Pulm - Mediastinal & Pleural Disease; Lung Tumors Flashcards
Spontaneous pneumothorax is due to rupture of what?
An emphysematous bleb
Does a spontaneous pneumothorax result in collapse of a portion of the lung?
Yes.
Does a spontaneous pneumothorax result in any tracheal deviation?
If so, which way?
Yes, towards the collapsed lung portion.
Does a tension pneumothorax result in any tracheal deviation?
If so, which way?
Yes, away from the pneumothorax.
How do mesotheliomas typically present in a clinical setting?
Recurrent pleural effusions;
dyspnea;
chest pain
Mesotheliomas often encase what organ?
The lung
How do mesotheliomal cells appear under microscopy and staining?
Calretinin-positive polygonal cells with numerous long surface microvilli
Name a few diseases associated with thymic hyperplasia.
Myasthenia gravis, Graves, SLE, RA
Thymomas are __________ (benign/malignant) tumors of __________ cells.
Thymomas are benign tumors of epithelial cells.
Are thymomas invasive or non-invasive?
Can be either
(can only be differentiated via extensive examination)
Thymomas are associated with what autoimmune reactions?
Lambert-Eaton syndrome,
pure red cell aplasia,
Grave’s disease,
Cushing’s disease
Are thymic carcinomas characterized by exceptionally small or exceptionally large cells?
Exceptionally large
What is the most common germ cell tumor?
Mature teratomas
Mature teratomas are _________ (benign/malignant).
Immature teratomas are _________ (benign/malignant).
Mature teratomas are benign.
Immature teratomas are malignant.
Immature teratomas are malignancies characterized by what histology (specific to the immaturity)?
Immature neuroepithelial tubules
How are seminomal cells shaped?
Round, polygonal cells
Parathyroid adenomas are associated with what paraneoplastic syndrome?
Hypercalcemia
(due to elevated PTH)
Mid-mediastinal masses are often cystic and arising from what two organs?
Bronchial cysts;
pericardial cysts
Are nodular goiters characterized by large or small tubules with colloid?
A mix of both large and small tubules with colloid
What form and subtype of lymphoma is common in the anterior mediastinum?
Nodular sclerosing Hodgkin’s lymphoma
Which lymphoma can be found in the anterior mediastinum, is more common in males, and often presents with respiratory compromise and CNS involvement?
Lymphoblastic lymphoma
Which lymphoma can be found in the anterior mediastinum, is more common in young adult females, and presents with large, atypical cells growing in fibrotic sheets?
Diffuse large B-cell lymphoma
Name three neurogenic tumors of the posterior mediastinum that are associated with the peripheral nervous sytem.
SNM
Schwannomas;
neurofibromas;
malignant peripheral nerve sheath tumor (MPNST)
Name four neurogenic tumors of the posterior mediastinum that are associated specifically with the sympathetic nervous sytem.
NGGP
Neuroblastomas;
ganglioneuroblastomas;
ganglioneuromas;
paragangliomas
What are the three aspects of Carney’s triad?
Extraadrenal paraganglioma
+
Malignant GI stromal tumor
+
Pulmonary chondroma
A patient presents with a neurogenic paraganglioma of the posterior mediastinum, a malignant GI stromal tumor, and a pulmonary chondroma. This triad is most common in what demographic?
Young women
(Carney’s triad)
Nasopharyngeal carcinomas are strongly associated with what substance to which pathologists are strongly exposed?
Formaldehyde
The most common pleural tumors are of what origin?
Metastatic
Does smoking increase the risk of mesotheliomas?
No
Mesotheliomas arise after what latency period?
25 - 45 years
Mesotheliomas are associated with what immunohistochemistry?
CKs,
WT-1,
calretinin
Solitary fibrous tumors of the pleura ______ (are/are not) associated with asbestos and are CD____+.
Solitary fibrous tumors of the pleura are not associated with asbestos and are CD34+.
What pleural tumor is CD34+ and associated with STAT6 and NAB2 mutations?
Solitary fibrous tumors
SVC syndrome is typically indicative of what?
A malignancy
Pericardial cysts are usually located at the ______________ radiographically (lined by mesothelium).
Pericardial cysts are usually located at the right cardiophrenic angle radiographically (lined by mesothelium).
Bronchogenic cysts are most common in what location?
Posterior to the carina
Esophageal cysts are most common in what location?
