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Respiratory SCE > Thoracic Oncology > Flashcards

Thoracic Oncology Flashcards

1
Q

What is Tx?

A

Cancer cells in sputum /bronchial washing’s but not been assessed on imaging /bronchoscopy

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2
Q

What is T0?

A

No sign of cancer

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3
Q

What is Tis

A

Carcinoma in situ

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4
Q

Outline T1

A

<3cm surrounded by lung/ visceral pleura NOT involving main bronchus

T1mi- minimally invasive lung cancer , grown no more than 0.5cm into lung tissue

T1a ≤ 1cm
T1b >1cm to ≤2cm
T1c >2cm to ≤ 3cm

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5
Q

Outline T2

A

> 3cm to ≤5cm
OR
involvement of main bronchus without carina, regardless of distance from carina
OR
invading visceral pleura
OR
atelectasis
OR
post obstructive pneumonitis extending to hilum

T2a >3cm to ≤4cm
T2b >4cm to ≤ 5 cm

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6
Q

Outline T3

A

> 5 to ≤7cm
OR
Involving the Chest Wall, Pericardium, Phrenic nerve or satellite nodules in same lobe

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7
Q

Outline T4

A

> 7cm
OR
involving :Mediastinum, Diaphragm, Heart , Great vessels , Carina, Oesophagus, Trachea , Recurrent laryngeal nerve , spine or separate tumour in different lobe of ipsilateral lung

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8
Q

What is N1?

A

Ipsilateral peribronchial and /or hilar nodes and intrapulmonary nodes

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9
Q

What is N2?

A

Ipsilateral mediastinal and/or sub carinal nodes

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10
Q

What is N3?

A

Contralateral mediastinal or hilar nodes , ipsilateral/contralateral suprclavicular /scalene nodes

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11
Q

What is M1a?

A

Tumour in the contralateral lung
OR
Pericardial / Pleural Nodule
OR
Pericardial/Pleural Malignant effusion

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12
Q

What is M1b ?

A

Single extrathoracic Mets including single non regional LN

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13
Q

What is M1c?

A

Multiple extra-thoracic Mets in one or more organs

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14
Q

What is the incidence of brain Mets at diagnosis of lung cancer ?

A

10-20%

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15
Q

Who get a CT head with contrast ?

A

Stage II or Small cell

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16
Q

Who gets MRI brain w contrast ?

A

Stage 3

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17
Q

What staging does Mets give you?

A

M1a/M1b - automatically Stage IV A
M1c - automatically Stage IV B

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18
Q

An incidental nodule is picked up on CT , if it’s a harmatoma or typical peri fissural nodule or <5mm what action required ?

A

None, patient can be discharged

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19
Q

Incidental solid nodule picked up on CT that is 9mm, what are the next steps ?

A

Calculate Brock score
IF <10% follow up with CT surveillance

IF ≥ 10% then for PET scan with risk assessment using Herder
—Herder <10% CT surveillance
—Herder 10-70% Image guided biopsy or excision biopsy or CT surveillance
— Herder >70% Consider excision or non surgical treatment (+/- image guided biopsy)

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20
Q

Incidental solid 5-6mm nodule picked up on CT what are the next steps as per BTS guidelines ?

A

Follow up CT one year after baseline

— If stable on basis of 2D diameter value: CT 2 years after baseline . Then calculate VDT categories as per 1 year follow up

— Stable on basis of volumetry : discharge

— VDT >600 days : consider discharge (only if based on volumetry) or ongoing CT surveillance depending on pt preference

— VDT 400-600 days: consider biopsy or further CT surveillance depending on pt preference

  • VDT <400 days or clear evidence of growth : further work up and consideration of definitive management
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21
Q

Incidental nodule ≥6mm or ≥80mm3 picked up on CT, talk through next steps

A

CT 3 months after baseline :

IF VDT ≤ 400 days / clear evidence of growth : further work up and consideration of definitive management

If VDT >400 days : repeat CT at 1 year from baseline and then
— if stable on basis of diameter then repeat CT 2 years from baseline (and VDT as per 1 year)
— if stable on basis of volumetry : discharge
— VDT > 600 days : consider discharge (only if based on volumetry) or ongoing CT surveillance depending on patient preference
— VDT 400-600 days : consider biopsy or further CT surveillance depending on patient preference
- VDT ≤ 400 days : further work up and consider definitive management

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22
Q

What variability in size of nodule is allowed ?

