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Pulmonology > Lung Cancer - Pathology > Flashcards

Lung Cancer - Pathology Flashcards

0
Q

3 main types of primary lung epithelial cancers?

A

Non-Small Cell Lung Cancer (NSCLC)- 80%.
Small Cell - 15-20%.
Carcinoid. - 1-2%.
(and salivary gland-like… but don’t worry about that)

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1
Q

Broadly speaking, what kind of tumors are most commonly found in the lungs?

A

Metastases from other organs.

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2
Q

3 types of NSCLC?

A

Adenocarcinoma. (most common)
Squamous cell.
Large cell.

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3
Q

Typical demographic for patients with adenocarcinoma?

A

Women, non-smokers.

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4
Q

Adenocarcinoma of the lung histologic appearance?

A

Lots of gland, with or without mucus.

just like other adenocarcinomas we’ve seen

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5
Q

3 major grades of adenocarcinoma of the lung?

A

Non-invasive - Atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AAS).
Minimally invasive.
Invasive.

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6
Q

How are minimally invasive and invasive adenocarcinoma of the lung distinguished?

A

Depth of invasion: < 0.5 cm is minimally invasive.

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7
Q

Features of adenocarcinoma in situ (AIS)?

A

No invasion.
Lepidic growth - i.e. along alveolar surface.
Can be mucinous or non-mucinous.
(this was formerly called Bronchioloalveolar Carcinoma -BAC)

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8
Q

2 histologic patterns of a invasive adenocarcinoma?

A

Papillary (fibrovascular cores).
Acinar.
…but it can be mixed.

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9
Q

What’s a notable histologic feature of AIS, other than a lepidic growth pattern?

A

Cuboidal or columnar “hobnail” cells with atypical nuclei.

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10
Q

Mucinous AIS is rare, but what does it look like on histology?

A

Lots of mucinous, goblet-like cells. Lots of mucin.

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11
Q

3 histologic patterns of invasive adenocarcinoma?

A

Papillary. (fibrovascular cores)
Acinar. (gland-forming)
Solid (w. intracytoplasmic mucus)

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12
Q

Which NSCLC is most strongly associated with smoking?

A

Squamous cell carcinoma.

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13
Q

Why is bronchiectasis a common problem in squamous cell carcinoma of the lung?

A

2/3 of squamous cell carcinomas are central, and cause airway obstruction -> post-obstructive PNA, bronchiectasis.

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14
Q

2 histologic features of a lung cancer that suggest squamous cell differentiation?

A

Keratinization.

Intercellular bridges.

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15
Q

Pre-invasive lesion of squamous cell carcinoma?

A

Carcinoma in situ (CIS).

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16
Q

What’s a NSCLC without squamous or glandular differentiation?

A

Large cell carcinoma.

large cells with eosinophilic cytoplasmic, ugly nuclei

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17
Q

What are the 2 main lung cancers associated with smoking?

A

Squamous cell carcinoma.

Small cell carcinoma.

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18
Q

Small cell cancer is neuroendocrine… so are carcinoid tumors.

A

Okay.

19
Q

Gross features of small cell carcinoma?

A

Usually central lesions.

Lots of lymphadenopathy.

20
Q

What does small cell carcinoma look like histologically? (3 thigs)

A

Small cells (surprisingly) - about 2-3x a lymphocyte nucleus.
High N:C ratio.
Nuclei with salt & pepper chromatin.

22
Q

Where in the lung do carcinoid tumors like to go?

A

They tend to be central (90%) and endobronchial.

23
Q

What kind of symptoms do carcinoid tumors cause?

A

Obstructive symptoms (adult onset “asthma”), recurrent PNA, hemoptysis.

24
Q

Histologic appearance of carcinoid tumor growth pattern?

Cell appearance?

A

Nests, cords, ribbons.

Round, ovoid, or spindle shaped cells… uniform cell size, abundant cytoplasm, fine granular chromatin.

25
Q

What distinguishes an atypical from a typical carcinoid tumor?

A

of mitoses per high power field and necrosis:
Typical: < 2 mitoses per 10 hpf, no necrosis.
Atypical: 2-10 mitoses per 10 hpf and/or necrosis

(atypical is higher grade)

26
Q

What’s a pulmonary hamartoma?

A

A benign tumor composed of… disorganized mature tissues, including lots of cartilage, fat, smooth muscle, calcification.

27
Q

How do pulmonary hamartoma’s appear on radiology?

A

Well-circumscribed, solitary nodules, with calcifications (“popcorn calcifications”)

28
Q

What do you call tumors arising from the pleura?

What about tumors of the pleura that come from elsewhere - where do they come from?

A

Mesothelial tumors are from pleura.

Other tumors of pleura come from mesenchyme (esp. solitary fibrous tumors), lymphoproliferative disorders, and mets.

29
Q

Epidemiological association with malignant mesothelioma?

A

Asbestos exposure (and some other fibers) - with a long latency period (decades).

30
Q

What does malignant mesothelioma look like grossly?

A

Thick tumor encasing the lungs and in the fissures.

Causes effusions.

31
Q

Natural history of malignant mesothelioma?

A

Rapidly progressive and fatal.

32
Q

2 major histologic types of mesothelioma?

A

Epithelioid

Sarcomatoid

33
Q

Where do most solitary fibrous tumors arise?

A

In the visceral pleura,

34
Q

Gross appearance of solitary fibrous tumors?

A

Solitary, well-circumscribed, firm, whitish, whorled.

35
Q

Histologic appearance of solitary fibrous tumors?

A

Patternless…. with hypocellular and hypercellular areas.

Dense collagenous stroma with “spindle cells” that look like fibroblasts.

36
Q

Should you assume that effusions to the pleura are malignant?

A

No, you should confirm with cytology.

37
Q

From which organs do mets in the pleura most commonly originate?

A

Lung, breast, ovary

38
Q

3 structures of the anterior and superior mediastinum?

A

Thymus.
Lymph nodes.
Sometimes thyroid or parathyroid tissue.

39
Q

4 primary tumors of the anterior and superior mediastinum?

Recall that here, too, mets are more common than primary tumors.

A 
The 4 T's:
Thymoma.
(Terrible) lymphoma.
Teratoma (germ cell tumors),
Thyroid or parathyroid conditions/tumors.
40
Q

3 ways a thymoma can present?

A

Asymptomatic.
Immunologic effects.
Local mass effect.

41
Q

Example of an immunologic effect of thymoma?

A

Mysasthenia gravis.

42
Q

In thymoma, what’s the neoplastic cell?

A

Epithelial cells are the malignant cells.

Lymphocytes in the background are benign.

43
Q

Structures of the middle mediastinum?

A

Lymph nodes, trachea, bronchi.
Heart and pericardium.
Great vessels.

44
Q

Lesions of the middle mediastinum?

not just tumors

A 
Mets.
Lymphoma.
Bronchogenic cysts.
Pericardial cysts.
Aortic aneurysm.
45
Q

Structures of the posterior mediastinum?

A 
Nerves, autonomic ganglia, lymph nodes, fat.
Esophagus.
Descending thoracic aorta.
Azygous veins.
Thoracic duct.
46
Q

Lesions (not just tumors) of the posterior mediastinum?

A 
Nerve sheath tumors (neurofibromas, Schwannoma).
Esophageal cysts.
Gastroenteric cysts.
Thoracic duct cysts.
Mets.
Lymphomas.

Pulmonology (42 decks)

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