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90 Cards in this Set
- Front
- Back
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what are the risk factors associated with lung cancer
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CHEMICAL
1. Smoke 2. Radiation 3. Radon gas 4. Auto exhaust (benzopyrene) 5. Berylium, nickle, chromate, arsenic 6. Asbestos GENETIC: 1. familial cancers (liFremmuni) 2. Nicotine R, CYP polymorphism 3. 3p 4. cMYC, K-RAS, EGFR, p53, p16INK4A |
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what are the oncogenes associated with lung CA
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1. C myc- small cell
2. K ras- adeno carcinoma 3. EGFR- non smokers 4. p53 mutation- benzypyrene (exhaust exposure) 5. p16INK4A |
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from where do malignancies arise in the lungs
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BRONCHOgenic
**come from brinchi, hilus is common |
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what is the progression of bronchogenic carcinoma
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1. squamous dysplasia
2. carcinoma in situ 3. atypical adenomatous hyperplasia (means PREcancer) 4. adenocarcinoma |
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why is cancer so bad for lung cancer
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it initiates all your cells, they only need one more event
**smokers will have faster and more diffuse CA |
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what is the growth pattern of lung ca
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initial warty leision on brinchus then most growth is in parynchema
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ok so lung cancer is top 2 cancer and number 1 killer in men and women. Lung Ca is a broad term, whats the break down
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1. Ademocarcinoma, most common, more likely in female
2. squamous cell, 2 most common, more likely in male 3. small cell |
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what is small cell CA
what is non small cell CA |
1. Small- mets a time of dx, no surgery
2. localized when discovered. surgery is possible |
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A 62 y/o man smoked 1 pack of cigarettes /
day for 45 yrs. He has developed a severe cough with hemoptysis over the past month and has experienced a 10‐kg wt. loss. He is afebrile. Labs: Na+ 120 mmol/L (low), K+ 3.8 mmol/L, Cl‐ 90 mmol/L (low), CO2 24 mmol/L, glucose 75 mg/dL, creatinine 1.2mg/dL, calcium 8.1mg/dL, phos. 2.9mg/dL and albumin 4.2 g/dL. Which of following is most likely to be seen on chest radiograph? A) Diaphragmatic pleural calcified plaques B) Right middle lobe subpleural 2 cm nodule with hilar lymphadenopathy C) Right perihilar 4 cm mass D) Right upper lung 3 cm nodule with air‐fluid level E) Bilateral upper lobe cavitation F) Bilateral fluffy infiltrates G) Left pneumothorax |
smoker
wt loss cough blood LOW Na (hyopnaturemia) can be: 1. Kidney 2. Adrenal 3. brain- post pit |
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what are these things associated with
A) Diaphragmatic pleural calcified plaques B) Right middle lobe subpleural 2 cm nodule with hilar lymphadenopathy C) Right perihilar 4 cm mass D) Right upper lung 3 cm nodule with air‐fluid level E) Bilateral upper lobe cavitation F) Bilateral fluffy infiltrates G) Left pneumothorax |
A) Diaphragmatic pleural calcified plaques- ASBESTOS
B) Right middle lobe subpleural 2 cm nodule with hilar lymphadenopathy- CANCER C) Right perihilar 4 cm mass- CANCER D) Right upper lung 3 cm nodule with air‐fluid: cavity, abcess level E) Bilateral upper lobe cavitation- TB F) Bilateral fluffy infiltrates- sarcoid G) Left pneumothorax- bullea |
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EF is a 72 y/o male who c/o night sweats for
4‐5 months. He has a 40 pack year history of smoking but quit 4 years ago. On chest x‐ray a 3 cm mass was identified in the right lower lobe of the lung. Bronchoscopy with biopsy yielded __________. Malignant squamous cells CT of the chest was negative for enlarged lymph nodes. The patient was taken for thoracotomy where mediastinal lymph nodes were negative by frozen section for metastases. A right lower lobectomy was performed with a bronchial margin free of tumor for >2cm. The pleura was not involved were found in bronchial brushings |
squamous cell carcinoma
CXR- mass lateral to LN, CENTRAL cancer **do LN for METS b4 surgery **after surgery the CXR will show a raised diaphragm bc that lobe of the lung is gone |
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what is the cancer that is central and tends to cavitate, was this person a smoker
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squamous cell
SMOKER+++ **also show eosinophelia, pearls **hypercalcemia, PTH related secreted by tumor **late mets |
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what can be a problem with the boipsy you get from a squamous cell carcinoma of lung
