Flashcards in Pulmonary Pathology IV Deck (47)
What is the most common benign lung tumor?
What is the most common malignant lung tumor?
What gene mutations is smoking associated with?
What are some oncogenes involved in lung cancer?
C-MYC, KRAS, EGFR, c-Met, C-KIT
What are some tumor suppressor genes involved in lung cancer?
p53, RB1, p16
Cancer of what organ has smoking not been shown to be related to yet?
What are the major classifications of lung carcinoma?
- Small Cell Carcinoma
- Non-small Cell Carcinoma
What are the groups within the non-small cell carcinoma class?
- Squamous Cell Carcinoma
- Large Cell Carcinoma
What is the typical population of squamous cell carcinoma?
More common in men with a smoking history
What are characteristic findings of squamous cell carcinomas?
Tend to grow very large before they are detected
and will outgrow its own vascular supply that can
lead to necrosis and are associated with keratinization
What is the pathogenesis of squamous cell carcinoma?
Smoke is a constant irritant which causes the columnar
epithelium to undergo metaplasia into squamous tissue which can lead to dysplasia and carcinoma eventually
What will PAP stain of squamous cell carcinoma show?
Orange where there is keratin
What is the highest frequency mutation found in SQC?
What is the most common type of lung cancer in non-smokers?
What is the typical population of adenocarcinoma?
Women - most common type in women - less associated with smoking than other types
What is seen in adenocarcinoma?
Irregular spiculated mass with entrapped anthracosis
What are the 3 types of precursor lesions of ADC?
- ￼Atypical Adenomatous Hyperplasia (AAH)
- Adenocarciinoma in situ (AIS)
- ￼Minimally invasive adenocarcinoma (MIA)
What are the characteristics of AAH?
- Well demarcated focus
- Less than 5mm
- Lined by cuboidal to low columnar epithelium
- Mild atypia
What are the characteristics of AIS?
• Grow along pre-existing structures
• Preservation of alveolar architecture
• NO INVASION
- Moderate to marked atypia
What are the characteristics of MIA?
- 3 cm or less
- Invasive focus less than 5 mm
- No invasion into pleura, lymphatics or blood vessels
What are some driver mutations in ADC?
- EGFR mutations
- ALK gene fusions
- KRAS mutations
What population are EGFR mutations often found in?
Mostly Asian females who were never smokers which results in constitutive activation - there IS targeted therapy though
What population are ALK gene fusions often found in?
Younger patients who were never smokers - targeted therapy with ALK inhibitors
Besides ADC what other lung cancer are ALK fusions seen in?
Large Cell Carcinoma
What population are KRAS mutations most often seen in?
Caucasians - mutations confer a worse prognosis with no specific targeted therapy
What is the prognosis of large cell undifferentiated carcinoma?
Poor prognosis as it metastasizes to the liver, adrenals, brain
What is seen on histology of large cel carcinoma?
Large tumor cells with hyperchromatic nuclei
What are the characteristics of small cell carcinoma?
- Rapidly growing, high grade neuroendocrine tumor
- Strong association with ￼smoking
- Widely metastatic
- Paraneoplastic Syndromes => ACTH, ADH
What is the appearance of SCC on histology?
Looks like oats AKA oat cell carcinoma
- Densely packed “small blue” tumor
- “Small” : size is about 3 times that of small, resting lymphocyte
- Round to ovoid nucleus
- Scant cytoplasm
What is the normal treatment for SCC?
Chemotherapy and radiotherapy
Seen in SCC with staining of the vessel walls
What genes are inactivated in SCC?
What are the characteristics of bronchial carcinoid tumors?
- Low grade malignant neuroendocrine tumors
- Locally invasive, rarely metastatic
- Earlier age (40 years)
- Often resectable and curable
What is the spectrum of neuroendocrine tumors?
Carcinoid - Atypical Carcinoid - Small Cell Carcinoma
Each has increasingly malignant potential
What is the general treatment of SCLC?
Chemotherapy with or without radiotherapy
What is the general treatment of NSCLC?
What are the most common complaints seen with lung cancer?
- Weight Loss
- Chest pain
Superior Vena Cava Syndrome
Facial swelling, cyanosis, dilatation of veins in head and neck
- Apically located/Superior sulcus tumors
- Can destroy 1st/2nd rib
- May show Horner syndrome
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 the tissue or origin of the tumor
- Muscle weakness
- Most commonly associated with small cell carcinoma.
- Autoantibodies against calcium channel.
Lymphatic fluid in pleural space
What is the origin cell of mesotheliomas?
Pleural mesothelial cells
What is the progression and prognosis of mesothelioma?
Spreads widely in pleural space invasive by contiguous spread or diffuse seeding of pleural space - survival more than 1 year is rare
What is mesothelioma related to?
What is the most common type of mesothelioma?