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CPR Exam 1 > Pulm Path Pt 3 > Flashcards

Pulm Path Pt 3 Flashcards

1
Q

Atypical adenomatous hyperplasia (AAH)

A
  • small! <5mm

- dysplastic pneumocytes present along alveoli with some interstitial fibrosis

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2
Q

Adenocarcinoma in Situ (AIS)

A
  • formerly bronchioalveolar carcinoma (BAC)
  • <3Cm
  • dysplastic pneumocytes confluently growing along alveoli
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3
Q

What is the most common lung malignancy in smokers and non-smokers?

A

pulmonary adenocarcinoma

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4
Q

What malignancy shows glands invading the lung tissue?

A

pulmonary adenocarcinoma

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5
Q

Why is mucinous adenocarcinoma so dangerous?

A

because it’s presentation can mimic pneumonia or other lung infection (with bilateral infiltrates), so diagnosis is often missed

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6
Q

What is the progression of squamous carcinoma? (4 stages)

A
  1. normal bronchial epithelium
  2. squamous metaplasia
  3. squamous carcinoma in situ
  4. invasive squamous carcinoma
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7
Q

What malignancy is more common in men, has a strong association with smoking, and often occurs centrally?

A

squamous carcinoma

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8
Q

What malignancy are Keratin pearls the hallmark of?

A

squamous carcinoma

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9
Q

What should you think of if you see orange cytoplasm on cytology slide?

A

Keratin => squamous carcinoma

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10
Q

What is small cell neuroendocrine carcinoma almost always associated with?

A

smoking!

  • has a high rate of metastasis (very mitotically active)
  • likely to necrose
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11
Q

Which is small cell neuroendocrine carcinoma important to ID for treatment?

A
  • surgical excision not recommended if metastatic to LN
  • requires specific chemotherapy
  • chemo/radiation-responsive, but high rate of recurrence
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12
Q

What does small cell carcinoma look like histologically?

A

small cells with fine blue nuclear chromatic, scant cytoplasm, nuclear “molding”, and characteristic necrosis

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13
Q

What molecular testing is used to diagnose adenocarcinoma?

A
  • EGFR
  • ALK
  • PDL-1
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14
Q

When would a Tyrosine Kinase Inhibitor be used to treat adenocarcinoma?

A

If genetic tests a positive for EGFR mutation

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15
Q

What chemotherapy treatment would be used if patient tested negative for EGFR mutation?

A

If positive for ALK rearrangement -> Crizontinib

If negative for ALK rearrangement -> chemotherapy with or without Bevacizumab

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16
Q

What is another implication of squamous carcinoma?

A

hypercalcemia (PTH-related peptide)

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17
Q

What are other implications of small cell carcinoma?

A
  • SIADH
  • Cushing’s syndrome

NOTE: might not be adrenal in origin, always a possibility that tumors originated in lungs and metastasized

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18
Q

What is Trosseau’s syndrome? What can it lead to?

A

vessel inflammation due to a blood clot

- can lead to migratory thrombophlebitis

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19
Q

What is DIPNECH?

A

diffuse interstitial pulmonary neuroendocrine cell hyperplasia
- very small, less than 5mm “tumorlets”

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20
Q

How is DIPNECH diagnosed?

A

high resolution CT

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21
Q

How can you tell DIPNECH apart from a carcinoid tumor?

A

size: carcinoid tumor is larger (>5mm), while DIPNECH is <5mm

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22
Q

What is it important to accurately diagnose a carcinoid tumor?

A

because they can metastasize! (though they are slow growing)

- they are considered a low grade carcinoma (not benign)

23
Q

What is considered a neuroendocrine carcinoma grade 1?

A

carcinoid tumor

24
Q

What is different about an atypical carcinoid tumor?