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it cavitates so maybe you get only the necrotic cells
**smoker, hypercalcemic |
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what is carcinoma in situ
what is atypia in the lungs |
entire length of epithelium
dysplasia |
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a well differentiated sq cell carcinoma will be what grade
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I
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a swirly keratin pearl is associated with what cancer
what is the growth, mets unique characteristic labs |
sq cell
slow growth, late mets. CENTRAL CAVITATES Hypercalcemia |
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This 67 y/o female long time smoker (or not) presented
with a cough g and weakness in the left arm and leg. Chest x‐ray showed a 4x2.5 cm mass in the RUL. Subcarinal lymphadenopathy was present on chest CT. MRI of the brain revealed multiple lesions. Percutaneous transthoracic needle biopsy of the lesion was adenocarcinoma. |
cancer with METS to brain
Subcarinal lymphadenopathy means no surgery- mets CXR- R upper lobe |
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what is the small peripheral tumor with early mets, what is it associated with
sex smoke genes labs |
adenocarcinoma
woman -/+ smoke EGFR overexpression, K-RAS TTF1, CEA **associated with scar |
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OM, a 73 y/o female saw her physician for
chronic cough. A “shadow” of unresolved pneumonia was present in the right lung. She was advised to have repeat chest x‐rays until the lesion resolved. The lesion grew slightly each year until it suddenly enlarged 5 years later to 7x6 cm. Her cough had worsened. She had recently lost 10# in one month to her present weight of 120#. A percutaneous transthoracic needle biopsy of the lung yielded bronchioloalveolar carcinoma. She is a life‐long nonsmoker. |
TRAGIC! if its pneumonia fu 6 mo. if its not clear DO SOMETHING!!!
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when might you see tall malignant columnar cells along alveolar septa
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in bronchialveolar carcinoma
**its a slow growing, diffuse looking cancer **NON smokers! |
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whats bronchialveolar carcinoma
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diffuse pneumonia like CA in NON SMOKERS
**tall malignant cells grow along alv septs **occurs in 3rd decade (20-30) **seeds and can cause suffocation |
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what cancer arises from atypical adenomatous hyperplasia with well demarcated focus of cells lining alveoli, it may then progress into an invasive adenocarcinoma
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bronchioalveolar carcinome
**non smoker **airborne mets |
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FR was a 59 y/o male who c/o double
vision and ataxic gait. He had lost 20 pound in the last 3 month. He had been a heavy smoker in the past but quit 8 mon. ago. Labs: Alk phos 259 (<130), LDH 550 (<200), AST 129 (< 35) CT of the chest showed a 2.4x4cm mass in the right lobe of the lung and multiple liver lesions. A percutaneous needle biopsy of the liver was metastatic small cell carcinoma |
Metastatic Small cell Carcinoma
Vision/Gait: AB mediated Quit 8 mo ago: ask if they have HISTORY of smoke ALK phos: liver, bones LDH: cancer Can do a liver biopsy bc it mets early and its easier to biopsy liver SMOKER!!! Early mets Central from major bronchi Derived from neuroendocrine |
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tell me about small cell carcinoma
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1. smoker
2. mets early, inoperable (liver) 3. from neuroendocrine (brinchi) so LOTS of paraneoplastic -ACHT, cushings -SIADH - Gastrin releasing peptide -calcitonin -lambert eaton meaasthetic syndrome 5. Grows beneath intact epithelium |
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what cancer will grow under the intact epithelium and have dark nuclei and little cytoplasm
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small cell carcinoma
**early mets **smoker **lots of neuroendocrine things going on (paraneoplastic) **NOT graded, all are high grade |
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what cancer is assocaited with DNA streaking (Azzupardi phenomenom)
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small cell carcinoma
necrosis DNA sterak small dark nuclie no cyto |
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what cancer shows dense core granules on EM
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small cell carconoma
**remember all those neuroendocrine things 1. Cushing (ACTH), hyponaturemia 2. SIADH 3. gastrin releasing peptide 3. calcitonin 4. Lambert Eaton Myasthemic syndrome (AB mediated at neuronal structures) **also does DNA streaking: azzupardi phenomon |
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WH saw his osteopathic physician for
