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CPR 2 Pulm Section > Respiratory Pathology Pt. 5 > Flashcards

Respiratory Pathology Pt. 5 Flashcards

1
Q

What are the two most frequently diagnosed cancers in men and women?

A

Men: prostate and lung

Women: breast and lung

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2
Q

What is the leading cause of cancer death in men and women?

A

Lung for both sexes

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3
Q

What is the most significant risk factor for lung cancer?

A

Tobacco use
(duration and intensity)
20x risk

–quantified as pack-years

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4
Q

What are some environmental exposures that are risk factors for lung cancer?

A
  • radiation
  • uranium
  • asbestos
  • radon
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5
Q

True or False: carcinogen exposure and its propensity to cause cancer may be mitigated by genetic variations in patients

A

True

  • CYP450 polymorphisms
  • genes responsible for DNA repair
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6
Q

What type of cancers are epithelial-derived?

A

carcinomas

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7
Q

What is the path leading to primary adenocarcinoma of the lung?

A
  • alveolar/bronchial epithelial cells
  • atypical adenomatous hyperplasia
  • not usually associated w/ smoking
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8
Q

What is the path leading to primary squamous cell carcinoma of the lung?

A
  • bronchial epithelial cells
  • squamous dysplasia
  • associated w/ smoking
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9
Q

What is the path leading to primary small cell carcinoma of the lung?

A
  • epithelial cells w/ neuroendocrine features
  • Rb inactivation in 90%
  • p53 inactivation in 90%
  • associated w/ smoking
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10
Q

Which type of lung cancer is the most aggressive?

A

small cell carcinoma (a neuroendocrine carcinoma)

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11
Q

What is the most common type of lung cancer and why?

A
  • adenocarcinoma b/c it comes from the most abundant cell of origin (alveolar parenchyma)
  • 50%
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12
Q

What are the stages of progression to pulmonary adenocarcinoma?

A

1) Atypical Adenomatous Hyperplasia
2) Adenocarcinoma in situ
3) Adenocarcinoma

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13
Q

What are the characteristics of Atypical Adenomatous Hyperplasia?

A

<5mm

-dysplastic pneumocytes are present along alveoli w/ some interstitial fibrosis

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14
Q

What are the characteristics of Adenocarcinoma in Situ?

A

< 3cm (if larger, it’s an adenocarcinoma)

-dysplastic pneumocytes confluently growing along alveoli

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15
Q

What can mucinous adenocarcinoma be mistaken for on a CXR?

A

PNA

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16
Q

What are the stages of progression to squamous carcinoma?

A

1) Squamous metaplasia
2) Squamous Carcinoma in Situ
3) Invasive Squamous Carcinoma

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17
Q

What will you see on histology when you’re looking at a squamous cell carcinoma?

A

keratin pearls

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18
Q

What will squamous cell carcinoma look like on cytology?

A

-orange cytoplasm

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19
Q

Is squamous cell carcinoma more common in women or men?

A

men

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20
Q

Does squamous cell carcinoma occur centrally or peripherally?

A

centrally

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21
Q

What symptoms would a patient get in a lung tumor was compressing the recurrent laryngeal nerve or the phrenic nerve?

A

Recurrent Laryngeal N. = hoarseness

Phrenic N. = diaphragm paralysis

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22
Q

True or False: small cell (neuroendocrine) carcinoma has a high rate of metastasis

A

True, it’s usually metastasized at time of diagnosis.

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23
Q

What will small cell (neuroendocrine) carcinoma look like on histology?

A
  • necrosis b/c the cancer is growing so fast
  • fine blue nuclear chromatin, scant cytoplasm
  • “squished” nuclear molding
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24
Q

Once you’ve identified a lung cancer as an adenocarcinoma, what should your next step be?

A

molecular testing for defects in a specific cell signaling pathway (EGFR, ALK, PDL-1)

25
Q

What type of chemotherapy do you avoid in squamous cell carcinoma and why?

A

-VEGF inhibitors because they can cause fatal bleeding since squamous cells are so near to vasculature

26
Q

What is a possible paraneoplastic syndrome associated with squamous cell carcinoma?

A
  • hypercalcemia d/t a PTH-related peptide

- hypercalcemia causes AMS

27
Q

What are possible paraneoplastic syndromes associated with small cell carcinoma?

A
  • SIADH (Syndrome of Inappropriate ADH secretion)

- Cushing’s Syndrome (secretion of ACTH), can cause weakness

28
Q

What is Trousseau’s Sign?

A

migratory thrombophlebitis that is a paraneoplastic syndrome of many cancers, including lung cancer

29
Q

What are the symptoms of Horner’s Syndrome?

