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64 Cards in this Set
- Front
- Back
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of what type are the lung tumors?
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90% carcinomas
5% bronchial carcinoids rest are mesenchymal and other miscellanous neoplasms |
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what is the incidence of lung cancer?
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Switzerland
M 60/100'000 F 23/100'000 |
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at what age is the peak of lung cancer?
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50-70 years
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what percentage of lung cancer occurs before age 40?
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2%
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what is the relative risk of a smoker to get lung cancer?
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10:1, 20:1 when >40 cigarettes per day
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what are other carcinomas associated with smoking?
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lip, tongue, floor of mouth, pharynx, larynx, esophagus, bladder, pancreas, kidney
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what are carcinogens in tobacco smoke?
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benzopyrene (initiator) and phenol derivatives (promoters)
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what are other risk factors for lung cancer other than smoking?
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radiation exposure, asbestos (5:1 for nonsmokers, 50:1 for smokers!)
exposure to nickel, chromate, iron, beryllium |
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what are the two broad classifications of lung cancer?
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80% NSCLC
20% SCLC |
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what percentage of NSCLC and SCLC are metastatic at diagnosis?
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50% of NSCLC
20% of SCLC |
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what is the spreading pattern of lung cancer?
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along bronchus proximally and distally, into lung parenchyma to mediastinum or pleura, causing pleural seeding and effusion and involvement of diaphragm and chest wall
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what are common sites of metastasis in lung cancer?
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for obscure reasons adrenal metastasis in more than half the cases, other common sites are liver (40%), brain (20%), bone (20%)
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what are favourable subtypes of lung cancer?
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non-mucinous bronchioloalveolar carcinoma and well differentiated squamous cell carcinoma
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what are gross characteristic of lung cancer?
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arise near hilus; hemorrhage, necrosis and cavities are common, up to 5% are multiple
peripheral tumors are usually adenocarcinomas |
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what are the dominant oncogenes found in lung cancer?
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c-MYC (small cell carcinoma), KRAS (adenocarcinoma, less often in nonsmokers), EGFR (adenocarcinoma), c-MET and c-KIT
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what types of cancer other than lung cancer show Kras mutations?
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leukemias, colon cancer, pancreatic cancer
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what are the suppressor genes affected in lung cancer?
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p53, RB1, p16, multiple loci on chromosome 3p
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what are the major categories of lung cancer?
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adenocarcinoma 40%
squamous cell carcinoma 30% small cell carcinoma 15% large cell carcinoma 15% |
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what are characteristic growth patterns for adenocarcinoma compared to squamous cell carcinoma?
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adenocarcinomas grow more slowly than squamous cell carcinoma but tend to metastasize widely and earlier
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what are NSCLC?
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adenocarcinoma
squamous cell carcinoma large cell carcinoma |
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what are oncogenes found in adenocarcinoma of the lung?
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KRAS, EGFR
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what is an uncommon, but distinct subtype of adenocarcinoma of the lung?
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bronchioloalveolar carcinoma
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what ist the gross apearance of pure bronchioloalveolar carcinoma?
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occurs in the peripheral portions of the lung parenchyma, often as multiple diffuse nodules, sometimes producing a pneumonia-like consolidation
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of what colour are the parenchymal nodules seen in bronchioloalveolar carcinoma?
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gray translucent with mucin production otherwise solid, gray-white areas that can be confused with pneumonia on gross inspection
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what is the key feature of bronchioloalveolar carcinoma?
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growth along preexisting structures without destruction of alveolar architecture
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what are the two subtypes of bronchioloalveolar carcinoma?
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mucinous and non-mucinous
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what is the difference between mucinous and nonmucinous bronchioloalveolar carcinoma?
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mucinous bronchioloalveolar carcinomas tend to spread aerogenously with formation of microsatellites
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what is thought to be the precursor lesion of adenocarcinoma of the lung?
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atypical adenomatous hyperplasia
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what are the epidemiological features of adenocarcinoma of the lung?
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more often in women, less frequently associated with a history of smoking, but still greater than 75% are found in smokers!
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what tissue do adenocarcinomas of the lung arise from?
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terminal bronchioles
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what are growth patterns of adenocarcinoma of the lung?
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acinar
papillary bronchioloalveolar solid with mucin formation in single cells |
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what are gross features of adenocarcinoma?
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80% involve visceral pleura producing pleural retraction
is often associated with peripheral scar or honeycombing |
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what are features of peripheral and central portions of adenocarcinoma fo the lung?
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peripheral portions with minimal atypia, central portion have marked atypia
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what are the epidemiological features of squamous cell carcinoma of the lung?
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most commonly found in men, closely related with a smoking history
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what are mutations commonly found in squamous cell carcinoma of the lung?
