Pulmonary Carcinoid Tumors and Other Primary Lung Tumors Flashcards

1
Q

Prevalence of pulmonary carcinoid tumors

A

0.4-3.0% of resected lung cancers

Lungs 2nd most common site of origin for primary carcinoid tumors

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2
Q

WHO classification of carcinoid tumors

A

Typical (< 2 mitotic figures/hpf, no necrosis)

Atypical (2-10 mitotic figures/hpf, tissue necrosis, or architectural disruption)

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3
Q

Prevelence of typical vs atypical carcinoid tumors

A

Typical: 75-80% of tumors

Atypical: 15-20% of tumors

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4
Q

According to WHO carcinoid tumors are part of the histologic spectrum of neuroendocrine tumors, including…

A
  • Typical carcinoid (low grade)
  • Atypical carcinoid (intermediate grade)
  • Large cell neuroendcrine (high grade)
  • SCLC (high grade)
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5
Q

Demographic characteristics of carcinoid tumor presentation

A

Bimodal age distribution (peaks at 35 and 55 years of age)

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6
Q

Patients older than ___ years have a higher incidence of atypical carcinoid tumors?

A

age = 50 years old

risk 25% vs 10% (50 years vs. <30 years)

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7
Q

Presentation of pulmonary carcinoid

A
  • Asymptomatic (1/3 pts)
  • recurrent PNA
  • cough
  • hemoptysis
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8
Q

Ectopic hormones secreted by carcinoid tumors

A
  • 5-hydroxytryptophan
  • ACTH
  • vasopressin
  • insulin
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9
Q

% pts wtih Cushings syndrome with localized disease

A

5%

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10
Q

Anatomic characteristics of carcinoid tumors

A
  • Central location
    • Typical (70%)
    • Atypical (50%)
  • Lobar or sublobar bronchus (75%)
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11
Q

CT findings of carcinoid tumors

A
  • Peripheral tumors:
    • smooth, round, homogenous appearance
  • Central tumors:
    • obvious airway component, post-obstructive atelectasis or pneumonitis
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12
Q

Other diagnostic studies used in w/u of carcinoid

A
  • PET scan
  • Octreotide scan
  • Bronchoscopy (with biopsy)
    • central tumors
  • CT guided FNA biopsy:
    • peripheral tumors
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13
Q

Success of preoperative diagnosis of carcinoid

A

70-80%

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14
Q

Most peripheral and central tumors without evidence of nodal disease

A

Typical carcinoid tumors

(no further eval needed prior to resection)

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15
Q

Distribution of atypical carcinoid tumors with central location and cN1 or cN2 disease

A

Cenral location (50%)

Peripheral location (50-70%)

*need thourough staging prior to resection (including mediastinoscopy)

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16
Q

Surgical treatment principles for carcinoid

A
  • R0 resection (limited resection is acceptable)
  • Medistinoscopy with LN bx shoud be performed:
    • Clinical nodal diseaes
    • Atypical carcinoid histology
17
Q

Indication for neoadjuvant/adjuvant chemotherapy for carcinoid

A

N2 disease

18
Q

Surgical option for carcinoid tumors in patients unable to tolerate parenchymal resection

A

Endobronchial resection

(negative margin important >> high chance of local recurrence)

19
Q

Definiton and characteristics of carcinoid tumorlets

A

Carcinoid tumors < 5 mm in diameter

  • 10% of patients with other primary carcinoid tumor or other types of NSCLC
  • should no be staged as metastatic disease
  • treatment should be based on primary lesion
20
Q

TOC for metastaic or unresectable carcinoid

A

Chemotherapy

Reponse rates 20-40%

30% will progress while receiving chemotherapy

21
Q

Duration of postoperative followup for carcinoid

A

20 years due to indolent nature of disease

22
Q

Tumor of trachea or mainstem bronchus usually detected when symptomatic with significant obstructive component

A

Adenoid cystic carcinoma

23
Q

Submucosal extension beyond gross intraluminal tumor characteristic of these tumors

A

Adenoid cystic carcinoma

Intraoperative frozen section thus essential for R0 resection

24
Q

Other salivary gland-type tumors

A

Mucoepidermoid

Acinic cell carcinoma

25
Q

Most common benign lung tumors

A
  • Hamartoma
  • Inflammatory pseudotumor
  • Sclerosing hemangioma
  • Bronchogenic cyst
  • Leiomyoma
  • Adenoma
  • Papilloma and soft tissue tumors