Lung Cancer

Question 1

This patient with a heavy smoking history, weight loss, cough, and a mediastinal mass with evidence of metastases (supraclavicular node elargement) has

Answer 1

small cell lung cancer (SCLC), also known as oat cell carcinoma.

Question 2

the most common form of cancer in both nonsmokers and the total population (especially women).

Answer 2

Adenocarcinoma

Question 3

histologically characterized by glandular differentiation (gland formation, mucin production)
tumor cells often show abundant cytoplasm
eccentrically placed nuclei.
Mucin + stain.
Arises in the periphery of the lung.

Answer 3

Adenocarcinoma

Question 4

Symptoms (fever, night sweats)
typically presents with cervical lymphadenopathy and can cause a mediastinal mass. Microscopy demonstrates Reed-Sternberg cells in a background of inflammatory cells.

Answer 4

Hodgkin lymphoma

Reed-Sternberg cells (large cell with multilobed nucleus or multiple nuclei, prominent nucleoli, abundant cytoplasm, and an “owl’s eye” appearance)

Question 5

typically arises centrally and is composed of polygonal cells with eosinophilic cytoplasm and distinct borders.

Answer 5

Squamous cell carcinoma

*Well-differentiated squamous cell carcinomas show keratin pearls and intercellular bridges on light microscopy.

Question 6

Histopathology shows smallround/oval cells with scant cytoplasm, hyperchromatic (blue) nuclei, and granular chromatin; abundant mitoses are also usually seen.

Immunohistochemical stains are frequently positive for neuroendocrine markers (chromogranin, synaptophysin, neural cell adhesion molecule [CD56]).

Answer 6

Adenocarcinoma

Question 7

the most common benign lung tumors.
They present as asymptomatic peripherally located “coin lesion” in patients 50-60 years old.
These tumors are composed of disorganized cartilage, fibrous and adipose tissue.

Answer 7

Hamartomas

Question 8

Lung ____ often contain islands of mature hyaline cartilage, fat, smooth muscle and clefts lined by respiratory epithelium.

Answer 8

hamartomas

Question 9

It almost always arises at the lung periphery and has a characteristic distribution along the alveolar septae without vascular or stromal invasion.

On chest x-ray it appears as a peripheral mass or as a pneumonia-like consolidation.

Answer 9

Bronchioloalveolar carcinoma

*a variant of adenocarcinoma.

Question 10

can lead to paraneoplastic hypercalcemia (due to tumor secretion of parathyroid hormone-related protein).

Answer 10

squamous cell carcinoma

Question 11

SIADH is characterized by hyponatremia,

decreased ____ & ____

Answer 11

serum osmolality

urine osmolality >100

Question 12

SIADH is characterized by _____,
decreased serum osmolality,
decreased urine osmolality >100

Answer 12

hyponatremia

Question 13

List the most common paraneoplastic syndrome of Small Cell Carcinoma of the lungs?
& the others

Answer 13

SIADH (ADH)

Cushing syndrome (ACTH)
Labert Eaton (ABs–Calcium channels)

Question 14

Clinical associations:
Clubbing
Hypertrophic osteoarthropathy

Answer 14

Adenocarcinoma

Question 15

Clinical associations:
Hypercalcemia
Necrosis &
cavitation

Answer 15

Squamous Cell Carcinoma

Question 16

Clinical associations:
Cushing syndrome
SIADH
Lambert-Eaton syndrome

Answer 16

Small Cell Carcinoma

• Lambert-Eaton (progressive proximal muscle weakness, often in the legs).

