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CPR Exam 2 > Pulmonary Pathology Part 5 > Flashcards

Pulmonary Pathology Part 5 Flashcards

1
Q

What are some epidemiology/risk factors for lung cancer?

A
  • Smoking
  • Radon
  • Asbestos
  • Environmental tobacco exposure
  • Genetics
  • Other lung diseases
  • Prior radiation
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2
Q

What is the progression to lung carcinoma of alveolar/bronchial epithelial cells?

A
  • Kras or B-catenin mutation leading to atypical adenomatous hyperplasia
  • The adenomatous hyperplasia leads to primary adenocarcinoma
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3
Q

What is the progression to lung carcinoma of bronchial epithelial cells?

A
  • Chr 3p LOH leading to squamous dysplasia

- This ends in primary squamous cell carcinoma

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4
Q

What is the progression to lung carcinoma of epithelial cells with neuroendocrine features?

A
  • Chr 3p LOH which causes a p53 inactivation

- Ends in primary small cell carcinoma

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5
Q

What is the most predominant type of carcinoma? Why?

A
  • Adenocarcinoma due to much more of the lung tissue being alveolar parenchyma
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6
Q

What is the progression of pulmonary adenocarcinoma?

A
  1. Normal tissue
  2. Atypical adenomatous hyperplasia
  3. Adenocarcinoma in Situ
  4. Adenocarcinoma
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7
Q

What is atypical adenomatous hyperplasia?

A
  • <5mm

- Dysplastic pneumocytes present along alveoli with some interstitial fibrosis

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8
Q

What is adenocarcinoma in situ?

A
  • Formerly bronchioloalveolar carcinoma (BAC)
  • <3cm
  • Dysplastic pneumocytes confluently growing along alveoli
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9
Q

What is pulmonary adenocarcinoma?

A
  • Can arise from precursors or develop de novo
  • Most common lung malignancy in smokers and non-smokers
  • Histology shows malignant glands invading the lung tissue
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10
Q

What does gland forming adenocarcinoma stain positive?

A
  • TTF-1 (thyroid transcription factor 1)
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11
Q

What can mucinous adenocarcinoma mimic? How is this a problem?

A
  • Mimics pneumonia

- A problem because a non-oncologist may assume that it is pneumonia and treat that

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12
Q

What is a key aspect of squamous carcinoma on histology?

A
  • Keratin pearls
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13
Q

What does orange cytoplasm mean on cytology?

A
  • Keratin
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14
Q

What is squamous carcinoma?

A
  • More common in men
  • Strong association with smoking
  • Occurs centrally
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15
Q

What is the TNM staging mnemonic mean?

A
  • T is the tumor size
  • N is the lymph node involvement
  • M is the metastasis to other body parts
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16
Q

What is small cell “neuroendocrine” carcinoma?

A
  • Almost always associated with smoking
  • High rate of metastasis
  • Important to identify for purposes of treatment
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17
Q

When is surgical excision not recommended for small cell “neuroendocrine” carcinomas?

A
  • If metastatic to LN
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18
Q

What is the treatment for small cell carcinomas?

A
  • Specific chemotherapy due to its responsiveness
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19
Q

What molecular testing do you do for adenocarcincomas?

A
  • EGFR
  • ALK
  • PDL-1
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20
Q

What do you use to treat adenocarcinoma if the EGFR mutation is positive?

A
  • Erlotinib

- Gefitinib

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21
Q

What do you use to treat adenocarcinoma if there is ALK rearrangment?

A
  • Crizotinib
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22
Q

What do you use to treat adenocarcinoma if there is a problem with the PD-1/PDL-1?

A
  • Pembrolizumab
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23
Q

What do you use to treat adenocarcinoma if there is a problem with CTLA-4?

A
  • Ipilimumab
24
Q

What don’t you use to treat squamous carcinoma?

A
  • Don’t use VEGF inhibitors due to risk of bleeding
25
Q

What do you use to treat small cell carcinoma?

A
  • Specific chemotherapeutic regimens
26
Q

What is can help diagnose squamous carcinoma?

