bronchioles into parenchyma

Question 10

Adenocarcinomas may assume a variety of growth patterns, including (gland-forming);

Answer 10

acinar

Question 11

What type of adenocarinoma growth pattern?

Answer 11

acinar (gland-forming)

Question 12

Adenocarcinomas may assume a variety of growth patterns, including acinar (gland-forming); ; mucinous which is often multifocal and may manifest as pneumonia-like consolidation; and solid types.*

Answer 12

papillary (finger-like)

Question 13

Adenocarcinomas may assume a variety of growth patterns, including acinar (gland-forming); papillary; which is often multifocal and may manifest as pneumonia-like consolidation; and solid types.*

Answer 13

mucinous

Question 14

Adenocarcinomas may assume a variety of growth patterns, including acinar (gland-forming); papillary; mucinous which is often multifocal and may manifest as pneumonia-like consolidation; and types.*

Answer 14

solid

Question 15

Answer 15

Squamous cell carcinomas

Squamous cell carcinoma appearing as a central (hilar) mass that is invading contiguous parenchyma.

Question 16

Large cell carcinomas may undergo central necrosis, giving rise to cavitation.

Answer 16

squamous

Question 17

Squamous cell carcinomas often are preceded by the development, over years, of squamous or dysplasia in the bronchial epithelium, which then transforms to carcinoma in situ, a phase that may last for several years.

Answer 17

metaplasia

note: normal on the left and metaplasia on the right

Question 18

Squamous cell carcinomas often are preceded by the development, over years, of squamous metaplasia or in the bronchial epithelium, which then transforms to carcinoma in situ, a phase that may last for several years

Answer 18

dysplasia

note: A = normal; C= metaplasion; D= dysplasia

Question 19

Squamous cell carcinomas often are preceded by the development, over years, of squamous metaplasia or dysplasia in the bronchial epithelium, which then transforms to carcinoma , a phase that may last for several years.

Answer 19

in situ (precedes invasive squamous cell carcinoma)

note: a= normal; c= metaplasia, d= dysplasia, e= in situ, f= invasive squamous cell carcinoma

Question 20

Eventually, the neoplasm reaches a symptomatic stage, when a well-defined tumor mass begins to obstruct the lumen of a major bronchus, often producing distal and infection.

• Simultaneously, the lesion invades surrounding pulmonary substance

Answer 20

atelectasis

note: invasive squamous cell carcinoma

Question 21

Histologically, these tumors range from squamous cell neoplasms showing keratin pearls and intercellular bridges, to poorly differentiated neoplasms exhibiting only minimal squamous cell features.

Answer 21

well-differentiated

note: notice the keratin pearls circled in yellow

this is an example of well-differentiated

Question 22

carcinomas generally appear as pale gray, centrally located masses that extend into the lung parenchyma.

• By the time of diagnosis, most will have to hilar and mediastinal lymph nodes

Answer 22

Small cell lung carcinomas (SCLCs); metastasized

Question 23

SCLCs are composed of relatively small tumor cells with a to fusiform shape, scant cytoplasm, and finely granular chromatin with a salt and pepper appearance.

Answer 23

round

note: round cell circled

Question 24

SCLCs are composed of relatively small tumor cells with a round to fusiform shape, scant cytoplasm, and finely granular chromatin with a salt and pepper appearance.

• The tumor cells are fragile and often show fragmentation and “ ” in small biopsy specimens.

Answer 24

crush artifact

note: the nucleus get crushed together

Question 25

SCLCs are composed of relatively small tumor cells with a round to fusiform shape, scant cytoplasm, and finely granular chromatin with a salt and pepper appearance. * The tumor cells are fragile and often show fragmentation and “crush artifact” in small biopsy specimens. * Nuclear results from close apposition of tumor cells that have scant cytoplasm.

