Pulmonary Pathology 5

Question 1

carcinogen exposure may be mitigated by genetic variation such as what?

Answer 1

P450 polymorphisms and genes responsible for DNA repair

Question 2

what is the most common type of lung cancer?

Answer 2

adenocarcinoma

Question 3

what is the second most common type of lung cancer?

Answer 3

squamous cell carcinoma

Question 4

what cells do squamous cell carcinomas arise from?

Answer 4

basal cells

Question 5

what cells do small-cell carcinomas arise from?

Answer 5

neuroendocrine cells

Question 6

what cell does adenocarcinomas arise from?

Answer 6

type II alveolar cells

Question 7

which types of lung cancer are heavily linked with smoking?

Answer 7

squamous cell carcinoma and small cell carcinomas

Question 8

how does a neuroendocrine cell become small cell carcinoma?

Answer 8

p53 inactivations

Question 9

which type of cancer is most likely to be found in non-smokers?

Answer 9

adenocarcinoma

Question 10

how does adenocarcinoma develop?

Answer 10

normal–> atypical adenoma hyperplasia–> adenoma in situ–> adenocarcinoma

Question 11

how is atypical adenomatous hyperplasia (AAH) defined?

Answer 11

less than 5mm (if it gets any bigger then it is considered to be AIS); dysplastic pneumocytes present along alveoli with some interstitial fibrosis

Question 12

how is adenocarcinoma in situ defined?

Answer 12

less than 3 cm (must be under 3 cms); dysplastic pneumocytes confluently growing along the alveoli

Question 13

how does pulmonary adenocarcinoma arise?

Answer 13

either from precursors or it develops de novo

Question 14

what does histology of pulmonary adenocarcinoma show?

Answer 14

malignant glands invading the lung tissue

Question 15

what is a test used for pulmonary adenocarcinoma?

Answer 15

TTF staining (thyroid-transcription fator-1)

Question 16

what is mucinous adenocarcinoma?

Answer 16

a variant of pulmonary adenocarcinoma; it is not in situ because it extends to far, but it is not invading; very deadly

Question 17

what does the progression of normal bronchial epithelium require in order to progress to squamous carcinoma?

Answer 17

metaplasia

Question 18

what is the progression of normal bronchial epithelium to squamous carcinoma?

Answer 18

normal–> squamous metaplasia–> squamous carcinoma in situ (dysplasia)–> invasive squamous carcinoma

Question 19

how do you recognize squamous carcinoma on histology?

Answer 19

keratin pearls

Question 20

how do you recognize squamous carcinoma on cytology?

Answer 20

orange cytoplasm= keratin

Question 21

what are the characteristic features of squamous carcinoma?

Answer 21

more common in men, strong association with smoking, often occurs centrally

Question 22

which lung cancer is almost always associated with smoking?

Answer 22

small cell neuroendocrine carcinoma

Question 23

how does small cell neuroendocrine carcinoma appear histologically?

Answer 23

small cells with fine blue nuclear chromatin, scant cytoplasm, nuclear “molding”, and characteristic necrosis

Question 24

how do you treat adenocarcinomas?

Answer 24

on the basis of molecular testing: EGFR, ALK, or PDL-1

Question 25

so when you know that an adenocarcinoma shows EGFR over expression, what do you do?

Answer 25

you know that that EGFR is driving the malignant function- so block it with erlotinib

Question 26

what is there is inversion of that area chromosome 2p where we find our ALK gene?

Answer 26

there may be a fusion protein there that sends the cell cycle into over drive/ proliferation; so you block it by using crizotinib

Question 27

what is the general flow chart for adenocarcinoma therapy?

Answer 27

look for an EGFR mutation, if it is positive you treat it with an EGFR TKI; if it is negative you look for an ALK rearrangement; if that is positive you treat with crizotinib

Question 28

what should you not use when treating squamous carcinoma?

Answer 28

VEGF inhibitors (these tumors are very sensitive to bleeding)

Question 29

what paraneoplastic syndrome is associated with squamous carcinoma?

Answer 29

PTH-rP hypercalcemia

Question 30

what paraneoplastic syndrome is associated with small cell carcinoma?

Answer 30

SIADH (syndrome of inappropriate ADH secretion) and Cushing's syndrome (secretion of ACTH)

Question 31

what may be the primary manifestation of the paraneoplastic syndromes?

Answer 31

electrolyte disturbances and/or mental status changes

Question 32

what makes up Horner's syndrome?

Answer 32

enophthalmos (sunken eyeball), ptosis, miosis (small pupil), anhidrosis; aka oculosympathetic palsy

Question 33

horner's syndrome can occur at many sites along the sympathetic pathway; how can you localize it to the thoracic outlet?

Answer 33

if the patient is present with brachial plexus symptoms--> wasting, pain, paresthesias, and paresis of arm and hand

Question 34

what are the stages of neuroendocrine tumors?

Answer 34

DIPNECH, carcinoid tumor, atypical carcinoid tumor, small cell neuroendocrine carcinoma

Question 35

what does DIPNECH stand for and what is it?

Answer 35

diffuse interstitial pulmonary neuroendocrine cell hyperplasia; very small (less than 5 mm) hyperplasia; basically a precursor lesion

Question 36

how do you tell apart DIPNECH and carcinoid tumors?

Answer 36

DIPNECH are less than 5 mm and carcinoid tumors are 5 mm or larger

Question 37

what are carcinoid tumors?

Answer 37

5 mm or larger, they can metastasize, neuroendocrine carcinoma grade 1

Question 38

what is atypical carcinoid tumors?

Answer 38

neuroendocrine carcinoma grade 2

Question 39

how do you tell apart carcinoid tumors and atypical carcinoid tumors?

Answer 39

atypical carcinoid tumors have increased mitotic activity, NECROSIS, and disordered growth; increased rates of metastasis

Question 40

what is carcinoid syndrome?

Answer 40

flushing, diarrhea, cyanosis

Question 41

which neuroendocrine tumor has the greatest 5 year survival rate?

Answer 41

carcinoid tumors, then atypical carcinoid tumors, then small cell carcinoma

Question 42

if a young man is presenting with SOB and hemoptysis and you find metastatic cancer, what two things should you be thinking about?

Answer 42

testicular cancer or melanoma