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79 Cards in this Set
- Front
- Back
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benign histologic with encapsulation have normal cartilage everything is normal (it is contained within a nodule)
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hamartoma
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•not a teratoma
•A malformation that may be classified as a true tumor, that typically occurs in adults. |
Pulmonary Hamartoma
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• The cause of about 10% of “coin lesions” discovered
incidentally on chest X-ray. • Grossly they appear as solitary, circumscribed lobulated masses with a white or gray cartilaginous cut surface, averaging about 2 cm in diameter. |
Pulmonary Hamartoma
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• The tumor consists of elements usually present in the lung, including cartilage, connective tissue, fat, bone, and occasionally smooth muscle, all interspersed with clefts lined by respiratory epithelium
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Pulmonary Hamartoma
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• The tumor is benign and well-circumscribed and shells out from the surrounding tissue.
• Most occur peripherally and about 10% are in a central endobronchial location. |
Pulmonary Hamartoma
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• The most common cause of cancer deaths worldwide, including the United States.
• In the U.S., it is the most common cause of cancer deaths in both men and women. • (breast: distant #2 in women) |
Carcinoma of the Lung
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the bastard "takes no prisoners"
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small cell
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•About ___% of lung cancers are a consequence of cigarette smoking, and all histologic types are associated with smoking, but the strongest association is with Squamous Cell and Small Cell Carcinomas.
•The peak age of lung cancer is between 60 and 70 yrs. of age. •There is a male predominance, but the male to female ratio is decreasing, owing to the increase in smoking among women. |
85%
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• Approx. __________ people will die of lung cancer each year in the U.S.
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150,000
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• The nonsmoker who develops cancer of the lung usually has an
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adenocarcinoma
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• Various chemicals in tobacco smoke probably act as the primary carcinogens,
-the most important of these are the Polycyclic Hydrocarbons. (_____________ is most potent) -In tissue culture, these chemicals can initiate and promote malignant transformation of normal cells. It is assumed that the exposure to these carcinogens in smoke initiates malignant transformation of bronchial cells and promotes their progression into invasive cancer. |
3,4 benze -pyrene
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• Mutations in the K-ras _________ are found in:
25% of Adenocarcinomas, 20% of Large Cell Carcinomas, and 5% of Squamous Cells, and -this oncogene mutation is correlated with cigarette smoking and a poorer prognosis in patients with adenocarcinomas. |
oncogenes
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Carcinoma of the Lung-Etiology
• This probably involves: -the direct action of carcinogens on cellular ___, -the activation of ________, or -mutations and inhibition of _____ suppressor genes. |
DNA
oncogenes tumor |
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• Myconcogene overexpression occurs in 10-40% of _______ Carcinomas.
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small cell
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what are two tumor Suppressor Genes in Lung Cancer:
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p53
retinoblastoma gene (Rb) also: deletions of short arm of chromosome 3 (3p) frequently found in all types of lung cancers |
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• Mutations in the ___ gene are found in more than:
80% of Small Cell Carcinomas and 50% of Non-Small Cell Carcinomas. |
p53
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•_____________ gene (Rb) mutations occur in more than:
80% of Small Cell Carcinomas and 25% of Non-Small Cell Carcinomas. |
retinoblastoma
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• Histologic studies of respiratory epithelia in smokers indicate that most cases of bronchial cancer is associated with _________ lesions.
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preneoplastic
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• The sequence of events:
begins as a metaplasia of the bronchial epithelium, a benign, reactive lesion characterized by a transformation of normal, pseudostratified columnar epithelium into a ______________ epithelium, and initially, is a reversible lesion. |
stratified squamous
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• If the smoking is discontinued, the lesions will disappear and the normal structure of the bronchial epithelium will be restored.
• 1) If the carcinogenic stimuli persists, metaplasia will progress to a carcinoma in-situ (dysplasia), -and this will give rise to an invasive ___________ carcinoma (anaplasia). |
Squamous Cell
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• 2) If the transformation of deeper, stem cells progress and become anaplastic, the tumor will be histologically classified as an “________________”, because these cells became anaplastic before differentiation.
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Undifferentiated Large-Cell Carcinoma
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• 3) The malignant transformation can also involve the neuroendocrine cells, which are normally present in the bronchial mucosa. (produce local hormones)
-These tumors of neuroendocrine cells are called “____________” |
Small or Oat-Cell Carcinomas
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• 4) Some bronchial tumors will be composed of ciliated and mucous cells, resembling the normal cells in the bronchus.
