Tumors of the Lung and Pleura

Question 1

Bronchogenic carcinoma def

Answer 1

Orginating from the bronchial or bronchiolar epithelium

Question 2

Patho of bronchogenic carcinoma

Answer 2

Final pathway of cumulative mutations which leads to malignant transformation (change from benign bronchial epithelium to neoplastic tissue)

Damage—basal hyperplasia/squamous metaplasia—-squamous dysplasia—CIS—-invasion

Question 3

Tobacco smoke and cancer

Answer 3

80% in active or recent

Linear between freq of lung ca and pack year smoking

Question 4

Genetics

Squamous cell

Small cell

Adeno

Answer 4

Strong with tobacco…CDKN2A (3p, 9p) or TP53 (17p) gene..PDL1

Strongest with smoking…amplication of MYC…TP53, RB1, and del 3p

Oncogenic gain of function mutations involving compoennts of GF receptor signaling pathways (EGFR, ALK, ROS, MET< RET)…if no TK mutations, oftne KRAS

In non-smokers - usually adeno…women - EGFR mutations and lack KRAS

Question 5

Presenting sx of lung tumors

Answer 5

Peak in 50-60

Insidious

May have some sx

Early detection showed 20% reduction in lung cancer related mortality

Question 6

Pathology

Answer 6

Spread - lymphatics or hematogenous

LN involvement in 50%

MEtastasis - adrenal, liver, brain, bone

Most are adenocarcinoma (38%), then Squam, then small , then large

Question 7

SVC syndrome

Answer 7

Venous congesiton and edema of head and arm…circulatory collapse

Question 8

Partial and total obstruction

Answer 8

Focal emphysema, ateelctasis

Total - atelectasis/collapse

Question 9

Small cell carcinoma

Squamous cell carcinoma

Paraneopplastic syndrome

Answer 9

ACTH - cushing syndrome or ADH (hyponatremia)

PTH/PTH-like (hypercalcemia)

Question 10

Labert

Answer 10

Eaten myashetnic - muscle weakness due to autoantibodies to neruonal calcium channel

Question 11

Adenocarcinoma

Answer 11

Malignant epithelial tumor with glandular diff or mucin production

Women and non-smokers

Peirpheral locaitons

Small but metastasize earlier

Pleural associated maybe

KRAS (worse prognosis and smokers) or EGFR (asian)

Tx with tyrosine kinase ihibitors

Question 12

Atypical adenomatous hyperplasia

Adenocarcinoma in situ

Answer 12

Small leisons, dysplastic pneumocyts line laveolar walls…single or multiple foci, near tumor or in other areas of ling

Less than 3cm, dysplastic cels grwo along septae but DO NOT invade (lipidic), more atypical than AAH, may be mucinous or non

Question 13

Min invasive adeno

Mucinous adeno

Answer 13

Tumors small, peripheral and assoc with scarring, lepidic grwoth, better outcome

Airway spread so may have satellite lesions….may present as single or multiple nodules …less likelyt o be cured by surgery

Question 14

Adeno microscopic

Answer 14

Gland formaiton and/or mucin production

TTF-1 positive, napsin A

Well, moderate, poor grades

Question 15

Squamous cell carcinoma

Answer 15

Malignant epithelia ltumor with presence of keratinization and/or IC bridges

Most common in men

SMoking

Central

Peripheral

Local spread with late metastasis

p53 mutations

PTH/PTH hypercalcemia

Squamous metaplasia, dysplasia, CIS

Question 16

Types and microscopis squamous

Answer 16

Keratinizing, non-keratinizing, basaloid

Keratinization (pearls), intracellular bridges (desomosomes), p40, p63, or CK5/6

Tumor grade well, mod, poor

Question 17

Small cell carcinoma

Answer 17

Epithelial tumor with neuroendocrine differentiation

EM level - dense core neurosecretory

Msot aggressive

Widley metastatic at dx

Strongest association with smoking

HIlar/central location common

Most common with ectopic hormone production (ACTH, ADH)

Question 18

Small cell micro

Answer 18

SMall cells with scant cytoplasm and nuclei with granular chromatin and absent nucleoli

Nuclear molding, crush artifact, necrosis, numerous mitoses

Neuroendocrine markers(CD56, chromogranin, synaptophysin)

All high grade

Question 19

Large cell carcinoma

Answer 19

Undifferentied malignant epithlial tumor

Lack def featurs of others

Dx of exlucions

Question 20

Large cell types and microscopic

Answer 20

Large cell carcinoma with null/unclear/or no stains immunohistochemical

Large cells with moderate amounts of cytoplasm and prominent nucleoli

Question 21

Dx of lung cancer

Answer 21

Cytology - 3 specimins, least invasive, central lesions

Bronchial washing/brushings/lavage - more material, beter preserved, intermeidatly located

FNA - radiographic guidance, most invasive, greatest risk, peripheral

Histology - biopsy

Question 22

Non-small cell tx and small cell carcinoma

Answer 22

Non - surgical +/- chemo and or radiotion…for adeno - EGFR and ALK inhibitors (TKI inhibitors)

Small - chemo and radiation…surg normally not an option

Question 23

NE tumors

Answer 23

Can get pulm neuroendocrine hyperplaisa due to friboriss and inflammation

Diffuse hyperplasia could be precurosrs

Question 24

Tumorlets

Answer 24

Benign - small inconsequential hyperplastic nests of NE cells

Seen in areas of scarring or chornic inflammation

DO NOT require tx

Question 25

Bronchial carcinoid

Answer 25

Low-grade malignant epithelial neoplasm with NE diff

MEN, type 1

Men and female equal

Under 40 y/o

Non-smokers

Usually small and intraluminal

most are non-functional

Question 26

Bronchial carcinoid clinical

Answer 26

Cough, hemop, pneumonia, bronchiectais

Good survial

Typical (lower mitotic), atytpical - more mitotis

Question 27

Microscopic bronchial carcinoid

Answer 27

Organoid, trabecular, palisading or rosette like
Nest and cords of bland cells

Separated by thin, fibrous strands

SMall, uniform round nuclei with mod amounts of esoinophilic cytoplasm

Question 28

Metastatic tumors

Answer 28

Frwqunt for carcinoma and sarcoma via blood, lynphatics, direct

Question 29

Hamartoma

Answer 29

Overgrowht of normal tissue, disordered in proportion or arrangement

Not true hamartoma but clonal neoplasm

Coin lesion on CXR

Round, solitary nodules of conn tissue

Predom cartilage, clefs lined by ciliated or non-ciliated epithelium