Respiratory

Question 1

Synonym for Bronchogenic Carcinoma

Answer 1

Lung Cancer

Question 2

Second most common cancer in women, after lung

Answer 2

Breast

Question 3

Second most common cancer in men, after lung

Answer 3

Colon

Question 4

Most common risk factor

Answer 4

Smoking

Question 5

Common occupational or environmental exposures

Answer 5

Asbestos, Air pollutants, Arsenic, Mustard Gas, Coal Tar etc.

Question 6

Lung cancer symptoms

Answer 6

10% asymptomatic, 90% Symptomatic
- Cough, Wheeze, Dyspnea, Hemoptysis, Pneumonia, Pleural Effusion, SVC Syndrome

Question 7

What is SVC Syndrome?

Answer 7

Superior Vena Cava Syndrome, characterized by the compression of the superior vena cava in the heart. This causes congestion in the head & neck area along with redness from blood accumulation.

Question 8

What is Pancoast Tumor?

Answer 8

Superior Sulcus, is the compression of the bronchial plexus nerve that causes paralysis of the mid face and upper amenity

Question 9

Diagnosing Images

Answer 9

Chest X-Ray, Computed Tomography (CT) Scan, Positron Emission Tomography (PET) Scan

Question 10

Techinques used for diagnosis of Lung Cancer

Answer 10

Cytology: Bronchial brush/wash, TBNA (EBUS), Percutaneous FNA
Tissue Biopsy: Bronchoscopic biopsy, Core needle biopsy

Question 11

Diagnostic markers/Stains

Answer 11

PD-L1: All Non Small Cell
EGFR: Adenocarcinoma
ALK: Adenocarcinoma
ROS1: Adenocarcinoma

Most Common:
P40: Squamous Cell Carcinoma
TTF1: Adenocarcinoma
Small Cell: Chromogranin & Synaptophysin

Question 12

Non Small Cell vs Small Cell

Answer 12

NSCLC:
Squamous Cell Carcinoma (Keratinizing/Non-K)
Adenocarcinoma (Most Common Lung Cancer)

Small Cell Carcinoma (Neuroendocrine Carcinoma)

Question 13

Squamous Cell Carcinoma; Location

Answer 13

Arises from: Squamous Metaplasia in the Bronchus, usually Centrally

Strongly associated with tobacco

Question 14

Squamous Cell Carcinoma Cytoarchitecture

Answer 14

Predominantly single cells

Question 15

Squamous Cell Carcinoma Nuclei

Answer 15

Pleomorphic, Hyperchromatic, Irregular
Nucleoli NOT prominent (in well differentiated)
Nucleoli may be present in poorly differentiated

Question 16

Squamous Cell Carcinoma Cytoplasm

Answer 16

Abundant, dense, organeophilic or blue
Odd shapes, necrosis
Cytoplasmic Keratinization
- Herxheimers Spirals

Question 17

Nonkeratinizing Squamous Cell Carcinoma

Answer 17

Poorly Differentiated

Question 18

Nonkeratinizing Squamous Cell Carcinoma; Cytoarchitecture

Answer 18

Disrodered groups, single cells

Question 19

Nonkeratinizing Squamous Cell Carcinoma; Nuclei

Answer 19

Pleomorphic, hyperchromatic, coarse chromatin

Somtimes present prominent nucleoli

Question 20

Nonkeratinizing Squamous Cell Carcinoma; Cytoplasm

Answer 20

Dense, cyanophilic
Well-defined cell boarders
Intercellular bridging (Cellblock)

Diff quick, H&E, PAP, *P40 Stain Positive *

Question 21

Pulmonary Adenocarcinoma

Answer 21

Most common type
Relationship to tobacco not as strong

Question 22

Pulmonary Adenocarcinoma: Location

Answer 22

Arises from brochoalveolar lining cells
Often arise peripherally

FNA procedure best for peropheral tumors

Question 23

Pulmonary Adenocarcinoma Subtypes

Answer 23

Nonmucinous
* Acinar, Papillary, Micropapillay, Solid (poorly diff.), Lepidic (In situ, bronchoalveolar)
Mucinous
Enteric

Question 24

Adenocarcinoma: Cytoarchitecture

Answer 24

Acinar, Papillary, Cell ball cluster
Single cells
Hobnail/floret apprearance with admixed macrophages

Question 25

Adenocarcinoma; Nuclei

Answer 25

Pleomorphic, irregular; granular chromatin Eccentric nuclear location; macronucleoli ## Footnote TTF1 will show postiive for Adeno, stain brown

Question 26

Adenocarcinoma; Cytoplasm

Answer 26

Delicate, ill-defined; sometimes vacuolated

Question 27

Large Cell Undifferentiated Carcinoma

Answer 27

Giant cells, sometimes

Question 28

Smell Cell Carcinoma

Answer 28

Neuroendocrine Origin (Kulschitsky Cells) Rapid, aggressive tumor Treatment: radiation/chemo vs biopsy Oat Cell Carcinoma ## Footnote TBNA's sometimes very helpful; transbronchial needle aspiration

Question 29

Small Cell Carcinoma; Cytoarchitecture

Answer 29

Loose clusters and single cells Frequent *crush/smear artifact* Prominent *nuclear molding*

Question 30

Smell Cell Carcinoma; Nuclei

Answer 30

Small; twice the diameter of an inflammatory cell Irregular nuclear boarders Nucleoli absent or very small Salt & Pepper Chromatin ## Footnote Synaptophysin, Chromogranin

Question 31

Less common neuroendocrine tumors

Answer 31

Atypical Carcinoid Tumor * NET with morphology & behavior intermediate between carcinoid & high grade Large cell neuroendocrine carcinoma (LCNEC) * High grade neuroendcrine carcinoma * Biological behavior & prognosis similar to small cell

Question 32

TNM System

Answer 32

Tumor - primary, size & relationship to structure Nodes- presence or absence of spread/ number & size Metastisis - Presence or absence of distant metastatic disease

Question 33

T Stage (TNM)

Answer 33

T1 - Confined to lung T2 - 3-5cm or extension to mainstem bronchus ot visceral pleura T3 - 5-7cm invades chest wall, mutltiple nodes in same lobe T4 - > 7 cm, invased mediastinum or multiple tumor in more than 1 lobe

Question 34

Node Stage (TNM)

Answer 34

N1- Hilar/peribronchial node(St. 10&12) N2 - Mediastinal/subcarinal nodes N0 - No nodal disease NX - Nodes not examined

Question 35

# Differentials Small Cell Carcinoma vs.

Answer 35

Reserve Cell Hyperplasia: * Regular arragnement,shape, minimal molding Benign Lymphocytes/Lymphoma (malignent): * Open chromatin, conspicuous nucleoli, lack of cell group, extensive smear artifact NSCLC * Adeno/SCC Criteria