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PATHOLOGY > PULMONARY NEOPLASM AND UPPER AIRWAY TUMOURS > Flashcards

PULMONARY NEOPLASM AND UPPER AIRWAY TUMOURS Flashcards

1
Q

CHARACTERISTICS OF SMALL CELL LUNG CA (CLUE: 6)

A
  1. UNDIFFERENTIATED TUMOUR - SMALL CELL, HIGH NC RATIO, LITTLE CYTOPLASM = OAT CELL, NUCLEI WITH SALT PAPER CHROMATIN, WITH NO NUCLEOLI
  2. HIGH INCIDENCE RATE OF EXTRAPULMONARY SPREAD
  3. A/W CIGARETTE SMOKING
  4. MOST CASES ARISE CENTRALLY
  5. COMMON A/W ECTOPIC HORMONE
  6. HIGH INITIAL RESPONSE TO CHEMOTHERAPY
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2
Q

CHARACTERISTICS OF NON SMALL CELL LUNG CA.

A
  1. DIFFERENTION TOWARDS SQUAMOUS CELL CA, ADENOCARCINOMA, MILD - MODERATE CYTOPLASM, NUCLEI WITH COARSE CHROMATIN, PROMINENT NUCLEOLI.
  2. LOWER INCIDENCE RATE OF EXTRAPULMONARY SPREAD
  3. VARIABLE A/W SMOKING, NON SMOKER -> ADENOCARCINOMA
  4. SQUAMOUS CELL CA = CENTRALLY, ADENOCARCINOMA = PERIPHERALLY
  5. LESS COMMON TO BE A/W ECTOPIC HORMONE
  6. LESS RESPONSIVE TO CHEMOTHERAPY.
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3
Q

PEAK AGE OF LUNG CA

A

50 - 60 YRS

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4
Q

CAUSE OF LUNG CA (2 CAUSE)

A
  1. TOBACCO SMOKING
    - AMOUNT OF DAILY SMOKING
    - TENDENCY TO INHALE
    - DURATION OF SMOKING
    - WOMEK MORE SUSCEPTIBLE TO CARCINOGEN IN TOBACCO SMOKE
    - PASSIVE SMOKER
    - SMOKING CIGAR AND PIPES
  2. INDUSTRIAL HAZARD
    - CHRONIC EXP TO ASBESTOS: IN SMOKERS
    - PEOPLE WHO WORK WITH NICKEL, CHROMATES, COAL, MUSTARD GAS, ARSENIC, BERRYLIUM, IRON: NEWSPAPER WORKER AND AFRICAN GOLD MINER
    - RADON GAS, AMONG URANIUM MINERS
    - ALL TYPES OF RADIATION MAY BE CARCINOGENIC SUCH AS ATOMIC BOMB BLAST AND URANIUM
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5
Q

EXAMPLES OF ACTIVATED ONCOGENES
“ ACTIVE MER MET HER TO KICK (KIT)”

A
  • C- MYC
  • EGFR
  • K- RAS
  • C- MET
  • HER-2
  • C- KIT
    “ ACTIVE MER MET HER TO KICK (KIT)”
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6
Q

EXAMPLES OF DELETED TM SUPPRESSOR GENE
“ P2ER”

A

P53
P16INK4A
RB1

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7
Q

ACTIVATED ONCOGENES WILL CAUSE

A

CELL PROLIFERATION AND HENCE DEVELOP THE CA

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8
Q

SOME ADENOCARCINOMAS DEVELOP FROM PRECURSOR LESION WHICH ARE (2 TYPES)

A
  • ATYPICAL ADENOMATOUS HYPERPLASIA
  • ADENOCARCINOMA INSITU
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9
Q

PRECURSOR LESION IN LUNG CARCINOMA

A
  • BASAL CELL HYPERPLASIA
  • SQUAMOUS METAPLASIA
  • SQUAMOUS DYSPLASIA
  • CARCINOMA IN SITU
  • INVASIVE CA
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10
Q

PRECURSOR LESION IN ADENOCARCINOMA

A
  • ATYPICAL ADENOMATOUS HYPERPLASIA
  • ADENOCARCINOMA INSITU
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11
Q

MACROSCOPY OF SCC

A
  • LOBULATD, WHITE TO TAN MASS
  • MASS LOCATED AT CENTRALLY
  • MASS WITH IRREGULAR BORDER
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12
Q

MICROSCOPY OF SCC

A
  • 5 MALIGNANT FEATURES
  • FINELY GRANULAR NUCLEAR CHROMATIN
  • ABSENCE OF NUCLEOLI
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13
Q

MACROSCOPY OF ADENOCARCINOMA

A
  • SINGLE
  • LARGE PALE TAN MASS
  • MASS LOCATED AT PERIPHERY
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14
Q

MICROSCOPIC OF ADENOCARCINOMA

A
  • 5 MALIGNANT FEATURES
  • MALIGNANT CELLS ARRANGED IN GLANDULAR FORMATION OR NESTS, MUCIN PRODUCTION
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15
Q

MACROSCOPIC OF SQUAMOUS CELL CARCINOMA

A
  • PALE WHITE TO TAN FIRM MASS
  • MASS LOCATED AT CENTRALLY
  • CAVITY IN THE TUMOUR
  • CONSOLIDATION DISTAL TO TUMOUR
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16
Q

MICROSCOPIC OF SQUAMOUS CELL CARCINOMA

A
  • INTERCELLULAR BRIDGES
  • 5 MALIGNANT FEATURES
  • KERATIN PEARL
17
Q

DESC OF LARGE CELL CA.