-These cells tend to form irregular glands and are classified as “____________”. |
Adenocarcinomas
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• Accounts for 30% of all invasive lung cancers in the U.S. (about equal with adenocarcinomas), and is always associated with cigarette smoking.
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Squamous Cell Carcinomas
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• Most arise in the central portion of the lung, although 10% can arise from the periphery.
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Squamous Cell Carcinomas
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•Grossly, the are firm, gray-white ulcerative masses which extend through the bronchial wall into the adjacent parenchyma.
•Characteristic: On cut section there is hemorrhage and necrosis. Central cavitation is frequent. |
Squamous Cell Carcinomas
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• The microscopic appearance is variable, depending on the histologic grading. Well differentiated tumors have keratin production (pearls) which consists of small round nests of eosinophilic aggregates of keratin surrounded by concentric layers of squamous cells.
• (Keratin = well differentiated) • (No keratin = poorly diffentiated) |
Squamous Cell Carcinomas
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features of ___________ tumors include intracellular bridges between the squamous cells and well formed but malignant nest and islands of squamous cells.
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well-differentiated
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_____________ tumors exhibit no keratinization and the tumor is difficult to determine if the tissue is squamous or some other cell type (undifferentiated).
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poorly-differentiated
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• Tumor cells may be readily found in the sputum and the diagnosis may be made by cytology from bronchial washings or bronchial brushings during bronchoscopy.
• Resection specimens of these tumors reveal carcinoma in-situ in only one-third of cases, whereas the rest reveal varying degrees of invasion. (very aggressive) |
Squamous Cell Carcinomas
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• Clinically, these tumors produce:
cough, dyspnea, hemoptysis, chest pain and possibly a pneumonia with pleural effusions |
Squamous Cell Carcinomas
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Most centrally located tumors may produce bronchial obstruction with pneumonia, persistent cough and hemoptysis if eroded into a vessel.
• Tends to metastasize to local lymph nodes and somewhat later so the life expectancy is a little better than the other cell types. (a little bit better prognosis) |
Squamous Cell Carcinomas
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• Accounts for about 30% of primary lung cancers, and tends to arise in the periphery of the lungs, and often associated with scars which can result in puckering of the pleural.
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Adenocarcinoma of the Lung
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• Slight association with smoking.
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Adenocarcinoma of the Lung
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• Appear as irregular masses, which on cut section appear gray-white in color, soft and glistening, depending on the amount of mucus production.
• Central tumors have endobronchial growth and tend to invade bronchial cartilage. |
Adenocarcinoma of the Lung
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• There are four different subtypes of Adenocarcinoma histologically:
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-acinar, (glands, "run of the mill")
-papillary, (finger-like projections) -solid with mucus formation, and -bronchioloalveolar, and commonly the tumor is a combination of any of these forms, and shows a cellular organization like that of bronchial glands. |
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• The neoplastic cells may resemble any level of the bronchial tree, from large bronchi mucosa to the smallest bronchiole epithelium.
• The most common histologic type is the acinar type, and when well-differentiated, form regular glandular structures, lined by neoplastic cuboidal cells, filled with mucus. |
Adenocarcinoma of the Lung
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• The papillary type has neoplastic cells resting on a fibrovascular connective tissue core.
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Adenocarcinoma of the Lung
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• Solid Adenocarcinomas with mucus production are usually (poorly or well) differentiated tumors.
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poorly
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• Mucus production occurs in only half of these, so the diagnosis may rest on the histologic pattern of the tumor as well as the presence of intracellular mucus with a PAS or Mucicarmine stain. (specific stain that stains mucus blue or red)
• Pt’s with tumor localized to the lung (Stage I), with surgical removal, have a 50-80% 5 yr. rate. |
Adenocarcinoma of the Lung
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• A distinctive subtype of adenocarcinoma that grows along preexisting alveolar walls.
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Bronchioloalveolar Carcinoma
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• Accounts for 1-5 % of all invasive lung tumors.
