Lung Tumors

1. Tx for small cell carcinoma? 2. what tumors can sometimes use surgery?

1. chemotherapy & radiation 2. squamous and adenocarcinoma tend to remain localized linger

1. what hormone do carcinoid tumors have? 2. how old are most patients with carcinoid tumor?

1. serotonin 2. younger than 40

familial clustering associated w/ what gene?

CYP1A1

what is the precursor lesion for small cell carcinoma?

Doesn't have one!

most common mutation in nonsmokers?

EGFR mutation

T/F most bronchial carcinoids do not have secretory activity and do not metastasize to distant sites but instead follow relatively benign course

True bro true

KRAS mutation most common in?

adenocarcinoma

malignant epithelial tumor w/ glandular differentiation or mucin production?

adenocarcinoma

most common type of lung cancer in women & nonsmokers?

adenocarcinoma

what is most common form of lung cancer in women?

adenocarcinoma

what tumors have the majority positive for thyroid transcription factor-1 (TTF1)?

adenocarcinoma

mucin production?

adenocarcinoma bronchioloalveolar carcinoma is a type of adenocarcinoma

almost always occurs in peripheral portions of lung as single nodule or multiple diffuse nodules producing pneumonia-like consolidation

bronchioloalveolar carcinoma

clara cells seen in what tumor?

bronchioloalveolar carcinoma

collar button lesion?

carcinoid tumor

precursor lesion: diffuse idiopathic neuroendocrine cell hyperplasia

carcinoid tumor

trabecular growth pattern?

carcinoid tumor

location of squamous cell carcinoma?

central lung/hilar. can migrate out to periphery over time. now can be seen in apex

bronchioloalveolar carcinoma arises from what cells?

clara cells, type II pneumocytes, mucin-secreting bronchioloalveolar cells

superior vena cava syndrome

compression or invasion of superior vena cava causing venous congestion & edema of head, arm, & ultimately circulatory compromise

what is carcinoid syndrome?

diarrhea, flushing, cyanosis

proliferation of spindle shaped fibroblasts & myofibroblasts, lymphocytes, plasma cells in children

inflammatory myofibroblastic tumor anaplastic lymphoma kinase (ALK) on 2p23

mix of epitheloid & sarcomoid components?

mesothelioma

prognosis of mucinous vs. nonmucinous bronchioloalveolar carcinomas

mucinous tend to spread aerogenously forming satellite tumors thus are less likely to be cured by surgery. aerogenously spread WITHIN lungs nonmucinous have rare spread so can be surgically removed...excellent 5 yr survival

lung harmatoma

non-malignant tumor. composed of tissue elements normally found at that site, but which are growing in a disorganized mass usually found incidentally on xray as a rounded focus of radio-opacity (coin lesion) cartilage is most common tissue

what eventually happens to bronchioloalveolar carcinomas? do they metastasize?

noninvasive tumors that do not metastasize. uness they are resected they will cause death by suffocation

Lambert-Eaton Myasthenic Syndrome

paraneoplastic syndrome. Muscle weakness is caused by autoantibodies directed to the neuronal calcium channel more common in lower extremities, worse in morning

Acanthosis Nigricans

paraneoplastic syndrome. dermatologic abnormality, darker, thick, velvety skin in body folds and creases.

characteristic growth along preexisting structures w/o destruction of alveolar architecture. seen in what tumor & whats name of growth pattern?

seen in bronchioloalveolar carcinoma referred to as lepidic

hyponatremia, elevated ACTH, & elevated ADH associated with...

small cell carcinoma

EM shows dense core neurosecretory granules

small cell carcinoma most commonly associated with ectopic hormone production

characterized by precursor lesion- squamous cell metaplasia/ dyplasia giving rise to carcinoma in situ

squamous cell carcinoma

intracellular bridges and squamous pearls

squamous cell carcinoma

tumor w/ highest frequency of p53 mutation?

squamous cell carcinoma

what creates PTH like hormone causing hyercalcemia?

squamous cell carcinoma

what enzyme is elevated in 80% of lung tumor tissue?

telomerase

typical vs. atypical carcinoid tumors

typical- have no p53 mutations or BCL2, BAX expression abnormalities. Have fewer than 2 mitoses per ten high power field. Lacks necrosis. atypical- can have p53 mutations, & BCL2 or BAX expression abnormalities. Have b/w 2-10 mitoses per ten high power field

is necrosis common in small cell carcinoma?

yes! azzopardi effect- basophilic staining of vascular walls d/t encrustation by DNA from necrotic cells