Lec 24 Lung Cancer Path Flashcards Preview

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Flashcards in Lec 24 Lung Cancer Path Deck (48):
1

What is field cancerization?

idea that entire upper aero-digestive tract is damaged by carcinogens in cigarette smoke

at risk for head/neck, esophagus, lung cancer

tumors can arise anywhere in that field

2

WHat are risks for lung cancer?

- tobacco smoking!!
- industrial hazards
- air pollution
- molecular genetics

3

What is precursor lesion to squamous cell carcinoma?

squamous dysplasia and carcinoma in situ

4

What is precursor lesion to adenocarcinoma?

atypical adenomatous hyperplasia

5

Who gets lung carcinoma?

- age 40-70; peak in 50s/60s

6

What is typical clinical presentation of lung cancer?

asymptomatic/incidental
local disease
disseminated disease
paraneoplastic syndromes

7

What type of cells do lung tumors derive from?

90% epithelial tumors
some mesothelial tumors

8

What type of neoplasms are epithelial tumors of lung? percentage of each?

90-95% carcinomas
5% carcinoids

9

What are 3 types of non small cell carcinoma?

- squamous cell carcinoma
- adenocarcinoma
- large cell carcinoma

10

What is most common type of lung carcinoma?

adenocarcinoma = 35-40%

11

What types of lung cancer are centrally located?

- squamous cell
- small cell

12

What types of lung cancer are peripherally located?

- adenocarcinoma
- large cell carcinoma

13

Who gets squamous cell carcinoma?

men; smokers

14

What are symptoms of squamous cell carcinoma?

bronchial obstruction; pneumonitis; atelectasis

15

What is progression of squamous carcinoma?

get squamous metaplasia --> dysplasia and carcinoma in situ --> invasive carcinoma

16

What are characteristics of squamous cell carcinoma?

- central tumors
- extensive necrosis w/ cavitation of tumor
- metastasize late
- hypercalcemia = classic paraneoplastic syndrome

17

What lung carcinoma tends to undergo necrosis and cavitate?

squamous cell carcinoma

18

What do you see microscopically in squamous cell carcinoma?

- sheets of cells w/ keratin
- clusters/islands of tumor cells w/ pink cytoplasm
- keratin pearls
- intercellular bridges

19

What type of cells is adenocarcinoma thought to arise from?

type 2 pneumocytes

20

What is classical person w/ adenocarcinoma?

non smoking female w/ EGFR mutation of asian descent

21

What 2 mutations of adenocarcinoma particularly seen in non-smokers?

- EGFR
- EML4-ALK

22

What is progression of adenocarcinoma?

atypical adenomatous hyperplasia --> adenocarcinoma in situ --> minimally invasive adenocarcinoma --> invasive adenocarcinoma

23

What is atypical adenomatous hyperplasia?

small area of proliferation moderately atypical type 2 pneumocytes or clara cells lining alveolar walls

absent other significant inflammation

24

What is adenocarcinoma in situ?

tumor cells growing along existing alveolar septa aka lepidic growth

greater than 5 mm size
non-mucinous

25

What is difference in prognosis adenocarcinoma in situ vs conventional adenocarcinoma?

much better prognosis adenocarcinoma in situ = close to 100% 5 yr survival

26

What do you see radiographically with adenocarcinoma in situ?

ground glass (as opposed to solid)

27

What is minimally invasive adenocarcinoma?

adenocarcinoma w/ lepidic pattern and < 5 mm invasion in any only focus

usually non-mucinous
solitary and discrete

28

What are characteristics of adenocarcinoma?

- glands or papillary structures
- mucin

29

What do you see grossly w/ adenocarcinomas?

- associated w/ pleural puckering

30

What is large cell carcinoma? features?

undifferentiated malignant epithelial tumor

large nuclei; moderate amount of cytoplasm; peripheral

31

What are characteristics of small cell carcinoma

- high grade neuroendocrine carcinoma
- usually smokers; very aggressive w/ early mediastinal lymph node involvement

32

What paraneoplastic syndromes associated with small cell lung cancer?

- ADH [hyponatremia]
- ACTH [cushings]
- Lamber Eaton

33

What do you see on micro w/ small cell lung cancer?

small to medium size round cells; minimal cytoplasm; hyperchromatic

34

Appears as a hilar mass and frequently results in cavitation; clearly linked to smoking; incidence greatly increased in smokers; may be marked by inappropriate parathyroid hormone (PTH)-like activity

Which type of cancer?

squamous cell carcinoma

35

Usually peripheral; less linked to smoking.

What type of cancer?

adenocarcinoma

36

Undifferentiated tumor; most aggressive bronchogenic carcinoma; least likely form to be cured by surgery; usually already metastatic at diagnosis; often associated with ectopic production of corticotrophin (ACTH) or antidiuretic hormone (ADH}; incidence greatly increased in smokers

What type of cancer?

small cell lung cancer

37

What do neurosecretory granules suggest?

type of neuroendocrine tumor --> small cell or carcinoid tumor

38

Who gets carcinoid tumors?

younger; equal for sexes; 20-40% are nonsmokers

39

What is carcinoid syndrome?

intermittent attacks of diarrhea; flushing; cyanosis

usually only see in metastatic disease

40

What do you see histologically w/ carcinoid tumors?

organoid, trabecular, palisading, ribbon arrangement of cells

moderate eosinophilic cytoplasm; nuclei w/ finely granular chromatin

41

What are typical vs atypical carcinoids?

typical = fewer tahn 2 mitoses and lack necrosis
atypical = 2-10 mitoses; + foci of necrosis

42

What is prognosis typical vs atypical carcinoid?

typical = > 90% survive
atypical = 30-50% survive

43

What is superior vena cava syndrome?

gradual compression of SVC
usually due to lung cancer

44

What is pancoast tumor?

- tumor in apex of lung
- get Horners + hoarseness from recurrent laryngeal nerve paralysis

45

Are tumors of pleura more commonly primary or metastatic?

more commonly metastatic

46

What are risks for mesothelioma?

usually due to amphibole asbestos exposure; develop after long latency 20+ yrs from time of exposure

47

What is morphology of mesothelioma?

early lesions start as multiple small nodules coalesce into confluent thick "rind"

diffuse involvement of mesothelial surfaces

48

What is prognosis of mesothelioma?

majority die in 18 months