Lung Tumors Flashcards
The most frequently diagnosed cancer and common way cause of mortality in the world is?
- Bronchogenic carcinoma (lung cancer)
- 95% of primary lung tumor
- includes carcinoma arising from the respiring epithelium lining the bronchi, bronchioles and alveoli
- 30% of cancer death
- commoner in men
- ages 40-70 (peak 50-60)
- 10mil death per year by 2030
Main histological types of Bronchogenic carcinoma are ?
- Adenocarcinoma
- squamous cell carcinoma
- small cell carcinoma
- large cell carcinoma
WHO histologic classification of malignant epithelial lung tumors ?
1) squamous cell carcinoma
2) small cell carcinoma
3) adenocarcinoma
4)large cell carcinoma
5) Adenisquamous carcinoma
6) carcinomas and it’s pleomorphic, sarcomatous elements
7) carcinoid tumor
8) carcinomas of salivary glad type
8) unclassified carcinoma
Better prognosis in which type of lung cancer?
Adenocarcinoma and squamous cell carcinoma compared to other differentiated cancers
Paraneoplastic syndromes in lung cancer?
SCC
- ADH - hyponatremia due to SIASH
- ACTH - Cushing’s syndrome
Squamous cell tumors
- Parathormone, parathyroid hormone related peptide, PGE2 - hypercalcemia
Calcitonin - hypocalcemia
Gonadotropins - gynecomastia
Carcinoid tumors
Serotonin and bradykinin - carcinoid syndrome
Lambert Eaton myasthenia syndrome in lung cancer?
- muscle weakness due to autoantibodies directed against the neuronal calcium channel
- systemic manifestation of lung cancer
Other systemic manifestations of lung cancer include ?
- Peripheral neuropathy - purely sensory loss
- Acanthosis nigricans
- leukemias reactions
- hypertrophic pulmonary osteoarthropathy
- Pancoast tumors;
superior pulmonary sulcus, apical lung cancers,
Invasion of the neural structures around the trachea and the cervical sympathetic plexus
( horners syndrome (enopthalmos, ptosis, mitosis, anhydrosisn) on the same side as the lesion )
Severe pain along ulnar nerve distribution
Clinical feature of bronchigenic carcinoma
WL, cough, Dyspnea, Hematogenous,chest pain, horners syndrome, tamponade, m abscess, dysphasia
Small cell carcinoma ?
- High grade tumor
- Metastasize widely
- Small epithelial cells, scanty cytoplasm,
- absent or inconspicuous nucleoli
- fine granular nuclear chromatic (salt and pepper pattern)
- High mitosis, extensive necrosis
- surgery is incurable
- cigarette smokers
- arises from major bronchi or lung periphery
- Neurosecretory granules are secreted by tumor and parathormone
- use of neuroendocrine markers (chromogranin, synaptophysin, Cd57)
- expresses mutated P53 and RB
- BCL2 positive
Large cell carcinoma
- Large nuclei
- Prominent nucleoli
- Moderate cytoplasm
- Neuroendocrine differentiation (using electron microscopy)
Squamous cell carcinoma
- history of smoking
- Keratinization (squamous pearls or individual cells with markedly eosinophilic dense cytoplasm)
- intercellular bridges
- tumor could rise from bronchi segment or sub segment
- P53 mutation
Adenocarcinoma ?
- Common in women and non smokers with EGFR mutation (good prognosis)
- slowly growing tumor but metastasize ealier and widely as they are small in size
- Positive for thyroid transcription factor-1 (TTF)
- 80% contain mucin
- characterized by gland formation and mucin production
- arises from atypical adenomatous hyperplasia —-> bronchioalveolar carcinoma ——> invasive adenocarcinoma
- Acinar, papillary, brinchioalveolar (non Mucinous and Mucinous), solid with mucin formation
Morphological feature of Bronchogenic carcinoma ?
Can occur anywhere in the lung but most commonly in the
1) Hilar region; right sided tumor arising directly from the hilus or branches of the main bronchus
Tumor Begins from the bronchial mucosa as small nodule, into a spherical mall occluding the lumen
2) peripheral type; common in adenocarcinoma and bronchioloalveolar carcinomas
- arises from the periphery of the lungs from the alveolar septal cells or terminal bronchioles
- single nodule or multiple nodules
- cut surface shows grayish and mucoid appearance
Three pressure or epithelial lesion types ?
- Squamous dysplasia and carcinoma in situ
- atypical adenomatous hyperplasia
- diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
Bronchogenic carcinoma has been divided into 2 clinically l, which are ?
1) SCC (20-25%)
2) NSCC (70-75%)
- squamous cell carcinoma
- adenocarcinoma (most frequent)
- large cell carcinoma
