Smoking types

Question 1

Adenocarcinoma

Answer 1

Peripheral
Most common in non smoker females
K-ras mutation
Associated with clubbing (hypertrophic osteoarthropathy)

Bronchioloalveolar subtype: hazy infiltrate similar to pneumonia due to growth along septa (thickening of alveolar walls); excellent prognosis

Question 2

SCC

Answer 2

1) Central
2) Hilar mass arising from bronchus;
3) Cavitation, cigarette, hyperCalcemia (produces PTHrP)

Keratin pearls and intercellular bridges

“All the C’s”

Question 3

Small cell (oat cell) carcinoma

Answer 3

1) Central
2) Undifferentiated=> very aggressiv
3) ACTH, ADH, antibodies against presynaptic Ca2+
4) Amplication of MYC oncogene.
5) Treated with chemo.
6) Neoplasm of neuroendocrine, Kulchitsky cells (small dark blue)

“Salt and pepper with high mitotic rate”
“All the A’s”

Question 4

Large cell carcinoma

Answer 4

1) Peripheral
2) Highly anaplastic undifferentiated tumor;
3) poor prognosis;
4) less responsive to chemo; surgery
5) Pheomorphic giant cells

Question 5

Bronchial carcinoid tumor

Answer 5

1) Excellent prognosis;
2) metastasis rare
3) Symptoms due to mass effect;
4) Occasional carcinoid syndrome (serotonin: flushing, diarrhea, wheezing)
5) Nests of neuroendocrine cells; chromogranin positive.

Question 6

Mesothelioma

Answer 6

1) Pleural
2) Associated with asbestosis
3) Results in hemorrhagic pleural effusions and pleural thickening.
4) Psammoma bodies.

Question 7

Pancoast tumor

Answer 7

Apex of lung may affect cervical sympathetic plexus;

Horner syndrome: ipsilateral ptosis, miosis, anhidrosis

Question 8

Superior vena cava syndrome

Answer 8

Impedes blood from head (facial plethora)
Neck JV distension,
Upper extremity (edema)

Commonly from malignancy and thrombosis from indwelling catheters.

Can raise ICP => HA, dizziness, and risk of aneurysm.