A

25%

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23
Q

An incidental sub-solid nodule is found on CT , what are the criteria that mean patient can be discharged ?

A
  • Nodule <5mm
  • Patient unfit for any treatment
  • Nodule stable over 4 years
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24
Q

Incidental finding of sub-solid nodule >5mm , no previous imaging , talk through follow up

A

Repeat thin section CT at 3 months:

IF resolved : discharge

IF stable: assess risk of malignancy (Brock/ Morphology) patient fitness and preference
— Low risk of malignancy (approx <10%) repeat CT at 1, 2 and 4 years from baseline
— High risk of malignancy (approx >10%) or concerning morphology , discuss options with patient EITHER Thin section CT at 1, 2 and 4 years OR Image guided biopsy OR Favour resection /non surgical treatment

IF growth/altered morphology: favour resection / non surgical treatment

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25
Q

What do we mean by change in morphology of a nodule ?

A

Change in mass/new solid component

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26
Q

Patient presents with 9mm solid nodule , Brock score 40% , PET shows FDG avid, Herder score >70% risk what are the options for treatment. ? They are fit for surgery

A

Wedge resection with on-table frozen section - proceed to completion lobectomy during same anaesthetic

OR

Anatomical Segmentectomy if unfit for lobectomy

OR

Image guided biopsy , if malignancy confirmed - lobectomy if not confirmed can either have repeat biopsy or proceeding to excision / non surgical treatment if concern about false negative biopsy

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27
Q

Patient presents with 9mm solid nodule , Brock score 40% , PET shows FDG avid, Herder score >70% risk what are the options for treatment. ? They are NOT fit for surgery

A

Image guided lung biopsy possible and safe ?

if yes then go for this and if malignancy confirmed for SABR , RFA or conventional radical radiotherapy. If malignancy not confirmed consider repeating biopsy or proceeding to excision/ non surgical treatment if concern about false -ve biopsy ;

If not safe then for SABR, RFA or conventional radical radiotherapy

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28
Q

How many segments does the RUL have ?

A

3

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29
Q

How many segments does the RML have ?

A

2

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30
Q

How many segments does the RLL have ?

A

5

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31
Q

How many segments does the LUL have ?

A

5
(3 upper divisions and 2 lingula)

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32
Q

How many segments does the LLL have ?

A

4

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33
Q

How do you calculate predicted post operative value of DLCO or FEV1?

A

T is total segments ; ie 19- obstructed
(Don’t include non functioning segments)
R is residual segments left behind post op ; ie T - Functioning segments to be resected

So:
ppoValue = Pre-Op value/ T * R

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34
Q

On functional assessment pre operatively what is considered evidence of good function?

A

Shuttle walk test > 400m
CPET peak oxygen consumption >15ml/kg/min

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35
Q

What are the poor prognosis factors in SCLC?

A

Impaired PS
Weight loss
Increased age
Male gender
Elevated LDH
Low sodium

** In patients with locally advanced SCLC tx with CRT , hight tot gross tumour volume predicts worse outcome

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36
Q

Talk through treatment of limited stage SCLC which is stage 1-2 (T1-2, N0)

A

Surgical Resection offered

IF at resection pT1-T2 N0 R0 then for adjuvant chemo with Cisplatin and Etoposide (4 cycles)

IF at resection N2 and/or R1-2 then for concurrent CRT (*** Then evaluate , if no progression then :
PS 0-1 and ≤ 70years PCI
PS 2 and ≤ 70 years PCI
If > 70years or frail shared decision making with patient for PCI )

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37
Q

Talk through treatment of limited stage SCLC which is stage 1-3 (T1-2, N0-3)

A

If PS 0-1 : Concurrent CRT

If PS ≥ 2: Sequential CRT

**Then evaluate , if no progression then :

PS 0-1 and ≤ 70years PCI
PS 2 and ≤ 70 years PCI
If > 70years or frail shared decision making with patient for PCI

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38
Q

What is the preferred chemo regimen in Limited SCLC

A

Cisplatin and Etoposide as 3 week cycle , given as 4 cycles usually
- Cisplatin can be split over 3/7 to improve tolerability
- If Cisplatin contraindicated can give carboplatin

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39
Q

What is preferred Radiotherapy approach for SCLC

A

Standard of care if 45 Gy twice daily in 30 fractions over 3 weeks , when standard twice daily not possible can have 66Gy once daily in 33 fractions over 6 weeks

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40
Q

What is the role of PCI in SCLC ?

