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Flashcards in Pathology 4 Deck (40):
1

lung tumors=

benign and primary malignant neoplasms

2

pleural tumors=

benign and malignant neoplasms

3

most malignant lesions in lung are:

-mets from other cancers = CANNON BALL LESIONS

4

most common benign lesons?

-granulomas
-chronic pneumonia and abscess

5

pulmonary hamartoma

-common BENIGN tumor
-PERIPHERAL
-asymptomatic and slow growing
-can appear as a "coin lesion"

6

-Majority of primary (bronchogenic) lung tumors are:

-peak incidence:

-carcinomas


-50s and 60s

MALES=FEMALES

7

Lung cancer symptoms:

-COUGH
-WL
-DYSPNEA

8

bloody pleural efusion in patient >40yrs... thikn?

cancer

9

non-inflam plueral effusions:

-hydrothorax=serous fluid; usually caused by cardiac failure
-hemothorax=blood in pleural space; usually ruptured aneurysm, vascular trauma, or cancer
-chylothorax=lymphatic obstruction; thoracic duct injury

10

Paraneoplastic syndromes

-common with lung cancers
-ex) squamous cell carcinoma = hypercalcemia (PTH, prostaglandin E)
-ex) small cell carcinoma - neuroendocrine cells so more syndromes (cushings, inappropriate ADH secretion, carcinoid...)

11

Other lung cancer systemic manifestations:

1) lambert-eaton myasthenic syndrome= muscle weakness due to autoantibodies
2) peripheral neuropathy=purely sensory
3) acanthosis nigricans=dermatologic
4) leukemoid reactions=hematologic
5) hypertrophic pulmonary osteoarthropathy = clubbing of fingers

12

Pancoast tumor

-UPPER LOBES
-grows directly into brachial plexus
-arm pain
-Horners syndrome (8th nerve screwed) possible
-superior vena cava syndrome

13

Horners syndrome

(pancoast tumor)
-enophthalmos
-ptosis of upper eyelid
-miosis
-anhidrosis

14

most important factor in cancers?

-SMOKING

15

most common mutation in lung cancers?

-p53

16

precursor lesions to lung cancer:

-squamous dysplasia and carcinoma in situ
-atypical adenomatous hyperplasia
-diffuse idiopathic neuroendocrine cell hyperplasia

17

TUmor classification -

1) adenocarcinoma - More females
2) squamous cel carcinoma -more males
3) small cell carcinoma - more females
4) large cell carcinoma - more males

18

treatment of cancer is based on?

-classifications

so we have:
-nonsmall cell carcinomas (adeno, squamous, large) 70-75%
-small cell
-some other combined patterns

19

adenocarcinomas

-most common
-increasing incidence
-**gland** formaton--> mucin production (MUCIN = MORE AGGRESSIVE)
-frequent desmoplastic response

-MOST COMMON LUNG CANCER IN WOMEN, YOUNGER PATIENTS AND NON-SMOKERS (SMOKERS STILL COMMONLY GET THIS)

20

adenocarcinomas - genes involved:

-KRAS and EGFR mutations

21

Adenocarcinoma

-PERIPHERAL with scars sometimes
-slow growing and mets early

22

2 froms of adenocarcinoma

-bronchial derived
-brochioloalveolar - origin=bronchioloalveolar stem cell; lepidic growth patter (no invasion- but grows along walls)

23

Bronchioloalveolar -
-precursor lesions:

-atypical adenomatous hyperplasia (AAH) - monoclonal

24

squamous cell carcinoma

-CLOSE CORRELATION WITH SMOKING
-CENTRAL ( IN OR NEAR HILUS)

-MEN!!v
-produced KERATIN!!!!!!

-grows rapid and mets slowly

25

squamous cell carcinoma- genes

hgih frequency of p53 mutation and EGFR overexpression

26

adeno vs squamous cell ca?

-adeno grows more slowly but mets early

-squamous grows rapidly but mets slowly

27

Squamous cell Ca - clinical features:

-bloody sputum
-cough
-obstruction symptoms
-pneumonia reccurent
-atelectasis

28

Squamous cell Ca- related syndromes:

-superior vena cava syndrome
-pancoast tumor

29

squamous cell Ca -histology==

intercellular bridges
keratin pearl formation!

30

small cell ca-

MOST MALIGNANT
-more males
-SMOKING!!!!!!!

-highly aggressive- rapid growing early mets
-surgery not helpful - CHEMO IS CHOICE

-paraneoplastic syndromes!!!!!!

31

small cell carcin - genes

c-MYC
-RB1

32

small cell Ca- histology:

-little cytoplasm
-OAT CELL CARCINOMA - round to oval cells

33

LArge cell Ca-

DIAGNOSIS OF EXCLUSION
-UNDIFFERENTIATED
-poor prognosis
-many variants - GIANT CELLS

34

secondary patholgoy due to lung cancer:

-changes occur distal to tumor!
-partial obstruction= focal emphysema
-complete obstruction = atelectasis
-severe bronchitis, bronchiectasis, pulmoanry abscess
-post obstructive pneumonia

35

MOST AGGRESSIVE?

SMALL CELL

36

MOST FAVORABLE?

-bronchioalveolar

37

most common mets?

-LN most!!
-adrenal
-liver
-brain
-bone

38

lugn cancer causes of death:

-PNEUMONIA
-lung abscess
-bleeding
-esophago-pleural fistula
-met effects on other organs

39

neuroendocrine prognosis?

-pretty good - 90-95% curable via surgery

40

carcinoid syndrome:

-intermittent: diarrhea, flushing, bronchoconstriction, cyanosis
-SEROTONIN PRODUCTION

-GREAT SURVIVAL for TYPICAL