Respiratory Pathology Pt. 5 Flashcards by Leah Ritter

What are the two most frequently diagnosed cancers in men and women?

Men: prostate and lung

Women: breast and lung

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What is the leading cause of cancer death in men and women?

Lung for both sexes

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What is the most significant risk factor for lung cancer?

Tobacco use
(duration and intensity)
20x risk

–quantified as pack-years

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What are some environmental exposures that are risk factors for lung cancer?

radiation
uranium
asbestos
radon

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True or False: carcinogen exposure and its propensity to cause cancer may be mitigated by genetic variations in patients

True

CYP450 polymorphisms
genes responsible for DNA repair

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What type of cancers are epithelial-derived?

carcinomas

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What is the path leading to primary adenocarcinoma of the lung?

alveolar/bronchial epithelial cells
atypical adenomatous hyperplasia
not usually associated w/ smoking

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What is the path leading to primary squamous cell carcinoma of the lung?

bronchial epithelial cells
squamous dysplasia
associated w/ smoking

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What is the path leading to primary small cell carcinoma of the lung?

epithelial cells w/ neuroendocrine features
Rb inactivation in 90%
p53 inactivation in 90%
associated w/ smoking

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Which type of lung cancer is the most aggressive?

small cell carcinoma (a neuroendocrine carcinoma)

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What is the most common type of lung cancer and why?

adenocarcinoma b/c it comes from the most abundant cell of origin (alveolar parenchyma)
50%

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What are the stages of progression to pulmonary adenocarcinoma?

1) Atypical Adenomatous Hyperplasia
2) Adenocarcinoma in situ
3) Adenocarcinoma

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What are the characteristics of Atypical Adenomatous Hyperplasia?

<5mm

-dysplastic pneumocytes are present along alveoli w/ some interstitial fibrosis

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What are the characteristics of Adenocarcinoma in Situ?

< 3cm (if larger, it’s an adenocarcinoma)

-dysplastic pneumocytes confluently growing along alveoli

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What can mucinous adenocarcinoma be mistaken for on a CXR?

PNA

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What are the stages of progression to squamous carcinoma?

1) Squamous metaplasia
2) Squamous Carcinoma in Situ
3) Invasive Squamous Carcinoma

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What will you see on histology when you’re looking at a squamous cell carcinoma?

keratin pearls

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What will squamous cell carcinoma look like on cytology?

-orange cytoplasm

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Is squamous cell carcinoma more common in women or men?

men

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Does squamous cell carcinoma occur centrally or peripherally?

centrally

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What symptoms would a patient get in a lung tumor was compressing the recurrent laryngeal nerve or the phrenic nerve?

Recurrent Laryngeal N. = hoarseness

Phrenic N. = diaphragm paralysis

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True or False: small cell (neuroendocrine) carcinoma has a high rate of metastasis

True, it’s usually metastasized at time of diagnosis.

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What will small cell (neuroendocrine) carcinoma look like on histology?

necrosis b/c the cancer is growing so fast
fine blue nuclear chromatin, scant cytoplasm
“squished” nuclear molding

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Once you’ve identified a lung cancer as an adenocarcinoma, what should your next step be?

molecular testing for defects in a specific cell signaling pathway (EGFR, ALK, PDL-1)

What type of chemotherapy do you avoid in squamous cell carcinoma and why?

-VEGF inhibitors because they can cause fatal bleeding since squamous cells are so near to vasculature

What is a possible paraneoplastic syndrome associated with squamous cell carcinoma?

- hypercalcemia d/t a PTH-related peptide | - hypercalcemia causes AMS

What are possible paraneoplastic syndromes associated with small cell carcinoma?

- SIADH (Syndrome of Inappropriate ADH secretion) | - Cushing's Syndrome (secretion of ACTH), can cause weakness

What is Trousseau's Sign?

migratory thrombophlebitis that is a paraneoplastic syndrome of many cancers, including lung cancer

What are the symptoms of Horner's Syndrome?

