Pulmonary Neoplasms Flashcards
What is the most common lung cancer?
Adenocarcinoma
What is the second most common lung cancer?
SCC
Who does SCC of the lung usually occur in?
Male smokers
If you are considering SCC of the lung in a young patients, female or non smoker, what should you consider first?
Mucoepidermoid carcinoma, poorly diff adenocarcinoma, metastasis
Where do most SCC of the lung arise from?
Centrally in the main to segmental bronchi
What are the variants of SCC of the lung?
Papillary, clear cell, basaloid, and small cell
What is the immunohistochemistry of SCC of the lung?
Positive for p40, p63, and high molecular weight cytokeratins
Negative for TTF-1 and napsin A
CK7 is positive in about 30%
How does adenocarcinoma of the lung present macroscopically?
Single, peripheral nodule, white in color with anthracotic pigmentation
On cytology, what is a helpful clue that the lung is benign?
Presence of cilia
What is adenocarcinoma in situ of the lung?
Single lesion, 3 cm or less, neoplastic cells grow exclusively along preexisting alveolar structures without stromal, vascular or pleural invasion
Papilla and micro papillae must be absent
Generally composed of nonmucinous cells
Why are adenocarcinoma in situ and minimally invasive adenocarcinoma important?
Because if completely excised they have a 100% cure rate
What is the immunohistochemistry of adenocarcinoma of the lung?
Diffuse CK7 positive
80% express TTF-1 and napsin A
P40 is always negative
P63 is occasionally positive
Is squamous cell carcinoma of the lung related to HPV?
Generally no
How can you tell the difference between lung SCC and thymic SCC?
Thymic SCC tend to be more organoid and express CK5 and CD117 more frequently than lung
What can be confused for adenosquamous carcinoma in the lung?
Peripheral SCC that entraps pneumocytes
What are features that are considered invasion and must not be present in adenocarcinoma in situ?
Papillae or micro papillae
What are the growth patterns for adenocarcinoma in the lung?
Lepidic, acinar, papillary, micro papillary, and solid
How do the growth patterns in lung adenocarcinoma correlate to grade?
Lepidic is grade I
Acinar and papillary is grade II
Micro papillary and solid is grade III
What are some histologic features in lung adenocarcinoma that are associated with a poor prognosis?
Signet ring cells and large collection of tumor cells in alveolar spaces isolated from the main mass
Is adenosquamous of the lung main peripheral or central?
Peripheral
What is required to call adenosquamous carcinoma of the lung?
Two components closely merging and each comprising at least 10%
Does vascular or lymphatic invasion modify staging of carcinoids of the lung?
No
What do peripheral carcinoids tend to show histologically?
Prominent spindle cell growth pattern with some whorl formation
The finding of an organoid pattern, stromal hyalinization, spindle-to-oval cell population, and finely dispersed nuclear chromatin support carcinoid and lack of necrosis
How does IHC help for pulmonary paraganglioma vs carcinoid?
Paraganglioma is positive for neuroendocrine but negative for CKs
What are the most specific and sensitive neuroendocrine markers?
Chromogranin A, synaptophysin, CD56/NCAM
What does large neuroendocrine require histologically besides large cells?
Greater than 10 mitotic figures per 2 mm squares
Nucleoli are prominent and there is comedy-like necrosis
How do more than 90% of small cell lung carcinoma present?
Centrally located, infiltrate the hilar structures, advanced/metastatic disease
What are the types of sarcomatoid carcinoma in the lung?
Pleomorphic carcinoma, spindle and/or giant cell carcinoma, carcinosarcoma, pulmonary blastoma
Which sarcomatoid carcinoma of the lung is associated with extensive angio invasion?
Spindle cell carcinoma
What is a characteristic of giant cell carcinoma of the lung?
Has discohesive, pleomorphic, mono or multinucleated giant cells intermixed with inflammatory infiltrate of neutrophils
There can be inflammatory cells inside the tumor cell cytoplasm
Where does giant cell carcinoma of the lung like to metastasize to?
The small intestine
