Path: Pulmonary Tumors I & II

lung adenocarcinoma cytology

wedge

what type of specimen with a video-assisted thoracoscopic surgery (VATS)

malignant (spiculated)

benign or malignant?

benign

benign or malignant?

malignant (mets)

benign or malignant?

benign (diffuse)

benign or malignant?

malignant

lighting up on pet scan is benign or malignant?

benign (hamartoma)

benign or malignant?

pulmonary hamartoma

• mass of disorganized tissue indigenous to a particular site

• adults with peak in 6th decade

• circumscribed, usually peripheral

pulmonary hamartoma

buzzword: popcorn calcification on x-ray

pulmonary hamartoma

pulmonary hamartoma

lung

most common cause of cancer death worldwide in men and women

squamous and small cell carcinoma

what type of lung cancers are most associated with smoking?

field effect

approximately 10-20 genetic mutations have likely already occured by the time the lung tumor is clinically apparent

peripheral

central or peripheral: adenocarcinoma

central

central or peripheral: SCC

central

central or peripheral: small cell carcinoma

small cell carcinoma

• 90% smokers

• predominantly arise near hilum

• rapid growth rate (doubling just over a month)

• poor progn

small cell carcinoma

buzzword: paraneoplastic syndromes (ADH, ACTH, antibodies)

small cell carcinoma

buzzword: chromogranin A, synaptophysin, neuron specific enolase (NSE)

small cell carcinoma

• extensive necrosis and mitoses

• amplification of genes in MYC family

kulchitsky cells (NET)

what type of cells are neoplastic in small cell carcinoma

azzopardi effect

small cell carcinoma

small cell carcinoma

small cell carcinoma

lots of necrosis with azzopardi effect

carcinoid tumor

• low grade malignant neoplasm

• chromogranin A and synaptophysin +

• <2 mitoses/10HPF and no necrosis

carcinoid tumor

diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is a potential precursor lesion for?

carcinoid tumor

ribbon-like architecture, lots of pink cytoplasm

carcinoid tumor

bronchial epithelial injury → squamous metaplasia → squamous dysplasia → SCC in situ → invasive SCC

what is the sequence to SCC of the lung

SCC

SCC

SCC

• over 80% smokers

• central location

• obstructive pneumonitis, frequent cavitation (central necrosis)

• majority are resectable

SCC

buzzword: paraneoplastic syndrome of hypercalcemia due to secretion of parathormone related peptide (PTHRP)

adenocarcinoma in situ

lesion that is less than 3 cm and is composed entirely of dysplastic cells growing along preexisting alveolar septae

atypical adenomatous hyperplasia

precursor to adenocarcinoma in situ that is usually less than 0.5 cm

adenocarcinoma in situ

buzzword: lepidic growth pattern

adenocarcinoma in situ (mucinous)

adenocarcinoma in situ

adenocarcinoma

malignant epithelial tumor with glandular differentiation or mucin production

adenocarcinoma

buzzword: TTF1 +

adenocarcinoma

• most common in women

• less strongly associated with smoking

• vascular invasion, brain mets common

• often pleural involvement

adenocarcinoma

adenocarcinoma

adenocarcinoma

TTF1+ IHC

adenocarcinoma (mucinous)

adenocarcinoma

adenocarcinoma

buzzword: cytokeratin 7 +

SCC

buzzword: cytokeratin 5/6 +

SCC

buzzword: p40+

large cell carcinoma

undifferentiated carcinoma with no cytologic, architectural, or IHC features; dx of exclusion and requires thoroughly sampled resection

driver mutations

abnormalities that are essential for tumor-cell survival; inactivation results in cancer cell death

adenocarcinoma

EGFR and ALK mutations

adenocarcinoma (smokers)

KRAS mutations

1. age

2. pk year hx of smoking

what are high risk factors for lung tumors?

superior vena cava syndrome

obstruction of the SVC that impairs blood drainage from the head

pancoast tumor

apical lung cancers in which the tumor invades neural

pancoast tumor

buzzword: horner syndrome

1. miosis

2. anhidrosis

3. ptosis

4. endophthalmitis

what is horner syndrome (4)

pancoast tumor

phrenic nerve paralysis

dermatomyositis

paraneoplastic syndrome associated with small cell carcinoma causing inflammatory myopathy with progressive proximal muscle weakness

acanthosis nigricans

paraneoplastic syndrome associated with small cell carcinoma that secretes epidermal GF

acanthosis nigricans

hyperkeratosis and pigmentation of axilla, neck, flexures, and anogenital region

lambert-eaton syndrome

paraneoplastic syndrome associated with small cell carcinoma with disease of neuromuscular junction; proximal muscle weakness and does not respond to anti-cholinesterase therapy

cushing syndrome

ectopic production of ACTH causing hypokalemia, hyperglycemia, hypertension, and muscle weakness; associated with pulmonary small cell carcinoma and carcinoid tumors

syndrome of inappropriate antidiuretic hormone secretion (SIADH)

paraneoplastic syndrome associated with small cell carcinoma with ectopic production of ADH leading to sodium and water retention, altered mental status, seizures, coma, possible death;

hypercalcemia

paraneoplastic syndrome associated with SCC of the lung; production of PTHrP; TGF-alpha activates osteoclasts and active vitamin D

false

T/F: hypercalcemia from bone mets is a paraneoplastic syndrome