Respiratory Flashcards
Synonym for Bronchogenic Carcinoma
Lung Cancer
Second most common cancer in women, after lung
Breast
Second most common cancer in men, after lung
Colon
Most common risk factor
Smoking
Common occupational or environmental exposures
Asbestos, Air pollutants, Arsenic, Mustard Gas, Coal Tar etc.
Lung cancer symptoms
10% asymptomatic, 90% Symptomatic
- Cough, Wheeze, Dyspnea, Hemoptysis, Pneumonia, Pleural Effusion, SVC Syndrome
What is SVC Syndrome?
Superior Vena Cava Syndrome, characterized by the compression of the superior vena cava in the heart. This causes congestion in the head & neck area along with redness from blood accumulation.
What is Pancoast Tumor?
Superior Sulcus, is the compression of the bronchial plexus nerve that causes paralysis of the mid face and upper amenity
Diagnosing Images
Chest X-Ray, Computed Tomography (CT) Scan, Positron Emission Tomography (PET) Scan
Techinques used for diagnosis of Lung Cancer
Cytology: Bronchial brush/wash, TBNA (EBUS), Percutaneous FNA
Tissue Biopsy: Bronchoscopic biopsy, Core needle biopsy
Diagnostic markers/Stains
PD-L1: All Non Small Cell
EGFR: Adenocarcinoma
ALK: Adenocarcinoma
ROS1: Adenocarcinoma
Most Common:
P40: Squamous Cell Carcinoma
TTF1: Adenocarcinoma
Small Cell: Chromogranin & Synaptophysin
Non Small Cell vs Small Cell
NSCLC:
Squamous Cell Carcinoma (Keratinizing/Non-K)
Adenocarcinoma (Most Common Lung Cancer)
Small Cell Carcinoma (Neuroendocrine Carcinoma)
Squamous Cell Carcinoma; Location
Arises from: Squamous Metaplasia in the Bronchus, usually Centrally
Strongly associated with tobacco
Squamous Cell Carcinoma Cytoarchitecture
Predominantly single cells
Squamous Cell Carcinoma Nuclei
Pleomorphic, Hyperchromatic, Irregular
Nucleoli NOT prominent (in well differentiated)
Nucleoli may be present in poorly differentiated
Squamous Cell Carcinoma Cytoplasm
Abundant, dense, organeophilic or blue
Odd shapes, necrosis
Cytoplasmic Keratinization
- Herxheimers Spirals
Nonkeratinizing Squamous Cell Carcinoma
Poorly Differentiated
Nonkeratinizing Squamous Cell Carcinoma; Cytoarchitecture
Disrodered groups, single cells
Nonkeratinizing Squamous Cell Carcinoma; Nuclei
Pleomorphic, hyperchromatic, coarse chromatin
Somtimes present prominent nucleoli
Nonkeratinizing Squamous Cell Carcinoma; Cytoplasm
Dense, cyanophilic
Well-defined cell boarders
Intercellular bridging (Cellblock)
Diff quick, H&E, PAP, *P40 Stain Positive *
Pulmonary Adenocarcinoma
Most common type
Relationship to tobacco not as strong
Pulmonary Adenocarcinoma: Location
Arises from brochoalveolar lining cells
Often arise peripherally
FNA procedure best for peropheral tumors
Pulmonary Adenocarcinoma Subtypes
Nonmucinous
* Acinar, Papillary, Micropapillay, Solid (poorly diff.), Lepidic (In situ, bronchoalveolar)
Mucinous
Enteric
Adenocarcinoma: Cytoarchitecture
Acinar, Papillary, Cell ball cluster
Single cells
Hobnail/floret apprearance with admixed macrophages
Adenocarcinoma; Nuclei
Pleomorphic, irregular; granular chromatin
Eccentric nuclear location; macronucleoli
TTF1 will show postiive for Adeno, stain brown
Adenocarcinoma; Cytoplasm
Delicate, ill-defined; sometimes vacuolated
Large Cell Undifferentiated Carcinoma
Giant cells, sometimes
Smell Cell Carcinoma
Neuroendocrine Origin (Kulschitsky Cells)
Rapid, aggressive tumor
Treatment: radiation/chemo vs biopsy
Oat Cell Carcinoma
TBNA’s sometimes very helpful; transbronchial needle aspiration
Small Cell Carcinoma; Cytoarchitecture
Loose clusters and single cells
Frequent crush/smear artifact
Prominent nuclear molding
Smell Cell Carcinoma; Nuclei
Small; twice the diameter of an inflammatory cell
Irregular nuclear boarders
Nucleoli absent or very small
Salt & Pepper Chromatin
Synaptophysin, Chromogranin
Less common neuroendocrine tumors
Atypical Carcinoid Tumor
* NET with morphology & behavior intermediate between carcinoid & high grade
Large cell neuroendocrine carcinoma (LCNEC)
* High grade neuroendcrine carcinoma
* Biological behavior & prognosis similar to small cell
TNM System
Tumor - primary, size & relationship to structure
Nodes- presence or absence of spread/ number & size
Metastisis - Presence or absence of distant metastatic disease
T Stage (TNM)
T1 - Confined to lung
T2 - 3-5cm or extension to mainstem bronchus ot visceral pleura
T3 - 5-7cm invades chest wall, mutltiple nodes in same lobe
T4 - > 7 cm, invased mediastinum or multiple tumor in more than 1 lobe
Node Stage (TNM)
N1- Hilar/peribronchial node(St. 10&12)
N2 - Mediastinal/subcarinal nodes
N0 - No nodal disease
NX - Nodes not examined
Differentials
Small Cell Carcinoma vs.
Reserve Cell Hyperplasia:
* Regular arragnement,shape, minimal molding
Benign Lymphocytes/Lymphoma (malignent):
* Open chromatin, conspicuous nucleoli, lack of cell group, extensive smear artifact
NSCLC
* Adeno/SCC Criteria
