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Flashcards in Path Deck (100):
1

What percent of coin lesions are malignant?

35-49%

2

What percent of coin lesions are benign?

51-65%

3

What are the two common cancerous form of coin lesions?

Bronchogenic carcinoma
Secondary met

4

What is the common benign form of coin lesions?

-Granulomas
-Chronic pneumonia and abscess

5

What organs of the body generally send mets to the lungs? (4)

Breast
Stomach
Pancreas
Colon

6

What are hamartomas of the lung? Where in the lung are they found? Are they usually symptomatic?

-Benign collection of tissue
-Usually found peripherally
-Usually asymptomatic

7

What is the most common form of primary lung cancer? Is this the same as the most common?

Carcinomas of the lung

secondary mets are more common

8

What age group is usually affected with bronchogenic carcinomas?

50s and 60s

9

What is the prognosis of bronchogenic carcinomas?

15% 5 year survival rate

10

What are the three usual ssx of bronchogenic carcinoma?

-cough
-Weight loss
-Dyspnea

11

What are the top 4 causes of pleural exudates?

-Microbial invasion
-Cancer
-Pulmonary infection
-Viral pleuritis

12

At what age are pleural exudate concerning for cancer?

Greater than 40 y/o

13

What are the three types of pleural effusions, and which ones are usually associated with cancers?

Hydrothorax
Hemothorax*
Chylothorax*

14

How do you diagnose lung cancer?

Sputum cytology
Fine needle aspiration

15

What percent of patients with lung cancer have paraneoplastic syndrome?

1-10%

16

True or false: Lung cancer is generally not resectable

True

17

What type of lung cancer is classically associated with paraneoplastic syndrome?

SCLC

18

What is the paraneoplastic syndrome caused by increased secretion of ACTH?

Cushing's syndrome

19

What is the paraneoplastic syndrome caused by increased secretion of ADH?

SIADH

20

What is the paraneoplastic syndrome caused by increased secretion of 5HT and bradykinin?

carcinoid syndrome

21

What are the two chemicals that paraneoplastic carcinomas secrete to produce hypercalcemia?

PTH
Prostaglandin E

22

What is the paraneoplastic syndrome caused by increased secretion of calcitonin?

Hypocalcemia

23

What is the paraneoplastic syndrome caused by increased secretion of gonadotropin?

Gynecomastia

24

What type of lung neoplasm usually causes paraneoplastic syndrome characterized by hypercalcemia

Squamous cell CA

25

What is the etiology of Lambert-Eaton syndrome?

increased secretion of autoantibodies against ACh receptors (can be caused by paraneoplastic syndrome)

26

What is the type of neuropathy that can occur with paraneoplastic syndrome?

Peripheral

27

What is the dermatologic symptom commonly caused by paraneoplastic syndrome?

Acanthosis Nigricans

28

What is the hematologic symptom commonly caused by paraneoplastic syndrome?

Leukemoid reaction

29

What is hypertrophic pulmonary osteoarthropathy? What type of lung cancer is this commonly seen in?

A medical condition combining clubbing and periostitis of the small hand joints, especially the distal interphalangeal joints. The condition may occur alone (primary), or it may be secondary to diseases like lung cancer. It is especially associated with non-small cell lung carcinoma.

30

What are the spinal nerves that are commonly affected with a pancoast tumor?

T1
T2
C8

31

What bones are commonly destroyed with a pancoast tumor?

1st and 2nd ribs

32

What type of tumors are pancoast tumors?

Usually squamous cell CA

33

What is the major vascular pathology that a pancoast tumor can cause?

SVC syndrome

34

What percent of lung cancer are smoking related?

90%

35

What is the relation between frequency of CA and pack years?

Linear

36

How many carcinogenic substances are found in cigarettes?

Over 1200

37

What are the industrial hazards that predispose to lung CA?

Asbestos
Ionizing radiation
Roofers

38

What is the element that causes lung cancer?

Ra

39

What are the precursor lesions to lung cancer? (3)

-Squamous dysplasia
-Atypical adenomatous hyperplasia
-Diffuse idiopathic neuroendocrine cell hyperplasia

40

What are the four major types of lung cancer?

Adenocarcinoma
Squamous cell CA
Small cell CA
Large cell CA

41

Which type of carcinoma never is appropriate for surgery:small cell CA or non-small cell?

Small cell

42

Which of the following is the most common: non-small cell, small cell, or combined

Non-small cell

43

What are the two mutations that are found within adenocarcinomas of the lung?

KRAS
EGFR

44

What is the the most common lung cancer in young, non-smoking females? Is this more common than in smokers?

Adenocarcinomas

Smokers still have it more often

45

What is the growing/metastatic potential of adenocarcinomas of the lung?

Usually grow slowly
Metastasizes early

46

What are the two forms of adenocarcinoma?

Bronchial derived and bronchoalveolar

47

What is the primary determinant of survival with lung adenoCA?

Clinical stage

48

What is bronchioloalveolar carcinoma? (where does it start, grow)

Uncommon form of adenoCA that arises in terminal broncholoalveolar regions, and grows along preexisting alveolar walls

49

What are the two types of bronchioloalveolar carcinoma?

