Pulmonology Quiz 3c

eem8u's version from 2016-11-21 21:17

Lung Cancer

Question Answer
cancers w/ leading incidence1) breast and prostate 2) lung
***lung cancer accounts for ___ of all cancer deaths~25-30%
smoking responsible for ___% of cancer in lung>85
****asbestos + smoking increases risk by20-50 x
****carcinogen assc w/ cancerpolycyclic aromatic hydrocarbons (in CIGARETTES, petroleum, coal tar, foundry workers)
****Radon definition & exposure riskdecay of Radium-226 from uranium 238 >> leading cause among nonsmokers
4 major categories of lung cancersmall cell VS NON (squamous c carcinoma, adenocarcinoma, large c carcinoma
define carcinoma vs sarcomacarcinoma - derive from epithelia tissue vs sarc- derive from CT or other non-epi tissue
define field canceraizationentire upper aero-digestive tract involvement w/ multiple pre-neoplastic foci


Squamous Cell
Question Answer
****___ % of lung cancer20
arise from/locationepithelial c — central (large/proximal airways)
****gross findingcavitation! very white/firm tumor
prognosisbest compared to other types (bad overall)
histologic progressionnormal epithelium > hyperplasia > squamous metaplasia (usually result of smoking) > dysplasia > carcinoma in situ > invasive carcinoma
****2 histologic Fea.(squamous cells) keratin PEARLS or INTERCELLULAR BRIDGE
****assc*most common tumor* in male smokers
clinical sx/presentationassc w/ OBSTRUCTION - distal to obstruction > pneumonitis & atelectasis
precursor lesionssquamous dysplasia/ carcinoma in situ


Question Answer
**** ___ % of lung cancer39 (most common!)
****arise from/locationfrom TYPE 2 pneumocytes **peripheral lung ndoule/mass
****histo finding - invasive typeglands, **mucous production
****CXR - adenocarcinoma in situ“ground glass” - NOT SOLID appearance (b/c of air mixed in)
**** assc*most common tumor* in NON smokers and in FEMALE
squamous vs small cell - spreadsquamous more likely to be localized at time of diagnosis
spread to**hilar and mediastinal lymph node AND distant (liver/bone/CNS)
precursor lesionatypical edematous hyperplasia
*** mutation most commonly seen in F nonsmokerEGFR (adenocarcinoma)
**** atypical edematous hyperplasia (AAH) definedless than 0.5cm — proliferation of Type II and/or Calra cells lining alveolar cell walls
**** adenocarcinoma in situ (3 fea.)> 5mm size / NON-mucinous / lepidic group (along alveolar septa) /
adenocarcinoma in situ- survival **improved** ~100% in 5 years
***Minimally invasive adenocarcinoma (MIA)adenocarcinoma 3cm or less w/ predominant lepidic pattern and ≤ 5 mm invasion
survival rate of Minimally invasive adenocarcinoma (MIA)same 5 year survival!
****invasive adenocarcinoma defined asmore than 5mm invasion
**** 85% of all adenocarcinomas are _____ type**invasive**
key histo features of invasiveglandular or papillary structures, may be poorly differentiated and appear solid
key gross features of invasivepleural puckering


Large Cell Carcinoma
Question Answer
___ % of lung cancer3
***arise from/locationneuroendocrine epithelium — peripheral MASS
histo definitionUNDIFFERentiated & MALIGNANT epithelial tumor — lacks glandular/squamous differentiation


Small Cell carcinoma
Question Answer
**** ___ % of lung cancer14
arise from/locationNEUROENDOcrine epithelium — CENTRAL (bronchial wall)
histological findingsmall/darkly stained/SPARE Cytoplasm = nuclear molding
natural hx/ speedRAPID dissementaiton >> lymph >> hilar mediastinal nodes >> DISTANT
**** asscsmokers, **PAREANEOPLASTIC SYNDROME**
prognosisterrible - does not respond to surgical resection
gross appearancecenter white-tan/soft/**necrosis (but not as cavitating as SQUAMOUS)
prognosis<5% 5-year survival


