Tumors of the Lung and Pleura Flashcards Preview

Respiratory 2 > Tumors of the Lung and Pleura > Flashcards

Flashcards in Tumors of the Lung and Pleura Deck (29):
1

Bronchogenic carcinoma def

Orginating from the bronchial or bronchiolar epithelium

2

Patho of bronchogenic carcinoma

Final pathway of cumulative mutations which leads to malignant transformation (change from benign bronchial epithelium to neoplastic tissue)

Damage---basal hyperplasia/squamous metaplasia----squamous dysplasia---CIS----invasion

3

Tobacco smoke and cancer

80% in active or recent

Linear between freq of lung ca and pack year smoking

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Genetics

Squamous cell

Small cell

Adeno

Strong with tobacco...CDKN2A (3p, 9p) or TP53 (17p) gene..PDL1

Strongest with smoking...amplication of MYC...TP53, RB1, and del 3p

Oncogenic gain of function mutations involving compoennts of GF receptor signaling pathways (EGFR, ALK, ROS, MET< RET)...if no TK mutations, oftne KRAS

In non-smokers - usually adeno...women - EGFR mutations and lack KRAS

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Presenting sx of lung tumors

Peak in 50-60

Insidious

May have some sx

Early detection showed 20% reduction in lung cancer related mortality

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Pathology

Spread - lymphatics or hematogenous

LN involvement in 50%

MEtastasis - adrenal, liver, brain, bone

Most are adenocarcinoma (38%), then Squam, then small , then large

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SVC syndrome

Venous congesiton and edema of head and arm...circulatory collapse

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Partial and total obstruction

Focal emphysema, ateelctasis

Total - atelectasis/collapse

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Small cell carcinoma

Squamous cell carcinoma

Paraneopplastic syndrome

ACTH - cushing syndrome or ADH (hyponatremia)

PTH/PTH-like (hypercalcemia)

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Labert

Eaten myashetnic - muscle weakness due to autoantibodies to neruonal calcium channel

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Adenocarcinoma

Malignant epithelial tumor with glandular diff or mucin production

Women and non-smokers

Peirpheral locaitons

Small but metastasize earlier

Pleural associated maybe

KRAS (worse prognosis and smokers) or EGFR (asian)

Tx with tyrosine kinase ihibitors

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Atypical adenomatous hyperplasia

Adenocarcinoma in situ

Small leisons, dysplastic pneumocyts line laveolar walls...single or multiple foci, near tumor or in other areas of ling

Less than 3cm, dysplastic cels grwo along septae but DO NOT invade (lipidic), more atypical than AAH, may be mucinous or non

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Min invasive adeno

Mucinous adeno

Tumors small, peripheral and assoc with scarring, lepidic grwoth, better outcome

Airway spread so may have satellite lesions....may present as single or multiple nodules ...less likelyt o be cured by surgery

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Adeno microscopic

Gland formaiton and/or mucin production

TTF-1 positive, napsin A

Well, moderate, poor grades

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Squamous cell carcinoma

Malignant epithelia ltumor with presence of keratinization and/or IC bridges

Most common in men

SMoking

Central

Peripheral

Local spread with late metastasis

p53 mutations

PTH/PTH hypercalcemia

Squamous metaplasia, dysplasia, CIS

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Types and microscopis squamous

Keratinizing, non-keratinizing, basaloid

Keratinization (pearls), intracellular bridges (desomosomes), p40, p63, or CK5/6

Tumor grade well, mod, poor

17

Small cell carcinoma

Epithelial tumor with neuroendocrine differentiation

EM level - dense core neurosecretory

Msot aggressive

Widley metastatic at dx

Strongest association with smoking

HIlar/central location common

Most common with ectopic hormone production (ACTH, ADH)

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Small cell micro

SMall cells with scant cytoplasm and nuclei with granular chromatin and absent nucleoli

Nuclear molding, crush artifact, necrosis, numerous mitoses

Neuroendocrine markers(CD56, chromogranin, synaptophysin)

All high grade

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Large cell carcinoma

Undifferentied malignant epithlial tumor

Lack def featurs of others

Dx of exlucions

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Large cell types and microscopic

Large cell carcinoma with null/unclear/or no stains immunohistochemical

Large cells with moderate amounts of cytoplasm and prominent nucleoli

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Dx of lung cancer

Cytology - 3 specimins, least invasive, central lesions

Bronchial washing/brushings/lavage - more material, beter preserved, intermeidatly located

FNA - radiographic guidance, most invasive, greatest risk, peripheral

Histology - biopsy

22

Non-small cell tx and small cell carcinoma

Non - surgical +/- chemo and or radiotion...for adeno - EGFR and ALK inhibitors (TKI inhibitors)

Small - chemo and radiation...surg normally not an option

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NE tumors

Can get pulm neuroendocrine hyperplaisa due to friboriss and inflammation

Diffuse hyperplasia could be precurosrs

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Tumorlets

Benign - small inconsequential hyperplastic nests of NE cells

Seen in areas of scarring or chornic inflammation

DO NOT require tx

25

Bronchial carcinoid

Low-grade malignant epithelial neoplasm with NE diff

MEN, type 1

Men and female equal

Under 40 y/o

Non-smokers

Usually small and intraluminal

most are non-functional

26

Bronchial carcinoid clinical

Cough, hemop, pneumonia, bronchiectais

Good survial

Typical (lower mitotic), atytpical - more mitotis

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Microscopic bronchial carcinoid

Organoid, trabecular, palisading or rosette like
Nest and cords of bland cells

Separated by thin, fibrous strands

SMall, uniform round nuclei with mod amounts of esoinophilic cytoplasm

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Metastatic tumors

Frwqunt for carcinoma and sarcoma via blood, lynphatics, direct

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Hamartoma

Overgrowht of normal tissue, disordered in proportion or arrangement

Not true hamartoma but clonal neoplasm

Coin lesion on CXR

Round, solitary nodules of conn tissue

Predom cartilage, clefs lined by ciliated or non-ciliated epithelium