A
  • increased mitotic activity
  • necrosis
  • disordered growth
  • increased rate of metastasis
  • lower survival (still better than small cell carcinoma)
25
Q

What are the survival rates for:

  • carcinoid tumors (grade 1)
  • atypical carcinoid tumors (grade 2)
  • small cell carcinoma (grade 3)
A
  • carcinoid tumors: 95%
  • atypical carcinoid tumors: 70%
  • small cell carcinoma: 5%
26
Q

What looks like “cauliflower” cartilage on a low mag histo slide?

What does it look like on high mag?

A

pulmonary hamartoma

- fibrous tissue with benign glandular epithelium around hyaline cartilage

27
Q

What does a hamartoma look like on CT scan?

A

“coin” lesion

28
Q

What loss of function is associated with lymphangioleiomyomatosis (LAM)?

A

TSC2 tumor supressor

29
Q

What population is most likely to present with LAM?

A

young women (extremely uncommon in men)

NOTE: may present with pneumothorax

30
Q

What is the MOA of LAM?

A

proliferation of cells creating cystic spaces

- cells are modified smooth muscle cells

31
Q

What markers are LAM cells positive for?

A
  • HMB-45 (melanoma marker)

- perivascular epithelioid cells (PEC-oma)

32
Q

What is the major cause of a transudate pleural effusion?

A

heart failure

33
Q

What are the major causes of exudate pleural effusion?

A
  • infection (Tb, bacterial pneumonia)

- malignancy

34
Q

When would a serous transudative effusion be seen?

A

patient with heart failure

35
Q

When would a milky chylous effusion be seen?

A

patient with bronchogenic carcinoma

- one in example was obstructing the thoracic duct

36
Q

When would a blood effusion be seen?

A

metastatic carcinoma involving the pleura

37
Q

What is empyema?

A

inflammatory exudate with accumulation of pus in the pleural space
- typically a bacterial infection

38
Q

What is notorious for creating “loculations” (web-like traps for fluid)

A

empyema

- CT shows interconnected webbing that traps pus inside

39
Q

What will the exudate of an empyema be like?

A

fluid will be thick, yellow, smear will show neutrophils and often bacteria

40
Q

What is a primary (idiopathic) pneumothorax?

A

rupture of subpleural blebs

- typically seen in younger patients

41
Q

What is a secondary pneumothorax caused by?

A
  • cystic infections
  • cystic tumors
  • rupture of subpleural blebs
  • positive-pressure ventilation
  • trauma
42
Q

What is a tension pneumothorax?

A

injury to the chest wall resulting in a one-way valve (vacuum), that allows air INto the pleural space, but not out

43
Q

What is the concept behind a tension pneumothorax?

A

it is the expansion of the chest wall (not the lungs per se) that is responsible for inspiration

44
Q

What does a tension pneumothorax look like on CXR?

A

mediastinal shift pushes all midline structures aside

45
Q

What type of pneumothorax has pleural cavity pressure less than atmospheric pressure?

A

primary pneumothorax

46
Q

What type of pneumothorax has pleural cavity pressure greater than atmospheric pressure?

A

tension pneumothorax

47
Q

What is a solitary fibrous tumor?

A
  • benign when small and pedunculated

- larger ones may behave like sarcoma

48
Q

What is a typical stain used to diagnose benign tumors?

A

CD34 stain

49
Q

What is a solitary fibrous tumor?

A

a circumscribed pleural-based mass

- on excision, it is pedunculated from the neighboring lung tissue (it is minimally attached => easy to excise)

50
Q

What is mesothelioma associated with?

A

asbestos exposure

51
Q

What stain is used to diagnose mesothelioma?

A

calretinin

NOTE: also look for ferruginous bodies***

52
Q

What are the variants of mesothelioma?

A
  • epithelioid
  • sarcomatoid
  • mixed
53
Q

Why is mesothelioma difficult to treat?

A
  • can’t be easily excised

- limited responsiveness to chemotherapy and radiation

CPR Exam 1 (18 decks)

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