Resp - Path (Lung cancer & Superior vena cava syndrome)

Question 1

What is the leading cause of cancer death?

Answer 1

Lung cancer is the leading cause of cancer death.

Question 2

What is the physical presentation of lung cancer?

Answer 2

Presentation: cough, hemoptysis, bronchial obstruction, wheezing

Question 3

How does lung cancer present on imaging?

Answer 3

pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT.

Question 4

In the lung, is metastases or primary neoplasms more common?

Answer 4

In the lung, metastases (usually multiple) lesions are more common than primary neoplasms

Question 5

What are the 4 most common cancers that metastasize to lung?

Answer 5

Most often from breast, colon, prostate, and bladder cancer

Question 6

What are the 4 sites of metastases from lung cancer?

Answer 6

Sites of metastases from lung cancer - adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatosplenomegaly)

Question 7

How might lung cancer metastases to the bone present? How about to the liver?

Answer 7

bone (pathologic fracture), liver (jaundice, hepatosplenomegaly)

Question 8

What are 6 complications associated with lung cancer?

Answer 8

SPHERE of complications: (1) Superior vena cava syndrome (2) Pancoast tumor (3) Horner syndrome (4) Endocrine (paraneoplastic) (5) Recurrent laryngeal symptoms (hoarseness) (6) Effusions (pleural or pericardial)

Question 9

Which lung cancer types are associated with smoking?

Answer 9

All lung cancer types except bronchial carcinoid are associated with smoking

Question 10

Which lung cancers are located centrally?

Answer 10

Squamous and Small cell carcinoma are Sentral (central)

Question 11

What are 5 types of lung cancer?

Answer 11

(1) Adenocarcinoma (2) Squamous cell carcinoma (3) Small cell (oat cell) carcinoma (4) Large cell carcinoma (5) Bronchial carcinoid tumor

Question 12

What is the location of Adenocarcinoma in the lung?

Answer 12

Peripheral

Question 13

What is the most common lung cancer in nonsmokers? What is the most common lung cancer overall?

Answer 13

Adenocarcinoma = Most common lung cancer in nonsmokers and overall (except for metastases)

Question 14

Name 3 activating mutations for Adenocarcinoma of the lung.

Answer 14

Activating mutations include k-ras, EGFR, and ALK.

Question 15

With what condition is Adenocarcinoma of the lung associated?

Answer 15

Associated with hypertrophic osteoarthropathy (clubbing).

Question 16

What is another name for Bronchioloalverolar subtype of Adenocarcinoma of the lung? What is often seen on CXR in this case?

Answer 16

Bronchioalveolar subtype (adenocarcinoma in situ): CXR often shows hazy infiltrates similar to pneumonia

Question 17

How is the prognosis for Bronchioloalveolar subtype of Adenocarcinoma of lung?

Answer 17

Excellent prognosis

Question 18

What is seen on histology in Bronchioloalveolar subtype of Adenocarcinoma of the lung?

Answer 18

Bronchioloalveolar subtype: grows along alveolar septa –> apparent “thickening” of alveolar walls

Question 19

Where is Squamous cell carcinoma of the lung located?

Answer 19

Central

Question 20

What kind of mass occurs in Squamous cell carcinoma of the lung, and where?

Answer 20

Hilar mass arising from bronchus

Question 21

What are 3 associations with Squamous cell carcinoma of the lung?

Answer 21

Cavitation; Cigarettes; hyperCalcemia (produces PTHrP)

Question 22

What is seen on histology of Squamous cell carcinoma of the lung?

Answer 22

Keratin pearls (dark pink) and intercellular bridges; Sheets of large dysplastic squamous cells surrounding dark, pink keratin pearls

Question 23

What is another name for Small cell carcinoma? What is its location?

Answer 23

Small cell (oat cell) carcinoma; Central

Question 24

What is the differentiation of small cell carcinoma? How aggressive is it?

Answer 24

Undifferentiated –> very aggresive

Question 25

What are 3 products that may result from Small cell (oat cell) carcinoma? Which of these is associated with a particular syndrome, and what is that syndrome?

Answer 25

May produce ACTH, ADH, or Antibodies against presynaptic Ca2+ channel (Lambert-Eaton myasthenic syndrome)

Question 26

Amplification of which genes is common is small cell (oat cell) carcinoma?

Answer 26

Amplification of myc oncogenes common.

Question 27

Is small cell (oat cell) carcinoma operable? How is it treated?

Answer 27

Inoperable; Treat with chemotherapy

Question 28

What is the histology of small cell (oat cell) carcinoma?

Answer 28

Neoplasm of neuroendocrine Kulchitsky cells --> small dark blue cells; Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and "salt and pepper" neuroendocrine-type chromatin

Question 29

Where is Large cell carcinoma of the lung located?

Answer 29

Peripheral

Question 30

Describe the differentiation and prognosis of Large cell carcinoma of the lung.

Answer 30

Highly anaplastic undifferentiated tumor; poor prognosis

Question 31

How is Large cell carcinoma of the lung treated/managed?

Answer 31

Less responsive to chemotherapy; removed surgically

Question 32

What kind of prognosis does Bronchial carcinoid tumor have?

Answer 32

Excellent prognosis

Question 33

How common is metastasis in Bronchial carcinoid tumor?

Answer 33

Metastasis rare

Question 34

What usually causes symptoms in Bronchial carcinoid tumor? What is an occasional symptom of which to be aware? What happens in this syndrome?

Answer 34

Symptoms usually due to mass effect; occasionally carcinoid syndrome (5-HT secretion --> flushing, diarrhea, wheezing)

Question 35

What is the histology of Bronchial carcinoid tumor?

Answer 35

Nests of neuroendocrine cells; chromogranin A (+)

Question 36

What is Mesothelioma, and with what is it associated?

Answer 36

Malignancy of the pleura associated with asbestosis

Question 37

What results from Mesothelioma?

Answer 37

Results in hemorrhagic pleural effusions and pleural thickening

Question 38

What is seen on histology in Mesothelioma?

Answer 38

Psammoma bodies seen on histology

Question 39

Describe the phenomena of Pancoast tumor and its possible effects.

Answer 39

Carcinoma that occurs in apex of lung may affect cervical sympathetic plexus, causing Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis), SVC syndrome, sensorimotor deficits, and hoarseness.

Question 40

What is superior vena cava syndrome, and what are its associated symptoms?

Answer 40

An obstruction of the SVC that impairs blood drainage from the head ("facial plethora"), neck (jugular venous distention), and upper extremities (edema).

Question 41

What are 2 common causes of superior vena cava syndrome?

Answer 41

Commonly caused by malignancy and thrombosis from indwelling catheters.

Question 42

In general, what is the clinical approach to superior vena cava syndrome, and why?

Answer 42

Medical emergency. Can raise intracranial pressure (if obstruction severe) --> headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries.