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CPR II Exam 2 > Chapter 15: Pneumonia in Immunosuppressed; Lung Transplants; Tumors > Flashcards

Chapter 15: Pneumonia in Immunosuppressed; Lung Transplants; Tumors Flashcards

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1
Q

List 3 common causes of diffuse pulmonary infiltrates in an immunocompromised host?

A
  • CMV
  • Pneumocystis jiroveci
  • Drug rxn
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2
Q

List 5 common causes of focal pulmonary infiltrates in immunocompromised hosts

A
  • Gram-negative bacterial infections
  • S. aureus
  • Aspergillus
  • Candida
  • Malignancy
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3
Q

What is the hallmark finding of MAC infections in patients with immunosuppressed (i.e., HIV, elderly, transplant); morphology of the organism?

A
  • Abundant ACID-FAST bacilli within macrophages
  • Thin mycobacteria seen as slender red forms
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4
Q

Common sx’s of pt with HIV who become infected with MAC?

A

Fever + drenching night sweats + weight loss

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5
Q

What is the most common opportunistic infection of AIDS patients?

A

Pneumocystis jiroveci pneumonia

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6
Q

Opportunistic infections are common causes of pneumonia in HIV pt’s, but what are 4 of the more common “usual” bacteria that may be seen?

A
  • S. pneumoniae
  • S. aureus
  • -* H. influenzae
  • Gram-negative rods
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7
Q

As a general rule of thumb which organisms causing infection in HIV pt’s are more likely with a CD4 count >200, <200, and <50?

A
  • >200 = bacterial and tubercular infections
  • <200 = Pneumocystis pneumonia
  • <50 = CMV, fungal, and Mycobacterium avium complex
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8
Q

What is most likely seen on CXR of pt with HIV infected with Pneumocystis jiroveci?

A
  • Diffuse BILATERAL interstitial infiltrates
  • Can also be focal or show nothing!
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9
Q

What is the characteristic morphology of the yeast, Pneumocystis jiroveci?

A

Cup-shaped yeast forms

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10
Q

Which type of organism is the most common cause of pulmonary infection in the early post-transplant period (first few weeks)?

A

Bacterial

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11
Q

Since acute rejection following a lung transplant has a similar picture to infections, diagnosis relies on what?

A

Transbronchial biopsy

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12
Q

What is the morphology of acute rejection of a lung transplant that differentiates it from an infection?

A

Rejection shows mononuclear infiltates around small vessels, in submucosa of airways, or both

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13
Q

What is the major morphological pattern of damage seen with chronic rejection following a lung transplant?

A

Bronchiolitis obliterans –> fibrosis causing partial or complete occlusion of small airways WITH or WITHOUT active inflammation

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14
Q

What age is the peak incidence of lung cancer seen?

A

50-60 y/o

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15
Q

Large areas of “benign” respiratory mucosa being mutagenized by exposure to carcinogens in tobacco smoke is known as what?

A

“Field effect“

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16
Q

Deletions of which 3 chromosomal loci and 3 genes are seen as early events in the squamous cell carcinoma of the lung

A
  • 3p and 9p (site of CDKN2A gene –> product = p16)
  • -* 17p (site of TP53 gene)
  • -* Loss of RB tumor suppressor
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17
Q

Amplification of which gene has been associated with squamous cell carcinoma of the lung?

A

FGFR1

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18
Q

Which type of lung cancer shows the strongest association with smoking?

A

Small cell carcinoma

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19
Q

Loss of function mutations in which 2 genes and chromosome are seen with small cell carcinoma of the lung?

A
  • TP53
  • RB
  • Chromosome 3p deletions
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20
Q

Amplification of which gene is associated with small cell carcinoma of the lung?

A

MYC family

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21
Q

Oncogenic gain of function mutations in which 5 RTK genes are associated with Adenocarcinoma of the lung?

Tumors without RTK mutations often have mutation in which gene?

A
  • RTK mutation = EGFR + ALK + ROS + MET and RET
  • Non-RTK = KRAS
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22
Q

Lung cancers in never smokers are more common in which sex and are most often what type of cancer?

A
  • Women
  • Adenocarcinoma
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23
Q

Lung cancers in never smokers are more likely to have mutations in which gene and never have mutations in what?

A
  • More likely to have EGFR mutations; sometimes TP53
  • NEVER have KRAS mutations
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24
Q

Which type of lung cancer is more commonly arising in the peripheral lung and which in the central/hilar lung?

