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*MHD Exam 6 > Pulmonary Path IV > Flashcards

Pulmonary Path IV Flashcards

1
Q

What is the most common benign primary lung tumor?

A

hamartoma

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2
Q

Approximately 95% of malignant lung tumors are:

A

carcinomas

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3
Q

What is a hamartoma?

A

A benign neoplasm with various mesenchymal tissues, with cartilage being the most common component (can also see adipose tissue and smooth muscle in some cases). It contains entrapped “clefted” respiratory epithelium.

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4
Q

What percentage of lung carcinomas occur in active smokers or those who stopped recently?

A

90%

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5
Q

Average smokers have a ___x greater risk of developing lung cancer, and heavy smokers have a ____x greater risk.

A

10; 60

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6
Q

Tobacco smoking is associated with alterations in which gene?

A

p53

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7
Q

What are the dominant oncogenes associated with lung cancer?

A

c-MYC, KRAS, EGFR, c-MET, c-KIT

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8
Q

What are the tumor suppressor genes associated with lung cancer?

A

p53, RB1, p16, other genes on chromosome 3 (FHIT, RASSF1A)

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9
Q

Asbestos increases the risk of lung carcinoma by ___x in smokers and ___x in non-smokers.

A

55; 5

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10
Q

What are the criteria that make a patient a candidate for lung cancer screening?

A
  • 55-77 y/o
  • in fairly good health
  • at least a 30-pack-year smoking history and are a current smoker
  • or former smoker who has quit within last 15 years
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11
Q

What are the most common complaints of those diagnosed with lung cancer?

A

cough, weight loss, chest pain, and dyspnea

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12
Q

What are the compartments in the 2-compartment model of molecular pathogenesis of lung cancer?

A
  • Central airway compartment: air conducting system and proximal bronchus; affected in smokers; causes SCLC and SQC
  • Terminal respiratory unit: gas exchange system and distal parenchyma; affected in non-smokers; causes ADC
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13
Q

What are common clinical features of lung cancer?

A
  • pneumonia or abscess
  • pleural effusion
  • pericardial tamponade
  • hoarseness
  • dysphagia
  • diaphragm paralysis
  • rib destruction
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14
Q

What are the most common sites of metastasis from the lung?

A

lymph nodes, liver, adrenals, brain, bone

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15
Q

A syndrome associated with lung cancer:

A

Superior vena cava syndrome (facial swelling, cyanosis, dilatation of veins in head and neck due to SVC involvement)

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16
Q

Symptoms that occur in patients with cancer that cannot be readily explained by local or distant spread or by the elaboration of hormones not indigenous to the site or origin of the tumor.

A

paraneoplastic syndromes (not related to the tumor or tumor spread itself but to something the tumor is producing, like cytokines)

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17
Q

Cervical sympathetic plexus involvement can cause which syndrome in lung cancer patients?

A

Horner syndrome

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18
Q

What are examples of paraneoplastic syndromes secondary to lung cancer?

A

SIADH, Cushing’s, hypercalcemia, calcitonin

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19
Q

Describe the simplistic classification of lung carcinomas.

A
  • Small cell (20%)

- Non-small cell (80%) - squamous cell, adenocarcinoma, unclassifiable/large cell

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20
Q

Describe some of the systemic manifestations of lung cancer.

A
  • Eaton-Lambert (muscle weakness most commonly associated with small cell due to autoantibodies against Ca channel)
  • Sensory neuropathy
  • Dermatologic abnormality (acanthosis nigricans)
  • Hypertrophic pulmonary osteoarthropathy (clubbing)
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21
Q

Small cell carcinoma is also known as:

A

oat cell carcinoma

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22
Q

What are the histological characteristics of small cell carcinoma?

A
  • densely packed tumor with small blue cells in a sheet-like pattern
  • round/ovoid nucleus
  • scant cytoplasm
  • finely dispersed chromatin
  • inconspicuous nucleoli
  • high mitotic activity
  • necrosis
  • Azzopardi effect
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23
Q

The lung carcinoma most strongly associated with smoking,

A

small cell carcinoma

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24
Q

Why is small cell carcinoma so dangerous?

A

It is a rapidly growing, high grade neuroendocrine tumor that is widely metastatic and rarely resectable. Only 5-8% of patients make it to a 2 year survival.

25
Q

What are the 2 main genes involved with development of small cell carcinoma?

A

p53 and RB (inactivation in 100% of cases)

26
Q

Describe some of the key features of a bronchial carcinoid.

A
  • low-grade malignant neuroendocrine tumor
  • locally invasive but rarely metastatic
  • appears at an earlier age (40 y/o)
  • often resectable and curable
  • classified into typical and atypical
  • surface is mucosa-like and non-necrotic
  • histologically well-nested with well-defined nuclei; cells separated by a delicate vascular network
27
Q

In which patient population is SQC most common?