thoracic spinal pain. Pain was out of proportion to his physical findings so MRI of the spine was ordered. A right paraspinal pleural‐based mass was identified within the lung. The patient underwent CT guided percutaneous transthoracic needle biopsy of the peripheral mass. The diagnosis was large cell undifferentiated carcinoma invading through the pleura. He had thrombophlebitis 4 months before the biopsy. Significance? |
- CXR bc the heart was in the way
-peripheral plaural based cacner with central anthrocosis LARGE Cell Carcinoma |
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what is large cell carconimoa
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unndifferentiated forms of squamous and adenocarcinoma
Large nuclei |
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if you see.... what kind of lung cancer
1. swirly pearls, necrosis 2. tubes, glands 3. dark nuclei, DNA streaking. necrosis 4. poorly undifferentiated 5. tall columnar cells on alv septa |
1. squamous cell, cavitates
2. adenocarcinoma 3. small cell (lots a paraneoplastic) 4. large cell 5. bronchioalveolar |
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A 37 y/o woman comes to her physician c/o
a chronic, nonproductive cough for 4 mons. During this time, she has experienced loss of appetite and a 6 kg. wt. loss. She has never smoked. She is employed by religious g order. She is afebrile with no remarkable findings. Chest radiograph shows a rt. subpleural mass. A fine needle aspiration is followed by lobectomy. The microscopic appearance is shown here. Which of the following neoplasms is most likely? circles lined with epithelim (tube) A) Large cell carcinoma B) Metastatic angiosarcoma C) Bronchial carcinoid D) Localized mesothelioma E) Adenocarcinoma |
1. large cell: cross btwn squamous and adeno. undifferentiated
2. metastatic angiosarcoma 3. Bronchial 4. mesotheleoma 4. Adeono**** young, woman, non smoker |
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A 57 y/o woman c/o cough and pleuritic chest
pain for the past 3 wks. She does not smoke. She is afebrile. Crackles are auscultated over the left lower lung. Chest radiograph shows an ill‐defined area of opacification in the left lower lobe. She does not improve on 1 mon. of antibiotic therapy and the lesion is still visible radiographically. CT guided percutaneous needle biopsy of the lung is performed. Biopsy of the lung reveals tall columnar cells with hyperchromatic, pleomorphic nuclei growing along alveolar septae. Which of the following neoplasms is most likely to be present in this patient? A) Squamous cell carcinoma B) Metastatic breast carcinoma C) Bronchogenic adenocarcinoma D) Small cell carcinoma E) Bronchioloalveolar carcinoma |
bronchioalveolar carcinoma
A) Squamous cell carcinoma- smoker, hypercalcemia, pearls B) Metastatic breast carcinoma- C) Bronchogenic adenocarcinoma- glands, woman, never smoked, peripheral D) Small cell carcinoma- early mets, small, grows under epithelium, dark nucleu |
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A 49 y/o man has a sudden onset of severe
lower abdominal pain with hematuria. He Passes a ureteral calculus. Labs show the calculus is composed of calcium oxalate. His serum calcium is 10.5 mg/dL (8.5‐10.2), phosphorus 2.9 mg/dL and serum albumin is 4.6 g/dL (normal). A chest radiograph shows a 7 cm hilar mass in the right lung. On CT the mass is centrally necrotic. Which of the following neoplasms is most likely to associated with these findings? A) Large cell carcinoma B) Bronchioloalveolar carcinoma C) Squamous cell carcinoma D) Small cell carcinoma E) Metastatic breast carcinoma |
uretal calcus, kidney stone, increased Ca
necrotic- Squamous cell carcinoma- cavitates |
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A 62 y/o man smoked 1 pack of cigarettes /
day for 45 yrs. He has developed a severe cough with hemoptysis over the past month and has experienced a 10‐kg wt. loss. He is afebrile. Labs: Na+ 120 mmol/L (low), K+ 3.8 mmol/L, Cl‐ 90 mmol/L (low), CO2 24 mmol/L, glucose 75 mg/dL, creatinine 1.2mg/dL, calcium 8.1mg/dL, phos. 2.9mg/dL and albumin 4.2 g/dL. Which of following is most likely to be seen on chest radiograph A) Diaphragmatic pleural calcified plaques B) Right middle lobe subpleural 2 cm nodule with hilar lymphadenopathy C) Right perihilar 4 cm mass D) Right upper lung 3 cm nodule with air‐fluid level E) Bilateral upper lobe cavitation F) Bilateral fluffy infiltrates G) Left pneumothorax |
small cell carcinoma
Smoker, hyponaturemia **subpleural with lymoh **grows beneath epithelium, early mets perihilar 4 cm is squamous- central and large |
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what is a local consequence of a brinchus being obstructed by cancer
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PNEUMONIA- behind the tumor
abcess bronchtectases focal emphysema etelectasis with total obstruction |
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what are the vascular manifestations of local extenstion of lung cancer
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SVC nad IVC can be blocked!
