Lung Cancer - pathology

Question 1

95% of lung tumors are _______ (which type).

Answer 1

carcinoma (CA of epithelial cells)

Question 2

Which type of lung cancer kills more people than colon, breast and prostate combined?

Answer 2

lung

Question 3

how do you calculate risk of lung CA for cigarrette smokers?

Answer 3

2 pack/day for 20 yrs = 60 x risk than non-smokers

Question 4

4 environmental risk factors for lung CA

other than smoking

Answer 4

1. asbestos
2. uraniam (radiation)
3. arsenic, chromium, nickle
4. vinyl chloride (plastics)

possibly air pollution &. mustard gas (WWI vets) & indoor air pollution

Question 5

Lung CA classifications

in order of prevalence

Answer 5

1. adenocarcinoma (50%)
2. Squamous cell (20%)
3. Small cell (15%)
4. Large cell (2%)

large cell are undifferentiated

tumors may be a mixture of these

Question 6

Which 2 types of lung cancer are centrally located?

Answer 6

1. Small cell
2. Squamous

Sentrally located

Question 7

Loss of TP53 & CDKN2A or amplification of FGFR1 will lead to which type of lung cancer?

Answer 7

squamous cell

Question 8

Adenocarcinoma is formed due to a gain-of-fxn mutation of EGFR, ALK & which 2 others?

these lead to un-checked growth factor production

Answer 8

1. MET
2. RET

Question 9

Lung CA in Never Smokers almost never have _____ mutations & less ______ mutations.

Answer 9

• KRAS
• TP53

Question 10

4 MC metastases of Lung CA

outside of the chest cavity

Answer 10

1. adrenals (50%)
2. liver
3. brain
4. bone

lymphatic and hemogenous spread

Question 11

dysplastic

Answer 11

abnormal cell (increased cytosol, nuclear enlargement, hyperchromasia)

Question 11

dysplastic

Answer 11

abnormal cell (increased cytosol,

Question 12

Lung carcinomas commonly metastasize to which 4 organs/tissues?

within the chest cavity

Answer 12

1. pleura
2. pericadium
3. mediastinum
4. lymph nodes (50%)

Question 13

atypical adenomatous hyperplasia

Answer 13

small lesions (<5mm) w/dysplastic celll lining alveolar walls

may lead to adenocarcinoma in situ

looks like interstitial fibrosis

Question 14

define adenocarcinoma in situ

1-5% of lung adenocarcinomas

Answer 14

small solitary lesion <3 mm
neoplastic cells grow along preexisting alveolar walls (NO INVASION…(in situ = “in place”; it stays in place))

(excision = 100% survival rate)

Question 15

2 MC types of adenocarcinoma in situ?

(in situ = “in place”; it stays in place)

Answer 15

1. nonmucinous
2. mucinous

(left: non-mucinous; right mucinous)

Question 16

Answer 16

non-mucinous adenocarcinoma in situ

Question 17

Answer 17

mucinous adenocarcinoma in situ

Question 18

Which lung cancer is associated with fetoprotein thyroid transciption factor-1?

Answer 18

adenocarcinoma

Question 19

Which lung cancer is invasie/malignant epithelial tumor w/glandular differentiation and/or mucin production?

Answer 19

adenocarcinoma

Question 20

what are the 4 patterns of adenocarcinoma?

Answer 20

1. acinar
2. lepidic
3. papillary
4. solid w/mucin

Question 21

why are mucinous adenocarcinomas difficult to excise?

Answer 21

spread aerogenously –> satellite tumors

(multiple nodules or entire lobe)

Question 22

Answer 22

well-differentiated adenocarcinoma
obvious gland formation

(pink within gland=mucin, inset is a postive stain for TTF-1)

Question 23

Where in the lungs does squamous cell carcinoma arise?

Answer 23

bronchus

Question 24

Squamous cell carinoma arises from respiratory epithelium which differentiates into ________.