A
  • Hypercalcemia: PTH-related peptide
27
Q

What can help diagnose small cell cardinoma?

A
  • SIADH (inappropriate secretion of ADH)

- Cushing’s syndrome (secretion of ACTH)

28
Q

How can a lung carcinoma cause horner’s syndrome?

A
  • Carcinoma in the upper lobe can disrupt the sympathetic pathway
29
Q

What is DIPNECH?

A
  • Diffuse interstitial pulmonary neuroendocrine cell hyperplasia
  • High-resolution CT scan detects these nodules
  • Very small, less than 5 mm
30
Q

What is a carcinoid tumor?

A
  • 5mm or larger
  • These can mestatize
  • Indolent
  • Neuroendocrine carcinoma grade 1
31
Q

What is an atypical carcinoid tumor?

A
  • Neuroendocrine carcinoma grade 2
  • Increased mitotic activity
  • Necrosis
  • Disordered growth
  • Increased rate of metastasis
  • Lower survival
32
Q

What is carcinoid syndrome?

A
  • Flushing
  • Diarrhea
  • Cyanosis
33
Q

What is the 5 year survival rate for the different neuroendocrine tumors?

A
  • Carcinoid tumors: 95%
  • Atypical carcinoid tumors: 70%
  • Small cell carcinoma: 5%
34
Q

What is a lymphangioleiomyomatosis (LAM)?

A
  • Proliferation of cells creating cystic spaces
  • Modified smooth muscle cells
  • Positive for melanoma markers like HMB-45
  • Perivascular epithelioid cells (PEC-oma)
35
Q

Who typically has LAM?

A
  • Young women
36
Q

What is LAM associated with?

A
  • Loss of function of tumor suppressor TSC2
37
Q

What are some major causes of pleural effusion?

A
  • Heart failure
  • Infection
  • Malignancy
38
Q

What is the cause of a bloody pleural effusion?

A
  • Malignancy
39
Q

What is the cause of a milky chylous pleural effusion?

A
  • Obstruction of the thoracic duct
40
Q

What is the cause of a serous pleural effusion?

A
  • Heart failure
41
Q

What is empyema?

A
  • Inflammatory exudate with accumulation of pus in the pleural space
  • Notorious for creating loculations (web like traps for fluid)
42
Q

What typically causes empyema?

A
  • Bacterial infection
43
Q

What does the fluid look like in empyema?

A
  • Fluid will be thick, yello; smears of fluid will show neutrophils and often bacteria
44
Q

What is a cause of a spontaneous pneumothorax?

A
  • Rupture of subpleural blebs (young patients)
45
Q

What are some causes of a secondary pneumothorax?

A
  • Cystic infection
  • Cystic tumors
  • Positive pressure ventilation
  • Trauma
46
Q

What causes a tension pneumothorax?

A
  • Injury to the chest wall resulting in a one-way valve allowing air into the pleural space, but not out
47
Q

What does a tension pneumothorax look like?

A
  • Air is pulled to where it is easier

- Trachea will deviate away from lesion

48
Q

What is a benign pleural tumor?

A
  • Solitary fibrous tumor
49
Q

What is a malignant pleural tumor?

A
  • Mesothelioma
50
Q

What are some characteristics of a solitary fibrous tumor?

A
  • Benign when small and pedunculated

- Larger ones may behave like sarcoma

51
Q

What is a solitary fibrous tumor?

A
  • A circumscribed pleural-based mass

- Easy to excised due to being pedunculated

52
Q

What is mesothelioma?

A
  • Associated with asbestos exposure
  • May occur decades after exposure
  • Lifetime exposure risk is as high as 10%
53
Q

What are the different variants of mesothelioma?

A
  • Epithelioid
  • Sarcomatoid
  • Mixed
54
Q

How is mesothelioma treated?

A
  • Not easily
  • Hard to excise surgically
  • Responsiveness to chemotherapy and radiation is limited
55
Q

What is the mortality of mesotehlioma?

A
  • Most will not live 2 years after diagnosis

CPR Exam 2 (12 decks)

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