A
  • Peripheral = adenocarcinoma
  • Central/hilar = squamous cell carcinoma
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25
Which precursor lesion is characterized by **dysplastic pneumocytes** lining alveolar walls that are **mildly fibrotic**?
**Atypical adenomatous hyperplasia**
26
Which precursor lesion is composed **entirely** of **dysplatic** cells growing **confluently** along pre-existing alveolar septae; and may or may not hav intracellular mucin?
**Adenocarcinoma in situ**
27
Majority of adenocarcinomas of the lung express which transcription factor required for normal lung development?
**Thyroid transcription factor-1**
28
Which tumor of the lung tends to spread **aerogenously**, forming satellite tumors and **may consolidate an entire lobe mimicking lobar pneumonia**?
**Mucinous ADENOCARCINOMA**
29
What is the characteristic histologly of squamous cell carcinoma?
**Keratin pearls** and/or **intracellular bridges**
30
Via cytology which color will the cytoplasm be if keratin is present and is indicative of SCC?
**Orange** cytoplasm
31
Which type of lung tumor is almost always metastatic at time of presentation and is best treated with specific chemotherapies/radiation?
Small cell \*neuroendocrine\* carcinoma
32
What is the most aggressive lung tumor with **no** known preinvasive phase?
Small cell \*neuroendocrine\* carcinoma
33
What is the histology of the chromatin, cytoplasm, nucleus, and nucleoli like with small cell carcinoma of the lung?
- Small cells w/ **scant cytoplasm** - Finely **granular (BLUE) nuclear chromatin** (**salt and pepper** pattern) - **Absent** nucleoli - **Necrosis is COMMON** and often **extensive**
34
What is a more **ominous** change squamous metaplasia or dysplasia?
**Dysplasia**
35
**Basophilic** staining of vascular walls due to encrustation by DNA from necrotic tumor cells (**Azzopardi effect**) is common with what lung tumor?
**Small cell carcinoma**
36
Which 3 markers are found in the neurosecretory granules of small cell carcinomas of the lungs?
- Chromogranin - Synaptophysin - CD57
37
Via immunohistochemistry high levels of which anti-apoptotic protein can be demonstrated in small cell carcinomas of the lung?
**BCL2**
38
Early distant spread of lung carcinoma generally occurs via which 2 pathways; which carcinoma specifically metastasizes late?
- **Lymphatic** and **hematogenous** - **Squamous cell carcinoma** spreads **late**
39
What are the 4 favored sites of metastasis for lung carcinomas?
- **Adrenals** - **Liver** - **Brain** - **Bone**
40
Which 3 LN's are common sites of metastasis for lung carcinoma?
- **Bronchial** - **Tracheal** - **Mediastinal**
41
What may **partial** or **total** obstruction caused by a lung carcinoma cause?
- **Partial** --\> **focal emphysema** - **Total** --\> **atelectasis**
42
Impaired drainage of the airways caused by lung carcinomas is a common cause of what?
**SEVERE suppurative** or **ulcerative bronchitis** or **bronchiectasis**
43
Venous congestion of the head and arm w/ circulatory compromise caused by an underlying lung carcinoma is known as what?
**SVC syndrome**
44
Phrenic nerve invasion by lung tumor is associated with what?
**Diaphragm paralysis**
45
Activating mutations of which gene in lung cancers is associated with a **worse prognosis** regardless of tx?
***KRAS***
46
Release of PTHrP leading to paraneoplastic **hypercalcemia** is associated with what type of lung tumor?
Squamous cell carcinoma
47
Which 2 hormones may be secreted by small cell carcinomas and what does each cause
- **ADH** ---\> **SIADH** - **ACTH** ---\> **Cushing Syndrome**
48
What are 2 systemic nervous system related syndromes that may be associated with lung tumors?
- **Lambert-Eaton myasthenic syndrome** --\> auto-abs against Ca2+ channels --\> **muscle weakness** - **Peripheral neuropathy** --\> usually **purely** sensory
49
What is a dermatologic manfiestation that may be associated with lung tumors?
**Acanthosis nigricans**
50
What characteristic of Lambert-Eaton Syndrome distinguishes it from Myasthenia Gravis?
**Sx's IMPROVE** w/ **more** movement throughout the day
51
Apical lung cancers (**pancoast tumors**) in the superior pulmonary sulcus tend to invade which neural structures around the trachea and produce what signs/sx's?
- Invade **cervical sympathetic plexus** - **Severe pain** in the distribution of the **ulnar nerve** - **Horner syndrome** --\> **enophthalmos + ptosis + miosis + anhidrosis**
52
What are 2 hematologic abnormalities that may be assocaited with lung tumors?
- **Leukemoid rxns** - **Trousseau syndrome** (DVT and thromboembolism)
53