A

PCI decreases risk of symptomatic brain Mets and increases survival I. Patient with complete remission

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41
Q

What does is prophylactic cranial irradiation given at in SCLC?

A

25 Gy over 10 fractions

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42
Q

Who is offered PCI in SCLC?

A

PS 0-1 , response to CRT , <70 years

Can be considered in PS 2

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43
Q

What is the treatment option for extensive SCLC (Stage IV or Stage III not eligible for tx with curative intent) and PS ≥ 2 due to co- morbidities

A

Best Supportive Care

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44
Q

What is the treatment option for extensive SCLC (Stage IV or Stage III not eligible for tx with curative intent) and PS 0-1 with no c/i for ICI?

A

Carboplatin + Etoposide + Atezolizumab and maintenance Atezolizumab

Or

Platinum - Etoposide - Durvalumab and maintenance Durvalumab

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45
Q

What is the treatment option for extensive SCLC (Stage IV or Stage III not eligible for tx with curative intent) and PS 0-1 with c/i for ICI?

A

Carboplatin + Etoposide
Or
Carboplatin + Oral Topotecan
Or
Cisplatin - Irinotecan

If response PS 0-2

Then :
- Consolidation thoracic RT is an option
- if <75 years then for PCI or MRI surveillance

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46
Q

What is the treatment option for extensive SCLC (Stage IV or Stage III not eligible for tx with curative intent) and PS ≥ 2

A

Carboplatin + Etoposide (4-6 cycles)
Or
Carboplatin + Gemcitabine (4-6 cycles)

If response PS 0-2

Then :
- Consolidation thoracic RT is an option
- if <75 years then for PCI or MRI surveillance

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47
Q

How do you manage recurrence of SCLC?

A

Platinum Resistant Relapse (<3 months treatment free interval) :

IF Refractory &/ or PS> 2 for BAC and LURBINECTEDIN

IF PS 0-2 for Oral or IV Topotecan OR Cyclophosphamide -Doxorubicin- Vinicristine OR LURBINECTEDIN

—————————-

Platinum Sensitive Relapse (≥ 3 months treatment free interval)

Rechallenge with Platinum and Etoposide
Or
Oral or IV Topotecan
Or
Cyclophosphamide - Doxorubicin - Vinicristine

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48
Q

What are the ESMO follow up suggestions for SCLC patients ?

A

Limited stage who receive potentially curative tx should have CT every 3-6 months for 2 years with lengthening intervals after

Extensive stage disease potentially qualifying for further treatments should have CT every 2-3 months

Regular MRIs every 3/12 for the first year then every 6 months advised in those not undergoing PCI

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49
Q

Screening for NSCLC with LDCT has been shown to reduce cancer related mortality in which high risk subjects ?

A

55-74 years with ≥ 30 pack years or ≤ 15 years since quit

50
Q

What is the treatment of unresectsble Stage III NSCLC?

A

Chemotherapy and Radiotherapy

IF no progression

Then for Durvalumab in PDL 1 ≥ 1%

51
Q

What is the treatment for stage IB -IIIA NSCLC ?

A

RESECTION

If R1 resection THEN for post operative radiotherapy and then adjuvant chemotherapy

IF R0 resection THEN for adjuvant chemo , Cisplatin in combo with Vinorelbine/Gemcitabine/Docetaxel / Pemtrexed (non squamous , adenocarcinomas) if resected primary tumour ≥ 4cm for Carboplatin and Paclataxel. If completed resection EGFR exon 19 del or exon 21 , L858R substitution&raquo_space; Osimertinib (NB data not entirely there as trial looked at T> 5 cm so < 5cm will be at clinician discretion

52
Q

List the biomarkers for metastatic NSCLC

A

EGFR
ALK
ROS1
BRAF
NTRK
PD-L1

53
Q

Which pts should have molecular testing ?

A

All patients w advanced /possible/ probably /definite adenocarcinoma should be tested

Molecular testing not recommended in Squamous Cell carcinoma except in never / long time ex /light (<15 pack years) smokers

54
Q

Who gets offered systemic therapy in NSCLC?

A

Stage IV NSCLC w PS 0-2

55
Q

What is the treatment for SCC?