Question 17

Clinical associations:
Gynecomastia
Galactorrhea

Answer 17

Large cell carcinoma

Giant cells

Question 18

Lung tumor secretes Prolactin

Answer 18

Large cell carcinoma

Question 19

Peripheral Lung tumors (2)

Answer 19

Adenocarcinoma

Large cell carcinoma

Question 20

Central Lung tumors (2)

Answer 20

Squamous Cell Carcinoma
Small Cell Carcinoma
(Sentral)

Question 21

It typically presents with wheezing due to bronchial obstruction and occasionally also causes episodic diarrhea, flushing, bronchospasm

Answer 21

Bronchial Carcinoid Tumor

of the lung

Question 22

Associated mutations:
epidermal growth factor receptor (EGFR)
ALK gene rearrangements
KRAS mutation (smokers mostly)

Answer 22

Adenocarcinoma

Question 23

patient with an extensive smoking history who now has hemoptysis and shoulder pain likely has

Answer 23

lung cancer

Question 24

caused by a tumor at the lung apex. Such tumors often arise in the superior sulcus (groove formed by the subclavian vessels). The apical location allows for extensive local tumor spread.

Answer 24

Pancoast syndrome

Question 25

``` Pancoast syndrome (Superior sulcus lung tumor) can cause Horner syndrome occurs due to involvement of the ______ ganglia.  Symptoms include ipsilateral ptosis, miosis, and anhydrosis. ```

Answer 25

cervical sympathetic ganglia

Question 26

Pancoast syndrome (Superior sulcus lung tumor) can cause ____ may be due to compression of subclavian vessels.

Answer 26

upper extremity edema

Question 27

``` Pancoast syndrome (Superior sulcus lung tumor) can cause _____.  It occurs due to involvement of the Lower brachial plexus.  ```

Answer 27

Shoulder pain radiating toward the axilla and scapula (most common presenting symptom) *atrophy of hand muscles, and pain in the distribution of C8, T1, and T2 nerve roots.

Question 28

``` Pancoast syndrome (Superior sulcus lung tumor) Other associated symptoms include ____, weakness, and muscle atrophy. ```

Answer 28

arm paresthesia | *C8, T1, and T2 root invasion of mass

Question 29

Pancoast syndrome (Superior sulcus lung tumor) can cause Spinal cord compression and ____ can result from tumor extension into the intervertebral foramina

Answer 29

paraplegia

Question 30

Pericardial effusions are characterized by dyspnea, distended neck veins, distant heart sounds, and particularly _____ if tamponade is present

Answer 30

pulsus paradoxus (decrease in systolic blood pressure >10 mm Hg during inspiration).

Question 31

Mucinous forms can produce copious amounts of watery sputum (bronchorrhea). Whcich Lung cancer?

Answer 31

Adenocarcinoma

Question 32

typically presents with a cavitary lesion in the upper lungs, often associated with hilar adenopathy.  Histology demonstrates caseating granulomas with multinucleated giant cells.

Answer 32

Pulmonary tuberculosis

Question 33

associated with smoking and typically arises centrally within a bronchial lumen.  Histopathology demonstrates invasive squamous cells with intercellular bridges and keratin pearls.

Answer 33

Squamous cell lung cancer

Question 34

The most aggressive type of lung cancer, typically occurs in patients with a history of heavy smoking. 

Answer 34

Small Cell Carcinoma Squamous cell is associated, but not as aggresive

Question 35

show evidence of neuroendocrine differentiation.  These tumors stain for neuroendocrine markers, such as neural cell adhesion molecule (CD56), neuron-specific enolase, chromogranin, and synaptophysin. 

Answer 35

Small cell carcinomas

Question 36

Normal bronchi are lined mainly by pseudostratified ____ cells that propel inhaled particles toward the oropharynx

Answer 36

ciliated columnar *Can progress to squamous cell then to Squamous cell carcinoma

Question 37

Signs and symptoms include facial swelling, conjuctival edema, distended collateral veins, headache, and dyspnea. Extrinsic compression of the superior vena cava by a mediastinal mass (ex: bronchiogenic carcinoma) can cause _____, with impaired venous return from the upper body. 

Answer 37

superior vena cava syndrome Headache, dizziness, and/or confusion (cerebral edema and elevated intracranial pressure) Cough and/or dyspnea due to laryngeal edema and/or direct compression of trachea by the mass