Tumors of the Lung and Pleura Flashcards
Bronchogenic carcinoma def
Orginating from the bronchial or bronchiolar epithelium
Patho of bronchogenic carcinoma
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
Tobacco smoke and cancer
80% in active or recent
Linear between freq of lung ca and pack year smoking
Genetics
Squamous cell
Small cell
Adeno
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
Presenting sx of lung tumors
Peak in 50-60
Insidious
May have some sx
Early detection showed 20% reduction in lung cancer related mortality
Pathology
Spread - lymphatics or hematogenous
LN involvement in 50%
MEtastasis - adrenal, liver, brain, bone
Most are adenocarcinoma (38%), then Squam, then small , then large
SVC syndrome
Venous congesiton and edema of head and arm…circulatory collapse
Partial and total obstruction
Focal emphysema, ateelctasis
Total - atelectasis/collapse
Small cell carcinoma
Squamous cell carcinoma
Paraneopplastic syndrome
ACTH - cushing syndrome or ADH (hyponatremia)
PTH/PTH-like (hypercalcemia)
Labert
Eaten myashetnic - muscle weakness due to autoantibodies to neruonal calcium channel
Adenocarcinoma
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
Atypical adenomatous hyperplasia
Adenocarcinoma in situ
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
Min invasive adeno
Mucinous adeno
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
Adeno microscopic
Gland formaiton and/or mucin production
TTF-1 positive, napsin A
Well, moderate, poor grades
Squamous cell carcinoma
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
Types and microscopis squamous
Keratinizing, non-keratinizing, basaloid
Keratinization (pearls), intracellular bridges (desomosomes), p40, p63, or CK5/6
Tumor grade well, mod, poor
Small cell carcinoma
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)
Small cell micro
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
Large cell carcinoma
Undifferentied malignant epithlial tumor
Lack def featurs of others
Dx of exlucions
Large cell types and microscopic
Large cell carcinoma with null/unclear/or no stains immunohistochemical
Large cells with moderate amounts of cytoplasm and prominent nucleoli
Dx of lung cancer
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
Non-small cell tx and small cell carcinoma
Non - surgical +/- chemo and or radiotion…for adeno - EGFR and ALK inhibitors (TKI inhibitors)
Small - chemo and radiation…surg normally not an option
NE tumors
Can get pulm neuroendocrine hyperplaisa due to friboriss and inflammation
Diffuse hyperplasia could be precurosrs
Tumorlets
Benign - small inconsequential hyperplastic nests of NE cells
Seen in areas of scarring or chornic inflammation
DO NOT require tx
Bronchial carcinoid
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
Bronchial carcinoid clinical
Cough, hemop, pneumonia, bronchiectais
Good survial
Typical (lower mitotic), atytpical - more mitotis
Microscopic bronchial carcinoid
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
Metastatic tumors
Frwqunt for carcinoma and sarcoma via blood, lynphatics, direct
Hamartoma
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
