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Pathology > Tumours of the lung > Flashcards

Tumours of the lung Flashcards

1
Q

What are the key epidemiological features of Adenocarcinoma?

A

Most common primary lung cancer in women.
Most common lung cancer in never-smokers.
Typically located peripherally in the lung.

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2
Q

What genetic mutation is associated with Adenocarcinoma?

A

EGFR mutations

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3
Q

What are the microscopic and histologic features of Adenocarcinoma?

A

May be preceded by Atypical Adenomatous Hyperplasia.
Histologic variants:
Acinar
Papillary
Solid with mucous formation
Bronchiolo-Alveolar (lepidic growth along pre-existing alveolar walls).

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4
Q

What is the synonym for Small Cell Lung Carcinoma?

A

Oat cell carcinoma

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5
Q

Localisation of small cell lung carcinoma?

A

Peri-hilar localization.

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6
Q

What are the macro-/microscopic features of Small Cell Lung Carcinoma?

A

High Nucleus to Cytoplasmic (N:C) ratio.
Neuroendocrine features.
Immunopositivity for Synaptophysin and Chromogranin.

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7
Q

Why is Large Cell Carcinoma a diagnosis of exclusion?

A

Poorly differentiated tumours.
No evidence of squamous or glandular differentiation.
Does not meet criteria for Small Cell Carcinoma.

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8
Q

What are common metastatic sites of Large Cell Carcinoma?

A

Hilar lymph nodes.
Adrenal gland (50% of cases).
Liver (30% of cases).
Brain (20% of cases).

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9
Q

What are the primary cancers that metastasize to the lungs?

A

Breast cancer, colon cancer, and renal cell carcinoma.

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10
Q

What are the common sites of lung metastasis?

A

Lung parenchyma.
Pleura and pleural space (can cause malignant effusions).
Lymphatics

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11
Q

What is the main symptom of metastatic cancer to the lungs?

A

Dyspnoea

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12
Q

What is the most common fatal cancer in both men and women?

A

Lung cancer

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13
Q

What percentage of cancer deaths are caused by lung cancer in men and women?

A

30% M
25% F

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14
Q

What is the peak incidence age range for lung cancer?

A

55–65 years.

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15
Q

What is the leading cause of lung cancer?

A

Cigarette smoking (85–90% of cases).

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16
Q

Which lung cancer types are most common in smokers?

A

Small Cell and Squamous Cell Carcinomas

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17
Q

What type of lung cancer is more frequent in never-smokers, and in which gender is it more common?

A

Adenocarcinoma; more common in women.

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18
Q

Name other risk factors for lung cancer apart from smoking.

A

Radiation (e.g., radium and uranium workers).
Asbestos exposure.
Exposure to certain metals (chromium, cadmium, beryllium, arsenic, nickel).

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19
Q

What oncogenes and tumour suppressor genes are associated with lung cancer?

A

Oncogenes: KRAS, MYC, HER-2/neu, BCL-2, EGFR.
Tumour suppressor genes: p53, RB1, p16.

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20
Q

What are the common symptoms of lung cancer?

A

Cough.
Haemoptysis.
Bronchial obstruction → Atelectasis and Pneumonitis.
Bloody pleural effusion.

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21
Q

What is Superior Vena Cava Syndrome, and what causes it?

A

Compression or invasion of the Superior Vena Cava.
Causes facial swelling, cyanosis, and dilated veins in the head, neck, and upper extremities.

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22
Q

What paraneoplastic endocrine syndromes are associated with lung cancer?

A

Small Cell Carcinoma:
ACTH-like activity.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Squamous Cell Carcinoma:
Parathyroid-like activity.

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23
Q

What is a Pancoast tumour, and what syndrome is associated with it?

A

A tumour involving the lung’s apex.
Ass w Horner Syndrome (ptosis, miosis, anhidrosis) due to cervical sympathetic plexus involvement.

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24
Q

Which type of lung cancer is generally not indicated for surgical intervention?

A

Small cell carcinoma

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25
Q

Which types of lung cancer may be treated with surgery?

A

Non-Small Cell Carcinoma (NSCLC)

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26
Q

Arrange the types of lung carcinoma in decreasing order of incidence.

A

Adenocarcinoma.
Squamous Cell Carcinoma.
Small Cell Lung Carcinoma.
Large Cell Carcinoma.
Bronchial Carcinoid.

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27
Q

What is a papilloma?

A

Benign tumour of the lung

28
Q

How does the occurrence of papillomas differ between children and adults?

A

Multiple papillomas: Seen in children and associated with HPV.
Solitary papillomas: Occur in middle to advanced age, not associated with HPV.

29
Q

What are the macroscopic findings of a papilloma?

A

Mucosal protrusions.
Pedunculated lesions.
Lobular pattern

30
Q

What are the microscopic findings in papilloma?

