PATH - Lung Cancer/Tumors

Question 1

Lung Cancer

Answer 1

Leading cause of cancer death.

cough, hemoptysis, bronchial
obstruction, wheezing, pneumonic “coin” lesion on CXR or noncalcified nodule on CT.

Most often metastases *from:
breast, colon, prostate, and bladder cancer more common than primary lung neoplasm

Sites of metastases from lung cancer *to:
adrenals, brain, bone, liver

SPHERE of complications:
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal nerve compression (hoarseness)
Effusions (pleural or pericardial)

Question 2

Small cell (oat cell) carcinoma

Answer 2

Central

Undifferentiated–>very aggressive

Amplification of *myc oncogenes common

Neoplasm of neuroendocrine
*Kulchitsky cells-->small
dark blue cells
Chromogranin A⊕
neuron-specific enolase⊕.

Question 3

Adenocarcinoma

Answer 3

Peripheral

Most common lung cancer in nonsmokers and overall

mutations include *KRAS, EGFR, and ALK.

Associated with hypertrophic osteoarthropathy (clubbing)

Glandular pattern
stains mucin ⊕

• Bronchioloalveolar subtype
• CXR often shows hazy infiltrates similar to pneumonia; better prognosis

Question 4

Squamous cell carcinoma

Answer 4

Central

Hilar mass arising from bronchus

Cavitation
Cigarettes
hyperCalcemia (produces PTHrP)

Keratin pearls and intercellular bridges

Question 5

Large cell carcinoma

Answer 5

Peripheral

Highly anaplastic undifferentiated tumor; poor prognosis

*Pleomorphic giant cells
Can secrete *β-hCG

Question 6

Bronchial carcinoid tumor

Answer 6

Symptoms due to mass effect or carcinoid syndrome
(flushing, diarrhea, wheezing).

Nests of neuroendocrine cells
chromogranin A⊕

Question 7

Mesothelioma

Answer 7

Malignancy of the pleura associated with *asbestosis

May result in hemorrhagic pleural effusion (exudative), pleural thickening

effusion (exudative), pleural thickening.

*Psammoma bodies
*Cytokeratin and calretinin⊕
Smoking not a risk factor

Question 8

PanPancoastcoast tumor (superior sulcus tumor)

Answer 8

Carcinoma that occurs in the *apex of lung may cause *Pancoast syndrome by invading cervical
sympathetic chain.

Compression of locoregional structures may cause array of findings:
ƒ-Recurrent laryngeal nerve–>hoarseness
ƒ-Superior cervical ganglion–>Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)
ƒ-Superior vena cava–>SVC syndrome
ƒ-Sensorimotor deficit

Question 9

Superior vena cava syndrome

Answer 9

An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”), neck (jugular venous distention), and upper extremities (edema)

Commonly caused by malignancy (eg, *Pancoast tumor) and *thrombosis from indwelling catheters

Medical emergency!

Can raise intracranial
pressure–>headaches,
dizziness, INC risk of aneurysm/rupture of
intracranial arteries