Lung And Pleural Tumors (8/24)

Front 1

Cancer is due to what?

Back 1

Cancer is due to a loss of normalhomeostatic growth control

Front 2

Cancer occurs due to mutations orepigenetic changes in genes that regulate what?

Back 2

Cancer occurs due to mutations orepigenetic changes in genes that regulate cell proliferation, celldifferentiation, cell metabolism and apoptosis.

Front 3

Are positive or negative regulators ofcell growth pathways key targets for gene mutations and epigeneticmodification in cancer?

Back 3

Both positive and negative regulators ofcell growth pathways are key targets for gene mutations and epigeneticmodification.

Front 4

How does lifestyle contribute to cancer development?

Back 4

Cancer is a lengthy process of geneticevolution and clonal selection that is modified by lifestyle.

Front 5

Define cancer.

Back 5

Canceris a common term for all malignant tumors

Front 6

Common features in cancer?

Back 6

- defectsin cell differentiation

- uncontrolled cell proliferation

- unlimited cellular lifespan (evadingapoptosis)

- genetic instability

- infiltration and invasion of surroundingtissues

- metastatic potential, includingangiogenesis

Front 7

The development of a malignanttumor is a multi-step process characterized by the progressive evolution andselection of a clone of what?

Back 7

A clone of transformed cells with malignant potential

Front 8

Clonal evolution involves bothgenetic and epigenetic changes that confer cells with what?

Back 8

Clonal evolution involves bothgenetic and epigenetic changes that confer cells with a selective growthadvantage.

Front 9

Cells may have increased growth potential because they of a gain and a loss of what functions?

Back 9

Cells may have increased growth potential because they gain newfunctions that encourage increased proliferation, lose functions that limitcell growth and differentiation, or control cell death (apoptosis).

Front 10

Possible cause of adenocarcinoma increase?

Back 10

Filters on cigarettes causing deeper inhalations

Front 11

Whatare oncogenes?

Back 11

Oncogenes are genes (viral orcellular) which encode proteins that subvert normal growth control mechanisms

Front 12

How are oncogenes generated?

Back 12

Oncogenes can be generated bymutation of existing cellular genes (called proto-oncogenes) by manymechanisms, including point mutations, deletions, truncations, translocations,amplification, or insertions.

Front 13

How are oncogenes encoded/introduced into the human genome?

Back 13

Oncogenes can be transduced byviruses, arise from errors in normal cellular processes (i.e. DNA replicationor repair), or result from environmental insults (sunlight, smoking, chemicalmutagens, etc.)

Front 14

What nodule location in the lung favors malignancy?

Back 14

Upper lung

Front 15

Nodule appearance favoring malignancy? Benignity?

Back 15

Spiculation and calcification

Front 16

If you have a highrisk patient and a high risk lesion, what 3 things should you do?

Back 16

•Biopsy

•Surgical removal

•Follow with serial imaging

Front 17

Define heterotopia?

Back 17

A mass of tissue normal to the site in abnormal location

Front 18

Define hamartoma? Are they benign or malignant? What are they made of and describe the environment around them?

Back 18

An abnormal mixing of the normal components of the organ, usually benign. Peripheral,solid, well-circumscribed. Nodules of mature connective tissue (often cartilage).

Front 19

What do hamartomas look like on CXR?

Back 19

Rounded “coin lesion” on x-ray

Front 20

How do you grade a tumor?

Back 20

Tumor Size

Nodal metastasis

Metastasis distantly (upper lung location favors malignancy)

Front 21

Type of common mutation in pulmonary hamartomas?

Back 21

Clonalchromosomal translocations

Front 22

What stage does small cell carcinoma usually present in? Treatment for it?

Back 22

Advanced Stage. Chemotherapy plus radiation.

Front 23

Non-small cell carcinomas include which types of carcinoma?

Back 23

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and small cell carcinoma

Front 24

Treatment for non-small cell carcinoma?

Back 24

Surgery plus chemotherapy/radiation

Front 25

What happens in a pancoast tumor?

Back 25

Apex carcinoma with direct invasion of surrounding tissues

Front 26

Most common histologic tumor type, especially in non smokers?

Back 26

Adenocarcinoma

Front 27

Where are adenocarcinomas usually found?

Back 27

Peripherally

Front 28

Mucin producing tumor usually means what type?

Back 28

Adenocarcinoma

Front 29

Mucicarmine stain in adenocarcinomas stains what color?

Back 29

Pink

Front 30

What kind of pattern of growth do adenocarcinomas have along the alveolar septa?

Back 30

Lepidic pattern

Front 31

Squamous cell carcinomas are located where? More common in men or women?

Back 31

Central and men (smokers)

Front 32

Cavitary tumors are usually what kind?

Back 32

Squamous cell

Front 33

What is the internal composition of squamous cell carcinomas?

Back 33

Keratinization and or intercellular bridges

Front 34

What kind of endocrine syndrome associated with squamous cell carcinomas?

Back 34

PTH related peptide

Front 35

Microscopic appearance of large cell carcinoma?

Back 35

Large cells with prominent nucleoli and vesicular chromatin, no glandular or squamous differentiation

Front 36

Where are large cell carcinomas usually located?

Back 36

Peripherally

Front 37

Growth potential and location of a small cell carcinoma?

Back 37

Centrally located, highly infiltrative growth into surrounding lung

Front 38

What kind of grading is typical for small cell carcinomas?