A
  • NON SMALL CELL LUNG CA
  • DOES NOT DISPLAY SQ OR GLANDULAR DIFFERENTIATION
  • MAY BE CENTRAL OR PERIPHERAL
18
Q

PRESENTING FEATURES OF LUNG CA

A
  • ASYMPTOMATIC
  • MAJOR:
    1. COUGH +/- HAEMOPTYSIS
    2. LOW
    3. CHEST PAIN
    4. DYSPNOEA
  • COMPLICATIONS:
    1. HAEMATOGENOUS (BONE FRACTURE)
    2. LYMPHATIC SPREAD (ENLARGED SUPRACLAVICULAR LN)
    3. LOCAL SPREAD TO NEARBY STRUCTURE
    4. PARANEOPLASTIC SYNDROME
  • SYSTEMIC FEATURES: LOA,LOW, LETARGY, FEVER
19
Q

EXAMPLES OF PARANEOPLASTIC SYNDROME

A
  1. HYPERCALCEMIA
    - CAUSED BY SECRETION OF THE PTH RELATED PEPTIDE
  2. CUSHING SYNDROME
    - INCREASED THE PRODUCTION OF THE ADRENOCOTROPIC HORMONE
  3. SIADH
  4. NEUROMUSCULAR SYNDROME
    - MG
    - PERIPHERAL NEUROPATHY
    - POLYMYOSITIS
  5. CLUBBING OF THE FINGERS AND HYPERTROPHIC PULMONARY OSTEOARTHYROPATHY
  6. COAGULATION ABNORMALITIES
    - MIGRATORY THROMBOPHLEBITIS
    - NON BACTERIAL ENDOCARDITIS
    - DIC
20
Q

INVESTIGATION FOR LUNG CA

A
  • CHEST RADIOGRAPHY
  • CT SCAN
  • CYTOLOGY:
    1. SPUTUM
    2. BAL
    3. FNA
    4. PLEURAL EFFUSION
  • BIOPSY
    1. LUNG: TRANSBRONCHIAL, CT GUIDED TRUCUT
    2. PLEURA
21
Q

SMALL CELL CARCINOMA IS THE WORST/ BEST PROGNOSIS

A

WORST

22
Q

DESC METASTATIC TUMOUR IN THE LUNG

A
  • MORE FREQUENT THAN PRIMARY CARCINOMA OF THE LUNG
  • BREAST, COLON, STOMACH, PANCREAS, KIDNEY, MELANOMA, PROSTATE, LIVER
  • GROSS: MULTIPLE NODULES IN MULTIPLE LOBE (CANNONBALL LESION)
23
Q

DESC NASOPHARYNGEAL CA

A
  • TUMOUR OF THE NASOPAHRYNX
  • AGE: BTWN 50 TO 60
  • SEX: MALE&raquo_space;>
  • HIGH FREQUENCY IN CHINESE
  • CLOSELY LINK WITH EBV
  • EBV OCCUR AFTER TUMOUR DEV.
  • AB TO VIRAL CAPSID AG ARE GREATLY ELEVATED AND IN ENDEMIC AREAS, PT DEV IGA BEFORE TUMOUR
24
Q

CLINCAL COURSE OF NASOPHARYNGEAL CARCINOMA

A
  • PAINLESS, SWELLING OR LUMP IN THE NECK
    -BLOCKED NOSE @ NOSE BLEED
  • CHANGES IN HEARING, RINGING IN THE EAR (TINNITUS)
  • INVADE LOCALLY, SPREAD TO CERVICAL LN, THEN METASTASIZE TO DISTANT AREA
  • TEND TO BE RADIOSENSITIVE
  • RESPONSE TO IMMUNE CP INHIBITORS
25
Q

MICROSCOPIC OF NASOPHARYNGEAL CA.

A
  • MOSTLY SQ CELL CA
  • HISTOLOGY SUBTYPES:
    1. KERATINISING SQ CELL CA (TYPE1) - LEAST RADIOSENSITIVE
    2. NON KERATINISING SQ CELL CA (TYPE 2)
    2. UNDIFFERENTIATED CA (TYPE 3)- MOST RADIOSENSITIVE
  • SPRINKLE OF LYMPHOCYTE WITHIN TUMOUR CLUSTERS
26
Q

DESC CARCINOMA OF THE LARYNX

A
  • COMMONLY OCCUR AFTER 40 YRS OF AGE
  • MORE COMMON IN MEN
  • ENVIRONMENTAL INFLUENCE:
    1. SMOKERS
    2. ALCOHOL AND ASBESTOS
  • HUMAN PAPILLOMAVIRUS: USUALLY HAVE BETTER PROGNOSIS
  • 95% ARE WELL DIFFERENTIATED SQ CELL CARCINOMA
  • SITE
    1. GLOTTIC TUMOUR (MOST COMMON) - DIRECTLY AT VOCAL CORD
    2. SUPRAGLOTTIC: ABOVE THE CORD
    3. SUBGLOTTIC: BELOW THE CORD
27
Q

CLINICAL COURSE OF CA OF THE LARYNX

A
  • PERSISTENT HOARSENESS
  • 90% OF GLOTTIC TUMOUR ARE CONFINED TO THE LARYNX ONLY
  • GLOTTIC REGION HAS A SPARSE LYMPHATIC
  • WITH SURGERY, RADIATION THERAPY, OR COMBINATION T(X), MANY PT CAN BE CURED
  • MAY BE COMPLICATE WITH PULM INFX

PATHOLOGY (13 decks)

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