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2 - CPR (pulmonary) > Respiratory Pathology - 5 (tumors) > Flashcards

Respiratory Pathology - 5 (tumors) Flashcards

1
Q

What are 2 risk factors for developing tumors in the lung?

A
  1. Tobacco use - duration and intensity

2. Environmental Exposure

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2
Q

How is Tobacco use measured as a risk factor for lung cancers?

A

Pack years = ppd X years of use

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3
Q

What are possible environmental exposures that can be risk factors for developing lung cancers?

A 
Radiation
Radon
Uranium
Asbestos
-- May be mitigated by certain genetic variations (P450)
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4
Q

What cell gives rise to Adenocarcinoma?

A

Type 2 Pneumocyte

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5
Q

What cell gives rise to Squamous Cell Carcinoma?

A

Basal Cell

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6
Q

What cell gives rise to Small Cell (Neuroendocrine) Carcinoma?

A

Neuroendocrine cells

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7
Q

What is the most common lung cancer and why?

A

Adenocarcinoma

– Affects lung parenchyma which is the most common tissue type!

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8
Q

What is the progression of Adenocarcinoma?

A
  • Atypical Adenomatous Hyperplasia (AAH)
  • Adenocarcionma In Situ (AIS)
  • Adenocarcionma
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9
Q

Atypical Adenomatous Hyperplasia (AAH)

A

Dysplastic pneumocytes along alveoli with some fibrosis

* < 5mm

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10
Q

Adenocarcinoma In Situ (AIS)

A

Dysplastic pneumocytes confluently growing along alveoli

* < 3cm

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11
Q

Does Adenocarcinoma always arise from precursor lesions in smokers?

A

NO

  • Can occur in smokers or non-smokers
  • Can occur from precursor lesions or outright
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12
Q

What does the histology show with Adenocarcinoma?

A

Malignant GLANDS invading lung tissue

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13
Q

Malignant glands invading lung tissue

A

Adenocarcinoma

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14
Q

What is a (+) stain for Adenocarcinoma?

A

(+) TTF-1

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15
Q

What type of Adenocarcinoma can mimic Pneumonia?

A

Mucinous Adenocarcinoma

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16
Q

What is the progression of Squamous Cell Carcinoma?

A
  • Normal bronchial epithelium
  • Squamous metaplasia
  • Squamous carcinoma In Situ
  • Invasive Squamous Cell Carcinoma
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17
Q

What is the normal bronchial epithelium?

A

Columnar with cilia

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18
Q

With Squamous cell Carcinoma, it starts by progressing from normal bronchial epithelium to Squamous Metaplasia. What does that look like?

A

Normal bronchial epithelium with more squamous and flattened cells growing on top/out towards periphery

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19
Q

What is seen on histology with Squamous Cell Carcinioma?

A

KERATIN pearls

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20
Q

What is seen on Cytology with Squamous Cell Carcinoma?

A

Orange cytoplasm = Keratin

“OK” - orange keratin

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21
Q

In what gender and what location is Squamous Cell Carcinoma most common?

A

More common in males and occurs centrally

22
Q

Small Cell (Neuroendocrine) Carcinoma is almost always associated with?

A

Smoking

23
Q

What does Small Cell (Neuroendocrine) Carcinoma look like on histology?

A

Small BLUE cells with little cytoplasm, nuclear molding and characteristic necrosis

24
Q

What marker is (+) for Small Cell (Neuroendocrine) Carcinoma?

A

(+) CD56

25
Q

What is the most deadly Neuroendocrine Tumor and why?

A 
Small Cell (Neuroendocrine) Carcinoma
-- responds to chemo but HIGH rate of recurrence and metastasis!!
26
Q

What is an important treatment implication for Adenocarcinomas specifically and why?

A

Molecular testing

– Stopping mutations that cause the uncontrolled growth is vital for treatment

27
Q

What are the molecular testings looking for with Adenocarcinomas?

A
  • EGFR
  • ALK fusion gene
  • PDL-1/CTLA-4
28
Q

Paraneoplastic Syndrome for Squamous Cell Carcinoma?

A

Hypercalcemia – PTH-rp

29
Q

What are 2 possible Paraneoplastic Syndromes for Small Cell (neuroendocrine) Carcinoma?

A

SIADH - excessive ADH

Cushing’s Syndrome - excessive ACTH

30
Q

What may be the only manifestations of Paraneoplastic Syndromes?

A

Electrolytes disturbances and/or mental status changes

31
Q

How does Horner’s Syndrome arise?

A

Tumor compresses sympathetics and brachial plexus

– Oculosympathetic palsy

32
Q

What are the manifestations of Horner’s Syndrome?

A
  • Enopthalmos = sunken eyeball
  • Ptosis and Miosis = droopy eyelid and small pupil
  • Anhidrosis = no sweating on affected side of face
  • Pain/paresthesias of that affected side’s arm
33
Q

What are the manifestations of Horner’s Syndrome?

A
  • Enopthalmos = sunken eyeball
  • Ptosis and Miosis = droopy eyelid and small pupil
  • Anhidrosis = no sweating on affected side of face
  • Pain/paresthesias of that affected side’s arm
34
Q

What lung cancer can cause Hypercalcemia (PTH-rp)?

A

Squamous Cell Carcinoma

35
Q

What lung cancer can cause SIADH and Cushing’s Syndrome?

A

Small Cell (neuroendocrine) Carcinoma

36
Q

What are the common Neuroendocrine tumors of the lung?

A
  • Carcinoid tumor
  • Atypical Carcinoid tumor
  • Small Cell (neuroendocrine) tumor
37
Q

What is a precursor lesion for Neuroendocrine tumors?

A

DIPNECH

- Diffuse Interstitial Pulmonary Neuroendocrine Cell Hyperplasia

38
Q

What classifies DIPNECH?

A

Nodules < 5 mm

– precursor lesion for neuroendocrine tumors

39
Q

What classifies a Carcinoid Tumor?

A

Nodules > 5 mm in size and can metastasize

40
Q

Grade 1 Neuroendocrine tumor

A

Carcinoid tumor

41
Q

Grade 2 Neuroendocrine tumor?

A

Atypical Carcinoid tumor

42
Q

What classifies an Atypical Carcinoid Tumor?

A
  • Increased mitotic activity
  • Disordered growth
  • NECROSIS
43
Q

What classifies an Atypical Carcinoid Tumor?

A
  • NECROSIS
  • Increased mitotic activity
  • Disordered growth
44
Q

What is the survival rate of the neuroendocrine tumors going from least deadly to most?

A
  • Carcinoid tumor
  • Atypical Carcinoid tumor
  • Small cell (neuroendocrine) carcinoma
45
Q

What symptoms are present with Carcinoid Syndrome?

A

Flushing, diarrhea and cyanosis

46
Q

Neuroendocrine tumor with nodules < 5 mm

A

DIPNECH precursor lesion

47
Q

Neuroendocrine tumor with nodules > 5 mm

A

Carcinoid Tumor

48
Q

Small blue cells (+) CD56 with nuclear molding and necrosis

A

Small Cell (neuroendocrine) Carcinoma

49
Q

Keratin pearls and orange cytoplasm on cytology

A

Squamous Cell Carcinoma

50
Q

(+) TTF-1 glands invading lung tissue

A

Adenocarcinoma

2 - CPR (pulmonary) (26 decks)

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