*******Bronchial Carcinoid
Question Answer
___ % of lung cancer<5
arise from/locationlow-grade neuroendocrine (well-differentiated!!) / central airways
****assc w/YOUNG adults (Not assc/ with smoking)
histological findingWELL differentiated neuroendocrine tumor, INTRAluminal growth, cell separated by fibrovascular stoma (can be organized, trabecular, palisading, rosette arrangements)
symptoms/cause of carcinoid syndromeflushing diarrhea, wheezing — due to serotonin production
clinical sx/presentaitonobstruction (central) and bleeding from hypervascularity
prognosisVERY GOOD- surgical resection
classical presentationpolyp-like mass
carcinoid syndrome sxdiarrhea, flushing, cyanosis
prognosis - typical vs atypical(>90% vs ~60% 5 year survival)


Malignant Mesothelioma
Question Answer
arises frompleura
****primary risk factorAMPHIBOLE asbestos (hace 30-40 yrs) (smoking NOT a risk factor)
CXRpleural fluid +/- thickened pleura
gross appearancemultiple nodules >> form a “RIND”
****prognosisfewer than 10% survive 3 years b/c entraps lungs (VERY BAD)
****3 histo subtypesepithelial / sarcomatous / biphasic
define mesotheliumthe epithelium that lines the pleurae, peritoneum, and pericardium ( derived from mesoderm)


Question Answer
*****most common clinical sx of primary lung lesioncough and hemoptsosis (also obstructive sx)
most frequent lung cancer typeadenocarcinoma
cancer w/ most targeted gene therapiesadenotherapy
***most common type of cancer to develop in NONsmokersadenocarcinoma (bronchial carcinoid and mesothelioma also not assc w/…)
worst prognosissmall cell
assc w/ hypercalcemia/paraTH hormone releasesquamous cell (b/ not common)
***** pan coast tumor assc w/ (2)IPSILATERAL compression of brachial plexus (pain/weakeness of arm) and cervical sympathetic chain (horner’s)
triad of horner’s syndromesympathetic compression —> ptosis / miosis (constriction) / anhidrosis of forehead
*****mediastinal mets can lead to (3)compression / invasion of 1) phrenic 2) recurrent laryngeal (vocal cord paralysis) 3) superior VC — facial / upper extremity edema
Paraneoplastic syndrome - definemalignancy producing hormone or hormone-like substance
*****5-­‐year survival of all patients with lung cancer14%
***** assc w/ encephalomyelitissmall c carcinoma
assc w/ lambert/eaton (myasthenia graves)small c carcinoma
***** 3 neuroendocrine tumorscarcinoid, small cell, large cell
all neuroendocrine carcinomas includeneuroepithelial bodies w/ NEUROSCRETORY granules
*****assc w/ cushin’gs syndromecarcinoid


paraneoplastic syndromes
Question Answer
syndromes most commonly assc w/small cell carcinoma
ADH causeshyponatremia
ACTH causescushing’s syndrome
PTH causeshyperparathyroidism
*****calcitonin causesHYPOcacemia
gonadotropins causesgynecomastia
serotonin causescarcinoid syndrome (flushing, diarrhea, dyspnea, tachypnea)
****mechanism of lambert-eatonantibodies directed against neuronal calcium channel (form of myasthenia graves!!!)


Solidarity Nodule / Diagnosis
Question Answer
***** solitary pulmonary nodule definedsingle lesion ≤ 3 cm (incidental diagnosis, may or may not be cancer)
evaluation of solitary pulmonary nodule**prior imaging to access growth
***** calcification -types of SNdiffuse (benign) / popcorn (benign) / laminated (beginning) / central or amorphous (possible malignant)
border of SNirregular more likely malignant
size of SNbigger - malignant
***** T stageprimary tumor - size, location
N stage(nodes) presence absence of tumor w/in hilar/mediastinal lymph nodes
M stage(mets) to other organs/tissues
limited small cell vs extensivelocalized w/in one hemithorax vs beyond one hemithorax (b/c the assumption is that small c is invasive)
***** screening age / pack year history55-80 y/o w/ 30 pack year (current or within past 15 years)