Respiratory Pathology - 5 (tumors) Flashcards
What are 2 risk factors for developing tumors in the lung?
- Tobacco use - duration and intensity
2. Environmental Exposure
How is Tobacco use measured as a risk factor for lung cancers?
Pack years = ppd X years of use
What are possible environmental exposures that can be risk factors for developing lung cancers?
Radiation Radon Uranium Asbestos -- May be mitigated by certain genetic variations (P450)
What cell gives rise to Adenocarcinoma?
Type 2 Pneumocyte
What cell gives rise to Squamous Cell Carcinoma?
Basal Cell
What cell gives rise to Small Cell (Neuroendocrine) Carcinoma?
Neuroendocrine cells
What is the most common lung cancer and why?
Adenocarcinoma
– Affects lung parenchyma which is the most common tissue type!
What is the progression of Adenocarcinoma?
- Atypical Adenomatous Hyperplasia (AAH)
- Adenocarcionma In Situ (AIS)
- Adenocarcionma
Atypical Adenomatous Hyperplasia (AAH)
Dysplastic pneumocytes along alveoli with some fibrosis
* < 5mm
Adenocarcinoma In Situ (AIS)
Dysplastic pneumocytes confluently growing along alveoli
* < 3cm
Does Adenocarcinoma always arise from precursor lesions in smokers?
NO
- Can occur in smokers or non-smokers
- Can occur from precursor lesions or outright
What does the histology show with Adenocarcinoma?
Malignant GLANDS invading lung tissue
Malignant glands invading lung tissue
Adenocarcinoma
What is a (+) stain for Adenocarcinoma?
(+) TTF-1
What type of Adenocarcinoma can mimic Pneumonia?
Mucinous Adenocarcinoma
What is the progression of Squamous Cell Carcinoma?
- Normal bronchial epithelium
- Squamous metaplasia
- Squamous carcinoma In Situ
- Invasive Squamous Cell Carcinoma
What is the normal bronchial epithelium?
Columnar with cilia
With Squamous cell Carcinoma, it starts by progressing from normal bronchial epithelium to Squamous Metaplasia. What does that look like?
Normal bronchial epithelium with more squamous and flattened cells growing on top/out towards periphery
What is seen on histology with Squamous Cell Carcinioma?
KERATIN pearls
What is seen on Cytology with Squamous Cell Carcinoma?
Orange cytoplasm = Keratin
“OK” - orange keratin
In what gender and what location is Squamous Cell Carcinoma most common?
More common in males and occurs centrally
Small Cell (Neuroendocrine) Carcinoma is almost always associated with?
Smoking
What does Small Cell (Neuroendocrine) Carcinoma look like on histology?
Small BLUE cells with little cytoplasm, nuclear molding and characteristic necrosis
What marker is (+) for Small Cell (Neuroendocrine) Carcinoma?
(+) CD56
What is the most deadly Neuroendocrine Tumor and why?
Small Cell (Neuroendocrine) Carcinoma -- responds to chemo but HIGH rate of recurrence and metastasis!!
What is an important treatment implication for Adenocarcinomas specifically and why?
Molecular testing
– Stopping mutations that cause the uncontrolled growth is vital for treatment
What are the molecular testings looking for with Adenocarcinomas?
- EGFR
- ALK fusion gene
- PDL-1/CTLA-4
Paraneoplastic Syndrome for Squamous Cell Carcinoma?
Hypercalcemia – PTH-rp
What are 2 possible Paraneoplastic Syndromes for Small Cell (neuroendocrine) Carcinoma?
SIADH - excessive ADH
Cushing’s Syndrome - excessive ACTH
What may be the only manifestations of Paraneoplastic Syndromes?
Electrolytes disturbances and/or mental status changes
How does Horner’s Syndrome arise?
Tumor compresses sympathetics and brachial plexus
– Oculosympathetic palsy
What are the manifestations of Horner’s Syndrome?
- 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
What are the manifestations of Horner’s Syndrome?
- 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
What lung cancer can cause Hypercalcemia (PTH-rp)?
Squamous Cell Carcinoma
What lung cancer can cause SIADH and Cushing’s Syndrome?
Small Cell (neuroendocrine) Carcinoma
What are the common Neuroendocrine tumors of the lung?
- Carcinoid tumor
- Atypical Carcinoid tumor
- Small Cell (neuroendocrine) tumor
What is a precursor lesion for Neuroendocrine tumors?
DIPNECH
- Diffuse Interstitial Pulmonary Neuroendocrine Cell Hyperplasia
What classifies DIPNECH?
Nodules < 5 mm
– precursor lesion for neuroendocrine tumors
What classifies a Carcinoid Tumor?
Nodules > 5 mm in size and can metastasize
Grade 1 Neuroendocrine tumor
Carcinoid tumor
Grade 2 Neuroendocrine tumor?
Atypical Carcinoid tumor
What classifies an Atypical Carcinoid Tumor?
- Increased mitotic activity
- Disordered growth
- NECROSIS
What classifies an Atypical Carcinoid Tumor?
- NECROSIS
- Increased mitotic activity
- Disordered growth
What is the survival rate of the neuroendocrine tumors going from least deadly to most?
- Carcinoid tumor
- Atypical Carcinoid tumor
- Small cell (neuroendocrine) carcinoma
What symptoms are present with Carcinoid Syndrome?
Flushing, diarrhea and cyanosis
Neuroendocrine tumor with nodules < 5 mm
DIPNECH precursor lesion
Neuroendocrine tumor with nodules > 5 mm
Carcinoid Tumor
Small blue cells (+) CD56 with nuclear molding and necrosis
Small Cell (neuroendocrine) Carcinoma
Keratin pearls and orange cytoplasm on cytology
Squamous Cell Carcinoma
(+) TTF-1 glands invading lung tissue
Adenocarcinoma