The wall of the lower esophagus
Which cysts are associated with the posterior mediastinum?
Gastric/enteric cysts
Carcinoid tumors of the thymus are associated with ____% of cases of paraneoplastic Cushing’s syndrome.
Carcinoid tumors of the thymus are associated with 33% of cases of paraneoplastic Cushing’s syndrome.
Adenocarcinomas are responsible for ____% of primary lung malignancies (with ____% being invasive and ____% being in-situ).
Adenocarcinomas are responsible for 50% of primary lung malignancies (with 30% being invasive and 20% being in-situ).
____________ are responsible for 50% of lung cancer.
____________ are responsible for 20% of lung cancer.
____________ are responsible for 15% of lung cancer.
Adenocarcinomas are responsible for 50% of lung cancer.
Squamous cell carcinomas are responsible for 20% of lung cancer.
Small cell carcinomas are responsible for 15% of lung cancer.
What is the most common origin of lung tumors?
Metastatic
Identify if each of the following lung tumors is typically central or peripheral:
Adenocarcinomas
Squamous cell carcinomas
Small cell carcinomas
Peripheral
Central
Central
What percentage of patients with small cell lung cancer have a history of smoking?
99%
How is the prognosis associated with small cell carcinoma?
Dismal
(regardless of stage)
What is the most common type of lung cancer seen in non-smokers and women?
Adenocarcinomas
How are large cell carcinomas diagnosed?
Via exclusion
Lung adenocarcinomas are associated with what genetics?
KRAS,
EGFR,
ALK
Lung small cell carcinomas are associated with what genetics?
TP53,
PB,
Myc
Low-grade lung malignancies of neuroendocrine glands are known as __________ tumors and are often made of small hyperplastic nests called __________.
Low-grade lung malignancies of neuroendocrine glands are known as carcinoid tumors and are often made of small hyperplastic nests called tumorlets.
What is the most common benign mesenchymal tumor found in the lungs?
A hamartoma
Metastatic tumors in the lungs often cause ‘_________’ lesions.
Metastatic tumors in the lungs often cause ‘cannonball’ lesions.
Non- small cell lung cancers are typically treated with ___________.
Small cell lung cancers are typically treated with ___________.
Non- small cell lung cancers are typically treated with resection.
Small cell lung cancers are typically treated with chemotherapy.
What is the most common general cause of pleural effusions?
Impaired drainage
Does the visceral and/or parietal layer of pleura produce pleural fluid?
Both
Does the visceral and/or parietal layer of pleura have stomata to resorb pleural fluid?
Parietal only
What is an empyema?
A fluid/pus-filled sac between the visceral/parietal pleura
How do CXRs of pleural effusions appear?
Haziness of lung fields
+
blunting of costophrenic angle
+
“Missing” Diaphragm
How are pleural effusions treated?
Thoracentesis
+
Diuretics
+
Antibiotics (if septic)
________ pleural effusions will shift with gravity while ________ pleural effusions will stay in the same spot.
Layering pleural effusions will shift with gravity while loculated pleural effusions will stay in the same spot.
Identify whether each of the following is individually associated with transudative or exudative pleural effusions:
CHF
Cirrhosis
Malignancies
Transudative
Transudative
Exudative
Identify whether each of the following is individually associated with transudative or exudative pleural effusions:
Pneumonia
Hypoalbuminemia
Pulmonary emboli
Nephrotic syndrome
Exudative
Transudative
Exudative
Transudative
What is the Lights criteria for defining exudative effusions?
Pleural protein : serum protein =
Pleural protein : serum LDH =
What is the Lights criteria for defining exudative effusions?
Pleural protein : serum protein = > 0.5
Pleural protein : serum LDH = > 0.6
(or pleural LDH > 2/3 of upper limit of serum LDH)
A patient has a pleural effusion with an acidic pH and elevated salivary amylase. What is the diagnosis?
Esophageal rupture
A patient has a pleural effusion with an high triglycerides and high chylomicrons. What is the diagnosis?
Chylothorax
A patient has a pleural effusion containing lupus cells.
What is the diagnosis?
Lupus pleuritis
A patient has a pleural effusion with a high hematocrit within the effusion. What is the diagnosis?
Hemothorax
A patient has a pleural effusion and an elevated serum amylase.
What is the diagnosis?
Acute pancreatitis
What is the most useful tool for assessing pleural effusion?
Diagnostic thoracentesis