A
  • enopthalmos (sunken eyeball)
  • ptosis
  • miosis (persistently small pupil)
  • anhidrosis (no sweating)
30
Q

How can Horner’s Syndrome be caused by a lung cancer?

A

tumor suppresses the sympathetic trunk as it passes over the lung superiorly

31
Q

What symptoms would indicate that the sympathetic trunk compression is occurring in the area of the thoracic outlet?

A

-arm pain/paresthesia

32
Q

What are three kinds of neuroendocrine tumors?

A
  • DIPNECH (only a precursor lesion)
  • Carcinoid Tumor
  • Atypical Carcinoid Tumor
33
Q

What are the features of DIPNECH (Diffuse Interstitial Pulmonary Neuroendocrine Cell Hyperplasia)?

A
  • not a malignancy
  • not fatal
  • detected by high resolution CT scan
  • very small (<5mm) “tumorlets”
34
Q

What are the features of a carcinoid tumor (neuroendocrine carcinoma grade 1)?

A

> 5mm

  • can metastasize (but usually slowly)
  • indolent
35
Q

What are the features of an atypical carcinoid tumor (neuroendocrine carcinoma grade 2)?

A
  • increased mitotic activity
  • NECROSIS
  • disordered growth
  • increased rate of metastasis
  • lower survival than a typical carcinoid tumor
36
Q

Which type of neuroendocrine tumor has the lowest 5-yr survival rate?

A

small cell carcinoma

neuroendocrine carcinoma grade 3

37
Q

What might you see in the lungs of a male w/ testicular cancer?

A
  • cannonball metastases

- this kind of cancer is very chemosensitive and highly treatable

38
Q

What are the characteristics of a Pulmonary Hamartoma?

A
  • totally benign

- sharply defined coin lesions on CT scan

39
Q

What do you see on low power pathology of a Pulmonary Hamartoma?

A

-firm “marble” w/ smooth edges

40
Q

What do you see on high power pathology of a Pulmonary Hamartoma?

A

-fibrous tissue w/ benign glandular epithelium around hyaline cartilage

41
Q

What is Lymphangioleiomyomatosis (LAM)?

A

–proliferation of modified smooth muscle cells (perivascular epithelioid cells) creating cystic spaces

–PEC-oma

42
Q

For what markers are the cells of Lymphangioleiomyomatosis (LAM) positive?

A

HMB-45 (a melanoma marker)

43
Q

What demographic of people are most commonly afflicted by Lymphangioleiomyomatosis (LAM)?

A

mostly young women

extremely uncommon in men

44
Q

What tumor suppressor gene is associated with Lymphangioleiomyomatosis (LAM)?

A

-loss of fxn of tumor suppressor TSC2

45
Q

What emergency clinical presentation might indicate Lymphangioleiomyomatosis (LAM)?

A

-spontaneous PTX (d/t ruptured cyst)

46
Q

What type of atalectasis does a pleural effusion cause?

A

-compression atalectasis

47
Q

What type of fluid escapes the intravascular compartment due to infection and inflammation?

A

exudate

48
Q

What type of fluid escapes the intravascular compartment due to heart failure?

A

transudate

49
Q

What is an empyema?

A

-inflammatory exudate w/ accumulation of pus in the pleural space, typically d/t a bacterial infxn

50
Q

What is a characteristic feature of an empyema?

A

–loculations (web-like traps for fluid)

51
Q

What does the fluid of an empyema look like?

A
  • thick
  • yellow
  • shows neutrophils on a smear
  • often shows bacteria on a smear
52
Q

How does a Tension Pneumothorax occur?

A

–injury to the chest wall that results in a one-way valve allowing air INTO the pleural space, but not OUT

53
Q

What do you see on a CXR of a Tension Pneumothorax versus a Primary Pneumothorax?

A

mediastinal shift in a Tension PTX

54
Q

What are two tumors of the pleura?

A
  • Solitary Fibrous Tumor (usually benign)

- Mesothelioma (malignant)

55
Q

What are the characteristics of a Solitary Fibrous Tumor of the pleura?

A
  • small
  • pedunculated
  • staghorn vessels on histology
  • CD34 stain
56
Q

What environmental exposure is causes mesothelioma?

A

asbestos

57
Q

What population is as risk for mesothelioma?

A
  • Navy shipyard workers

- construction workers

58
Q

What is seen on histology of mesothelioma?

A

ferruginous bodies

59
Q

True or False: mesothelioma can be excised

A
  • False, and its response to chemo and radiation is limited.

- most pts live < 2yrs after Dx.

CPR 2 Pulm Section (9 decks)

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