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Flashcards in Lung Cancer Pathology Deck (45)
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1

Which cells are adenocarcinoma precursors?

Clara cells - non-ciliated secretory cells inthe small airways

2

What are the WHO classes of lung tumors?

benign epithelial tumors

malignant epithelial tumors

mesenchymal tumors

lymphoproliferative neoplasms

miscellaneous

metastatic tumors

3

NSCLC malignant epithelial tumors

squamous cell carcinoma

adenocarcinoma

adenosquamous carcinoma

large cell undifferentiated carcinoma

sarcomatoid carcinoma

4

neuroendocrine neoplasms - malginant epithelial tumors

small cell carcinoma

large cell neuroendocrine carcinoma

atypical carcinoid

typical carcinoid

5

common histologic features of small cell carcinoma

small size (generally less than the diameter of 3 small resting lymphocytes)

scant cytoplasm with molding

nuclei is finely granular - salt and pepper appearance

high mitotic rate

frequent necrosis, often in large zones

6

What stains will any neuro-endocrine tumor be positive for?

synaptophysin, chromogranin, CD56

7

What molecular markers are associated with lung cancer?

activated proto-onco genes

tumor suppressor genes

autocrine growth factors

8

ras family of oncogenes

K-ras

H-ras

N-ras

correlated with cigarette smoking and poor prognosis

9

EGFR mutations

seen in 25% of lung adenocarcinoma, mostly in non-smoking asian women

10

benign epithelial tumors

papillomas and adenomas

11

preinvasive tumors

squamous dysplasia

atypical adenomatous hyperplasia (AAH)

adenocarcinoma in situ

12

What is the precursor to small cell carcinoma?

pluripotent bronchial precursor cell (Stem Cell) or the neuroendocrine cell in the bronchus

13

general histologic features of non-small cell carcinoma

tumor cells are large

abundant cytoplasm

vesicular and coarse chromatin

nucleous present

14

adenocarcinoma

a malignant epithelial tumor with glandular differentiation or mucin production, showing acinar, papillary, lepidic, or solid growth patterns or a mixture of these patterns

can occur in non-smokers

more common in women

majority are peripheral in location

15

common patterns of adenocarcinoma

peripheral adenocarcinoma with desmoplastic fibrosis retracting the overlying pleura

central or endobronchial adenocarcinoma

diffuse pneumonia-like consolidation

diffuse pleural thickening seen in pseudomesotheliomatous carcinoma

adenocarcinoma arising the background of underlying fibrosis

16

pathogenesis of adenocarcinoma

smoke or somatic mutation → type 2 pneumocyte and clara cell hyperplasia → atypical adenomatous hyperplasia → adenocarcinoma in situe → invasive adenocarcinoma

17

What is the defining feature of atypical adenomatous hyperplasia?

cells are less than 5 mm

(type 2 pneumocytes)

18

lepidic patterning

a pattern seen in adenocarcinoma where the tumor cells grow along the alveolar setpa

suggests EGFR mutation

19

pemetrexed

antifolate to inhibit thymidylate synthase

20

acinar growth patterns

seen in adenocarcinomas - formation of glandular structures

suggest K-RAS mutation

21

papillary growth patterns

found in adenocarcinoma

tumor filling alveolar space, no fibrovascular coat

more aggressive

suggests K-RAS mutation

22

major adenocarcinoma mutation in smokers vs. non-smokers

non-smokers - EGFR

smokers - KRAS

23

What are the functions of the EGFR receptor in tumor growth?

invasion

metastasis

survival

angiogenesis

proliferation

apoptosis

24

KRAS mutation

K-RAS involved in signal transduction in MAPK pathway

mutations are downstream of EGFR, so anti-EGFR therapy does not affect K-RAS mutant cancers

25

ALK rearrangements

found mostly in solid pattern adenocarcinomas

signet ring cells common

26

squamous cell carcinoma

central in location, involving major bronchi

strongly smoking associated

more likely to experience an elevated calcium level which can result in muscle weakness and cramps

27

common histological findings for squamous cell carcinoma

keratin production

intercellular bridges

solid growth pattern

tumor necrosis

28

pathophysiologic progression of squamous cell carcinoma

irritation (from smoke) → squamous metaplasia (bronchial epithelium) → dysplasia → high-grade dysplasia carcinoma in situ (CIS) → invasive SCC

29

TTF-1

common nuclear marker for adenocarcinoma

normally important for development of lung and thyroid

30

p63

common nuclear marker for squamous cell carcinoma

important for development of epithelial tissue