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show the highest frequency of p53 mutations
overexpression of EGFR is detected in most p16 kinase inhibitor inactivation |
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what are microscopic features of small cell carcinoma?
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epithelial cells with scant cytoplasm, ill-defined borders and filey granular nucelear chromatin (salt and pepper pattern)
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what is a frequent finding of vessels in small cell carcinoma?
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Azzopardi effect with basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells
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what percentage of small cell carcinoma occur in nonsmokers?
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1%
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what are immunohistochemical findings in small cell carcinoma?
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BCL2, anti-apoptotic protein
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what are common tumor suppressor gene mutations in small cell carcinoma?
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p53 and RB1
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what are the microscopic features of large cell carcinoma?
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undifferentiated malignant epithelial tumor lacking cytologic features of small cell carcinoma or squamous or glandular differentiation
probably represent squamous cell carcinomas or adenocarcinomas so undifferentiated they can no longer be recognized by ligh microscopy! |
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what cells is small cell carcinoma derived from?
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probably primitive cells of basal bronchial epithelium with partial differentiation towards neuroendocrine cells
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what is an important feature of pleural effusion in squamous cell carcinoma?
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cytology does not contain tumor cells!
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what are pulmonary pathologies secondary to lung cancer?
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partial obstruction of bronchi can cause obstruction and focal emphysema, total obstruction can cause atelectasis
impaired drainage is a common cause for infection with ulcerative bronchitis and bronchiectasis and formation of pulmonary abscesses |
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what are local extrapulmonary pathologies secondary to lung cancer?
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superior vena cava syndrome with venous congestion and edema of the head and arm
pericarditis or pleuritis by extension to pleural or pericardial sac |
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what is the T staging system for lung cancer?
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T1 < 3cm and localized
T2 > 3cm or main stem bronchus or visceral pleural involvement or local atelectasis T3 > 7cm or local extrapulmonary involvement, ie mediastinal pleura, pericardium, extensive atelectasis T4 local invasion or separate tumor in different ipsilateral lobe |
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what is the N staging system for lung cancer?
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N0 no regional lympho node involvement
N1 peribronchial or hilar nodal involvement N2 subcarinal or mediastinal nodal involvement N3 contralateral or supraclavicular nodal involvement |
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what is the M staging system for lung cancer?
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M0 no distant metastasis
M1a contralateral lobe, or pleural effusion or pleural nodules M1b distant metastasis |
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what is the stage grouping for lung cancer?
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T1 --> stage Ia
+N1 --> IIa T2 --> stage Ib +N1 --> IIb T3 --> stage IIb T4 --> stage IIIb M1 --> stage IV N2 --> at least stage IIIa N3 --> stage IIIb |
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which lung cancer is particularly sensitive to radiotherapy?
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small cell carcinoma
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what are epidemiologic features of carcinoid tumors of the lung?
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most are younger than 40 years of age, in contrast to bronchogenic tumors with most patients being >40 years
not related to smoking |
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what is the M:F ratio for carcinoid tumors of the lung?
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1:1
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what is the subclassification for carcinoid tumors of the lung?
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typical and atypical
typical carcinoids have no p53 (tumor suppressor) mutation or BCL2 (anti-apoptotic) or BAX (pro-apoptotic) expression abnormalities |
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what are neoplasms of neuroendocrine cells in the lung
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carcinoids as low-grade malignant epithelial neoplasm
aggressive small cell carcinoma and large cell neuroendocrine carcinoma of the lung |
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what is a genetic predisposing syndrome for carcinoid tumors of the lung?
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multiple endocrine neoplasia type 1 (MEN)
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what percentage of lung tumors are carcinoid tumors of the lung?
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<5%
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what is the location of carcinoid tumors of the lung?
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central as endobronchial poylps covered by intact mucosa in major bronchi
or peripheral as solid nodules |
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what are the gross features of carcinoid tumors of the lung?
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well defined without necrosis
pink to ivory cut surface |
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what are the microscopic feature of carcinoid tumors of the lung?
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delicate fibrovascular stroma
cells are quite regular with unifomr round nuclei and eosinophilic cytoplasm |
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what are microscopic differentiating features between typical and atypical carcinoid tumors of the lung?
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typical carcinoids have < 2 mitoses and no necroses
atypical carcinoids have 2-10 mitoses and/or necrosis |
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what are markers for carcinoid tumors of the lung?
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synaptophysin and chromogranin A as neuroendocrine markers
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what is a relatively common benign neoplasm of the lung
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hamartoma, usually incidental finding on chest xray as coin lesion
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what is a hamartoma?
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nodule of connective tissue
connective tissue is most often cartilage, others are cellular fibrous tissue and fat |
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what is a disorder in which the macroscopic finding can be mistaken for a tumor?
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Wegener's granulomatosis
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