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70 Cards in this Set

  • Front
  • Back
Most common pulmonary neoplasm
mestastasis from breast
most common primary pulmonary neoplasm
carcinoma
mortality rate of lung cancer
52/100K?!
Percent of heavy smokers that develop lung cancer
10% [40 cigs/day]
percent of pts with lung cancers with smoking history
90%
Some factors that correlate with lung cancer
smoking, p53 mutation, radiation
Clinical presentation of lung cancer:
Cough
Weight loss
Chest pain
The two major classes of carcinomas:
small cell and non-small cell
Types of non-small cell carcinomas:
squamous, adenocarcinoma, bronchioalveolar carcinoma (to transition to adenocarc.), and large cell

SLAB
Which tpyes of lung cancer are found centrally?
Scentrally
Squamous cell
Small cell
Most common type of lung cancer and how it presents morphologically?
adenocarcinoma, occurs peripherally around prior sites of injury
What is lepidic?
scale-like spread assocaited wit adenocarcinoma
What genetic changes are associated with adenocarcinomas?
gain of Ch5p

also mutations of HER2/KRAS/EGFR
Morphology of bronchioalveolar carcinomas
peripheral, non-invasive, either mucinous or non-mucinous.
Non vs mucinous bronchioalveolar carcinomas
non - single, solitary;
mucinous - multiple nodules w pneumonia infiltrate
morphology of squamous cell carcinoma of lung?
centrally located and larger, associated with necrosis and cavitation
Genetic alterations associated with squamous cell carcinoma of lung?
loss of 3p and 9p
progression of squamous cell lung carcinoma:
metaplsia, dysplasia, carcinoma in situ,, invasive carcinoma
What is large cell carcinoma?
heterogenous leftover classification, includes neuroendocrine carcinomas
What are the types of neuroendocrine neoplasias of the lung?
large cell NE, small cell and carcinoid
Which neoplasia has the strongest association with smoking?
small cell carcinomas
Mutations in small cell carcinomas?
p53, RB1,

overexpression of BCL2 and low expression of BAX
Where are carcinoid tumors found?
centrally by corina or peripheral in nodules
Typical vs atypical carcinoid tumors of lung?
typical have less than 2 mitosis, no necrosis

atypical have 2-10 mitosis with necrosis
morphology of large cell neuroendocrine carcinoma
like carcinoid but larger, more necrosis, and more mitoses
Which two lung cancers have the poorest outcomes?
small cell, also large cell neuroendocrine
morphology of small cell carcinoma of lung
centrally located, small cells, high mitosis
Staging based upon what?
Tumor (1-4), Nodes 0-3, metastasis 0 or 1
Stace IV cancer
means METASTASIS dun dun dun
What do pancoast tumors cause?
horner's syndrome (tumor of pulmonary apex)
Most common paraneoplastic syndrome and what is it caused by?
hyperCa, caused by calcemic humoral substance, not osteolysis
paraneoplastic syndromes associated with small cell
Cushing's, SIADH, Lambert Eaton
Paraneoplastic syndromes associated iwth NSCLC
carcinoid, dermatologic, osteoarticular like clubbing
Who can and can't you use EGFR-TKI's?
can: asian adenocarcinoma nonsmokers

can't - smokers with KRAS mutation
Radiation therapy used for:
emergency situations and palliation for advanced local disease like SVC
Factors that make metastasis to lung :)
high CO, O2, molecular expression
Which lung pleura has nerves?
parietal
What adheres the two pleura togethers?
surface tension
What is considered pleural effusion?
>15ml of fluid
Types of pleural effusion:
transudate (increased hydrostatic P like in CHF)

exudate (>3 mg/dL protein and indicates vascular permability or decreased lymph drainage)
Pulmonary embolism causes which type of pleural effusion?
mostly exudative b/c of imflammatory response
Types of inflamammatory pleural effusions?
THESE ARE ALL PLEURITIS

exudative:
Serous/serofibrinous/fibrinous pleritis
Suppurative (from infeciton like TB or pnemonia
Hemorrhagic (blood from tumor)
Noninflammatory pleural effusions?
hydrothorax (blood filtrate)
hemothorax (ruputred vessel)
chylothorax (trauma, thoracic duct obstruction by tumor)
What is Meig's syndrome?
Meg is irresponsible:

benign ovarian fibroma from sexing, ascites from drinking, and hydrothorax from smoking
Main clinical presentation of pleural effusion?
PAIN
dyspnea
hemoptysis
cough
minimum fluid needed to cause effusion symptoms
600 cc
What neoplasm is also considered a disease of the pleural cavity?
mesothelioma
common cause of spontaneous pneumothorax
subpleral bleb rupture
What is seen in spontanous pneumothorax?
tracheal deviation to side of collaps
What is tension pneumothorax?
increasing air incavity because of a flaplike defect; result of resucitation

compression of medistinal structures to contralateral side
What does benign mesothelioma usually attack?
visceral pleura; no relation to asbestos!
benign mesothelioma morphology?
fibroblastic on visceral pleura, associated with hypoglycemia and pulmonary osteoarthropathy which regresses when tumor is resected.
Smoking and malignant mesothelioma?
no increased risk
Presentation of malignent meso?
chest pain, dyspnea, pleural effusions
What does EM show in mesotheliomas?
numerous long, slender microvilli (cs short plump microvilli in adenocarcinomas)
Mesotheliomas stain positive for what?
Cytokeratin, vimentin, calretinin, and negative for CEA
What mechanisms may cause atelectasis?
internal obstruction, external compression, or fibrosing contraction
Obstructive vs compressive atelectasis?
obstructive, mediastinum shifts TOWARD affected area;

compressive, the mediastinum shifts away from the tissue
Which atelectasis is irreversible?
Contraction atelectasis because of fibrosing
Example of thoracic space deformint that may be associated with hypoplastic lungs?
congenital diaphragmatic hernia
Most common TE fistula?
blind upper and fistula between lower segment and trachea
What are congenital lung cysts from?
abnormal detach ment of developing foregut in hilum or middle mediastinum
Most common lung cyst?
bronchogenic cysts with bronchial epithelium and mucous glands
Main complications of congeital cysts?
infection (causing abcess) and rupture, causing hemoptysys or pneumothorax
What are intralobar and extrapulmonary lobar sequestrations?
pieces of lobe without airways; can be within the lung under pleura or extralobar like in thorax
What problems may arise from lobar sequestrations?
none really, just associated with recurrent infections
SVC syndrome?
compression of SVC causing facial swelling, dysphagia, perhaps intercrainal pressure; considered an oncologic emergency
what is the distribution of mess lesions of the medastinum?
most are benign (50%-70%, around 30-50% malignant, and around 10% are secondary to inflammatory process.)
Acute mediastinitis?
posterior mediastina cute inflammation due to edophageal perforation
chronic mediastinitis?
a chronic fibrosing condition which may stimulate tumor and produce SVC symptoms, obstructions, compression of trachea...