Pulmonary Pathology IV Flashcards Preview

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Flashcards in Pulmonary Pathology IV Deck (47):
1

What is the most common benign lung tumor?

Hamartoma

2

What is the most common malignant lung tumor?

Metastasis

3

What gene mutations is smoking associated with?

P53 alterations

4

What are some oncogenes involved in lung cancer?

C-MYC, KRAS, EGFR, c-Met, C-KIT

5

What are some tumor suppressor genes involved in lung cancer?

p53, RB1, p16

6

Cancer of what organ has smoking not been shown to be related to yet?

Breast

7

What are the major classifications of lung carcinoma?

- Small Cell Carcinoma
- Non-small Cell Carcinoma

8

What are the groups within the non-small cell carcinoma class?

- Squamous Cell Carcinoma
- Adenocarcinoma
- Large Cell Carcinoma

9

What is the typical population of squamous cell carcinoma?

More common in men with a smoking history

10

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

11

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

12

What will PAP stain of squamous cell carcinoma show?

Orange where there is keratin

13

What is the highest frequency mutation found in SQC?

p53

14

What is the most common type of lung cancer in non-smokers?

Adenocarcinoma

15

What is the typical population of adenocarcinoma?

Women - most common type in women - less associated with smoking than other types

16

What is seen in adenocarcinoma?

Irregular spiculated mass with entrapped anthracosis

17

What are the 3 types of precursor lesions of ADC?

- Atypical Adenomatous Hyperplasia (AAH)
- Adenocarciinoma in situ (AIS)
- Minimally invasive adenocarcinoma (MIA)

18

What are the characteristics of AAH?

- Well demarcated focus
- Less than 5mm
- Lined by cuboidal to low columnar epithelium
- Mild atypia

19

What are the characteristics of AIS?

• 3cmorless
• Grow along pre-existing structures
• Preservation of alveolar architecture
• NO INVASION
- Moderate to marked atypia

20

What are the characteristics of MIA?

-􏰄 3 cm or less
- Invasive focus less than 5 mm
􏰄- No invasion into pleura, lymphatics or blood vessels

21

What are some driver mutations in ADC?

- EGFR mutations
- ALK gene fusions
- KRAS mutations

22

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

23

What population are ALK gene fusions often found in?

Younger patients who were never smokers - targeted therapy with ALK inhibitors

24

Besides ADC what other lung cancer are ALK fusions seen in?

Large Cell Carcinoma

25

What population are KRAS mutations most often seen in?

Caucasians - mutations confer a worse prognosis with no specific targeted therapy

26

What is the prognosis of large cell undifferentiated carcinoma?

Poor prognosis as it metastasizes to the liver, adrenals, brain

27

What is seen on histology of large cel carcinoma?

Large tumor cells with hyperchromatic nuclei

28

What are the characteristics of small cell carcinoma?

- Rapidly growing, high grade neuroendocrine tumor
- Strong association with smoking
- Widely metastatic
- Paraneoplastic Syndromes => ACTH, ADH

29

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

30

What is the normal treatment for SCC?

Chemotherapy and radiotherapy

31

Azzopardi Effect

Seen in SCC with staining of the vessel walls

32

What genes are inactivated in SCC?

- P53
- RB

33

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

34

What is the spectrum of neuroendocrine tumors?

Carcinoid - Atypical Carcinoid - Small Cell Carcinoma

Each has increasingly malignant potential

35

What is the general treatment of SCLC?

Chemotherapy with or without radiotherapy

36

What is the general treatment of NSCLC?

Surgical treatment

37

What are the most common complaints seen with lung cancer?

􏰀- Cough
􏰀- Weight Loss 􏰀
- Chest pain
􏰀- Dyspnea

38

Superior Vena Cava Syndrome

Facial swelling, cyanosis, dilatation of veins in head and neck

39

Pancoast tumors

-􏰀 Apically located/Superior sulcus tumors 􏰀
- Can destroy 1st/2nd rib
􏰀- May show Horner syndrome

40

Paraneoplastic Syndromes

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

41

Eaton-Lambert Syndrome

-􏰀 Muscle weakness
􏰀- Most commonly associated with small cell carcinoma.
􏰀- Autoantibodies against calcium channel.

42

Chylothorax

Lymphatic fluid in pleural space

43

What is the origin cell of mesotheliomas?

Pleural mesothelial cells

44

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

45

What is mesothelioma related to?

Asbestos

46

What is the most common type of mesothelioma?

Epithelioid

47

What is the clinical presentation of mesothelioma?

-􏰀 Chest pain
􏰀- Dyspnea
􏰀- Recurrent pleural effusion

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