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Pulmonology > Lung and Pleural Tumors - Gupta > Flashcards

Lung and Pleural Tumors - Gupta Flashcards

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1
Q

example of a benign lung tumor

A

Hamartoma

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2
Q

how does hamartoma appear on X-ray?

A

“coin lesion” rounded, well circumscribed, peripheral, solitary

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3
Q

what is the definition of Hamartoma?

A

nodules of mature** connective tissue (often cartilage)

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4
Q

for hamartomas - are they congenital or a neoplasm?

A

evidence supports neoplasm

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5
Q

What is this? and describe it

A

Pulmonary Hamartoma

grey-white glistening nodule grey tinged = cartilage

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6
Q

What is this? describe

A

Harmatoma

lobules of mature, benign cartialge with entrapped benign respiratory epithelium

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7
Q

compare death rates of lung cancer and breast cancer in women

A

more women now die each year from lung cancer than breast cancer in the US

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8
Q

where does lung cancer rank as far as cancer mortality?

A

is most common cause of cancer mortality worldwide

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9
Q

what percentage of lung cancers occur in smokers or ex-smokers?

A

87%

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10
Q

what is the increase risk for lung cancer in 1 ppd smokers? 2 ppd smokers?

A

1 ppd = 10 fold increased risk 2 ppd = 60 fold increased risk

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11
Q

what is the second most common cause of lung cancer in the US? (besides tobacco smoke)

A

Radon

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12
Q

besides radon and cigarettes, what are some other common causes of lung carcinoma?

A

Industrial hazards - radiation, uranium Asbestos Air pollution

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13
Q

what is the relationship between smoking and asbestos exposure for lung cancer? what types of carcinoma?

A

asbestos exposure is synergistic w/ smoking 50-90 times greater risk in asbestos workers who smoke inc risk for adenocarcinoma (bronchiogenic carcinoma) NOT mesothelioma

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14
Q

for primary lung carcinoma, what are the 4 histologic classifications? (the 4 main types of lung cancer)

A

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

Small cell carcinoma

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15
Q

For small cell carcinoma, when does the pt usually present? what treatment options are available? prognosis?

A

Usually presents at an advanced stage - very aggressive, usually have mets before presenting tx options = chemotherapy +/- radiation NOT surgical candidates

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16
Q

for Non-small Cell Carcinoma, what are the treatment options? how does this compare to small cell carcinoma? prognosis?

A

NSCLC is more resistant to traditional chemotherapy than small cell

Tx options: surgery, +/- chemotherapy/radiation

much better prognosis

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17
Q

what is the most common histologic type of lung carcinoma, especially for non-smoker and female smokers

A

adenocarcinoma

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18
Q

where do most adenocarcinomas of the lung usually arise? how can you help remember this?

A

peripherally adenocarcinoma is most common histologic type in female smokers - females smoke filtered cigarettes - have to draw in harder to get puff - gets smoke further more distally into lungs - peripheral

Goljan: filters filter out the big particles, small particles make it deeper down in the bronchial tree - further out to periphery

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19
Q

Adenocarcinoma - what is the appearance (differentiation)? production of what? growth pattern?

A

glandular differentiation

mucin production *

lepidic growth sometimes pneumonia-like consolidation

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20
Q

what is lepidic growth?