Answer 25

molding ## Footnote **note: cell squished together like a puzzle**

Question 26

SCLCs are composed of relatively small tumor cells with a round to fusiform shape, scant cytoplasm, and finely granular chromatin with a salt and pepper appearance. * The tumor cells are fragile and often show fragmentation and “crush artifact” in small biopsy specimens. * Nuclear molding results from close apposition of tumor cells that have scant cytoplasm. * Numerous mitotic figures and are present

Answer 26

necrosis ## Footnote **note: necrosis outlined on left (light pink)**

Question 27

cell carcinomas are undifferentiated malignant epithelial tumors that lack the cytologic features of neuroendocrine carcinoma, and show no evidence of glandular or squamous differentiation. • The cells typically have large nuclei, prominent nucleoli, and moderate amounts of

Answer 27

Large; cytoplasm.

Question 28

Advanced cancers often extend into the or pericardial space, leading to inflammation and effusions.

Answer 28

pleural

Question 29

Answer 29

small cell carcinoma

Question 30

Carcinoid tumors are malignant tumors composed of cells that contain dense-core neurosecretory in their cytoplasm and, rarely, may secrete hormonally active polypeptides.

Answer 30

granules

Question 31

๏ Most carcinoids originate in main bronchi and grow in one of two patterns: 1. An obstructing , intraluminal mass 2. A mucosal plaque penetrating the bronchial wall, to fan out in the peribronchial tissue.\*

Answer 31

polypoid

Question 32

carcinoids, like those in the intestinal tract, are composed of nests of uniform cells that have regular round nuclei with “salt-andpepper” chromatin, absent/rare mitoses and little pleomorphism.

Answer 32

๏Typical

Question 33

carcinoid tumors display a higher mitotic rate and small areas of necrosis.\*

Answer 33

๏Atypical

Question 34

Malignant is highly related to exposure to airborne asbestos.

Answer 34

mesothelioma

Question 35

What It is a rare cancer of mesothelial cells, usually arising in the parietal or visceral pleura; it also occurs much less commonly in the peritoneum and pericardium?

Answer 35

Malignant mesothelioma

Question 36

The period for developing malignant mesothelioma after the initial exposure is long, often 25 to 40 years.

Answer 36

latent

Question 37

The combination of cigarette smoking and asbestos exposure greatly increases the risk for developing carcinoma, but **does /does not** increase the risk for developing malignant mesothelioma .

Answer 37

lung; does not

Question 38

Malignant mesotheliomas begin in a localized area and over time spread widely, either by growth or by diffuse of pleural surfaces.

Answer 38

contiguous; seeding

Question 39

At autopsy, what malignancy leaves the affected lung typically is ensheathed by a layer of yellow-white, firm, variably gelatinous tumor that obliterates the pleural space.

Answer 39

Malignant mesothelioma

Question 40

Concerning malignant mesothelioma- The neoplasm may directly invade the thoracic wall or the subpleural lung tissue, but distant metastases are **uncommon/ common**?

Answer 40

uncommon

Question 41

Normal mesothelial cells are , giving rise to pleural lining cells as well as the underlying fibrous tissue.

Answer 41

biphasic

Question 42

Similarly, mesotheliomas take on one of three morphologic appearances: 1. , in which cuboidal cells with small papillary buds line tubular and microcystic spaces;\* 2. , in which spindled, occasionally fibroblastic-appearing cells grow in sheets; and 3. , having both sarcomatous and epithelial areas.

Answer 42

Epithelial; Sarcomatous; Biphasic ## Footnote **note: left= epithelial; right= both sarcomatious and biphasic**

Question 43

What are the 3 presenting complaints of Malignant Mesothelioma?

Answer 43

chest pain, dyspnea, and recurrent pleural effusions.

Question 44

Concerining Malignant Mesothelioma, The lung is invaded directly, and there is often metastatic spread to the lymph nodes and, eventually, to the and other distant organs.

Answer 44

hilar; liver

Question 45

What is the prognosis for malignant mesothelioma?

Answer 45

poor- 50% of patients die within 12 months of diagnosis, and few survive over 2 years

Question 46

What is the most common site of metastatic neoplasms?

Answer 46

lung

Question 47

Both and arising anywhere in the body may spread to the lungs via the blood or lymphatics or by direct continuity.\*

Answer 47

carcinomas; sarcomas

Question 48

Concerning metastatic tumors, In the usual case, multiple discrete nodules (cannonball lesions) are scattered throughout all lobes, more at the . Where as primary tumors have a single sight.

Answer 48

periphery.