Mucinous and nonmucinous

50

What is the precursor lesions with bronchioloalveolar carcinoma?

Atypical adenomatous hyperplasia

51

true or false: by definition there is no stromal, vascular, or pleural invasion with bronchioloalveolar carcinoma

True

52

What is the 5 year survival rate with bronchioloalveolar carcinoma?

42%

53

What is the origin (cell) of bronchioloalveolar carcinoma? What is the normal function of these? Where are they usually located?

bronchioloalveolar stem cells

Stem cells at the bronchoalveolar junction, to replenish normal cell types

54

What are the genetic mutations found in bronchioloalveolar carcinoma?

KRAS and others

55

What is lepidic growth pattern, which can be seen in bronchioloalveolar carcinoma?

Growth along the bronchial walls

56

What percent of squamous cell carcinoma is caused by smoking?

98%

57

Where in the lung is squamous cell carcinoma usually found?

near hilum

58

What is the marker that squamous cell CA produces, and can thus be stained for histologically?

Keratina

59

What are the characteristics of the growth and metastasis rate of squamous cell carcinoma?

Grows rapidly, buts mets slowly

60

What are the two major genetic mutations associated with squamous cell carcinoma?

p53 and EGFR

61

What is the progression of squamous cell carcinoma? (4)

metaplasia
Dysplasia
CIS
Invasive CA

62

What are the usual ssx of squamous cell carcinoma? Why?

Hemoptysis
Obstruction d/t growth along the bronchi

63

What is the respiratory epithelium?

Ciliated pseudostratified

64

What are the two classic histological findings of squamous cell carcinoma?

keratin pearls
Intercellular bridges

65

What is the most malignant for of all lung cancers?

Small cell carcinoma

66

In what gender is small cell carcinoma more common in?

Men

67

True or false: small cell lung carcinoma is only loosely correlated with smoking

False--9%

68

What are the genetic mutations that take place with small cell lung carcinoma?

c-Myc
RB1

69

What is the treatment (generally) for SCLC?

Chemotherapy (NOT surgery)

70

What is the 5 year survival rate with SCLC? mean survival time?

5-10%
1 year

71

What are the histological characteristics of SCLC?

Little cytoplasm with high mitotic count

72

What is the cellular origin for SCLC?

Neuroendocrine cell

73

What is the stain that highlights keratin?

Papanikoli

74

Where in the lung is SCLC usually found?

Spreading along the bronchi centrally

75

true or false: large cell CA is usually a diagnosis of exclusion

True

76

What are the histological characteristics of large cell carcinomas?

Anaplastic with vesicular nuclei and prominent nucleoli

Undifferentiated

77

What is the metastatic potential with large cell carcinoma?

High

78

What are the secondary pathologies that occur with primary lung cancers?

-Partial obstruction to total atelectasis
-Bronchitis
-Bronchiectasis

79

Where do changes in the lung occur relative to tumors

Distally

80

What are the primary determinants of operability with lung cancer?

Stage
Cardiopulmonary status

81

What is a pneumonectomy?

Total lung resection

82

What are the 5 common sites of metastases with lung cancer?

1. Lymph nodes
2. Adrenals
3. Liver
4. Brain
5. Bone

83

What are the common CODs with lung cancer, besides the neoplasm itself?

Pneumonia
Lung abscesses
esophago-pleural fistula

84

What is diffuse idiopathic pulmonary neuroendocrine cell hyperplasia?

rare disorder that may be a precursor to typical or atypical carincoids

85

What are tumorlets?

benign, small clusters of hyperplastic neuroendocrine cells

86

What is the chemical that carcinoid tumors secrete? What are the ssx that this causes?

5HT
Flushing, diarrhea, fibrosis

87

True or false: there is no relationship between the development of carcinoid tumors of the lung and smoking

True

88

What percent of carcinoid tumors of the lung are resectable?

90-95%

89

What are the histological characteristics of carcinoid tumors?

Uniform small cells in rosettes

90

What is the risk of atypical carcinoid tumors?

Progression to SCLC

91

What is the prognosis of atypical carcinoid tumors?

5-10 years survival rate of 87%

92

What is the major benign tumor of the pleura?

Pleural fibroma

93

What is the major malignant tumor of the pleura?

Malignant mesothelioma

94

True or false: pleural tumors are most often metastatic

True

95

What are pleural fibromas? Is there a relationship to asbestos?

Solitary tumor of the pleural made up of fibroblasts

No relation to asbestos

96

What is malignant mesothelioma?

malignant tumor of mesothelial cells of the visceral or parietal pleura, resulting from asbestosis exposure

97

What is the age group that is most commonly affected with malignant mesothelioma?

40-70 y/o

98

What percent of malignant mesothelioma is asbestosis related? How long does this take to present? What is the prognosis (1 year survival)?

90%
25-40 year

50% 1 year survival

99

What are the three patterns of malignant mesotheliomas?

-Epithelioid (resembles adenoCA)
-Sarcomatoid )like fibrosarcoma)
-Combo

100

What are the ssx of malignant mesothelioma?

Chest pain
Dyspnea
Pleural effusion