Back 38

High grade

Front 39

Sensitivity of small cell carcinoma to chemo/radiation compared to non-small cell carcinoma?

Back 39

Small cell is more sensitive to chemo/radiation

Front 40

What tumor should you think when you hear "crush artifact"? Or, nuclear molding and abundant mitoses?

Back 40

Small cell carcinoma

Front 41

What do small cell carcinoma cells look like?

Back 41

Smallcells with scant cytoplasm and granular chromatin (hyperchromatic)

Front 42

What neuroendocrine syndromes/hormones produced by small cell carcinoma?

Back 42

Mayproduce ADH or ACTH or cause Lambert-Eaton syndrome (paraneoplastic)

Front 43

What is azzopardi phenomenon?

Back 43

DNA settles around a vessel to stain dark purple in small cell carcinoma

Front 44

Immunohistochemical stains (2) for small cell carcinoma?

Back 44

Chromogranin and synaptophysin

Front 45

What does carcinoid mean?

Back 45

Low grade, neuroendocrine carcinoma

Front 46

Where are carcinoid tumors seen?

Back 46

Central (endobrachial) but can be peripheral

Front 47

Who do carcinoid tumors affect?

Back 47

Young people

Front 48

Potential for growth/grading/5 year survival of carcinoid tumors?

Back 48

Indolent, low grade with 5 year survival greater than 87%

Front 49

How are carcinoid tumors usually discovered?

Back 49

Incidentally via hemoptysis or dyspnea

Front 50

Gross and microscopic/ultrastructural appearance of carcinoid tumors?

Back 50

Collar button/circumscribed tumor with nests of blands cells of granular chromatin. Often, dense core granules on ultrastructural exam.

Front 51

What does carcinoid syndrome result in? What is secreted to cause this? What stage of tumor does this usually indicate?

Back 51

Serotonin release results in diarrhea, flushing, and cyanosis. Very advanced tumors.

Front 52

Stage 1 tumor features?

Back 52

Localized tumor, no nodal or distant metastases

Front 53

Stage 4 tumor feature?

Back 53

Distant metastases

Front 54

EGFR Tyrosine Kinase Inhibitors produce a good response in which tumor type?

Back 54

Adenocarcinomas

Front 55

Most common oncogenic driver mutations in adenocarcinomas? Typically arise in what population?

Back 55

K-ras mutations in smokers

Front 56

EGFR mutations occur in which populations?

Back 56

Non-smokers, females, and asian ethnicity

Front 57

Secretion of which hormones/antibodies is affiliated with small cell carcinomas?

Back 57

SIADH, ACTH, and antibodies to voltage gated calcium channels

Front 58

What is Lamber Eaton Syndrome?

Back 58

Secretion of antibodies to voltage gated calcium channels by small cell carcinomas

Front 59

Multiple nodules in brain means you should immediately think what?

Back 59

Metastases

Front 60

Most common site of metastases?

Back 60

Lung

Front 61

What represents the boundary between lung and pleural space?

Back 61

Visceral pleura

Front 62

Are tumors in pleura mostly static or metastatic?

Back 62

Metastatic

Front 63

Are pleural tumors usually primary or secondary?

Back 63

Secondary

Front 64

How long is the latency between exposure and development of malignant mesothelioma?

Back 64

Very long

Front 65

Is malignant mesothelioma a primary or secondary phenomenon?

Back 65

Primary

Front 66

What virus is often, controversially, associated with malignant mesothelioma?

Back 66

Simian virus 40

Front 67

Chromasomal deletions associated with malignant mesothelioma?

Back 67

1p, 3p, 6q, 9p, and 22 q

Front 68

What does a malignant mesothelioma resemble grossly?

Back 68

Diffuse, rind-like encasement of the lung

Front 69

Time course of malignant mesothelioma after presentation?

Back 69

Rapid course (50% die in a year)

Front 70

Is malignant mesothelioma the most common disease associated with asbestos?

Back 70

No

Front 71

Microscopic appearance patterns (3) of malignant mesothelioma?

Back 71

-Epithelioid type of mesothelioma with tubules that mimic glandular structures seen in adenocarcinoma

-Sarcomatoid

-Biphasic mixture of both above patterns

Front 72

What is calretinin staining used for?

Back 72

Mesothlioma

Front 73

What does hyaluronic acid stain for?

Back 73

Mesothelioma

Front 74

What does long slender microvilli mean on electron microscopy?

Back 74

Mesothelioma

Front 75

What does stubby microvillous rootlets mean on electron microscopy?

Back 75

Adenocarcinoma

Front 76

What does positive carcinoembryonic antigen (CEA) staining mean?

Back 76

Adenocarcinoma

Front 77

A 67-year-old man developed increasingshortness of breath over a three day period. His neighbor drove him to theemergency department where a chest x-ray revealed fluffy pulmonary infiltrates,a partially calcified, rounded density in the right upper lobe, and bilateralpleural effusions. Aspiration of some of the pleural fluid showed a specificgravity of 1.006. Of the following, the effusion is most likely due to?

Back 77

CHF

Front 78

The pulmonary function primarilycompromised in a mesothelioma is what?

Back 78

Ventilation

Front 79

A 26 year old man presented withcough, hemoptysis, and episodes of flushing, diarrhea, and cyanosis. What is the likely diagnosis?

Back 79

Bronchial carcinoid tumor

Front 80

Smoker, blood streaked sputum, and left hilar mass. What kind of tumor?

Back 80

Small cell carcinoma