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Bronchioloalveolar Carcinoma
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• Copious mucin in the sputum is a distinctive sign of
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Bronchioloalveolar Carcinoma
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• Grossly, it may appear as:
-a single peripheral nodule or coin lesion (over 50% of cases), -multiple nodules or a -diffuse infiltrate indistinguishable from a lobar pneumonia. |
Bronchioloalveolar Carcinoma
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• Histologically, the tumor has two major patterns:
2/3 are nonmucinous, and the remaining 1/3 are mucinous tumors featuring increased amounts of goblet cells. |
Bronchioloalveolar Carcinoma
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• Patients with tumor limited to the lung (Stage I), detected as a solitary coin lesion have a good prognosis, whereas those who have multiple nodules or diffuse lung involvement are more likely to have a poorer outcome.
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Bronchioloalveolar Carcinoma
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• Previously called “oat cell carcinoma”.
• A highly malignant epithelial tumor that exhibits neuroendocrine features. |
Small Cell Carcinoma
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• Accounts for 20% of all lung cancers and is strongly associated with cigarette smoking.
• The male to female ratio is about 2:1. |
Small Cell Carcinoma
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• The tumor grows and metastasizes rapidly, and 70% of pt’s have advanced disease at diagnosis. (probably higher)
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Small Cell Carcinoma
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• A variety of Paraneoplastic Syndromes (it is neuroendocrine) are distinctive, including:
-Diabetes Insipidus, due to ADH production, -ectopic ACTH (corticotropin) or -Parathormone production. |
Small Cell Carcinoma
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• Usually appears as a perihilar (central) mass, frequently with extensive lymph node metastases
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Small Cell Carcinoma
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• On cut section, it is soft and white, but with extensive hemorrhage and necrosis.
• Histologically, they consist of sheets of small, round, oval or spindle-shaped cells. |
Small Cell Carcinoma
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• The tumor cells display scant cytoplasm with finely granular nuclear chromatin.
• By EM, many of the cells contain secretory neuroendocrine granules (large black nodules on EM) |
Small Cell Carcinoma
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• This type of lung cancer is the only tumor that is sensitive to radiotherapy.
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Small Cell Carcinoma
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• A diagnosis of exclusion in a poorly undifferentiated non-small cell carcinoma that does not show features of squamous or glandular differentiation.
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Large Cell Carcinoma
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• Accounts for 10% of all invasive lung cancers.
• The cells are large and irregular and exhibit ample cytoplasm. (arise from stem cells) • The nuclei frequently show prominent nucleoli and vesicular chromatin. • (negative keratin stain) |
Large Cell Carcinoma
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• (can be benign or malignant)(can produce some neuroendocrine features: flushing syndrome)
• Comprise a group of neuroendocrine neoplasms derived from the basal cells of the bronchial epithelium. • Resembles a small cell carcinoma. |
Carcinoid Tumor
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• About 2% of all primary lung tumors and usually not associated with smoking.
• The large majority are endocrinologically silent. • A small subset of cases is associated with an endocrinopathy, such as Cushing syndrome. (ACTH) • This type of Cushing syndrome is due to ectopic corticotropin production by tumor cells. |
Carcinoid Tumor
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• Pathologically, they may be found centrally, peripherally, or in the mid-portion of the lung.
• Central _________ tumors are found inside the bronchioles with a fleshy, polypoid mass that protrudes into the lumen. |
Carcinoid Tumor
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• These tumors average 3 cm in diameter.
• Histologically, the cells have uniform cytological features, consisting of: eosinophilic, finely granular cytoplasm with round, uniform nuclei, all in various patterns of growth, embedded in a vascular stroma. |
Carcinoid Tumor
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• Clinically, the vast majority are discovered because of a mass on CXR, and over half of these patients are asymptomatic.
• In symptomatic patients, the most common manifestations are hemoptysis and dyspnea. |
Carcinoid Tumor
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• There is a slight female predominance and the mean age of diagnosis is 55 years, but can occur at any age.
• Bronchial __________ are the most common lung tumor in childhood. • Pt’s have an excellent prognosis with a 90% 5 yr. survival after surgery. -Regional lymph node mets only occurs about 20% of the time. |
Carcinoid Tumor
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• Overall, lung cancer is a highly invasive tumor and it tends to metastasize early.
