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MD2 Ambulatory Care and Emergency Medicine > Respiratory Pathology 2 (Neoplastic) > Flashcards

Respiratory Pathology 2 (Neoplastic) Flashcards

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1
Q

What is the average of lung cancer diagnosis?

A

60

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2
Q

What are the risk factors for lung cancer?

A 
Tobacco smoke
Occupational hazards
Scarring
Molecular genetics
- EGFR
- ALK mutation
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3
Q

What are the clinical features of lung cancers?

A 
Depends on location and size
Central
- Cough
- Dyspnoea
- Wheezing
- Haemoptysis
Apex
- Pancoast syndrome
Secreting hormones
- Paraneoplast syndromes
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4
Q

How is tissue sampled in suspected lung cancer?

A

Core biopsy

  • CT guided
  • Bronchoscopy
  • EBUS
  • Wedge excision
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5
Q

How are lung carcinomas classified?

A 
Non-small cell carcinoma
- Squamous cell carcinoma
- Adenocarcinoma
- Large cell carcinoma
- Sarcomatoid carcinoma
Small cell carcinoma
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6
Q

What are the macroscopic features of squamous cell carcinomas of the lung?

A 
Tend to be central
Frequently involve large airways
Cavitation in 1/3 of cases
Grey-white to yelloww
Keratinisation > dry, flaky appearance
Necrosis
Haemorrhage
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7
Q

How are squamous cell carcinomas of the lung histologically classified?

A 
Intercellular bridges
Keratinisation
Immunohistochemistry needed if poorly differentiated
- CK5
- P63
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8
Q

What is the most common non-small cell carcinoma?

A

Adenocarcinoma

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9
Q

What are the macroscopic features of adenocarcinoma of the lung?

A 
Peripheral
Well circumscribed
Unrelated to bronchi
May have pleural involvement
Grey-white
Necrosis
Haemorrhage
If produce lots of mucin > mucoid appearance
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10
Q

What are the histological features of adenocarcinoma of the lung?

A 
Well-moderately differentiated
Glandular and/or papillary structures
Cytoplasmic mucinous vacuoles/mucin in stroma
Immunohistochemistry
- TTF1
- CK7
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11
Q

What are the macroscopic features of small cell carcinomas?

A

Neuroendocrine differentiation
Rapidly growing
- Often causes local obstruction; eg: major bronchi, SVC
Regional lymph node involvement/distant metastasis at presentation
Strong association with smoking

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12
Q

How are small cell carcinomas treated?

A

Chemo-sensitive

Surgery usually not recommended

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13
Q

What are the histological features of small cell carcinomas?

A 
Neuroendocrine architecture
- Nests
- Trabeculae
- Ribbons
- Rosetts
High nucleus-cytoplasm ratio
Enlarged ovoid nuclei
Granular nuclear chromatin
Inconspicuous nucleoli
Nuclear molding
Scanty cytoplasm
Many mitoses
Apoptotic bodies
Areas of necrosis
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14
Q

What classification is used to stage lung cancer?

A

TNM

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15
Q

When is staging of a lung cancer often done?

A

Pre-operatively to determine whether patient surgical candidate

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16
Q

Where do lung cancers often metastasise?

A 
Adrenal glands
Liver
Brain
Bone
Other lung lobes and opposite side
17
Q

Which demographic has a significant rate of EGFR mutations?

A

Young non-/light smoking female Asians with low-stage disease

18
Q

Are all EGFR mutations in lung cancer sensitive to treatment with inhibitors?

A

No, some sensitive, but others resistant

19
Q

Which demographic has a significant rate of ALK mutations?

A

Males 40-60 with light/non-smoking history

Often high stage

20
Q

What are the different types of neuroendocrine tumours of the lung?

A

Typical carcinoid
Atypical carcinoid
Small cell carcinoma
Large cell neuroendocrine carcinoma

21
Q

What is the clinical presentation of carcinoid tumours of the lung?

A

Half found incidentally on radiology
Cough
Haemoptysis

22
Q

Are carcinoid tumours “benign”?

A

No, all have metastatic potential

23
Q

What are the histological features of carcinoid tumours of the lung?

A 
Neuroendocrine architecture
- Nests
- Trabeculae
- Ribbons
- Rosettes
Round-ovoid nuclei
Granular chromatin
Small nucleoli
Moderate amounts of granular cytoplasm
24
Q

What are the histological features of atypical carcinoid tumours of the lung?

A

More mitoses and/or necrosis

25
Q

What are the immunohistochemistry markers for the diagnosis of carcinoid tumours of the lung?

A

Synaptophysis
Chromogranin
CD56

26
Q

What are common sites of cancers that metastasise to the lung?

A

Breast
Lower GI tract
Melanoma
Renal cell carcinoma

27
Q

What are different patterns of metastases in the lung?

A 
Multiple nodules
Solitary metastasis
Lymphangitic metastases
Endobronchial metastases
Pleural metastases
Interstitial spread
28
Q

How is metastatic disease confirmed?

A

Clinical and radiological correlation
Histology with morphological assessment
Immunohistochemical staining

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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