Respiratory Pathology 2 (Neoplastic)

Question 1

What is the average of lung cancer diagnosis?

Answer 1

60

Question 2

What are the risk factors for lung cancer?

Answer 2

Tobacco smoke
Occupational hazards
Scarring
Molecular genetics
- EGFR
- ALK mutation

Question 3

What are the clinical features of lung cancers?

Answer 3

Depends on location and size
Central
- Cough
- Dyspnoea
- Wheezing
- Haemoptysis
Apex
- Pancoast syndrome
Secreting hormones
- Paraneoplast syndromes

Question 4

How is tissue sampled in suspected lung cancer?

Answer 4

Core biopsy

• CT guided
• Bronchoscopy
• EBUS
• Wedge excision

Question 5

How are lung carcinomas classified?

Answer 5

Non-small cell carcinoma
- Squamous cell carcinoma
- Adenocarcinoma
- Large cell carcinoma
- Sarcomatoid carcinoma
Small cell carcinoma

Question 6

What are the macroscopic features of squamous cell carcinomas of the lung?

Answer 6

Tend to be central
Frequently involve large airways
Cavitation in 1/3 of cases
Grey-white to yelloww
Keratinisation > dry, flaky appearance
Necrosis
Haemorrhage

Question 7

How are squamous cell carcinomas of the lung histologically classified?

Answer 7

Intercellular bridges
Keratinisation
Immunohistochemistry needed if poorly differentiated
- CK5
- P63

Question 8

What is the most common non-small cell carcinoma?

Answer 8

Adenocarcinoma

Question 9

What are the macroscopic features of adenocarcinoma of the lung?

Answer 9

Peripheral
Well circumscribed
Unrelated to bronchi
May have pleural involvement
Grey-white
Necrosis
Haemorrhage
If produce lots of mucin > mucoid appearance

Question 10

What are the histological features of adenocarcinoma of the lung?

Answer 10

Well-moderately differentiated
Glandular and/or papillary structures
Cytoplasmic mucinous vacuoles/mucin in stroma
Immunohistochemistry
- TTF1
- CK7

Question 11

What are the macroscopic features of small cell carcinomas?

Answer 11

Neuroendocrine differentiation
Rapidly growing
- Often causes local obstruction; eg: major bronchi, SVC
Regional lymph node involvement/distant metastasis at presentation
Strong association with smoking

Question 12

How are small cell carcinomas treated?

Answer 12

Chemo-sensitive

Surgery usually not recommended

Question 13

What are the histological features of small cell carcinomas?

Answer 13

Neuroendocrine architecture
- Nests
- Trabeculae
- Ribbons
- Rosetts
High nucleus-cytoplasm ratio
Enlarged ovoid nuclei
Granular nuclear chromatin
Inconspicuous nucleoli
Nuclear molding
Scanty cytoplasm
Many mitoses
Apoptotic bodies
Areas of necrosis

Question 14

What classification is used to stage lung cancer?

Answer 14

TNM

Question 15

When is staging of a lung cancer often done?

Answer 15

Pre-operatively to determine whether patient surgical candidate

Question 16

Where do lung cancers often metastasise?

Answer 16

Adrenal glands
Liver
Brain
Bone
Other lung lobes and opposite side

Question 17

Which demographic has a significant rate of EGFR mutations?

Answer 17

Young non-/light smoking female Asians with low-stage disease

Question 18

Are all EGFR mutations in lung cancer sensitive to treatment with inhibitors?

Answer 18

No, some sensitive, but others resistant

Question 19

Which demographic has a significant rate of ALK mutations?

Answer 19

Males 40-60 with light/non-smoking history

Often high stage

Question 20

What are the different types of neuroendocrine tumours of the lung?

Answer 20

Typical carcinoid
Atypical carcinoid
Small cell carcinoma
Large cell neuroendocrine carcinoma

Question 21

What is the clinical presentation of carcinoid tumours of the lung?

Answer 21

Half found incidentally on radiology
Cough
Haemoptysis

Question 22

Are carcinoid tumours “benign”?

Answer 22

No, all have metastatic potential

Question 23

What are the histological features of carcinoid tumours of the lung?

Answer 23

Neuroendocrine architecture
- Nests
- Trabeculae
- Ribbons
- Rosettes
Round-ovoid nuclei
Granular chromatin
Small nucleoli
Moderate amounts of granular cytoplasm

Question 24

What are the histological features of atypical carcinoid tumours of the lung?

Answer 24

More mitoses and/or necrosis

Question 25

What are the immunohistochemistry markers for the diagnosis of carcinoid tumours of the lung?

Answer 25

Synaptophysis
Chromogranin
CD56

Question 26

What are common sites of cancers that metastasise to the lung?

Answer 26

Breast
Lower GI tract
Melanoma
Renal cell carcinoma

Question 27

What are different patterns of metastases in the lung?

Answer 27

Multiple nodules
Solitary metastasis
Lymphangitic metastases
Endobronchial metastases
Pleural metastases
Interstitial spread

Question 28

How is metastatic disease confirmed?

Answer 28

Clinical and radiological correlation
Histology with morphological assessment
Immunohistochemical staining