Lung cancer

Question 1

Adenocarcinoma

Answer 1

• Peripheral
  
  • often sites of prior injury and scarring
• Nonsmokers + females
• k-ras activation mutation
• association with hypertrophic osteoarthropathy (clubbing)
• Histology
  
  • glands
  • mucin

Question 2

Bronchioalveolar

Answer 2

• Adenocarcinoma subtype
• Peripheral
• Clara cells
• No smoking association
• CXR:
  
  • hazy infiltrates similar to pneumonia
• Histology
  
  • grows along alveolar septa
    
    • “thickening” of alveolar walls
• Excellent prognosis

Question 3

Squamous Cell Carcinom

Answer 3

• Central
• Hilar mass arising in bronchus
• Three C
  
  • cavitations
  • cigarettes
    
    • most common tumor in male smoker
  • hypercalcemia
    
    • secrete PTHrP –> stimulate osteoclasts –> release of calcium from bone –> Ca++ increased

Question 4

Small cell carcinoma

(oat cell)

Answer 4

• Central
• Undifferentiated
• myc gene amplification
• Very aggressive – worse prognosis
  
  • No surgery b/c metastasis early
  • Treat with chemo
• May produce
  
  • ACTH = increased cortisol = Cushing syndrome
  • ADH = SAIDH = fluid retention and hyponatremia
  • Antibodies against presynaptic Ca+ channels = Lambert-Eaton Syndrome = proximal muscle weakness
• Histology
  
  • Nueroendocrine tumors
    
    • express neuroendocrine markers
    • contain neurosecretory granules with neurofilaments
  • Kulchitsky cells = small dark blue cells

Question 5

Larger Cell Carcinoma

Answer 5

• Peripheral
• Highly anaplastic
• Undifferentiated
• Poor prognosis
  
  • less respones to chemo
  • remove surgically
• Histology
  
  • pleimorphic giant cells

Question 6

Bronchial Carcinoid Syndrome

Answer 6

• Excellent prognosis
  
  • metastasis rare
• Symptoms due to mass effect
  
  • presents as bronchial obstruction with cough adn hemoptysis
• Can get Carcinoid Syndrome occasionally
  
  • serotonin secretion
    
    • flushing
    • diarrhea
    • wheezing
• No smoking association
• Histology
  
  • nests of neuroendocine cells
    
    • carcinoid cells in Rosette pattern
  • Chromagranin (+)

Question 7

Mesothelioma

Answer 7

• Pleura
• Malignant tumors of mesothelial cells
  
  • line pleura and secrete fluid to lubricate it thereby facilitating movement of lung against chest wall
• due to asbestosis
• Symptoms
  
  • hemorrhagic pleural effusions
  • pleural thickening
  • tumors encases lung
• Histology
  
  • psammoma bodies
  • Clusters of 10 or more cells with knobby boarders

Question 8

Pancoast tumor

Answer 8

• Carcinoma
• apex of lung
• May compress other parts of body
  
  • Cervical sympathetic plexus = Horner’s Syndrome
  • Brachial plexus = pain + weakness in arm and hands
  • Recurrent laryngeal nerve = hoarseness