• Locally, these tumors extend into the mediastinum and often spreads into the pleural cavity. • At the time of diagnosis, more than ___% of patients already have metastasis that are grossly apparent and probably more have microscopic metastases that are clinically unapparent. |
70%
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• Carcinomas of the lung of all histological types metastasize most commonly to the regional lymph nodes,
-particularly the mediastinal and hilar lymph nodes. • The most frequent site of extranodal metastasis is the _________. • It is sometimes initially detected as metastatic disease: -with the brain, bone, and liver being the most common sites after the ______________. |
adrenal gland
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• Approx. ______% of patients with lung cancer have no obvious symptoms and the tumor is again discovered incidentally during routine CXR. (another coin lesion)
• Of those who are symptomatic, ______ will present with symptoms related to local effects of the tumor in the chest, like: -bronchial obstruction, -atelectasis, and -symptoms of lung infection. |
10 - 15%
1/3 |
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clinical features of lung cancer:
• Bronchial irritation results in coughing, wheezing, dyspnea, and hemoptysis (reported in about ___% of all patients). • Extension to the pleural surface is associated with effusion and progressive dyspnea secondary to lung compression. • Ingrowth of tumor into the mediastinal nerves causes _____ or _____ of muscles of the diaphragm or vocal cords. • Tumor may also extend into the esophagus causing dysphagia. |
30%
pain or paralysis |
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clinical features of lung cancer:
_____% will present with symptoms pertaining to distant metastasis: -liver metastasis will cause hepatomegaly, -brain metastasis causes neurologic symptoms, such as seizures. -Bone metastasis results in fractures and -adrenal metastasis causes destruction of the glands, causing Addison’s disease. |
1/3
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What amount of symptomatic pts will present with nonspecific systemic complaints, including:
-weight loss, -cachexia, -anorexia, -night sweats and -general malaise. |
1/3
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can produce polypeptide hormones, as previously described, causing Paraneoplastic Syndromes (PTH, ACTH, and ADH).
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small cell carcinoma
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• The main tools in the diagnosis are _______ for localization.
• A solitary, circumscribed nodule on CXR is of importance and may be the earliest indication of a bronchogenic carcinoma, along with follow-up CT or MRI. |
radiology
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• Bronchoscopy with a biopsy is the most successful technique in the diagnosis of _____________ carcinoma (centrally located).
• Fine needle aspiration with cytology of the tumor yields high results as far as diagnosis without invasive thoracic procedures. • Cytology of the sputum, along with bronchial washings and brushings, along with examination of the pleural fluid also plays a role in the diagnosis in centrally located tumors of the lungs. |
squamous cell
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• The mainstay of treatment includes a combination of Chemo, Radiation, and Surgery.
• The only tumors that usually can be cured are those that are clinically unapparent and discovered by chance on examination (usually means early evolution of the tumor). • Essentially, the vast majority are incurable, the overall 5 yr survival rate is _______%. |
10 - 15%
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mesothelioma
• A neoplasm of the mesothelial cells, is most common in the pleura, followed by __________. |
peritoneum
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• It affects 2000 persons/year in the U.S.
• 80% of patients have exposure to Asbestos. • The latency period between exposure and the appearance of the tumor is about 20-30 years. |
Malignant Mesothelioma
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• Grossly, encase and compresses the lung, extending into interlobar fissures. (Rind tumor)
• Invasion of the pulmonary parenchyma is generally limited to the periphery adjacent to the tumor, usually sparing the lymph nodes. |
Malignant Mesothelioma
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• Histologically, they exhibits a biphasic appearance with both:
epithelial and sarcomatous patterns. -There can be several variations of these two patterns, and immuno-histochemistry provides help with diagnosis. |
Malignant Mesothelioma
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• The average age of patients is 60 years. (biphasic pattern)(once dx, it moves quick and not much that can be done)
• Pt’s are first seen with a pleural effusion or a pleural mass, chest pain along with weight loss and malaise. • Tends to spread locally within the chest cavity, invading and compressing structures. (usually found w/pneumonia) • Mets can occur to the lung parenchyma, as well as to the liver, bones, peritoneum and adrenals. • Tx. is ineffective, and the prognosis is poor. |
Malignant Mesothelioma
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• The most common malignant tumor of the lung is :
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metastatic tumors
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•In one-third of all fatal cancers, pulmonary mets are evident at autopsy.
•Metastatic tumors to the lungs are usually multiple and radiographically these nodules, -if large enough, they are called “_________” metastasis. • The histologic appearance resembles that of the primary tumor, the usual sites being the pancreas or stomach, but can be from any place. |
cannon ball
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