A

Platinum based doublets with addition of third generation cytotoxic agent (Gemcitabine, Vinorelbine and taxanes) in those without major comorbidities and PS 0-2

56
Q

What is the 30 day mortality for lobectomy and pneumonectomy ?

A

Lobectomy - <2%
Pneumonectomy 5.8%

57
Q

At what dose does lidocaine toxicity develop in flexible bronch?

A

Levels >9.6mg/kg

58
Q

What size of tumour would make patient suitable for SABR?

A

<5cm

59
Q

Describe Horner’s Syndrome

A

Miosis, Ptosis, Enophthalmos, Anhydrosis

60
Q

What is hypertrophic pulmonary osteoarthropathy?

A

Often associated with clubbing (any cell type, more common in squamous and adenocarcinoma). Periosteal bone proliferation with symmetrical painful arthropathy , predominantly large joints but hands and feet are involved

61
Q

What is Lambert Eaton Myasthenic Syndrome?

A

-Associated with SCLC

  • Symptoms may pre-date diagnosis of lung cancer by 4 years
  • Proximal limbs and trunk with autonomic involvement (dry mouth, constipation, erectile dysfunction) and hyporeflexia , although reflexes return on exercising affected muscle group
  • VGCC Antibodies cause it due to reduced acetylcholine release at motor nerve terminal
  • Tx of underlying SCLC may improve neurology. If weakness severe can trial IVIG/ plasmapharesis with short term benefits. 3-4 diaminopyridine may increase muscle strength
62
Q

What is limbic encephalitis ?

A

Associated with SCLC (also breast , testicular, other cancers)

Occurs within 4 years of diagnosis

Personality change , seizures, depression, subacute confusion and short term memory loss

Anti Hu Antibodies positive in 50% if associated with lung cancer

63
Q

What is lymphangitis carcinomatosis ?

A

Infiltration of pulmonary lymphatics by tumour , may be due to lung cancer (or breast, prostate, stomach, pancreas)

Causes SOB and cough. Often sign of advanced malignancy

Oral steroids/ Diuretics can give symptomatic relief but usually part of rapid decline

64
Q

What are current NHS stipulations re 2 WW referral times ?

A

TREAT within 31 days of decision to treat
TREAT within 62 days of urgent referral
DIAGNOSTICS requested by 28 days

65
Q

Who should have a PET scan?

A
  • All patients considered for radical therapy
  • Patients with apparent N2-N3 on CT of uncertain significance who are otherwise surgical candidates
  • Limited stage SCLC

NB any FDG avid node that would exclude patient from surgery if malignant should be confirmed with biopsy

66
Q

Who gets false negative results with PET ?

A

Tumours with reduced metabolic activity (typically carcinoids), small ground glass nodules and hyperglycemic patients

67
Q

Who gets false positive results with PET?

A

Benign pulmonary nodules with high metabolic rate such as infective granulomata/rheumatoid nodules

68
Q

With bronchoscopic samples what makes them more likely to be histologically positive ?

A
  • An endobronchial component to the tumour
  • Tumour < 4cm from the origin of the nearest lobar bronchus
  • A segmental or larger airway leading to the mass
69
Q

Who do we undertake TBNA-EBUS in ?

A

PET avid and >10mm in the short axis on CT

NB nodes that are enlarged (>10mm on short axis) should be sampled prior to surgery for definitive nodal staging whether PET avid or not

70
Q

For radiological guided lung biopsy what is seen as more favourable lung function?

A

FEv1> 1L (or >35% predicted)
*no absolute cut off

71
Q

What is the median survival of limited SCLC treated and untreated ?

A

Treated : 15-20 months
Untreated 12 weeks

72
Q

What is the median survival of extensive SCLC treated and untreated ?

A

Treated: 8-13 months
Untreated : 6 weeks

73
Q

Describe treatments available for EGFR-TK mutations

A

17% NSCLC
Non smoking , Asian women
Treat with Tyrosine Kinase Inhibitor (TKI) : Afatinib, Dacomitinib , Erlotinib, Gefitinib

Toxicities: GI, Liver derrangements, Pneumonitis , Dry eyes , Corneal erosions

74
Q

Describe treatments available for ALK gene rearrangements

A
  • Fusion oncogene created when EML4-ALK are fused
  • Younger patients with light / no smoking history
  • Treat with Tyrosine Kinase Inhibitors : Alectinib, Crizotinib, Ceritinib
75
Q

Describe treatment for ROS-1 gene rearrangement

A

TKI - Crizotinib

76
Q

What treatments can we give to NSCLC advanced disease with PS0-2 who have no mutations but PD-L1>50%?

