Singh Respiratory Pathology #5 Flashcards
How do you calculate Pack years?
- Packs smoked per day x number of years
- ex: 1 ppd for 30 yrs= 30 yr hx
- 2 ppd for 30 yrs = 60 pack years
What type of cells does squamous cell carcinoma develop from?
basal cells
What cells do small cell carcinomas arise from?
Neuroendocrine cells scattered throughout respiratory epithelium
What cells do adenocarcinomas of the lung arise from?
type II alveolar
What cancers are most common to leawst?
- Adenocarcinoma (50%)
- Squamous carcinoma (20%)
- Small cell carcinoma (15%)
Describe progression of Adenocarcinoma?
- Atypical adenomatous hyperplasia (AAH)
- <5mm, dysplastic pneumocytes along alveoli with interstitial fibrosis
- Adenocarcinoma in Situ (AIS)
- <3 cm
- Dysplastic pneumocytes growing along alveoli
What stain can help diagnose adenocarcinoma of the lung?
TTF-1
Mucinous adenocarcinoma?
grows on surface of alveoli, and is not in situ because it spreads so far. Mimics pneumonia on CXR
What is this?
squamous carcinoma
What is this?
SCC, orange cytoplasm is keratin
Epidemiology of SCC?
- More common in me
- Associated with smoking
- Occurs centrally
What is small cell neuroendocrine carcinoma almost always associated with?
Smoking
High rate of metastasis
What tumor characteristics should be looked for with adenocarcinoma to help with treatment?
- EGFR
- can use erlotinib or gefinitib
- ALK1
- crizotinib
- PD1
- pembrolizumab
- CTLAA4
- ipilimumab
what inhibitor should NOT be used to treat squamous carcinomas and why?
VEGF as it will cause bleeding
What paraneoplastic syndrome can be seen with squamous carcinoma?
- Hypercalcemia due to PTH-rp released by the tumor
- causes mental status changes and EKG changes
What paraneoplastic syndromes can be seen with small cell carcinoma?
- SIADH
- hyponatremia
- mental status changes and siezures
- hyponatremia
- Cushing syndrome via secretion of ACTH
- atypical cushing syndrome, no central obesity or striae
What is Trosseau’s syndrome?
Migratory thrombophlebitis
What is an unexpected way that lung cancers can primarily manifest?
As electrolyte disturbances or mental status changes
Horners syndrome?
- Oculosympathetic palsy
- can occur at many sites along sympathetic pathway
In horners syndrome, why do patients sometimes have arm pain?
- Depending where the tumor is, the brachial plexus can be involved resulting in pain down the arm
What is DIPNECH?
- diffuse interstitial pulmonary neuroendocrine cell hyperplasia
- High resolution CT scan detects
- Very small nodules less than 5 mm
- precursor to carcinoid tumor
Describe a carcinoid tumor.
- 5mm or larger (how you tell apart from DIPNECH)
- can metastasize
- Indolent
- Would call this neuroendocrine carcinoma grade 1 tumor
What do you see in atypical carcinoid tumors (neuroendocrine carcinoma grade 2) compared to carcinoids?
- necrosis
- increased mitotic activity
- disordered growth
What is carcinoid syndrome?
- Flushing
- Diarrhea
- cyanosis
5 yr survival rates for Carcinoid tumors, Atypical carcinoid tumors, and Small cell carcinoma?
- Carcinoid 95%
- Atypical 70%
- Small cell 5%
what is happening in this 26 yr male patient with SOA and hemoptysis?
- Cannonball mets in testicular cancer
- Metastatic malignancy
Lymphangioleiomyomatosis (LAM) characteristics?
- Proliferation of cells creating cystic spaces
- tuberous sclerosis association
- cells are modified smooth mm cells and are positive for melanoma markers such as HMB-45
- Perivascular epithelioid cells
- Young women
- LOF in tumor suppresor TSC2
- Spontaneous pneumothorax can occur
Transudative fluid? What causes it in pleural effusions?
- low protein content
- few cells
- decreased colloid osmotic pressure can be seen with nephrotic syndrome
- Increased hydrostatic pressure causing overflow of liquid from lung can be seen in heart failure
Describe exudative fluid and what causes it with a pleural effusion?
- Inflammation!
- Infection such as bacterial pneumonia or TB
- PE
- CTD
- Malignancy
- High protein content may contain cells
What should a bloody pleural effusion make you think of?
Malignancy
What is Empyema?
- Inflammatory exudate with accumulation of pus in pleural space
- Usually bacterial
- Creates loculations (web like traps for fluids)
Tension pneumothorax?
- Injury to chest wall that creates a one way valve allowing air IN but not out
- Every breath traps more and more air occupying space in the thoracic cavity, pushing the mediastinum
Differentiate these two pictures
- left is a primary pneumothorax
- the left lung is collapsed and you can tell because there are no lung markings (white streaks) it is just black
- Right side is tension pneumothorax
- you can tell because the entire mediastinum is shifted to the left and the right lung is not seen
How do you initially treat tension pneumothorax?
Needle decompression
When is a solitary fibrous tumor benign?
Benign when it is small and pedunculated
How do large solitary fibrous tumors “behave”?
like sarcomas
Describe Mesothelioma?
- Associated with asbestos exposure
- may take decades for disease to present
What stain is positive for mesothelioma?
- Calretinin stain is positve
- may also see ferrunginous bodies on histology
