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.Pathology 2 > Lung Cancer > Flashcards

Lung Cancer Flashcards

1
Q

describe the pathogenesis of small cell carcinoma

A
  • myc amplification
  • p53
  • pRB
  • 3p deletion
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2
Q

describe the pathogenesis of non-small cell carcinoma

A
  • 3p deletion
  • p16/CDKN2a
  • adenocarcinoma: KRAS, EGFR
    • signet ring adenocarcinoma, non-smokers: ALK
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3
Q

describe peripheral vs. central tumors

A
  • peripheral: may be clinically silent
  • central tumors (hilar):
    • obstruction = partial or total
    • infection = pneumonia, abscess, bronchiectasis
    • resorption atelectasis
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4
Q

describe clinical features of lung cancer

A
  • cough, weight loss, hemoptysis, dyspnea
  • pulmonary osteoarthropathy (clubbing)
  • hoarseness, chest pain
  • pericardial and pleural effusion
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5
Q

lung cancer can lead to ____ syndrome due to obstruction

A

lung cancer can lead to superior vena cava (SVC) syndrome due to obstruction

  • blood flow accumulation in upper part → swelling of the face, neck and upper part of the body and arms
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6
Q

lung cancer can lead to ____ where the cervical sympathetic plexus is damaged

what are clinical features of this?

A

lung cancer can lead to Horner syndrome where the cervical sympathetic plexus is damaged

  • ipsilateral enophthalmos, ptosis, miosis, anhidrosis (PAM)
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7
Q

describe clinical features of a pancoast tumor

A
  • pancoast tumor:
    • apical neoplasm
    • T1, T2 destruction → wasting of hand muscles, pain in arms (ulnar nerve)
    • Horner syndrome
    • compression of blood vessels → edema
    • recurrent laryngeal nerve paralysis
    • esophagus involvement → dysphagia
    • thoracic duct obstruction → chylothorax
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8
Q

hypercalcemia (increased PTH) is seen in _____

A

hypercalcemia (increased PTH) is seen in squamous cell carcinoma

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9
Q

Cushing’s syndrome (increased ACTH secretion) is seen in ____

A

Cushing’s syndrome (increased ACTH secretion) is seen in small cell carcinoma

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10
Q

SIADH leading to hyponatremia is seen in ____

A

SIADH leading to hyponatremia is seen in small cell carcinoma

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11
Q

Lambert-Eaton syndrome is seen in _____

A

Lambert-Eaton syndrome is seen in small cell carcinoma

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12
Q

describe the metastasis of lung cancer

A

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  • lymph node matastases most common
  • adrenal (50%)
    • very rarely Addison’s (insufficiency)
  • liver (30-50%)
  • brain (20%)
  • bone (15-20%)
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13
Q

____ metastasize quickly; virtually all ___ metastasize at time of diagnosis

A

small cell carcinoma metastasize quickly; virtually all SCC metastasize at time of diagnosis

  • tx = chemo +/- radiation therapy
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14
Q

____ is the precursor lesion to adenocarcinoma

A

atypical adenomatous hyperplasia (AAH) is the precursor lesion to adenocarcinoma

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15
Q

describe what is seen in the image

A

atypical adenomatous hyperplasia (AAH)

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16
Q

____ lacks invasive disease (lepidic growth)

A

adenocarcinoma in-situ lacks invasive disease (lepidic growth)

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17
Q

describe what is seen in the image

A
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18
Q

___ is the most common primary lung tumor, as well as the most common in women that have never smoked

A

adenocarcinoma is the most common primary lung tumor, as well as the most common in women that have never smoked

19
Q

___ is more peripherally located (as opposed to centrally)

A

adenocarcinoma is more peripherally located (as opposed to centrally)

20
Q

describe the grading of adenocarcinoma (ratio of glands to solid elements)

A
21
Q

describe squamous cell carcinoma

A
22
Q

describe the progression of squamous cell carcinoma

A
  • progression:
    • squamous metaplasia → squamous dyaplasia → squamous cell carcinoma in-situ → invasive sq. cell carcinoma
23
Q

describe the histologic evidence of squamous differentiation

A
  • keratin pearls
  • intercellular bridges
  • individual cell keratinization
24
Q

describe what is seen in the image

A

squamous cell carcinoma

arrow = keratin pearl formation

25
Q

describe the grading of squamous cell carcinoma

A
26
Q

describe large cell carcinoma

A
  • undifferentiated epithelial malignancy
    • lacks features of small cell
    • no glandular differentiation
    • no squamous differentiation
  • poor prognosis, early metastasis
27
Q

describe what is seen in the image

A

large cell carcinoma

28
Q

describe a small cell carcinoma

A

small cell carcinoma = neuroendocrine cell origin

29
Q

describe the histology of small cell carcinoma

A
  • round, scant cytoplasm, finely granular chromatin, fragile, crush artifacts, nuclear molding, extensive necrosis
  • frequent mitoses
30
Q

describe the image

A

small cell carcinoma

31
Q

describe features of small cell carcinoma

A
32
Q

describe the importance of accurate typing of primary lung neoplasms (treatment)

A
33
Q

describe EGFR, ALK and KRAS analysis

A
  • the rationale is that KRAS mutations are associated with poor response to EGFR inhibitor treatment and should be therefore avoided as the patients do not respond
34
Q

describe a carcinoid tumor of the lung

A
  • neuroendocrine tumor of the lung
  • arises from Kulchitsky cells
35
Q

describe features of a carcinoid tumor of the lung

A
36
Q
A
37
Q

describe malignant mesothelioma

A
  • primary malignancy of pleura, peritoneum or pericardium, strongly associated with asbestos
  • patients present with chest pain and/or dyspnea; occasionally with cough or fatigue
  • imaging studies show moderate to large unilateral pleural effusion, nodular pleural thickening, enhancement with PET
38
Q

describe histological findings in mesothelioma

A
  • mesothelioma can assume a variety of histological patterns and thus mimic other malignancies
  • 3 primary patterns are:
    • epithelial
    • sarcomatoid
    • mixed (biphasic)
39
Q

describe what is seen in the image

A

mesothelioma

40
Q
A

epithelial mesothelioma

41
Q
A

mixed mesothelioma

42
Q

describe what is seen in the image

A

intercellular bridges seen in squamous cell carcinoma

43
Q

describe what is seen in the image

A

well-differentiated neuroendocrine cells (nests) seen in carcinoid tumor

44
Q

describe what is seen in the image

A

chromogranin (neuroendocrine origin) stained slide shows a carcinoid tumor

.Pathology 2 (28 decks)

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