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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?

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?

25
What is the most deadly Neuroendocrine Tumor and why?
``` Small Cell (Neuroendocrine) Carcinoma -- responds to chemo but HIGH rate of recurrence and metastasis!! ```
26
What is an important treatment implication for Adenocarcinomas specifically and why?
Molecular testing | -- Stopping mutations that cause the uncontrolled growth is vital for treatment
27
What are the molecular testings looking for with Adenocarcinomas?
- EGFR - ALK fusion gene - PDL-1/CTLA-4
28
Paraneoplastic Syndrome for Squamous Cell Carcinoma?
Hypercalcemia -- PTH-rp
29
What are 2 possible Paraneoplastic Syndromes for Small Cell (neuroendocrine) Carcinoma?
SIADH - excessive ADH | Cushing's Syndrome - excessive ACTH
30
What may be the only manifestations of Paraneoplastic Syndromes?
Electrolytes disturbances and/or mental status changes
31
How does Horner's Syndrome arise?
Tumor compresses sympathetics and brachial plexus | -- Oculosympathetic palsy
32
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
33
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
34
What lung cancer can cause Hypercalcemia (PTH-rp)?
Squamous Cell Carcinoma
35
What lung cancer can cause SIADH and Cushing's Syndrome?
Small Cell (neuroendocrine) Carcinoma
36
What are the common Neuroendocrine tumors of the lung?
- Carcinoid tumor - Atypical Carcinoid tumor - Small Cell (neuroendocrine) tumor
37
What is a precursor lesion for Neuroendocrine tumors?
DIPNECH | - Diffuse Interstitial Pulmonary Neuroendocrine Cell Hyperplasia
38
What classifies DIPNECH?
Nodules < 5 mm | -- precursor lesion for neuroendocrine tumors
39
What classifies a Carcinoid Tumor?
Nodules > 5 mm in size and can metastasize
40
Grade 1 Neuroendocrine tumor
Carcinoid tumor
41
Grade 2 Neuroendocrine tumor?
Atypical Carcinoid tumor
42
What classifies an Atypical Carcinoid Tumor?
- Increased mitotic activity - Disordered growth - NECROSIS
43
What classifies an Atypical Carcinoid Tumor?
- NECROSIS - Increased mitotic activity - Disordered growth
44
What is the survival rate of the neuroendocrine tumors going from least deadly to most?
- Carcinoid tumor - Atypical Carcinoid tumor - Small cell (neuroendocrine) carcinoma
45
What symptoms are present with Carcinoid Syndrome?
Flushing, diarrhea and cyanosis
46
Neuroendocrine tumor with nodules < 5 mm
DIPNECH precursor lesion
47
Neuroendocrine tumor with nodules > 5 mm
Carcinoid Tumor
48
Small blue cells (+) CD56 with nuclear molding and necrosis
Small Cell (neuroendocrine) Carcinoma
49
Keratin pearls and orange cytoplasm on cytology
Squamous Cell Carcinoma
50
(+) TTF-1 glands invading lung tissue
Adenocarcinoma

2 - CPR (pulmonary) (26 decks)

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