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why do we CXR oneumonia after its treated
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cancer will obstruct bronchus and cause pneumonia, if pneumonia clears and we still ahve liesion its bad news
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what is vena cava obstruction
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blocked by cancer, can get venous dilation (caput medusa)
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if you have small cell were you a smoker
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ALWAYS
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if you are a smoker and might have lung cancer and have venous congestion in the hear, cyanosis/edema of UE whats the deal
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superior vena cava syndrome
*inoperable **neck edema **vasodilation *pericardial mets |
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what is SVC syndrome
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when cacner grows around the SVC nad blockes it
You get UE/head edema and congestion vasodilation pericardial METS *arm wont empty when its elvated |
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where can lung cancer extend to
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1. SCV, IVC
2. SNS gang- horner 3. pleura- effusion 4. pericardium- tamponade 5. esophagous- dysphagia 6. horaseness- laryngeal is messed with 7. phrenic N paralysis- cant move diaphragm |
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what is hormer syndrome
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1. extension of lung cancer into SNS ganglion
**pancoast tumor of the superior sulcus of the apex of the lung- same side as facial abnormality |
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UL: ptosis, exopthalmosis, miosis and facial anhydrosis is associated with what
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Horners syndrome
**cervical gang gets invaded with cancer (and other) **pancoast tumor of the super sulcus of the spen of the lung on the same side as the facial abnormalities |
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what is a pancoast tumor of the superior sulcus associated with
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horners
**facial abnormality, no sweat ont eh same side *lung invades SNS gang **can invade bone also, brachial plexus **subclavian |
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Patient c/o persistent rt. shoulder pain for 3
mon. He has a 100 pack yr. smoking history and a 20# wt. loss in the past 3 mon. While he is diffusely perspiring, the rt. shoulder is cool with anhidrosis of the skin. There is no loss of range of motion, no muscle atrophy and no palpable tenderness. Chest x‐ray shows a mass that on CT involving the lower cervical/ upper thoracic vertebrae. Diagnosis? |
pancoast tumoe in apex of lung- horners syndrome
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where does lung cancer mets to
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small cell mets early and fast, adeno also early mets, squamous is late and bronchioalv is airborne
**hilar LN (mediasteinal, pretrachial. all the same) *supraclavicular LN **brain, BM, Liver **ADRENAL |
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if you have a chance to biopsy the adrenal for mets whats the 1 CA
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lung (and a few others, not many things go there)
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brian bone, LN (supraclavicular, mediasteinal) adrenal
mets from what primary |
lung
if its mets is INOPERABLE |
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lets stage some lung cancer
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T1 <3. T2 >3 <2 cm from carina T3/4mets
N1/2 IL LN N3 CL LN INOPERABLE M |
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TMN
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Tumor
T1-T4 w Mets Nodes |
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whats the T in staging of tumors
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Tumor
T1- less than 3 T2- more than 3 cm (at least 2 cm from carina) T3/T4- invasion of chest wall, diaphragm, carina, heart, vessels, esophagous. Malgnant. NO cancer |
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what T staging is NOT operable
what N What M |
T3/4 its invaded local structures
N3- CL LN, M1 |
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what is stage 1a
what is stage 2 operable wht is stage 4 |
1a tumor is less than 3 cm and is more than 2 cm from carina (no nodes no mets. T1a N0M0)
2: same as above but UL LN involved **these in theory are operable but usually dont present until its further Stage 4 is distant mets, inoperable |
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3 cm lung mass on x‐ray. CT of the chest was
negative for enlarged lymph nodes. The patient was taken for thoracotomy where mediastinal lymph nodes were negative by frozen section for metastases. A right lower lobectomy was performed with a bronchial margin free of tumor for >2cm. The pleura was not involved. • What is the stage? |
T1 (1b bc of tumor size)
N0 M0 |
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This 67 y/o female long time smoker presented
