CHest Wall, Pleura, and Mediastinum Flashcards
(25 cards)
Increase the risk for tracheal stenosis
- Age over 70 years (older)
- Radiation
- Female
- Excessive corticosteroid therapy
- prolonged intubation
- high tracheostomy
- transverse incision
- autoimmune disorders
- severe reflux
- OSA
- severe respiratory failure
Adenoid cystic carcinomas
- Spreads submucosally
- slow growing, tend to infiltate along nerve sheath and tracheal wall
- together with Squamous cell carcinoma (65%)
- radiosensitve (50 gray)
- nodal positivity does not seem to be associated with worse outcome
Non small cell tumor of the lungs
- Squamous cell
- Adenocarcinoma
- large cell carcinoma
The most common pattern of benign calcification in hamartomas
Popcorn
four patterns of benign calcification
- diffuse
- solid
- central
- laminated or popcorn
For adenocarcinoma that has pleural invasion, tumor necrosis, and has lymphovascular invasion, the correct subtype is
Lepidic predominant adenocarcinoma
- size of the invasive component is recorded for the T stage
Neuroendocrine carcinoma
- Grade I (Classic or typical)- low grade; 8-% arise in the epithelium of the central airways; younger patients. classically presents as hemoptysis. Arranged in cords and clusters
- Grade II (Atypical carcinoid) Higher malignant potential; cigarette smoking nad are peripherally located. Area of necrosis, nuclear pleomorphism, higher mitotic rates
- Grade III - large cell types in heavy smokers; mid to peripheral lung fields. Large with central necrosis and high mitotic rate. (+)neuroendocrine staining
- Grade IV (small cell lung carcinoma) - most common; early widespread metastasis; central pathways; hemoptyis, wheezing, dyspnea
Predictive or prognostic tumor marker for adenocarcinoma
- EGFR, KRAS, EML4-ALK
- treatment with bevacizumab-based chemotherapy is associated with improved progression-free survival in patients with adenocarcinoma but not squamous cell cancer
Desmoid tumors
- treated with wide local excision with a 2 to 4 cm margin with intraoperative frozen section
- open incisional biopsy for lesions over 3 to 4 cm
- Chest wall resection
- involved ribs + 1 rib above and 1 rib below
- A margin of less than 1cm results in much ghigher recurrence
- okay if a major neurovascular structure must be sacrificed
A 57 year old non small cell lung cancer patient with a potentially resecctable tumor found on CT scan who can walk on a flat surface indefinitely without oxygen or stopping to rest, secondary to dyspnea will msot likely tolerate
Lobectomy
- If the patient can walk up to two flights of stairs without having to stop and rest secodnary to dyspnea, he will likely tolerate pneumonectomy
- Nearly all patients, except those with CO2 retetntion on ABG will be able to tolerate periods of single-lung ventilation and wedge resection.
AN onion peel appearance of a rib on CT is suggestive of
Ewing sarcoma
- Primitive neuroectodermal tumors
- translocation of chromosome 11 and 22
- MIC2 gene expression
- adolescents and young adults
- progressive chest wall pain but without the presence of mass
- bony destruction is common
- percutaneous needly biopsy or an incisional biopsy
Pancoast tumor
- Tumors of the aprietal pleura or deeper structures overlying the first rib
- Superior sulcis
- Extreme apex of chest
- arm and shoulder pain, atrophy of the muscles of the hand, and Horner syndrome
The most likely cause of aspiration pneumonia is
Anaerobes only
- 50% anaerobes
- 25% mixed
- 25% aerobes only
Laboratory evaluation of a chest wall mass shwoing elevated ESR idicates?
Ewing sarcoma
- Plasmacytoma - protein electrophoresis with single monoclonal spike
- Osteosarcoma - ALP
The most common benign chest wall tumor
Chondromas
- children and young adults
- Costochondral junction anteriorly
- Radiographically, lesion is lobulated and radiodense; it may have diffuse or focal calcifications; and it may displace the bony cortex without penetration
- Treatment is surgical resection with a 2 cm margin
- LArge chondromas may harbor well differentiated chondrosarcoma
- 4 cm margin
Indications for surgical drainage
- Hemoptysis
- failure of medical therapy
- abscess under tension
- Abscess icnreasing in size during appropriate treatment
- contralateral lung contamination
- abscess >4-6cm in diameter
- Necrotozing infections with multiple abscesses, heoptysis, abscess rupture, or pyopneumothorax
- Inability to exclude a cavitating carcinoma
What percentages of chest wall masses are malignant?
50-80%
The population most at risk for developing active tuberculosis?
HIV infected patients
The fungi associated with the highest mortality rate due to invasive mycoses in the US
ASpergillus
- Saprophytic, filamentous fungus
- A. niger, A. fumigatus, A. flavus, A. terreus
- acute in onset
- occurs in settings of neutropenia, chronic steroid therapy or cytotoxic chemotherapy, COPD patients
A patient presenting with a history and finding of dyspnea, wheezing, hemptysis, and a mediastinal mass in the visceral compartment
Mediastinal granuloma
A patient with an anterior mediastinal mass and elevated serup AFP most likely has
A nonseminomatous germ cell tumor
- Elevaed AFP and hCG >500ng/ml
The primary site for male patients with malignant pleural effusion
Lungs
- Male
- lung>lymphoma/leukemia>GI>GU>melanoma
- Female
- Breast>Lung>lymphoma>GI>malanoma>GU
Eosinophilic granulomas are associated with
Langerhans Hisiocytosis
- benign osteolytic lesions
- 79% are solitary, 7% multiple eosinophilic, 14% other forms of more systemic LCH
- 5 -1 5 y/o ; healing may occur spontaneously
- surgical resection with 1 2cm margin
A chylothorax is likely to be present in a patient whose plueral fluid analysis results show a TG level of
>110 mg/100ml =99 % accurate
<50mg/mL = 5% chance
Osteosarcoma of the rib
- treated with adjuvant chemotherapy before resection
- most common bone malignancy but 10 to 15 % malignant chest wall
- Sunburst appearance
- complete resection with a wide (4cm) margins followed by reconstruction
- in patients with lung mets that are potentially amenable to surgical resection
- induction chemo may be given followed by resection
- Maintenance chemos is usually recommended
