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PATHOLOGY > Rosai Chapter 11 - Pleura > Flashcards

Rosai Chapter 11 - Pleura Flashcards

1
Q

Classic gross presentation of malignant mesothelioma

A

Multiple gray or white ill-defined nodules in a diffusely thickened pleura

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2
Q

Frequency of Mesothelioma

A

Epithelioid > Biphasic/mixed > Sarcomatoid

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3
Q

a subtype of sarcomatoid mesothelioma accompanied by abundant deposition of fibrous tissue demonstrating a storiform or “Patternless pattern of Stout” arrangement of neoplastic spindle cells

A

Desmoplastic mesothelioma

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4
Q

Histologic features helpful in separating desmoplastic mesothelioma from benign fibrous proliferations (4)

A
  • invasion of chest wall soft tissue or lung parenchyma
  • bland necrosis
  • frankly sarcomatoid areas with cytologic atypia
  • characteristic storiform growth pattern in the context of random variation
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5
Q

Features in favor of malignancy versus from a reactive mesothelial hyperplasia (6):

A
  • Stromal invasion
  • Full-thickness involvement
  • Expansile nodules
  • Random variation in cellularity
  • Architectural complexity
  • irregular distribution of vessels
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6
Q

Malignant Mesothelioma / Adenocarcinoma:

-Substantial number of columnar-shaped cells

A

Adenocarcinoma

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7
Q

Malignant Mesothelioma / Adenocarcinoma:

-Cellular crowding

A

Adenocarcinoma

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8
Q

Malignant Mesothelioma / Adenocarcinoma:

-Nuclear molding

A

Adenocarcinoma

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9
Q

Most reliable criterion for distinguishing malignancy from reactive mesothelial hyperplasia

A

Stromal invasion

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10
Q

Most useful for distinguishing epithelioid mesotheliomas from metastatic carcinoma, particularly in small biopsies

A

Immunostains

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11
Q

Account for the majority of cases presenting with a pseudomesotheliomatous growth pattern and is therefore the most likely primary site in the absence of a history of prior or concomitant extrathoracic malignancy

A

Lung adenocarcinoma

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12
Q

More sensitive than calretinin for sarcomatoid mesothelioma

A

antibodies to podoplanin (ie. D2-40, antipodoplanin)

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13
Q

Most common recurrent somatic mutations in malignant mesothelioma which target 3 genes functioning as tumor suppressors:

A
  • cyclin-dependent kinase inhibitor 2A (CDKN2A)
  • BRCA1-associated protein 1 (BAP1)
  • Neurofibromin 2 (merlin) (NF2)
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14
Q

Useful diagnostic tool for separating benign from malignant mesothelial proliferations

A

homozygous deletion of p16

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15
Q

Solitary fibrous tumor with Hypoglycemia

A

Doege-Potter syndrome

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16
Q

Hypoglycemia in Doege-Potter syndrome is due to secretion of __ by neoplastic cells

A

insulin-like growth factor II

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17
Q

Characteristics of malignant SFT (4)

A
  • increased cellularity
  • cytologic atypia (nuclear hyperchromasia and pleomorphism)
  • Mitoses
  • Necrosis
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18
Q

Differential diagnosis of the more sclerotic types of SFT (3):

A
  • Fibrous plaque
  • Fibromatosis (desmoid tumor)
  • Calcifying fibrous pseudotumor
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19
Q

Relatively sensitive IHCs for diagnostically challenging SFT cases

A
  • STAT6 (diffuse nuclear)
  • CD34
  • BCL2
20
Q

fusion between the two pleural layers

A

pleural symphysis

21
Q

secondary to pneumothorax of any cause

A

Reactive eosinophilic pleuritis

22
Q

Asbestos is a family of fibrous hydrated silica that are divided into two groups:

A
  • Serpentines

- Amphiboles

23
Q

Main pleural manifestations of asbestos exposure (3):

A
  • pleural plaques
  • pleural fibrosis
  • mesothelioma
24
Q

Fiber types found in most cases of asbestos-related mesothelioma

A
  • Amosite

- Crocidolite

25
Q

Mesothelioma variant:

-prominent formation of papillae lined by bland mesothelial cells with minimal or no invasion

A

Well-differentiated papillary mesothelioma

26
Q

Mesothelioma variant:

-characterized by the presence of large tumor cells with an abundant ground-glass cytoplasm that simulates the appearance of decidual cells

A

Deciduoid mesothelioma

27
Q

The cytoplasmic clearing in mesothelioma with clear cell features is due to the accumulation of

A

Glycogen

28
Q

Mesothelioma variant:

characterized by a diffuse proliferation of atypical histiocyte-like malignant mesothelial cells admixed with numerous lymphocytes

A

Lymphohistiocytoid mesothelioma

29
Q

Lymphocytes in Lymphohistiocytoid mesothelioma is almost exclusively of _ type

A

T-cell

30
Q

An epithelioid mesothelioma variant characterized by highly pleomorphic large cells with abundant eosinophilic cytoplasm and single or multiple nuclei with marked variation in size and shape and large nucleoli

A

Pleomorphic mesothelioma

31
Q

Mesothelioma / Carcinoma / Both:

IHC:

  • Pankeratins
  • EMA
  • Basement membrane components
  • S-100
A

Both

32
Q

Mesothelioma / Carcinoma / Both:

IHC:

  • MOC-31
  • Ber-EP4
  • CEA
  • B72.3
  • BG8
  • CD15
  • MUC4
  • Claudin-4
A

Carcinoma

33
Q

Mesothelioma / Carcinoma / Both:

IHC:
-TTF-1

A

Metastatic Carcinoma

-Lung and Thyroid

34
Q

Mesothelioma / Carcinoma / Both:

IHC:
-Napsin A

A

Metastatic Carcinoma

-Lung and Kidney

35
Q

Mesothelioma / Carcinoma / Both:

IHC:
-PAX8

A

Metastatic Carcinoma

-Kidney, Mullerian, Thymus

36
Q

Mesothelioma / Carcinoma / Both:

IHC:
-CDX2

A

Metastatic Carcinoma

-GI and Pancreaticobiliary

37
Q

Mesothelioma / Carcinoma / Both:

IHC:

  • GCDFP
  • Mammaglobin
A

Metastatic Carcinoma

-Breast

38
Q

Mesothelioma / Carcinoma / Both:

IHC:
-ER

A

Metastatic Carcinoma

-Breast, Mullerian

39
Q

Mesothelioma / Carcinoma / Both:

IHC:
-p63/p40

A

Metastatic Carcinoma

-Squamous cell, Urothelial

40
Q

Mesothelioma / Carcinoma / Both:

IHC:
-GATA3

A

Metastatic Carcinoma

-Breast, Urothelial, Squamous cell

41
Q

Mesothelioma / Carcinoma / Both:

IHC:

  • Calretinin
  • WT1
A

Mesothelioma

exception:

  • Breast
  • Mullerian serous
42
Q

Mesothelioma / Carcinoma / Both:

IHC:
-CK5/6

A

Mesothelioma

exception:

  • Squamous cell
  • Urothelial
43
Q

Mesothelioma / Carcinoma / Both:

IHC:
-D2-40/podoplanin

A

Mesothelioma

exception:

  • Mullerian serous
  • Squamous cell
44
Q

Mesothelioma / Carcinoma / Both:

IHC:
-Thrombomodulin

A

Mesothelioma

exception:
-Squamous cell

45
Q

Pleural tumor characterized by proliferation of mesenchymal spindle cells separated by thick bands of keloid-type collagen

A

Solitary Fibrous Tumor

PATHOLOGY (26 decks)

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