A

Fibro-vascular stalk.
Squamous epithelium without atypia or mitosis.

31
Q

What is another name for a solitary pulmonary nodule?

A

Coin lesion

32
Q

How is a solitary pulmonary nodule characterized on a chest X-ray?

A

Discrete, well-marginated, rounded opacity of ≤3 cm in diameter.
Completely surrounded by lung parenchyma.
No relation to the hilum or mediastinum.
No association with adenopathy, atelectasis, or pleural effusion.

33
Q

What is the risk of malignancy for a coin lesion in individuals under 35 years old?

A

1%

34
Q

What is the risk of malignancy for a coin lesion in individuals over 50 years old?

A

50-60%

35
Q

What are common causes of a solitary pulmonary nodule?

A

Granulomas (e.g., tuberculosis, histoplasmosis).
Malignancy (primary cancer).
Bronchial (chondroid) hamartoma.

36
Q

What is a synonym for a hamartoma?

A

Adenochondroma

37
Q

What is the most common benign lesion of the lung?

A

Hamartoma

38
Q

How does a hamartoma appear on imaging?

A

As a peripheral, round, or lobulated opacity.

39
Q

What is the typical size of a hamartoma?

A

3-4cm

40
Q

How do endo-bronchial hamartomas appear macroscopically?

A

Sessile or pedunculated.

41
Q

How do parenchymal hamartomas appear macroscopically?

A

Sub-pleural with cystic foci.

42
Q

What is the appearance of a hamartoma’s cut surface?

A

Grey or yellow (in case of fat presence).

43
Q

What connective tissue is most commonly found in a hamartoma?

A

Cartilage.

44
Q

How are epithelial clefts in a hamartoma lined?

A

By ciliated columnar epithelium or non-ciliated epithelium.

45
Q

What intersects the nodules of connective tissue in a hamartoma?

A

Epithelial clefts

46
Q

What is the primary population affected by squamous cell carcinoma of the lung?

A

Almost exclusively in smokers.

47
Q

Where is squamous cell carcinoma typically located?

A

Centrally in the lung.

48
Q

What are the differentiation levels observed in squamous cell carcinoma?

A

Tumours can range from well to poorly differentiated.

49
Q

What lesion often precedes squamous cell carcinoma?

A

Squamous Dysplasia.

50
Q

What type of tumour are bronchial carcinoids classified as?

A

Broncho-pulmonary neuroendocrine tumours (NETs).

51
Q

What is the incidence of bronchial carcinoids among primary lung tumours?

A

1-5% of all primary lung tumours.

52
Q

From which cells do bronchial carcinoids originate?

A

Normal neuroendocrine components of bronchial epithelium.

53
Q

What are the two subtypes of bronchial carcinoids?

A

Typical carcinoids and atypical carcinoids.

54
Q

What genetic abnormalities are seen in atypical carcinoids?

A

p53 mutations & abnormalities in BCL-2 and BAX expression.

55
Q

Describe the typical macroscopic appearance of bronchial carcinoids.

A

Tumour growth in the form of a finger-like or spherical polypoid mass projecting into the bronchial lumen, often covered by intact mucosa.

56
Q

What is a “collar-button” lesion in bronchial carcinoids?

A

A lesion where the tumour penetrates the bronchial wall to spread into peri-bronchial tissue.

57
Q

What are the growth patterns seen in bronchial carcinoids microscopically?

A

Solid, trabecular, gyriform, or glandular growth patterns.

58
Q

What are key microscopic features of bronchial carcinoid cells?

A

Uniform round nuclei, salt-and-pepper chromatin, moderate eosinophilic cytoplasm, & delicate fibrovascular stroma.

59
Q

Name immunohistochemistry markers positive in bronchial carcinoids.

A

Serotonin, Neuron-Specific Enolase (NSE), & Calcitonin.

60
Q

What is the mitotic rate in typical carcinoids?

A

<2 mitoses per 10 High Power Fields (HPF).

61
Q

Do typical carcinoids show necrosis or metastatic potential?

A

No, they lack necrosis and have no metastatic potential.

62
Q

What is the prognosis for typical carcinoids?

A

Excellent; 5-year survival rate of 90%.

63
Q

What features distinguish atypical carcinoids from typical carcinoids?

A

Increased pleomorphism, cytologic atypia, prominent nucleoli, 2-10 mitoses per 10 HPF, and presence of necrosis.

64
Q

What are common symptoms caused by the intraluminal growth of bronchial carcinoids?

A

Persistent cough, haemoptysis, secondary infections, bronchiectasis, emphysema, & atelectasis.

65
Q

What is carcinoid syndrome, and what symptoms does it include?

A

A syndrome caused by secretory activity, including intermittent attacks of diarrhoea, flushing, and cyanosis.

Pathology (26 decks)

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