A

grows along the alveoli - snaking a long

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21
Q

What is this? and describe

A

Pulmonary Adenocarcinoma - CT

spiculated peripheral mass

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22
Q

what is this? and describe

A

lung adenocarcinoma

peripheral location

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23
Q

What is this? and describe

A

Lung Adenocarcinoma

occasional pneumonia-like consolidation of entire lobe

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24
Q

What is this? and describe

A

Lung Adenocarcinoma

mucin-producing glandular structures

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25
what is this? and describe
Lung adenocarcinoma lepidic pattern shows growth along alveolar septa
26
what gender does squamous cell carcinoma arise more in? with what modifiable risk factor?
males smokers
27
where are Squamous cell carcinomas typically found
centrally located
28
What are some histologic features of Squamous cell carcinoma?
tendency to show central necrosis/cavitation keratinization / keratin pearls intercellular bridges
29
what hormone may be produced by squamous cell carcinoma?
PTHrP
30
What is this? and describe
Squamous Cell Lung Carcinoma large centrally situated mass
31
What is this? and describe
Squamous Cell Lung Carcinoma large tumor that obliterates entire central portion of lung and shows an area of cavitation
32
What is this? and describe
Squamous Cell Lung Carcinoma keratin pearls also note the distinct borders of surrounding cells - squamous cells
33
# define a large cell carcinoma located where? differentiation?
undifferentiated non-small cell carcinoma often peripherally located no glandular or squamous differentiation
34
describe how large cell carcinoma appears on microscopy - comment on nucleus and chromatin
large nuclei with prominent nucleoli and vesicular (clumpy) chromatin look anaplastic - variation of size and shape
35
what is the prognosis of Large cell carcinoma?
poor
36
What is this? and describe
Large Cell Lung Carcinoma large cells w/ prominent nucleoli no glandular or squamous differentiation is evident
37
define small cell carcinoma. what does it have a strong association with?
High-grade neuroendocrine carcinoma strong relationship to smoking
38
what is the likelihood of small cell carcinoma to metastasize?
small cell carcinomas exhibit aggressive growth with widespread metastases
39
small cell carcinoma of lung - how sensitive is it to chemo or radiation?
small cell carcinomas are more chemo/radiosensitive than non small cell carcinomas
40
What are the histologic features of small cell carcinoma?
small cells w/ scant cytoplasm and granular chromatin nuclear molding, abundant mitotic bodies, crush artifact
41
what paraneoplastic syndromes or hormones may be produced by small cell carcinoma of the lung? (3)
ADH ACTH Lambert-Eaton syndrome
42
What is this? and describe
Small Cell Lung Carcinoma Central tumor with infiltrative growth into surrounding lung
43
What is this? and describe
Small Cell Lung Carcinoma small cells w/ scant cytoplasm and crush artifact
44
what immuno stains can be done for small cell lung carcinoma?
chromogranin and synaptophysin
45
define carcinoid tumor of lung (primary malignant tumor)
low-grade neuroendocrine carcinoma
46
what percentage of all lung tumors do carcinoid tumors comprise? which population does it predominantly affect?
1-5% of all lung tumors affects the relatively young (5th decade - age is only a number I guess)
47
where are carcinoid tumors most often located
central (endobronchial) or peripheral
48
how do carcinoid tumors present?
hemoptysis and dyspnea or discovered incidentally
49
what is the prognosis of carcinoid tumor? buzzword? 5 year survival?
good prognosis indolent 5 yr survival 87% or more
50
what is this? and describe
carcinoid tumor endobronchial circumscribed tumor homgenous in appearance, no necrosis or hemorrhage or shit
51
what is this? and describe
carcinoid tumor nests of bland cells w/ granular chromatin low grade
52
What is this? describe
Carcinoid Tumor dense core granules are evidence of neuroendocrine differentiation
53
what system is used to define prognosis of lung carcinoma? define the components of this system
TNM staging T - tumor size, visceral pleura or mainstem bronchus involvement, distance from carina, invasion of structures outside of lung N - lymph nodes mets M - distant metastases
54
where does lung carcinoma most often mets to? (4)
adrenal, liver, brain, bone (also hilar lymph nodes)
55
which stage of lung carcinoma has best survival? worst?
stage I (localized tumors with no nodal or distant mets) has significant better survival than stage IV (distant mets)
56
for lung carcinoma, what are 2 genetic alterations we want to look for?
KRAS and EGFR
57