A

Pembrolizumab (Anti PD-1)

77
Q

What treatments can we give to NSCLC advanced disease with PS0-2 who have no mutations but PD-L1 <50%?

A

Atezolizumab (Anti PD-L1 antibody) + Bevacizumab (VEGF inhibitor) + Carboplatin + Paclitaxel

OR

Pembrolizumab + Pemetrexed + (carbo/cisplatin)

OR

Pemetrexed + Carboplatin

OR

Other platinum doublet chemotherapy

78
Q

What is the initial therapy for Squamous NSCLC ?

A

PD-L1 Expression ≥ 50% : Pembrolizumab

PD-L1 Expression <50%: Pembrolizumab + Paclitaxel + Carboplatin (if tolerated)

otherwise

(Gemcitabine /Vinorelbine) + (Carbo/Cisplatin)

Combined chemoradiotherapy may be given to some patients with stage III disease and this is Cisplatin and Etoposide if so

79
Q

What are the side effects of chemotherapy ?

A

Nausea, myelosuprresion, ototoxicity , peripheral neuropathy, nephropathy if dehydrated , alopecia

80
Q

What is the LFT cut off for radical radiotherapy?

A

FEV1 ≥ 1.5L

(RFA, FEV1 >1L)

81
Q

What is SVCO?

A

Superior Vena Cava Obstruction , obstructs blood flow in SVC caused by external compression of the SVC by tumour extending from Right lung (4x more common than left) , LN or other mediastinal structure OR thrombosis within the vein.

Most common cause is malignancy and of the malignancies lung and lymphoma . 10% lung are SCLC

Usually a clinical diagnosis but can have CT . Stents gold standard , radiotherapy takes time to work (10/7)

Prognosis depends on underlying disease, not related to duration of SVCO

82
Q

Why do patients with lung cancer get hypercalcemia?

A

Increased Osteoclast activity from boney Mets or production of PTH related protein

In malignant hypercalcemia PTH is suppressed

83
Q

Causes of SIADH

A

Drugs (Fluoxetine, Carbamazepine, high dose cyclophosphamide)
Post major surgery
Pneumonia
HIV infection
CNS disorders (stroke, infection, psychosis)
SCLC (ectopic ADH secretion or stimulation of normal ADH secretion - poor prognostic factor)

84
Q

What is pulmonary carcinoid?

A
  • Uncommon primary lung tumour
  • More common in women 40-50
  • Form of neuroendocrine tumour , can have similar histology to SCLC , occasionally associated with MEN1
  • Common endobronchially but can be peripheral
  • Typically slow growing benign but may be more agressive
85
Q

What are the symptoms of carcinoid?

A

Isolated wheeze , dyspnoea, infection, haemoptysis or persistent lobar collapse

Carcinoid syndrome with flushing , tachycardia , sweats , diarrhoea , wheeze and hypotension 2-5% predominantly with liver Mets

Can also cause Cushing syndrome due to ectopic ACTH

86
Q

What scan is useful for carcinoid?

A

Octreotide scan or Ga68-DOTA-Octreotate PET have a role in staging

Normal PET has reduced sensitivity

87
Q

What bloods / ix useful for carcinoid?

A

Standard + Plasma Chromogranin A

For carcinoid - 24 hour urinary 5HIAA
For Cushings- Cortisol + ACTH & 24 hour urinary cortisol

88
Q

What do you see on bronch for carcinoid?

A

Cherry red covered with intact epithelium

Brushings may be adequate for diagnosis

Biopsy- significant concerns with bleeding

89
Q

What are the histological types of carcinoid?

A

TYPICAL: no necrosis , occasional nuclear pleomorphisms and <2 mitoses , distant Mets rare

5 year survival 87-100% and 10 year survival 82-87%

ATYPICAL : focal necrosis, often multiple pleomorphisms , increased levels of Ki-67 expression , distant Mets 20%

5 year survival 30-95% , 10 year survival 35-56%

90
Q

What is management of pulmonary carcinoid tumour ?

