Pleural Disease and Lung Cancer B&B Flashcards
The lung pleura is lined by ______ which secrete small amounts of pleural fluid for lubrication
mesothelial cells
Primary versus secondary spontaneous pneumothorax
Primary – rupture of subpleural bleb, common and tall/thin young males
secondary - older patients with underlying pulmonary disease like COPD
patient is an 89-year-old male with a history of COPD presenting with sudden onset dyspnea and pleuritic chest pain. CXR is used to make the diagnosis. What is the most likely diagnosis?
spontaneous pneumothorax - secondary cause, most likely COPD
In what medical emergency, usually from trauma, does air enter the pleural space but cannot leave, and the trachea deviates away from the affected side?
tension pneumothorax
what are the three general at etiologies of plural effusion?
- transudative: something driving fluid it pleural space (most often CHF high pressures), mostly fluid in effusion (very little protein)
- exudative: fluid leaking into pleural space (high vascular permeability) with high protein content, requires drainage
- lymphatic: from thoracic duct obstruction/injury (malignancy most common cause), milky-appearing fluid high in TAGs
what causes transudative pleural effusion? how is it characterized? how is it treated?
Something driving fluid into pleural space (high hydrostatic pressure), most commonly CHF due to high pressures
Can also be due to nephrotic syndrome (low protein) or cirrhosis (low albumin)
mostly fluid in effusion (very little protein)
treat underlying cause (no drainage required)
what kind of plural effusion is caused by nephrotic syndrome and cirrhosis?
transudative: Something driving fluid into pleural space (high hydrostatic pressure), most commonly CHF due to high pressures
Can also be due to nephrotic syndrome (low protein) or cirrhosis (low albumin)
mostly fluid in effusion (very little protein)
treat underlying cause (no drainage required)
what causes exudative pleural effusion and how is it characterized?
fluid leaks into pleural space due to high vascular permeability - many causes such as malignancy or pneumonia
High protein content in pleural fluid, usually requires drainage
how can transudative vs exudative pleural effusion be differentiated in a patient?
transudative: due to high hydrostatic pressure, mostly fluid in effusion, treat underlying cause (no drainage)
exudative: due to high vascular permeability, high protein/LDH content, requires drainage
—> obtain fluid via thoracentesis and test for protein and LDH (Light’s Criteria to analyze fluid)
what kind of plural effusion is due to high vascular permeability?
exudative: many causes such as malignancy or pneumonia
High protein content in pleural fluid, usually requires drainage
what is the most common cause of the lymphatic plural effusion and how is it characterized?
“chylothorax”: due to thoracic duct obstruction/ injury, most often caused by malignancy
can also be caused by trauma (usually surgical)
milky-appearing fluid high in triglycerides
empyema
infected pleural fluid —> pus, putrid odor, positive culture
this cancer presents with slow onset symptoms and asbestos is the only known risk factor - what is?
mesothelioma: pleural tumor, slow onset of dyspnea/cough/ chest pain
presents decades after asbestos exposure, poor prognosis
imaging shows pleural thickening and effusion
where do polycyclic aromatic hydrocarbons come from and what do they put patients at risk for?
PAH (polycyclic aromatic hydrocarbons) are found in cigarette smoke - carcinogens (lung cancer)
hamartoma
Benign pulmonary nodule – lung tissue and cartilage with scattered calcification
which two type of fungi and what type of bacteria are known to cause granulomas in the lung?
fungi:
1. Histoplasmosis – patients from Midwest, Mississippi/Ohio river valley.
2. coccidioidomycosis - southwest/ California
bacteria:
Mycobacteria – usually tuberculosis.
into what two classes are lung cancers divided, and how do they differ?
small cell – 15%, fast growing and early metastasis, non-amendable to surgical resection, smokers/those treated with chemo, poor prognosis
Non-small cell – 85%, can sometimes be respected, better prognosis, smokers and non-smokers
describe the following paraneoplastic syndromes of small cell lung cancer:
a. Cushing syndrome.
b. SIADH
c. Lambert Eaton syndrome.
a. Cushing syndrome: tumor secreting ACTH – progressive obesity and hyperglycemia
b. SIADH: tumor secreting ADH – hyponatremia (—>confusion)
c. Lambert Eaton syndrome: tumor secreting antibodies against presynaptic calcium channels in neurons – block release of acetylcholine, main symptom is weakness
what are the five types of non-small cell lung cancer?