with a cough and weakness in the left arm and leg. Chest x‐ray showed a 4x2.5 cm mass in the RUL. Subcarinal lymphadenopathy was present on chest CT. MRI of the brain revealed multiple lesions. Percutaneous transthoracic needle biopsy of the lesion was adenocarcinoma. • What is the stage |
T-2
N-3 M- distant stage 4, distant mets |
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t1
t2 t3/4 N1/2 N3 |
T1- less than 3
T2 more than 3, 2 cm margin from carina T3/4- invasion N1/2: IL N3: CL |
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FR was a 59 y/o male who presented c/o double
vision and ataxic gait. He had been a heavy smoker in the past. CT of the chest showed a 2.4x4cm mass in the right lobe of the lung and multiple liver lesions. A percutaneous needle biopsy of the liver was metastatic small cell carcinoma. • What is the stage |
T 2
Nx (no assessed!) M 1 stage 4, distant mets |
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A right paraspinal pleural‐based mass was identified
within the lung invaded the pleura. The patient underwent CT guided percutaneous transthoracic needle biopsy of the peripheral mass. The diagnosis was large cell undifferentiated carcinoma. He had thrombophlebitis 4 months before the biopsy. • Stage? • What is the significance of thrombophlebitis? |
T3/4 INOPERABLE
Nx (not assessed) M 1 Trousseau’s syndrome: sign of malignancy Thrombophlebitis: trousseaus syndrome |
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what are some sx of lung ca
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slow indisious onset, nothing acute about it
cough with blood weight loss chest oain dyspnea paraneoplastic **suspect Ca if a person who was a hard core smoker recently quit, the body tells them to stop |
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whats the prognosos of lung cancer
1. whats most operable 2. mets common, inoperable |
1. swuamous, adenoma
2. large cell, small cell inoperable overall all lung ca: 15% 5 year survival |
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tell me about sputum cytology and Ca
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limited use, waste of money
**bronchial obstruction, take a bite of the bronchus Pearl: squamous Mucin: adeno Oat Cells: |
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ok so CXR is good for lung CA, what ones might it miss
whats the benefic of CT?MRI |
adenocarcinoma- its small
squamous- its central, heart may block it MRI/CT- can stage by LN size at same time |
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what are hte lung Ca related paraneoplastic syndromes
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usually presenting sx
**common in Squamous (high Ca) **common in small cell (loq Na) |
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whats SIADH
whats cushings |
inappropriate ADH- small cell
**low Na Cushings: small cell. low K, weight gain |
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if you ahve low Na or low K what lung Ca, what paraneoplastic
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Both are small cell
Low Na: SIADH Low K: cushings (osteoperosis) |
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A 62 y/o man smoked 1 pack of cigarettes /
day for 45 yrs. He has developed a severe cough with hemoptysis over the past month and has experienced a 10‐kg wt. loss. He is afebrile. Labs: Na+ 120 mmol/L (low), K+ 3.8 mmol/L, Cl‐ 90 mmol/L (low), CO2 24 mmol/L, glucose 75 mg/dL, creatinine 1.2mg/dL, calcium 8.1mg/dL, phos. 2.9mg/dL and albumin 4.2 g/dL. Which of following is most likely to be seen on chest radiograph? A) Diaphragmatic pleural calcified plaques B) Right middle lobe subpleural 2 cm nodule with hilar lymphadenopathy C) Right perihilar 4 cm mass D) Right upper lung 3 cm nodule with air‐fluid level E) Bilateral upper lobe cavitation F) Bilateral fluffy infiltrates G) Left pneumothorax |
Low Na: renal, adrenal, post pit
SIADH B, R middle lobe subpleural with hilar lymphadenopathy |
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A 64 y/o male with a 100 pack year history of
cigarette g smoking presents c/o back pain. X‐ray of the spine reveals vertebral collapse from osteoporosis. Physical exam shows truncal obesity with moon facies, ruddy complexion and easy bruisability that the patient relates that symptoms had their onset within the last 6 months. Diagnosis? |
Cushings- small cell
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PTH like is release with what lung Ca, what does it do
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squamous cell
high Ca **low Ca is assoicated with calcitonin in small cell |
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lambert eaton myasthenia like syndrome
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small cell
MM weakness (pelvis, thigh) peripheral sensory neuropathy **auto AB to Ca channels |
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what is teh pulm osteoarthropathy paraneoplastic
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painful long bones (increased blood to affected bone)
clubbing **sx resolve when tumor is removed |
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45 y/o woman with 27 pack-yr history of smoking c/o polyarthralgias
increasing over 18 mon, For 3 mon she had pain in long bones of legs and a nonproductive cough. Clubbing was present. whats the deal |
lung Ca with a paraneoplastic syndrome
osteoarthropasty |
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tell em about trousseau
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thrombophlebitis associated with visceral ca.
