Pulmonary: Pathology Part IV - Cancer and Pleura Flashcards
1
Q
- Contains over 60 carcinogens; 85% of Lung cancer occurs in Smokers
- Polycyclic aromatic hydrocarbons and Arsenic (SCC of Lung) are particularly mutagenic
- Cancer risk is directly related to the duration and amount of smoking (‘pack years’)
A
Cigarette Smoke
2
Q
- Formed by Radioactive decay of Uranium, from soil
- Accumulates in Closed spaces such as Basements
- Responsible for most of the public exposure to Ionizing Radiation, 2nd most frequent cause of Lung Carcinoma in US
- Increased risk of Lung cancer is also seen in Uranium miners
A
Radon Gas
3
Q
- Often reveals a Solitary nodule (‘Coin-lesion’)
- Biopsy is necessary for a Diagnosis
- Benign Lesions – mostly young pts. can produce ‘coin-lesion’
- Granuloma – often TB or Fungus (Histoplasma – Midwest)
- Bronchial Hamartoma – Tumor composed of Lung and Cartilage
A
Lung Cancer imaging
4
Q
- Lung carcinoma is clasically divided into 2 categories
- Small cell carcinoma (15%) – usually not amenable to surgical resection (treated w/ Chemo) – too small to see – non-surgical
-
Non-Small cell carcinoma (85%) – treated upfront w/ surgical resection
- Adenocarcinoma (40%)
- Squamous cell carcinoma (30%)
- Large cell carcinoma (10%)
- Carcinoid tumor (5%)
A
Lung Carcinoma categories
5
Q
- T – Tumor size and local extension
- Plural involvement is classically seen w/ Adenocarcinoma
- Obstruction of SVC leads to Distended Head and Neck veins w/ Edema and Blue discoloration of Arms and Face (Superior vena cava syndrome)
- Involvement of Recurrent laryngeal (Hoarsness) or Phrenic (diaphragmatic paralysis) nerve
- Compression of Sympathetic chain leads to Horner Syndrome characterized by Ptosis, Miosis, and Anhidrosis; usually due to an Apical (Pancoast) tumor
- N – Spread to regional lymph nodes (Hilar and Mediastinal)
- M – Unique site of distant metastasis is the Adrenal gland
A
TNM Staging
6
Q
- Poorly Differentiated/Undifferentiated Small cells → inoperable, Tx: Chemotherapy
- Neuroendocrine (Kulchitsky) cells - small dark blue cells - ‘Salt-n-Pepper’ appearance
- Male smokers - Centrally located
- Neuroendocrine - Synaptophysin chormogranin
- Rapid growth and Early Metastasis (non-related); may produce ADH or ACTH (Cushings syndrome) or Antibodies against presynaptic Ca2+ channels - Eaton-Lamert myasthenic syndome (paraneoplastic syndrome)
- Amplification of **myc **oncogens is common
A
Small Cell Carcinoma
7
Q
- Keratin pearls or Intercellular bridges
- Most common tumor in Male smokers
- Hilar mass arising from Bronchus
- Centrally located
- Cavitation, Cigarettes, HyperCalcemia (produce PTHrP)
A
Squamous Cell Carcinoma
8
Q
- Glands and Mucin
- Most common tumor in **Nonsmokers, ** Female smokers, and Overall (except metastases)
- Mutations* - k-ras**, **EGFR, andALK
- A/w Hypertrophic osteoarthropathy (clubbing)
- Bronchioloalveolar subtype (adeno in situ) → grows along Alveolar septa → apparent “thickening” of Alveolar walls
- CXR: Hazy infiltrates, Peripherally located, similar to pneumonia - Large cell carcinomas
- No paraneoplastic syndrome associated w/ and has excellent prognosis
A
Adenocarcinoma
9
Q
- Highly anaplastic undifferentiated tumor (loss of morphological mature cell characteristics)
- Poorly differentiated large cells (NO Keratin pearls, No Intercellular bridges, No glands, and No mucin)
- Pleomorphic Giant cells
- A/w Smoking
- Centrally and Peripherally located
- Poor prognosis - less responsive to Chemo
- Tx: Surgical resection
A
Large cell Carcinoma
10
Q
- Columnar cells that grow along pre-existing Bronchioles and Alveoli
- Arises from Clara cells
- Not related to smoking
- Peripherally located
- May present w/ Pneumonia-like consolidation on Imagine; excellent prognosis
A
Bronchioalveolar carcinoma
11
Q
- Well differentiated neuroendocrine cells
- Occasionally carcinoid syndrome (**5-HT secretion **→ Flushing, Diarrhea, Wheezing)
- Stain Chromogranin positive
- Not related to smoking
- Centrally or Peripherally
- Central – forms a Polyp-like mass in the Bronchus
- Neuroendocrine cells: Chromogranin A⊕
- Low-grade malignancy - excellent prognosis
- (rarely) can cause Carcinoid Syndrome
A
Bronchial Carcinoid Tumor
12
Q
- “Coin” lesions on CXR
- Non-calcified nodule on CT
- Most common sources are Breast, Colon, Prostate, and Bladder carcinomas
- Multiple ‘Cannon-ball’ nodules on imaging rather than one primary neoplasms
- Metastases from the Lung
- Adrenals, Brain, Bone (pathologic fracture), Liver (Jaundice, Hepatomegaly)
- SPHERE of complicatons
A
Metastasis to Lung
-
SPHERE
- Superior Vena Cava syndrome
- Pancoast tumor
- Horner syndrome
- Endocrine (paraneoplastic)
- Recurrent Laryngeal symptoms (Hoarsness)
- Effusions (pleural or pericardial)
13
Q
- Accumulation of air in the Pleural space
- Unilateral chest pain and dyspnea
- Unilateral chest expansion
- ↓ Tactile fremitus (vibration through body)
- Hyperresonance w/ diminshed breath sounds all on affected side.
- Results in collapse of a portion of the Lung
A
Pneumothorax
14
Q
- ↓ Breath sounds, Hyperresonant, ↓ Fremitus
- Arises w/ Penetrating chest wall injury (Trauma) or Lung Infection
- Air enters the pleural space, but cannot exit
- Trachea is pushed opposite to the side of injury
- Medical emergency; treated with insertion of chest tube
A
Tension pneumothorax
15
Q
- Malignant neoplasm of Mesothelial cells (Pleura)
- Highly associated w/ Occupational exposure to Asbestos
- Presents w/ Reccurent Pleural Effusions, Hemorrhagic Pleural effusions, Pleural thickening
- Dyspnea, and Chest Pain
- Tumor encases the Lung, likes to form along Fissures
- **Epithilioid (round) **and Sarcomatoid (spindle)
- **Psammoma bodies - **are concentric lamellated calcified structures
- Sometimes w/ excessive surfactant
A
Mesothelioma