A

Isolated pulmonary carcinoid :

Surgical resection- lobectomy with nodal dissection
Endobronchial resection - may rarely be possible with intraluminal polyploid tumour with no CT evidence of extra liminal compression

IF METASTATIC
- isolated liver Mets - resection, RFA, arterial embolisation
- Hotmonal overproduction SSA (Octreotide )
- if heavy bulk can have SSA then local ablation or peptide receptor radionuclide therapy
- if advanced and unresectable then can have chemo - no standard regimen

91
Q

What is the 5 year survival for Stage IA lung cancer ?

A

77-92%

92
Q

What is the 5 year survival for Stage IB lung cancer ?

A

68%

93
Q

What is the 5 year survival for Stage IIA lung cancer ?

A

60%

94
Q

What is the 5 year survival for Stage IIB lung cancer ?

A

53%

95
Q

What is the 5 year survival for Stage IIIA lung cancer ?

A

36%

96
Q

What is the 5 year survival for Stage IIIB lung cancer ?

A

26%

97
Q

What is the 5 year survival for Stage IIIC lung cancer ?

A

13%

98
Q

What is the 5 year survival for Stage IVA lung cancer ?

A

10%

99
Q

What is the 5 year survival for Stage IVB lung cancer ?

A

0%

100
Q

What is ECOG PS 0

A

Fully active, able to carry on all pre-disease performance without restriction

101
Q

What is ECOG PS 1

A

Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work

102
Q

What is ECOG PS 2

A

Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours

103
Q

What is ECOG PS 3

A

Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours

104
Q

What is ECOG PS 4?

A

Completely disabled; cannot carry on any selfcare; totally confined to bed or chair

105
Q

What is ECOG PS 5?

A

Dead

106
Q

Summarise the tumour markers of Adenocarcinoma

A

TTF1 positive
CK7 positive
Napsin A positive

107
Q

Summarise the tumour markers of Squamous Cell Carcinoma

A

P63 positive
CK5 positive
CK6 positive
TTF1 negative

108
Q

Summarise the tumour markers of Small Cell Carcinoma

A

TTF1 Positive
Neuroendocrine markers positive (CD56, synaptophysin, chromogranin)

109
Q

Immunohistochemistry (IHC) testing reveals the sample is positive for calretinin, CK5, CK6, GLUT-1, and is negative for TTF-1, CK7, p63, and BerEP4.

A

Mesothelioma can be difficult to differentiate from pleural-based adenocarcinoma and the diagnosis can often rely on immunohistochemistry from a pleural biopsy. To confirm a diagnosis of mesothelioma, immunohistochemistry must show 2 positive mesothelial markers and 2 negative adenocarcinoma markers. Mesothelial markers include calretinin, CK5/6, Wilms’ tumour 1, D2-40, thrombomodulin, GLUT-1, and p53. Adenocarcinoma markers include TTF-1, CEA, Ber-EP4, Leu1, and CD15

110
Q

What is included in the Brock Score ?

A

Age
Sex
Family history of lung cancer
Emphysema
No of nodule
Size of nodule
Type of nodule
UL nodule
Spiculated nodule

111
Q

Why do a Brock?

A

Because if >10% alters nodule mx

112
Q

What is the Herder score ?

A

Probability of malignancy based on PET

113
Q

What is Brock score ?

A

Probability of Malignancy based on CT

114
Q

What is included in the Herder Score?

A

Age
Smoking history
Hx of extra thoracic cancer
Nodule size
Nodule in UL
Nodule spiculated
Nodule PET avid

115
Q

What is a <5mm ground glass nodule?

A

Atypical adenomatous hyperplasia

116
Q

What is a > 5mm ground glass nodule?

A

Adenocarcinoma in situ

117
Q

What is a <5mm part solid nodule?

A

Minimally invasive adenocarcinoma

118
Q

What is >5mm part solid nodule ?

A

Invasive adenocarcinoma

119
Q

What is the histology features for adenocarcinoma ?

A

Mucin, gland formation
(In lepidic, alveolar structure is preserved)

120
Q

What is the histology features in squamous ?

A

Bridges, keratin pearls

121
Q

What are the histology features in small cell?

A

Almost all nucleus , crowding

122
Q

What are the features of benign nodules?

A

Perifissural or subpleural location
Lentiform or Triangular shape, macroscopic fat and calcification

Respiratory SCE (15 decks)

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