PULMONARY NEOPLASMS QUESTIONS AND ANSWERS A+
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Lung neoplasm causes
-tobacco smoking - most lung cancers associated with cigarette smoking
-60x higher risk
-cessation decreases risk over time
-pipe and cigar
-chewing tobacco
-vaping
-second hand smoke
industrial hazards
-Asbestos - malignant mesothelioma, commonly causes non small cell lung cancer
(adeno, squamous)
-uranium - weakly radioactive (10x incidence)
-high dose radiation - carcinogenic
air pollution
-chronic exposure to smog - chronic inflammation
-anthracosis - carbon particles accumulation - due to car exhaust, smoking, coal dust
radon gas
-trapped in mines, subways, basements
-naturallu occuring radioactive gas
Carcinomas classification
-Adenocarcinoma - pulmonary most common
-Squamous cell
-neuroendocrine tumors - small cell, large cell, carcinoid
-Large cell carcinoma
Adenocarcinoma
-associated with smoking, but not always cause (most common in never smokers)
-atypical adenomatous hyperplasia
-glandular differentiation or mucin production
-grow peripherally
adenocarcinoma histologic patterns
-different patterns in 1 tumor
-papillary - fibrovascular cores
-micropapillary - florets, aggressive
-acinar - gland forming
-lepidic - grow along alveolu
-solid
adenocarcinoma immunohistochemistry
-TTF-1 - thyroid transcription factor (required for normal lung dev)
, -Napsin A
Adenocarcinoma pathogenesis
genetic mutations
-KRAS
-EGFR
-ALK
-targeted therapeutic implications
lung cancer in never smokers
-adenocarcinoma - most
-more common in females of Asian descent
-EGFR mutations
squamous cell carcinoma
-more in men, strong ass in smokers
-precursor lesions (grow from something) - squamous metaplasia
-occurs centrally in major bronchi - obstruct lumen, downstream atelectasis and
infection
-genetic mut: tp53
-paraneoplastic syndromes - ectopic production of PTH-rp causing hypercalcemia
-tx: sx, xhemo, radiation
squamous CC histology
-Keratinization - squamous pearls or eosinophillic cells
-intracellular bridges (desmosomes)
-increased mitotic activity
Squamous CC histologic variants
-Keratinizing
-Non Keratinizing
-Basaloid
Squamous CC immunohisto
stain positive for p40 and p63
neuroendocrine tumors
-NE cells within epithelium as single cells or clusters
NE tumor immunohisto
Stain positive for neuroendocrine markers:
CD56
Synaptophysin
Chromogranin
Carcinoid tumor
low to intermediate grade
-typical (better) and atypical (worse)
-<60, not related to smoking
-central or peripheral confned to mainstem bronchi
-carcinoid syndrome - secreting serotonin and bradykinin --> diarrheas, flushing,
cyanosis/wheezing
-good prognosis
Carcinoid tumor histo
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