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ANATPATH > Lung neoplasms > Flashcards

Lung neoplasms Flashcards

1
Q

What is a hamartoma?

A

It is a disorganized admixture of cells indiginous to that site. Includes, blood vessels, glands, cartilage, smooth muscle, inflammatory cells, fat, etc in various proportions

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2
Q

Radiographically, what is a hamartoma of the lung called?

A

Coin lesion

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3
Q

Describe a lung hamartoma macroscopically

A

It is a well-circumscribed spherical small mass (1-4cm). It is a discrete lesion with yellowish pale cut surface. Often has calcifications recognizable on radiography.

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4
Q

What is a choristoma?

A

It is a mass composed of normal tissues but in an ectopic location. EG pancreatic islets in liver or stomach.

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5
Q

Usually what causes a hamartoma?

A

It is caused by clonal expansion of cells with 6p21 or 12q14
q15 chromosomal alterations

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6
Q

What is the differential diagnoses for hamartoma?

A

The differential diagnosis includes granuloma,
small primary carcinoma, solitary metastasis, or
hamartoma

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7
Q

Microscopically, what does a pulmonary hamartoma look like?

A

cartilage that is jumbled with a fibrovascular stroma and scattered bronchial
glandular structures

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8
Q

T/F Most lung tumors are benign. Explain

A

F they are malignant
metastatic tumors are the most common lung carcinoma seen in clinical
practice

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9
Q

What is Atypical adenomatous hyperplasia (AAH)?

A

It is a small (<5mm) lesion characterised by dysplastic pneumocytes lining alveolar wall that are midly fibrotic

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10
Q

What is adenocarcinoma in situ (AIS)?

A

A lesion 3cm or less composed of cells that are entirely dysplastic, growing along peexisting alveolar septa without rapturing it. Has a lepidic growth pattern

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11
Q

when the AIS becomes invasive, it forms what?

A

It forms desmoplasia (fibrosis)

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12
Q

What is a minimally invasive adenocarcinoma (MIA)?

A

<3cm lesion. It is a solitary adenocarcinoma with either pure lepidic growth or predominant lepidic growth with <5cm of stromal invasion

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13
Q

List the 3 precursor lesions associated with adenocarcinoma

A
  1. Atypical adenomatous hyperplasia (AAH)
  2. Adenocarcinoma in situ (AIS)
  3. Minimally invasive adenocarcinoma (MIA)
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14
Q

What is a bronchoalveolar carcinoma?

A

It is a subtype of adenocarcinoma. But this type does not have any stromal, vascular, or pleural invasion. The tumor grows along thr pre-existing alveolar septa

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15
Q

Broncheoalveolar carcinoma has which type of spread?

A

It has an aerogenous spread. It does not have metastatic spread

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16
Q

What is the common cause of death for bronchoalveolar carcinoma?

A

Due to involvement of the airways,
the patient usually dies by suffocation

17
Q

What are the clinical features of bronchoalveolar carcinoma? (7)

A

Cough
Weight loss
Dyspnoea
Anorexia
Fatigue
Hemoptysis
Chest pain

18
Q

Describe the metastatic pattern of bronchoalveolar carcinoma

A

Metastasis of the cancer causes involvement of adrenal (most commonly) followed by liver, brain and bone.
Intrathoracic spread of the cancer causes enlargement of lymph nodes (hilar, mediastinal, bronchial and
tracheal), pleural involvement,
hoarseness (recurrent laryngeal nerve invasion),
dysphagia (esophageal obstruction),
diaphragmatic paralysis (phrenic nerve paralysis),
Horner syndrome and
superior vena cava (SVC) syndrome

19
Q

List 5 endocrinological syndromes associated with bronchogenic cancer, and their causes

A

a. Cushing syndrome (Due to ACTH)
b. Syndrome of inappropriate ADH secretion (SIADH) [Due to anti-diuretic hormone]
c. Hypercalcemia: Due to parathyroid hormone related peptide (PTH related peptide).
d. Hypocalcemia: Due to calcitonin
e. Gynecomastia: Due to gonadotropins

20
Q

Which paraneoplastic syndrome is caused by autoantibodies against neuronal calcium channel?