‐NBTE (nonbacterial thrombotic endocarditis) ‐‐may result in systemic embolism **hypercoagulable, remember they always say Ca is a risk for DVT |
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A 40 y/o man c/o increasing cough with
hemoptysis for 2 wks. His temp. is 98.2oC. A chest radiograph shows consolidated area in the rt. upper lobe of lung. His condition improves with antibiotic therapy; however, the cough and hemoptysis persists for 2 more wks. A chest CT shows rt. upper lobe atelectasis. Bronchoscopic examination shows an obstructive mass filling the bronchus of the rt. upper lobe Which of the following is most likely to produce these findings? A) Hamartoma B) Adenocarcinoma C) Kaposi sarcoma D) Carcinoid tumor E) Sarcoid |
A) Hamartoma
B) Adenocarcinoma- peripheral, not central C) Kaposi sarcoma D) Carcinoid tumor*** well differnetiated, neuroendocrine E) Sarcoid |
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what are the neuroendocrine cancers of the lung
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1. small cell
2. bronchial carcinoids 3. tumorlets |
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A 14 y/o boy presented with signs and
symptoms y p of pneumonia with hemoptysis. Bronchoscopy was performed and an endobronchial lesion observed that bled extensively when biopsied. Following diagnosis of bronchial carcinoid, a lobectomy was performed. An obstructing carcinoid tumor was noted that invaded the adjacent hilar lymph nodes. |
Bronchial Carcinoid
*yong pts *non smokers *serotonin is secreted in carcinoid syndrome *adjacent LN means N3 **collar button leision that depressed the mocosa |
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tell me about bronchial carcinoid
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young
can be non smoker mets (good survival but can mets) serotonin collar button leision- depression of mucosa (uniform cells) |
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ok so we know lung Ca mets to bone, brain, liver and adrenal. do 1 tumors mets to lung
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YES common
carcinomas, sarcomas |
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pneumothorax
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air in pleural cavity, can be spontaneous (tall skinny) or result of truama. ruptured emphysema bulla
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tension pneumothroax
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BAD news gets worse with breath
**perforation forms flap valve, increases with breathm mediasteinal compression |
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wht will the PE for pneumothorax be
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No breath sounds UL
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what tumors involve the pleura
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1. spread from breast ca/lung
2. spread from LN **dx with exudative effision with malignant cells |
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what is a pleura plaque, when do we get them
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benign
asbestos |
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an exudative effision with malignant cells is what
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secondary pleural tumor
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what is a solitary fibrous tumor
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benign mesothelioma
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This 71 y/o male presented with
shortness of breath. Chest x‐ray showed a large pleural effusion. Thoracentesis was performed with relief of symptoms. 2200cc of serosanguinous fluid was obtained. Lab of the effusion: protein 4.2 gm/dL glucose 82 ( serum range 70‐110mg/dL) LDH 443 U/L (serum range < 220U/L) Differential of effusion: 34,500 RBCs, 1500 WBCs 48% lymphs, 48% mononuclear cells, 12 % polys. Patient arrived at the ER 2 weeks later in acute respiratory distress with hypoxia Thoracentesis was repeated with some relief. Past history: he had worked in the family business all of his life as a plumber. He had a 50 pack year history of smoking. One sister had mesothelioma. He was taken to surgery for biopsy via videoscope that demonstrated diffuse pleural studding by neoplasm. Frozen section was invasive malignancy. Talc pleurodesis was performed. Final diagnosis was mesothelioma, biphasic type. |
lots of protein, exudate
mesothelioma, asbestos related sarcomatoid patern spindle cells |
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is mesothelioma related to smoking
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nope, asbestos (like years after exposure)
encases the ling, inoperable asbestos body (ferrugrusion) |
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if you have a cancer that grows around the lung and encases it what is the cancer
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mesothleioma
biphasic: sarcomatoid and edenamcarcinoma can be epitheloid or biphasic |
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what is biphasic mesothelioma
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Sarcomatoid and
glandular cells both stain with calretinin |
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A 65 y/o man worked in a shipyard for 10 yrs.
then worked for a company installing fireretardant insulation for the next 5 yrs. He experienced increasing dyspnea for several yrs. and died with hypoxemia. At autopsy, a firm, tan mass encased the left lung. Within the lung adjacent to the mass, many ferruginous bodies were identified microscopically. Which of the following findings is most likely to have been seen on a chest radiograph before his death? A) Bilateral fluffy infiltrates B) Bilateral upper lobe cavitation C) Diaphragmatic pleural calcified plaques D) Left main bronchus, 1.5 cm endobronchial mass E) Right middle lobe bronchial dilation |
plaques
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