Pulmonary Pathology III Flashcards
Primary Lung Carcinoma Risk Factors
Genetic (3) and Environmental (4)
P450 defect
p53 deficiency
RB deficiency
Smoking
Radiation exposure
Asbestos
Radon
Adenocarcinoma
Progression with Descriptions (3)
Atypical Adenomatous Hyperplasia:
<5mm, dysplastic pneumocytes
Adenocarcinoma in situ:
~3cm, Grows on alveoli
Adenocarcinoma:
>3cm, malignant
Adenocarcinoma
Histology, Imaging and Behavior
Malignant glands
Mucinous adenocarcinoma looks like pneumonia on CXR
Lepidic growth pattern along alveoli
Squamous Cell Carcinoma
Histology, Behavior and Progression
Shows Keratin Pearls (pink swirls)
Mostly central around bronchi
Starts with squamous metaplasia of respiratory squamous epithelium
Small Cell (Neuroendocrine) Carcinoma Association, Histology (2), Behavior (2)
Strongest association to smoking
Nuclear molding
Necrosis
Highly aggressive metastasis with no preinvasive stage
Paraneoplastic Syndromes
Squamous Cell, Small Cell (2), Adenocarcinoma, Apical
Hypercalcemia from PTH-related peptide
SIADH - hyponatremia
Cushing’s syndrome (ACTH)
Trousseau’s syndrome (migratory thrombophlebitis)
Horner’s syndrome
Neuroendocrine Tumors (3) Grading, Characterization and Radiography
DIPNECH: Benign tumor <5 mm
Precursor to carcinoid tumors
Carcinoid: Grade 1, Can metastasize, >5mm
Atypical Carcinoid: Grade 2, Metastatic, Necrotizing
Collar-Button lesions seen in some carcinoid tumors
Pulmonary Hamartoma
Diagnosis and Description
Coin lesion on CXR
Nodules of connective tissue with epithelial clefts
Lymphangioleiomyomatosis (LAM)
Cause (2) and Presentation (2)
Loss of function mutation in TSC2
May be associated with tuberous sclerosis
Presents with spontaneous pneumothorax in young women
Inflammatory Myofibroblastic Tumors
Presentation (4) and Diagnosis (2)
Fever
Cough
Chest pain
Hemoptysis
CXR or Biopsy
Transudative vs Exudative Effusion
Mechanism, Appearance and Examples
Transudative:
Increased hydrostatic pressure
Serous
Congestive heart failure
Exudative:
Inflammation
Purulent
Infection or Malignancy
Empyema
Mechanism, Appearance and Complication
Bacterial infection
Thick and yellow
Loculations (web-like scarring)
Pneumothorax Spontaneous vs Tension
Mechanism and Presentation
Spontaneous:
Usually sub-pleural blebs bursting
Present in younger people
Tension:
Damage to chest wall creates one way air flow in
Progressively worsens causing mediastinal shift
Mesothelioma
Risk Factor, Diagnosis (2), Prognosis
Asbestos exposure
Calretinin stain showing ferruginous bodies
Difficult to treat, death within 2 years