KRAS mutation - prognosis and population most often arise in
bad in an already grim picture 25% of adenocarcinomas arising in smokers
58
what populations do EGFR mutations most often occur in?
non-smokers, females, Asians
59
what do lung adenocarcinomas containing EGFR mutation respond to? pharm shit
novel tyrosine kinase inhibitors
60
why is it important to get the diagnosis right as to what type of lung cancer you have? there is a anti-lung cancer drug that can cause hemorrhage in a certain type of lung cancer, what is it?
Bevacizumab can cause hemorrhage in squamous cell carcinoma (this is more pharm, but she mentioned it)
61
what kind of cancer is associated with ALK mutation
mucinous adenocarcinoma
62
what are 4 sites of involvement in the local effects of lung cancer spread? what are their consequences in each site?
1) tumor obstruction of airway --\> pneumonia, abscess, collapse 2) recurrent laryngeal n invasion --\> hoarseness 3) SVC compression --\> SVC syndrome 4) sympathetic ganglion invasion --\> Horner syndrome
63
What paraneoplastic syndrome is caused by squamous cell carcinoma? what hormone is released and what is the result?
PTH-related peptide --\> hypercalcemia
64
what 3 paraneoplastic syndromes are associated with small cell lung carcinoma? what hormones are released and what is the result?
1) SIADH --\> hyponatremia 2) ACTH --\> Cushing's 3) antibodies to voltage gated calcium channels --\> Lambert-Eaton syndrome
65
what is Lambert-Eaton's syndrome
an autoimmune disease that is characterized by muscle weakness in the limbs - due to the antibodies blocking the voltage gated calcium channels at the presynaptic nerve terminals at the NM junction
66
what is a pancoast tumor?
carcinoma that occurs in the apex of the lung
67
what are 2 common side effects of a pancoast tumor?
1) Horner's syndrome - impinging on the cervical sympathetic chain, inhibiting it --\> ipsilateral ptosis, miosis, anhidrosis 2) SVC syndrome
68
lungs are the most common site of metastatic tumors - how do they usually get there? what do they look like?
via blood or lymphatics usually multiple well-circumscribed nodules 'cannon balls'
69
for mets to the lungs, where are the common sites of origin? (5)
lung breast colon melanoma sarcomas
70
What is this? describe
Metastatic involvement of the lung multiple well-circumscribed "cannonball" nodules
71
what is a primary malignant tumor of the pleura?
mesothelioma
72
are primary or secondary (metastatic) pleural tumors more common?
secondary are more common by far
73
what are the 2 most common sites of origin for secondary mets tumors to the pleura?
lung and breast
74
what is the most common cause of primary malignant tumors of the pleura
asbestos
75
what type of tumor is most common from asbestos exposure?
adenocarcinoma (bronchogenic carcinoma according to Muthiah) mesothelioma from asbestos only carries a 7-10% lifetime risk w/ heavy exposure
76
how does smoking and asbestos exposure relate to risk for mesothelioma
there is no increased risk from smoking
77
what are the presenting symptoms of mesothelioma? what is the course of this disease?
chest pain, dyspnea, effusions rapid course - 50% die within 1 year
78
what is treatment possibilities for mesothelioma
aggressive surgery, chemo/radiotherapy sometimes prolongs survival
79
what is this? describe
Malignant Pleural Mesothelioma diffusely thickens pleura with characteristic "rind-like" encasement of lung
80
what are the 3 histologic types of mesothelioma? what do they resemble? which is most common?
1) Epitheliod (most common) - can resemble metastatic adenocarcinoma 2) Sarcomatoid - resemble sacromas 3) biphasic - mixture of epitheliod and sarcomatoid patterns
81
What is this? describe
Malignant Pleural Mesothelioma epitheliod type of mesothelioma can show tubules that mimic glandular structure seen in adenocarcinoma
82
what histochemical stains are used to differentiate mesothelioma from adenocarcinoma? which one is used for which?
Hyaluronic acid - mesothelioma Mucin - adenocarcinoma
83
what immunohistochemical stains are used to differentiate mesothelioma from adenocarcinoma? which one is used for which?
Calretinin - mesothelioma Carcinoembryonic antigen (CEA) - adenocarcinoma
84
what is the caveat for calretinin stain used for mesothelioma
it will stain both malignant and benign mesothelial cells need to know history and other features to know ahead of time if it is malignant or not
85
what is the appearance on electron microscopy of mesothelioma vs adenocarcinoma?
mesothelioma - long slender microvilli adenocarcinoma - stubby microvillous rootlets
86
what color are we looking for in the calretinin immunohistochemistry stain for malignant mesothelioma? \*
tumor cells stain positively - brown color

Pulmonology (31 decks)

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