- squamous cell carcinoma.
- Adenocarcinoma.
- Large cell carcinoma.
- Bronchioalveolar carcinoma
- Carcinoid tumor.
describe squamous cell lung carcinoma (include who is usually affected)
hilar mass arising from bronchus, keratin “pearls” produced by tumor cells and “intracellular bridges” between desmosomes
can produce PTH (parathyroid hormone) —> hypercalcemia —> stones, bones, groans, psychiatric overtones (bones/abdominal pain, confusion)
usually male smokers
What do squamous cell lung carcinomas sometimes secrete and what is the effect of this?
can produce PTH (parathyroid hormone) —> hypercalcemia —> stones, bones, groans, psychiatric overtones (bones/abdominal pain, confusion)
what pathology findings are associated with squamous cell lung carcinoma? (2)
keratin “pearls” produced by tumor cells and “intracellular bridges” between desmosomes
What is the most common type of lung cancer in non-smokers and females?
Adenocarcinoma: glandular tumor in the periphery of the lungs
This type of lung cancer is poorly differentiated, considered a smoker’s cancer, can be central or peripheral, and has poor prognosis. What is?
Large cell carcinoma
Describe the features of bronchioalveolar carcinoma
subtype of adenocarcinoma with many similar features – non-smokers, peripheral
Mucinous (goblet cells) or non-mucinous (Clara/Type II cells) types
Looks like pneumonia on CXR – lobar consolidation
Excellent prognosis
what are the two types of bronchioalveolar carcinoma?
Mucinous type: derived from goblet cells
Non-mucinous type: derived from Clara cells or type II pneumocytes
[bronchioalveolar carcinoma is subtype of adenocarcinoma – glandular tumor]
patient is a 35-year-old female, presenting with chronic cough and dyspnea. No past history of smoking. CXR shows lobar consolidation which was originally diagnosed as pneumonia, but is now thought to be malignant. What cancer is most likely and what is the most likely prognosis?
bronchoalveolar carcinoma: subtype of adenocarcinoma with many similar features – non-smokers, peripheral
Mucinous (goblet cells) or non-mucinous (Clara/Type II cells) types
Looks like pneumonia on CXR – lobar consolidation
Excellent prognosis
describe the features of carcinoid lung tumor?
Neuroendocrine tumor with well differentiated cells – chromogranin positive
Usually in non-smokers
*Rarely causes carcinoid syndrome (secretion of serotonin – flushing/diarrhea)
Neuroendocrine lung tumor with well differentiated cells – chromogranin positive
Usually in non-smokers
carcinoid tumor (type of non-small cell lung cancer)
describe the symptoms of SVC syndrome, which may be caused by compression by lung masses (NSCLC, SCLC), mediastinal mass (lymphoma), or thrombosis (indwelling catheters, pacemaker wires)?
SVC syndrome: obstruction of blood flow through SVC, caused by compression or thrombosis
—> facial swelling, arm swelling, increased ICP (headaches, confusion, cranial artery rupture)
Pancoast tumor
carcinoma at apex of lung, involving superior sulcus (groove is formed by subclavian vessels)
—> arm edema on affected side, shoulder pain, radiating toward axilla/scapula, arm paresthesias/weakness
can compressed sympathetic nerves —> Horner’s syndrome (miosis, ptosis, anhidrosis)
what are symptoms associated with a pancoast tumor?
carcinoma at apex of lung, involving superior sulcus (groove is formed by subclavian vessels)
—> arm edema on affected side, shoulder pain, radiating toward axilla/scapula, arm paresthesias/weakness
can compressed sympathetic nerves —> Horner’s syndrome (miosis, ptosis, anhidrosis)
This type of tumor may cause arm edema on the affected side, shoulder pain radiating toward axilla/scapula arm, weakness, and Horner syndrome. What is?
Pancoast tumor: carcinoma at apex of lung, involving superior sulcus (groove is formed by subclavian vessels)
can compressed sympathetic nerves —> Horner’s syndrome (miosis, ptosis, anhidrosis)
what are four common metastasis sites from lung cancer?
- adrenal - usually found on imaging without symptoms
- brain - headache, neurodeficits, seizures
- bone - pathologic fractures
- liver - hepatomegaly, jaundice
Which cancer is most often metastasized to the lungs?
most commonly from breast or colon cancer
More common for cancer to metastasize to the lung, then primary lung tumors to form
Usually multiple lesions on imaging
