Pathology- tumor of the lung Flashcards
What is the most common benign lung tumor?
hamartoma also called coin lesion
What does the benign hamartoma consist of:
mature cartilage with fat, fibrous tissue, and blood vessels.
Though this benign lung tumor is called a “hamartoma”, what is it truly?
a benign neoplasm
What lesion is demonstrated in this image:
lung coin lesion or hamartoma
What is the most important cause of cancer-related deaths in industrialized countries?
carcinoma of the lung
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?
lung carcinoma
Which lung lesion the presence of a popcorn-like pattern of calcification?
Coin Lesion - Hamartoma
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?
adenocarcinomas
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
small; parenchyma.
note the masses invading from bronchioles into parenchyma
Adenocarcinomas may assume a variety of growth patterns, including (gland-forming);
acinar
What type of adenocarinoma growth pattern?
acinar (gland-forming)
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.*
papillary (finger-like)
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.*
mucinous
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.*
solid
Squamous cell carcinomas
Squamous cell carcinoma appearing as a central (hilar) mass that is invading contiguous parenchyma.
Large cell carcinomas may undergo central necrosis, giving rise to cavitation.
squamous
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.
metaplasia
note: normal on the left and metaplasia on the right
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
dysplasia
note: A = normal; C= metaplasion; D= dysplasia
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.
in situ (precedes invasive squamous cell carcinoma)
note: a= normal; c= metaplasia, d= dysplasia, e= in situ, f= invasive squamous cell carcinoma
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
atelectasis
note: invasive squamous cell carcinoma
Histologically, these tumors range from squamous cell neoplasms showing keratin pearls and intercellular bridges, to poorly differentiated neoplasms exhibiting only minimal squamous cell features.
well-differentiated
note: notice the keratin pearls circled in yellow
this is an example of well-differentiated
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
Small cell lung carcinomas (SCLCs); metastasized
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.
round
note: round cell circled
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.
crush artifact
note: the nucleus get crushed together
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.
molding
note: cell squished together like a puzzle
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
necrosis
note: necrosis outlined on left (light pink)
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
Large; cytoplasm.
Advanced cancers often extend into the or pericardial space, leading to inflammation and effusions.
pleural
small cell carcinoma
Carcinoid tumors are malignant tumors composed of cells that contain dense-core neurosecretory in their cytoplasm and, rarely, may secrete hormonally active polypeptides.
granules
๏ Most carcinoids originate in main bronchi and grow in one of two patterns:
- An obstructing , intraluminal mass
- A mucosal plaque penetrating the bronchial wall, to fan out in the peribronchial tissue.*
polypoid
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.
๏Typical
carcinoid tumors display a higher mitotic rate and small areas of necrosis.*
๏Atypical
Malignant is highly related to exposure to airborne asbestos.
mesothelioma
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?
Malignant mesothelioma
The period for developing malignant mesothelioma after the initial exposure is long, often 25 to 40 years.
latent
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 .
lung; does not
Malignant mesotheliomas begin in a localized area and over time spread widely, either by growth or by diffuse of pleural surfaces.
contiguous; seeding
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.
Malignant mesothelioma
Concerning malignant mesothelioma- The neoplasm may directly invade the thoracic wall or the subpleural lung tissue, but distant metastases are uncommon/ common?
uncommon
Normal mesothelial cells are , giving rise to pleural lining cells as well as the underlying fibrous tissue.
biphasic
Similarly, mesotheliomas take on one of three morphologic appearances:
- , in which cuboidal cells with small papillary buds line tubular and microcystic spaces;*
- , in which spindled, occasionally fibroblastic-appearing cells grow in sheets; and
- , having both sarcomatous and epithelial areas.
Epithelial; Sarcomatous; Biphasic
note: left= epithelial; right= both sarcomatious and biphasic
What are the 3 presenting complaints of Malignant Mesothelioma?
chest pain, dyspnea, and recurrent pleural effusions.
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.
hilar; liver
What is the prognosis for malignant mesothelioma?
poor- 50% of patients die within 12 months of diagnosis, and few survive over 2 years
What is the most common site of metastatic neoplasms?
lung
Both and arising anywhere in the body may spread to the lungs via the blood or lymphatics or by direct continuity.*
carcinomas; sarcomas
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.
periphery.
