Pulm Path IV

Question 1

What is the most common primary tumor?

Answer 1

Hamartoma (benign)

-approximately 95% of tumors

Question 2

Top 3 most prevalent cancers in men by number of cases

Answer 2

• Prostate
• Lung & Bronchus
• Colon & Rectum

Question 3

Top 3 most prevalent cancers in women by number of cases

Answer 3

• Breast
• Lung & Bronchus
• Colon & Rectum

Question 4

Top 3 killer cancers

Answer 4

• Lung & Bronchus
• Prostate/Breast
• Colon & Rectum

Question 5

Percent of lung carcinomas that occur in smokers?

Answer 5

90%

Question 6

Increased chance of developing lung cancer if you smoke?

Answer 6

• Average smokers have 10x risk

- Heavy smokers have 60x greater risk

Question 7

Other facts about smoking and cancer

Answer 7

• women more susceptible than men
• second hand smoke increases risk by 2 compared to non-smoking
• cessation of smoking decreases risk but may not return person to baseline
• associated with alterations in p53

Question 8

Which organ has no evidence of being at higher risk of cancer due to smoking?

Answer 8

Breast

Question 9

Types of Lung cancer by percentage

Answer 9

• Small cell carcinoma (20%)
• —-Non-small cell carcinoma (80%)
• Squamous cell carcinoma (25-30%)
• Adenocarcinoma (30-40%)
• Unclassifiable/Large cell (10-15%)

Question 10

Is Squamous cell carcinoma more common in men or women?

Answer 10

Men

Question 11

Is Squamous cell carcinoma associated with smoking?

Answer 11

yes

Question 12

Which elevated hormone is Squamous cell carcinoma associated with?

Answer 12

inappropriate PTH secretion (elevated Ca++)

Question 13

What is the progression of Squamous cell carcinoma?

Answer 13

• Squamous metaplasia –> dysplasia –> carcinoma in situ

- arises centrally

Question 14

Describe the immunohistochemistry of Squamous cell carcinoma

Answer 14

• intercellular bridges or keratinization
• diffuse p63/p40
• local nodes involved in 70 - 90%
• spreads outside the thorax, later than other histological types
• highest frequency of p53 mutations

Question 15

What is the 5 year survival?

Answer 15

5 - 7.5%

Question 16

Clinical presentation of Adenocarcinoma

Answer 16

Female non-smokers

Question 17

What is the progression of Adenocarcinoma?

Answer 17

Atypical Adenomatous Hyperplasia –> Adenocarcinoma in situ –> Minimally invasive adenocarcinoma
-more often peripheral

Question 18

Another name for Adenocarcinoma in situ?

Answer 18

Bronchioalveolar Carcinoma

Question 19

What are subtypes of Adenocarcinoma?

Answer 19

• Acinar
• Papillary
• Solid
• Mucinous

Question 20

What are mutations of Adenocarcinoma?

Answer 20

• —-EGFR
• 30 - 40% asians
• targeted therapy: erlotinib (EGFR inh.)
• —-ALK gene fusions
• targeted therapy: Crizotinib (ALK inhibitors)
• —-KRAS
• most common in caucasians
• presence leads to worst outcome
• confers resistance to EGFR inhibitors and no targeted therapy

Question 21

Large cell/undifferentiated carcinoma

Answer 21

• un-differentiated
• poor prognosis
• metastasize to liver, adrenal, brain
• 2 - 3 % 5 year survival

Question 22

Where does small cell carcinoma arise from?

• tissue
• location

Answer 22

• rapidly growing, high grade neuroendocrine tumor

- central

Question 23

Is small cell carcinoma associated with smoking?

Answer 23

yes

Question 24

Characteristics of small cell carcinoma

Answer 24

• widely metastatic
• Paraneoplastic syndromes
• –ACTH, ADH
• Rarely resectable

Question 25

Treatment for small cell carcinoma

Answer 25

Radiotherapy | Chemotherapy

Question 26

2 year survival for small cell carcinoma

Answer 26

5 - 8%

Question 27

Histologic characteristics of small cell carcinoma

Answer 27

densely packed "small blue" tumor - size is 3 times larger than small, resting lymphocytes - round to ovoid nucleus - scant cytoplasm - finely dispersed chromatin, inconspicuous nucleoli, high mitotic activity

Question 28

Mutations in small cell carcinoma

Answer 28

- inactivation of p53 | - inactivation of RB

Question 29

What is a Bronchial Carcinoid?

Answer 29

Low grade malignant neuroendocrine tumor | -locally invasive, rarely metastatic

Question 30

Average age of person who gets Bronchial Carcinoid?

Answer 30

40 y/o

Question 31

Clinical presentation of Bronchial Carcinoid

Answer 31

- carcinoid syndrome | - intermittent diarrhea, flushing, and cyanosis

Question 32

Classification of Bronchial Carcinoid

Answer 32

- Typical = low mitotic rate and absent necrosis | - Atypical = more frequent mitosis and focal necrosis

Question 33

Outcomes for Bronchial Carcinoid

Answer 33

- often resectable and curable | - 5 to 10 year survival rate: 50 - 95%

Question 34

What is the importance of differentiating between small cell carcinoma and Non small cell lung carcinoma?

Answer 34

- non small cell carcinoma is generally resectable - small cell carcinoma has wide spread metastases by the time of diagnosis (requires chemotherapy with or without radiotherapy)

Question 35

Clinical presentations of Lung cancer

Answer 35

- Cough - Weight loss - Chest pain - Dyspnea

Question 36

Clinical features of lung cancer

Answer 36

- pneumonia, access - pleural effusion - pericardial tamponade - hoarseness - dysphagia - diaphragm paralysis - rib destruction

Question 37

Superior vena cava syndrome

Answer 37

- facial swelling - cyanosis - dilatation of veins in head and neck

Question 38

Paraneoplastic syndromes

Answer 38

- SIADH - Cushings - Calcitonin

Question 39

Eaton-Lambert

Answer 39

- Autoantibodies against calcium channels - muscle weakness - most commonly associated with small cell carcinoma

Question 40

Survival for Mesothelioma

Answer 40

rarely over a year

Question 41

Types of Mesothelioma

Answer 41

- Epithelioid - Sarcomatoid - Mixed

Question 42

Histology of Mesothelioma

Answer 42

- Asbestos body | - Ferruginous body

Question 43

Clinical presentation of Mesothelioma

Answer 43

- Chest pain - Dyspnea - Recurrent pleural effusion