Tumors of the Lung and pleura Flashcards
A patient comes in with leg weakness, dry mouth, and drooping eye lids.
What type of cancer could be causing his symptoms?
This patient has Lambert-Eaton Myasthenic Syndrome an auto immune disease that attacks the pre-synaptic Ca++ channels at the neuromuscular junction.
Lambert-Eaton Myasthenic Syndrome occurs in about 60% of patients with Small Cell Lung Cancer
Small Cell Carcinoma
. . . is most commonly associated with a history of ____?
. . . with mutations in what three genes?
Small Cell Carcinoma is strongly associated with cigarette smoking
mutations in
p53 (50-80% of cases)
RB1 (80-100%)
Bcl2 (90%)
This is the most common type of cancer in women and non-smokers
Adenocarcinoma
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A 60 year old female with no history of smoking comes to your office. She has been diagnosed with a mucin producing tumor with glandular differentiation. The tumor is EGFR (+)
What type of cancer is this and what drug would you treat it with to target EGFR?
This patient has an Adenocarcinoma.
We would treat her cancer with Erlotinib- and EGFR inhibitor that binds to the ATP binding site of the tyrosine kinase and reduces downstream effects like proliferation
A 60 year old female with no history of smoking comes to your office. She has been diagnosed with a mucin producing tumor with glandular differentiation. The tumor is EGFR (+) and has rearrangements in the ALK gene.
You have tried Erlotinib but it did not stop the progression of the cancer. What is another choice for this patient
Because this tumor has rearrangements in the ALK gene, the tumor is resistant to tyrosine kinase inhibitors. The drug of choice for this patient is Crizotinib which will inhibit the fusion of EML4 and ALK proteins.
The fusion of these proteins promotes malignant behavior
This lesion is <5mm ad is characterized by dysplastic pneumocytes lining alveolar walls.
This lesion is a precursor for what?
What gene is likely mutated?
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This lesion is an Atypical Adenomatous Hyperplasia. It is a precursor for adenocarcinoma (remember: some, but not all adenocarcinomas arise from these lesions)
Atypical Adenomatous Hyperplastic lesions have mutations in EGFR
This lesion is >3cm, non-mucinous, and made of cuboidal to columnar cells.
What is it?
what is the survival rate after a complete resection?
a >3cm, non-mucinous lesion is a
non-mucininous adenocarcinoma in-situ
the survival rate for this type of cancer is 100% after a complete resection
This type of lesion is >3cm, made of tall, columnar cells with cytoplasmic and intra-alveolar mucin.
what type of lesion is this?
what is the most frequent mutation?
This lesion is
Mucinous sybtype of adenocarcnioma in-situ
KRAS mutations are more frequent in the mucinous subtype and have a worse prognosis
What morphologic pattern of invasive adenocarcinoma has the best prognosis?
worst prognosis?
1) lepidic
2) Acinar
3) Papillary
4) Solid
Lepidic has the best prognosis
Solid has the worst prognosis
What is the body’s first response to an inhaled noxious stimulus (i.e. smoke).
If exposure continues, the columnar epithelium eventually turn to what type of cells?
increase mucus production to help clear toxins
goblet cell hyperplasia
the columnar epithelium eventually turns into squamous cells (squamous metaplasia) which can lead to squamous cell carcinoma
a 65 yo man with a 20 year pack history comes to your office complaining of belly aches, increased anxiety, and increased frequency of urination.
What is one possible cause of his symptoms?
His symptoms are due to increased PThRP causing hypercalcemia. This paraneoplastic syndrome is associated with Squamous cell carcinoma
(hypercalcemia: “stones, bones, groans, thrones, and psychiatric overtones)
What factor can distinguish squamous cell carcinoma from adenocarcinoma on IHC?
TTF-1.
TTF-1 (-) in SSC
TTF-1 (+) in adenocarcinoma
“Salt and Pepper Pattern” on histology are buzzwords for what type of tumor?
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Neuroendocrine tumors
(carcinoid tumors)
a 35 year old patient comes into your office complaining of a persistent cough, hemoptysis. You suspect a type of lung cancer that has an equal incidence in both sexes and has the ability to produce serotonin and cause classical carcinoid syndrome.
What is it?
what features of this tumor might make it more worrisome?
Bronchial Carcinoid tumor
atypical features include:
pleomorphism and prominent nucleii
p53 mutations
increased expression of BCL2
a patient comes in with a drooping left eye lid, constricted pupil, and isn’t sweating on his left side despite the day being quite humid and warm.
what type of lung tumor could be causing his symptoms?
Pancost Tumor
the tumor is in the apex of the lungs and can grow into the regional nerves and vessels causing horner syndrome