Respiratory Pathology 2 (Neoplastic) Flashcards
What is the average of lung cancer diagnosis?
60
What are the risk factors for lung cancer?
Tobacco smoke Occupational hazards Scarring Molecular genetics - EGFR - ALK mutation
What are the clinical features of lung cancers?
Depends on location and size Central - Cough - Dyspnoea - Wheezing - Haemoptysis Apex - Pancoast syndrome Secreting hormones - Paraneoplast syndromes
How is tissue sampled in suspected lung cancer?
Core biopsy
- CT guided
- Bronchoscopy
- EBUS
- Wedge excision
How are lung carcinomas classified?
Non-small cell carcinoma - Squamous cell carcinoma - Adenocarcinoma - Large cell carcinoma - Sarcomatoid carcinoma Small cell carcinoma
What are the macroscopic features of squamous cell carcinomas of the lung?
Tend to be central Frequently involve large airways Cavitation in 1/3 of cases Grey-white to yelloww Keratinisation > dry, flaky appearance Necrosis Haemorrhage
How are squamous cell carcinomas of the lung histologically classified?
Intercellular bridges Keratinisation Immunohistochemistry needed if poorly differentiated - CK5 - P63
What is the most common non-small cell carcinoma?
Adenocarcinoma
What are the macroscopic features of adenocarcinoma of the lung?
Peripheral Well circumscribed Unrelated to bronchi May have pleural involvement Grey-white Necrosis Haemorrhage If produce lots of mucin > mucoid appearance
What are the histological features of adenocarcinoma of the lung?
Well-moderately differentiated Glandular and/or papillary structures Cytoplasmic mucinous vacuoles/mucin in stroma Immunohistochemistry - TTF1 - CK7
What are the macroscopic features of small cell carcinomas?
Neuroendocrine differentiation
Rapidly growing
- Often causes local obstruction; eg: major bronchi, SVC
Regional lymph node involvement/distant metastasis at presentation
Strong association with smoking
How are small cell carcinomas treated?
Chemo-sensitive
Surgery usually not recommended
What are the histological features of small cell carcinomas?
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
What classification is used to stage lung cancer?
TNM
When is staging of a lung cancer often done?
Pre-operatively to determine whether patient surgical candidate
Where do lung cancers often metastasise?
Adrenal glands Liver Brain Bone Other lung lobes and opposite side
Which demographic has a significant rate of EGFR mutations?
Young non-/light smoking female Asians with low-stage disease
Are all EGFR mutations in lung cancer sensitive to treatment with inhibitors?
No, some sensitive, but others resistant
Which demographic has a significant rate of ALK mutations?
Males 40-60 with light/non-smoking history
Often high stage
What are the different types of neuroendocrine tumours of the lung?
Typical carcinoid
Atypical carcinoid
Small cell carcinoma
Large cell neuroendocrine carcinoma
What is the clinical presentation of carcinoid tumours of the lung?
Half found incidentally on radiology
Cough
Haemoptysis
Are carcinoid tumours “benign”?
No, all have metastatic potential
What are the histological features of carcinoid tumours of the lung?
Neuroendocrine architecture - Nests - Trabeculae - Ribbons - Rosettes Round-ovoid nuclei Granular chromatin Small nucleoli Moderate amounts of granular cytoplasm
What are the histological features of atypical carcinoid tumours of the lung?
More mitoses and/or necrosis
What are the immunohistochemistry markers for the diagnosis of carcinoid tumours of the lung?
Synaptophysis
Chromogranin
CD56
What are common sites of cancers that metastasise to the lung?
Breast
Lower GI tract
Melanoma
Renal cell carcinoma
What are different patterns of metastases in the lung?
Multiple nodules Solitary metastasis Lymphangitic metastases Endobronchial metastases Pleural metastases Interstitial spread
How is metastatic disease confirmed?
Clinical and radiological correlation
Histology with morphological assessment
Immunohistochemical staining
