Zaman: Lung 6 & 7 Flashcards
Identify. What would be your main concern?
Pulmonary Hamartoma (shows a coin lesion formed by a fibromixoid material). Worry about cancer. (this particular one is benign)
Pulmonary arterial hypertension (PAH) is defined by WHO as sustained elevation of pulmonary arterial pressure greater than ___________ at rest or greater than ___________ with exercise, with a mean pulmonary capillary wedge pressure and left-ventricular end-diastolic pressure of less than __________.
25 mmHg; 30 mmHg; 15 mmHg
In half of all familial cases of PAH and 25% of sporadic cases, the gene associated is ________.
BMPR2. may require a trigger: two-hit hypothesis.
In PAH, ___________ & ___________ are decreased and _____________ is increased leading to VC.
Prostaglandin and NO; endothelan.
Identify.
Pulmonary Arterial HTN. (Plug in lower pic).
Thick vascular wall restricting lumen – pressure is increased as a result.
Sarcoidosis is characterized by __________________ granulomas.
non-caseating
Sarcoidosis seems to be a dysfunction of?
Circulating T cells with overactive B cells
In Sarcoidosis, the BAL will show?
- CD4/CD8 ratio 5-15:1
- oligoclonal expansion of T-cell subsets, and increased TNF concentration
Identify.
Sarcoidosis. Lower pic shows giant cell with asteroid body. (SAR -> STAR).
What is the main classification of lung cancer?
Small cell (oat cell) and non-small cell (adenocarcinoma)
- small cell usually tx’d with chemo
- non-small cell usually tx’d with surgery if localized (rare)
- lung cancers are either “central” (bronchogenic) or “peripheral” (subplural; scars)
Squamous Cell Carcinoma microscopic findings include?
Keratin pearls and intercellular bridge to poor- differentiated neoplasm having only minimal residual squamous features and dyskeratocytes.
Usually sheets of large cells that have keratinization (keratin pearls) and or intercellular bridges (diagnostically important).
Identify.
Squamous Cell Carcinoma.
What are the common clinical features and symptoms of adenocarcinoma?
peripheral tumors (frequently asymptomatic with x-ray lesion as presenting symptom in 50%)
Late symptoms of : chest pain, weight loss, dyspnea
(a silent disease as sx come late)
Identify.
Adenocarcinoma. Evidence of gland formation/musuc production.
Identify. Most of these are positive for _______ & _______ and negative for __________.
Adenocarcinoma. TTF1; Cytokeratin 7. Cytokeratin 20.
(pinkish stain shows positive for mucin.)
Patients with which type of carcinoma may have ectopic hormones produced, such as ADH and ACTH?
Small Cell Carcinoma
What percentage of patients already have mets upon dx of small cell CA?
2/3
In small cell CA, are the tumors usually central or peripheral?
central
What are the key microscopic features for small cell carcinoma?
Small oval or fusiform cells with very high NC ratio, very little cytoplasm. Cell of origin probably the Kulchitsky cell, a neuroendocrine cell
Features of neuroendocrine differentiation apparent by electron microscopy and immunocytochemistry (neurosecretory granules and neurosecretory granule proteins)
Identify. Positive for TTF-1, CD56, synaptophysin,chromogranin. Negative for CK34BE12 (cytokeratins).
Small cell CA.
Top left, the dark dots are the lymphocytes to compare to.
Bottom: strings and broken up cells due to dmamge when removing the needle is called crush artifact: characteristic of small cell CA.
Staging Chart.
T: tumor size (most important)
N: Node
M: Mets (determined by CT)
Staging Chart with given criteria.
Stage IIIa is important. Most common.
You have found a tumor in your 4 year old patient who has never been exposed to cigarette smoke. What is the most likely type of tumor?
Lab results show that it is typical, and you let the parents know that it is most likely (benign or malignant)?
Carcinoid Tumor. (C for children)
About 2% of primary lung tumors and have been reported and account for up to 80- 85% of primary malignant lung tumors in children.
No relation to cigarette smoking or other causative factors.
TYPICAL.
Typical carcinoid is benign (90% of total, 1% mortality) vs. atypical carcinoids.
Atypical carcinoids (10% of total); 30% mortality.
Which tumor is a neuroepithelial tumor with biogenic amine and polypeptide production (ACTH)? Most likely seen in?
Carcinoid; children.