A

men with a smoking history

28
Q

SQC may be associated with inappropriate secretion of which hormone?

A

PTH (leading to elevated calcium)

29
Q

What are the main histological features of SQC?

A
  • intercellular bridges
  • focal areas of keratinization (high MW keratins)
  • bright orange keratinized cells on PAP stain
30
Q

Squamous cell carcinoma has a high frequency of which mutations?

A

p53 (also FGFR; very rarely EGFR and KRAS)

31
Q

What is the most common lung carcinoma in women?

A

adenocarcinoma

32
Q

What is the most common lung carcinoma in non-smokers?

A

adenocarcinoma

33
Q

visualized as a spiculated lung mass on CT scan

A

adenocarcinoma

34
Q

What are the precursor lesions of adenocarcinoma?

A

atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)

35
Q

“Adenocarcinoma” means that the tumor is:

A

gland-forming, mucin-containing, or TTF-1 positive

36
Q

What are adenocarcinomas dangerous?

A

Although they are slower growing and generally smaller masses, they can metastasize early with local nodes involved in over 50% of cases.

37
Q

Describe the invasive properties of minimally invasive adenocarcinoma (MIA).

A
  • invasive focus less than 5 mm

- no invasion into pleura, lymphatics, or blood vessels (primarily in lung parenchyma)

38
Q

Adenocarcinomas stain positive for what in immunohistochemistry?

A

TTF-1 (thyroid transcription factor 1)

39
Q

What are the major driver mutations in ADC?

A
  • EGFR mutations
  • ALK gene fusions
  • KRAS mutations
40
Q

What are the subtypes of ADC?

A
  • acinar
  • papillary
  • solid
  • mucinous
41
Q

What are the options for targeted therapy in ADC?

A
  • Erlotinib (EGFR inhibitor)

- Crizotinib (ALK inhibitor)

42
Q

Which ADC patients classically have EGFR mutations?

A
  • 30-40% of Asians and 10-15% of Caucasians
  • Females
  • Never-smokers
43
Q

Which ADC patients classically have ALK gene fusions?

A
  • Younger patients

- Never-smokers

44
Q

What is the cause of the proliferative advantage in adenocarcinomas with EGFR mutations?

A

mutations occur in the kinase receptor of the tyrosine kinase domain, resulting in constitutive activation

45
Q

Mutations in _____ correlate with worse outcomes in ADC.

A

KRAS (KRAS mutations confer resistance to EGFR inhibitors, and there is no targeted therapy for KRAS)

46
Q

Does large cell/undifferentiated carcinoma have a good or poor prognosis?

A

poor

47
Q

How is large cell carcinoma diagnosed on histology?

A

It is a diagnosis of exclusion, in that it lacks the features of small cell carcinoma and glandular or squamous differentiation. The anaplastic cells are larger with a higher cytoplasm to nucleus ratio.

48
Q

Why is the distinction among histologic types of lung cancer important?

A

The phenotype determines therapy and prognosis.

49
Q

Which treatment is available for advanced NSCLC without driver mutations?

A

PDL1 immunotherapy

50
Q

What is the origin of mesothelioma?

A

pleura (mesothelial cells) - NOT the parenchyma itself

51
Q

What is the prognosis for mesothelioma?

A

survival beyond 1 year is rare (very aggressive tumor)

52
Q

What are the different histologic types of mesothelioma, and which is the most common?

A
  • epithelioid (most common)
  • sarcomatoid
  • mixed
53
Q

What are the cytogenetic abnormalities associated with mesothelioma?

A
  • deletions of certain chromosome arms

- somatic mutations of tumor suppressor genes

54
Q

How can mesothelioma easily be distinguished from adenocarcinoma?

A

immunohistochemical stain that is positive for calretinin

55
Q

What is the clinical presentation of mesothelioma?

A

chest pain, dyspnea, and recurrent pleural effusion

56
Q

How can lung mets be distinguished from primary lung cancer?

A

Metastases are multifocal nodules of various sizes with central necrosis; often subpleural.

57
Q

Are male or female smokers more susceptible to developing lung cancer?

A

female

58
Q

What are pancoast tumors?

A

non-small cell tumors that have spread and affected nearby tissues, specifically the vertebrae and ribs (located apically; also called superior sulcus tumors; can destroy 1st and 2nd ribs)

59
Q

What do pleural tumors arise from?

A
  • Spread of lung tumors
  • Metastasis from other areas of boddy
  • Mesothelioma
  • Completely benign (solitary fibrous tumor)

*MHD Exam 6 (20 decks)

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