What is a peculiar abnormality of connective tissue associated with lung tumors and what is seen with this?
**Hypertrophic pulmonary osteoarthropathy** --\> **clubbing** of fingers
54
Lambert-Eaton Syndrome is most often associated with what tumor of the lung?
**Small cell carcinoma**
55
Trousseau sign (migratory thrombophlebitis) is most often associated with what type of lung tumor?
Adenocarcinoma
56
What is the main difference between Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) and Carcinoid tumors?
- **SIZE!!!** - **DIPNECH** = **very** small, **\<5mm** ---\> **"Tumorlets**" - **Carcinoid tumor** = **5mm** or **larger**
57
Why is it important to differentiate DIPNECH from Carcinoid tumors?
**Carcinoid tumors** have ability to **metastasize**
58
Which tumor of the lungs grows as **fingerlike** or **spherical** **polypoid masses** that commonly project into the lumen of the bronchus and may produce so-called **collar-button lesions**?
Carcinoid tumor
59
Which lung tumor is characterized by organoid, trabecular, palisading, ribbon, or rosette-like arrangements of cells w/ uniform round nuclei and abundant cytoplasm separated by a delicate fibrovascular stroma?
Carcinoid tumor
60
What are features of atypical carcinoid tumors (neuroendocrine tumor grade 2) which differ from typical carcinoid tumors (grade 1)?
- ↑↑↑ **mitotic activity** - **NECROSIS** (typical carcinoids **lack** necrosis) - **Disordered growth** - ↑↑↑ rate of **metastasis** w/ **LOWER survival**
61
Immunohistochemical stains of carcinoid tumors may be positive for what 4 markers?
- **Serotonin** - **Neuron-specific enolase** - **Calcitonin** - **Bombesin**
62
What are clinical features of carcinoid tumors which may result from their intraluminal growth?
- **Persistent** cough - **Hemoptysis** - Impairment of drainage of resp. pathways --\> 2' infections - **Bronchiectasis** - **Emphysema** - **Atelectasis**
63
What are the sx's of Carcinoid Syndrome?
- Flushing - Diarrhea - Cyanosis
64
What is the prognosis like for typical carcinoid vs. atypical carinoid tumors?
- **Typical** have 5-year survival of **95%** - **Atypical** have 5-year survival of **70%**
65
What is a feature that can be seen on CXR and CT that points to metastasis **TO** the lung?
**Multiple** discrete nodules (**cannonball lesions**) scattered throughout all lobes
66
How are lung hamartomas most often discovered and how do they appear?
- **Incidental** finding on CXR - Appear as **rounded, radio-opacity ("coin lesion")**
67
What do pulmonary hamartomas consist of?
**Nodules** of CT; most often **cartilage**, also **fat** and **fibrous tissue;** intersected by **epithelial clefts**
68
Which 2 chromosomal aberrations are associated with lung hamartomas?
- **6p21** - **12q14**-**q15**
69
Lymphangioleiomyomatosis is a lung disorder occurring almost exclusively in whom?
**Young women**
70
Which markers are expressed by Lymphangioleiomyomatosis?
**Melanoma**, like **HMB-45** and **smooth muscle cells**
71
Lymphangioleiomyomatosis is characterized by proliferation of which cells and what does this create morphologically?
**Perivascular epithelioid cells** --\> **CYSTIC**, emphysema-like **dilation** of terminal air spaces, thickening of interstitium, and obstruction of lymph vessles
72
Lymphangioleiomyomatosis is associated with loss of function of which tumor suppressor; this tumor suppressor is normally a negative regulator of what?
***TSC2*** --\> neg. regulator of **mTOR activity**
73
What is the only definitive tx currently available for Lymphangioleiomyomatosis?
Lung transplant
74
Diffuse involvement of both lungs with cystic, emphysem-like dilation of airspaces in Lymphangioleiomyomatosis, may present with what complication?
Pneumothorax
75
The strong tendency for Lymphangioleiomyomatosis to affect young women suggests what hormone contributes to proliferation of perivascular epithelioid cells?
Estrogen
76
Inflammatory myofibroblastic tumors, though rare, is more common in whom; presents how?
- **Children** - **Fever + cough + chest pain** + **hemoptysis** - May be **asymptomatic**
77
Imaging of a child with suspected Inflammatory myofibroblastic tumor will show what?
**Single** (rarely multiple) **round**, well-defined, **peripheral mass** that often has **calcium** deposits
78
Inflammatory myofibroblastic tumors are associated with activating rearrangements of which gene and on which chromosome?
***ALK*** gene on **chromosome 2p23**
79
Growth of contiguous tumors (aka direct continuity) into the lungs most often occurs with what 2 types of tumors?
- Esophageal carcinomas - Mediastinal lymphomas

CPR II Exam 2 (23 decks)

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