Answer 24

squamous cell dysplasia (lose cilia) (leads to CIS = carcinoma in situ --> breaks thru the lamina propria)

Question 25

squamous cell carcinoma may be identified via

Answer 25

cytology smear of sputum | (screening for caner of cancer that arise from bronchi)

Question 26

Answer 26

Goblet cell hyperplasia

Question 27

Answer 27

Basal cell (reserve cell) hyperplasia | goblet cell hyperplasia before this & squamous cell hyperplasia after

Question 28

Answer 28

Question 29

Answer 29

Question 30

Answer 30

Question 31

Answer 31

Question 32

Dx? Why?

Answer 32

1. squamous cell LC 2. grayish white & firm | note how it comes from the bronchus

Question 33

Answer 33

* squamous cell LC * well-differentiated nests of neoplastic epithelium (blue: whirling "keratin pearls"), fibroblasts (desmoplastic response), keratin

Question 34

Which tumor is most likely associated w/neuroendocrine progenitor cells in the bronchial epithelium?

Answer 34

small cell carcinoma

Question 35

Which type of lung cancer is commonly a/wectopic hormone production?

Answer 35

small cell carcinoma

Question 36

Most aggresive type of lung CA?

Answer 36

small cell carcinoma | **metastasize early, non-surgical**

Question 37

Dx? why?

Answer 37

* small cell LC * sheets of hyperchromatic neoplastic cells (high N/C ratio) & areas of necrosis (yellow arrow) | no glands, mucous or keratin

Question 38

Dx? Why?

Answer 38

* small cell carcinoma * round-oval tumor cells: hyperchromatic (nigh N/C ratio

Question 39

DX? why?

Answer 39

* large cell carcinoma * sheet of tumor cells having large, optically clear (vesicular) nuclei with prominent nucleoli + moderate cytoplasm

Question 40

Which lung cancer is a dx of exclusion?

Answer 40

large cell

Question 41

TNM staging stands for

Answer 41

* **T**umor (size) * **N**odes (spread to nodes) * **M**etastasis | metastasis most important

Question 42

Answer 42

bronchial carcinoid tumor | inside the lumen

Question 43

Answer 43

Typical carcinoid tumor 1. Uniform in appearance with small round basophilic nuclei 1. trabecular (cord-like) arrangement. 1. Rosette formation: tumor cells are arranged around blood vessels (yellow arrow) | looks like normal tissue = “organoid” appearance.

Question 44

2 paraneoplastic syndromes associated w/small cell carcinoma?

Answer 44

1. SIADH (increased ADH) 1. cushing (increased ACTH)

Question 45

paraneoplastic syndrome a/w squamous cell carcinoma

Answer 45

hypercalcemia (PTH & PTH related peptide)

Question 46

What staging factor automatically makes lung cancer stage IV?

Answer 46

any distant metastases | doen't matter how far

Question 47

MC site of metastatic tumors

Answer 47

lung | malignant. tumors invade veins first --> systemic

Question 48

MC metastatic lung tumor pattern

Answer 48

multple well-circumscribed nodules throughout lung

Question 49

Answer 49

metastatic carcinoma | aka “cannon ball” lesion

Question 50

age of mesothelioma manifestation

Answer 50

25-45 yo

Question 51

What are the 3 types of mesothelioma?

Answer 51

1. epithelioid 1. sarcomatoid 1. biphasic

Question 52

mesothelioma prognosis

Answer 52

2 years

Question 53

Answer 53

Lung encased by a dense gray-white mesothelioma | restrictive lung diz

Question 54

Answer 54

* biphasic mesothelioma * Slit-like glandular structures lined by epitheliod cells (yellow arrows) * Stroma between the glandular structures has a sarcomatoid appearance w/cellular proliferation of atypical spindle-shaped cells (red). | Mesotheliomas spread widely throughout the pleural cavity, and are usual

Question 55

Answer 55

* Epitheliod mesothelioma * plump epithelial-like cells having abundant cytoplasm. | looks like adenocarcinoma; check for CEA and calretinin to distinguish

Question 56

Immunohistochemical staining is used to distinguish adenocarcinoma from epithelial mesothelioma (they look similar on histo). What are each positive for?

Answer 56

* Adenocarcinomas: carcinoembryonic antigen (CEA) * Mesotheliomas: calretinin

Question 57

Answer 57

Biphasic mesothelioma stained for calretinin (the epitheliod component is strongly positive (dark brown), while the sarcomatoid component is less so)