- enopthalmos (sunken eyeball) - ptosis - miosis (persistently small pupil) - anhidrosis (no sweating)

How can Horner's Syndrome be caused by a lung cancer?

tumor suppresses the sympathetic trunk as it passes over the lung superiorly

What symptoms would indicate that the sympathetic trunk compression is occurring in the area of the thoracic outlet?

-arm pain/paresthesia

What are three kinds of neuroendocrine tumors?

- DIPNECH (only a precursor lesion) - Carcinoid Tumor - Atypical Carcinoid Tumor

What are the features of DIPNECH (Diffuse Interstitial Pulmonary Neuroendocrine Cell Hyperplasia)?

- not a malignancy - not fatal - detected by high resolution CT scan - very small (<5mm) "tumorlets"

What are the features of a carcinoid tumor (neuroendocrine carcinoma grade 1)?

> 5mm - can metastasize (but usually slowly) - indolent

What are the features of an atypical carcinoid tumor (neuroendocrine carcinoma grade 2)?

- increased mitotic activity - NECROSIS - disordered growth - increased rate of metastasis - lower survival than a typical carcinoid tumor

Which type of neuroendocrine tumor has the lowest 5-yr survival rate?

small cell carcinoma | neuroendocrine carcinoma grade 3

What might you see in the lungs of a male w/ testicular cancer?

- cannonball metastases | - this kind of cancer is very chemosensitive and highly treatable

What are the characteristics of a Pulmonary Hamartoma?

- totally benign | - sharply defined coin lesions on CT scan

What do you see on low power pathology of a Pulmonary Hamartoma?

-firm "marble" w/ smooth edges

What do you see on high power pathology of a Pulmonary Hamartoma?

-fibrous tissue w/ benign glandular epithelium around hyaline cartilage

What is Lymphangioleiomyomatosis (LAM)?

--proliferation of modified smooth muscle cells (perivascular epithelioid cells) creating cystic spaces --PEC-oma

For what markers are the cells of Lymphangioleiomyomatosis (LAM) positive?

HMB-45 (a melanoma marker)

What demographic of people are most commonly afflicted by Lymphangioleiomyomatosis (LAM)?

mostly young women | extremely uncommon in men

What tumor suppressor gene is associated with Lymphangioleiomyomatosis (LAM)?

-loss of fxn of tumor suppressor TSC2

What emergency clinical presentation might indicate Lymphangioleiomyomatosis (LAM)?

-spontaneous PTX (d/t ruptured cyst)

What type of atalectasis does a pleural effusion cause?

-compression atalectasis

What type of fluid escapes the intravascular compartment due to infection and inflammation?

exudate

What type of fluid escapes the intravascular compartment due to heart failure?

transudate

What is an empyema?

-inflammatory exudate w/ accumulation of pus in the pleural space, typically d/t a bacterial infxn

What is a characteristic feature of an empyema?

--loculations (web-like traps for fluid)

What does the fluid of an empyema look like?

- thick - yellow - shows neutrophils on a smear - often shows bacteria on a smear

How does a Tension Pneumothorax occur?

--injury to the chest wall that results in a one-way valve allowing air INTO the pleural space, but not OUT

What do you see on a CXR of a Tension Pneumothorax versus a Primary Pneumothorax?

mediastinal shift in a Tension PTX

What are two tumors of the pleura?

- Solitary Fibrous Tumor (usually benign) | - Mesothelioma (malignant)

What are the characteristics of a Solitary Fibrous Tumor of the pleura?

- small - pedunculated - staghorn vessels on histology - CD34 stain

What environmental exposure is causes mesothelioma?

asbestos

What population is as risk for mesothelioma?

- Navy shipyard workers | - construction workers

What is seen on histology of mesothelioma?

ferruginous bodies

True or False: mesothelioma can be excised

- False, and its response to chemo and radiation is limited. | - most pts live < 2yrs after Dx.