A

Lambert eaton syndrome

21
Q

Which paraneoplastic syndrome is causes hyperpigmentation of the axillary region?

A

Acanthosis nigrans

22
Q

Explain the pathogenesis of bronchogenic cancer

A

1.Stepwise accumulation Oncogenic driver mutations causes neoplastic transformation of epithelial cells

23
Q

What are the subdivisions of bronchogenic cancer?

A

Commonly divided into non-small cell (including adenocarcinoma, squamous cell carcinoma, other types) and small cell
carcinoma based on behaviour and prognosis.

24
Q

Pathogenesis of adenocarcinoma

A

Most common type in never-smokers, although it is also associated to a lesser extent with smoking. A third
of adenocarcinomas have oncogenic gain-of-function mutations involving growth factor receptor signalling pathways that can
be targeted by specific inhibitors e.g. tyrosine kinase receptors (EGFR, ALK, ROS1) or their downstream molecules (KRAS –
usually in smokers)

25
Q

Pathogenesis of squamous cell carcinoma

A

Highly associated with smoking and has diverse genetic aberrations. Most haveTP53 mutations,
often as an early event, and may also have FGFR1 amplification

26
Q

Small cell carcinoma pathogenesis

A

: Almost always smoking-related and the highest mutational burden, with inactivation of both TP53 and
RB. May also have MYC amplification* Precursor lesions: There are morphologic precursor epithelial lesions which do not
necessarily all progress to cancer

27
Q

Describe Small cell carcinoma (Poorly differentiated neuroendocrine/ Oat cell

A

Aggressive, highly malignant, tumour .
* Poor prognosis : due to late presentation ,
usually demonstrates metastasis at initial presentation
Least likely to be cured by surgery
* Associated with cigarette smoking 95% of patients (unlike adenocarcinoma)
* Common in men

28
Q

How does small cell carcinoma present?

A

Present as hilar or perihilar mass

29
Q

Which paraneoplastic syndromes can be associated with small cell carcinoma?

A

Has ability to secrete a host of polypeptide hormones such as ACTH (adrenocorticotropic hormone) , ADH
(antidiuretic hormone).
* It may associated with Paraneoplastic Syndrome , Cushing syndrome , Eaton- Lambert syndrome] These
phenomena are mediated by humoral factors (by hormones or cytokines) secreted by tumor cells or by an
immune response against the tumor

30
Q

Explain superior vena cava syndrome

A

: invasion leads to obstruction of venous drainage which leads to dilation of veins in the
upper part of the chest and neck resulting in swelling and cyanosis of the face, neck, and arms.

31
Q

What is a pancoast tumor (superior sulcus tumor)?

A

Apical (upper lobe) Bronchogenic carcinoma (could be either squamous or
adenocarcinoma) neoplasms may invade the brachial sympathetic plexus to cause severe pain, numbness and
weakness in the distribution of the ulnar nerve. Accompanied by destruction of the first and second ribs and thoracic
vertebrae. It often coexists with Horner syndrome (ptosis + asymmetrical miosis + anhidrosis)

32
Q

What is Horner syndrome?

A

invasion of the cervical thoracic sympathetic nerves and it leads to ipsilateral enophthalmos
(displacement of the eyeball within the orbit –eyes goes inside-). miosis, ptosis, and facial anhidrosis. (Anhidrosis is
the inability to sweat normally –leads to dryness in –leads to dryness in facial areas-).
The combination of these clinical findings is known as Pancoast syndrome.

33
Q

Where are pancoast tumors normally located?

A

primary bronchus or at the lung periphery

34
Q

Describe carcinoid tumor appearance

A

The tumour is a smooth surfaced yellow nodule.
* Histologically these resemble carcinoid
tumours of the appendix.

A small proportion of these tumours metastasise to regional lymph nodes – all are potentially malignant

35
Q

Central tumours tend to block the bronchus in which they arise RESULTING IN….? (5)

A

Obstruction
* Collapse of lung.
* Pneumonia Infection
* Bronchiectasis
* Lung abscess

36
Q

Which tumor shows nuclear pleomorphism, mitotic activity
and necrosis. Over half eventually metastasised

A

Atypical carcinoid tumors

ANATPATH (19 decks)

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