20 - Malignant lung pathology

What are the primary malignant lung tumours?

- Small cell carcinoma (15-20%)

- Non-small cell carcinoma (80-85%)

How are malignant lung tumours classified?

Light microscopy

What are the further divisions of non-small cell carcinomas?

- Squamous cell carcinoma (20-30%)

- Adenocarcinoma (30-40%)

- Large cell undifferentiated carcinoma (10-15%)

What are the main differences between small cell carcinoma and non-small cell carcinoma?

- Nuclear and cytoplasm differences

- Almost all small cell carcinoma is related to cigarette smoking

What are the characteristics of squamous cell carcinoma of the lung?

Presence of keratinisation and or intercellular bridges

What is the main protein marker for adenocarcinoma?

P63

What are the characteristics of adenocarcinoma of the lung?

Mucin production and or gland formation

What are the clinical presentations of adenocarcinoma of the lung?

- Gynaecomastia

- Hypertrophic pulmonary osteoarthropathy (HPOA)

What is hypertrophic pulmonary osteoarthropathy (HPOA)?

Proliferative inflammation of the periosteum (surrounds bones) of long bones - very painful

What is the main protein marker for small cell carcinoma?

TTF1

What is the main characteristics of small cell carcinoma of the lung?

Typical morphology with specific protein markers: CD56, synpatophysin, chromogranin and TTF1

Which are more common, primary lung cancers or secondary lung cancers?

Secondary

What are the most common secondary lung tumours?

- Breast, GI tract, kidney

- Sarcomas

- Melanomas

- Lymphomas

What is the epidemiology of lung cancer?

- Most common cause of cancer death in UK

- M>F

- 40-70 years old

What is the aetiology of lung cancer?

- Cigarette smoking

- Occupational hazards: asbestos, uranium, arsenic, nickel

- Radiation

- Genetics: ECFR, KRAS, ALK, ROS1

What are the local symptoms of lung cancer?

- Haemoptysis

- Dyspnoea

- Chest pain

- Hoarseness

- Horner's syndrome

- Dysphagia

What are the clinical signs of lung cancer?

- Clubbing

- Cachexia

- Weight loss

- Endocrine effects

What are the common metastases for lung cancer?

- Lymph nodes

- Pleura

- Liver

- Bone

- Adrenal

- Brain

What are the symptoms of squamous cell lung carcinoma?

- PTH secretion causing hypercalcaemia

- Clubbing

- HPOA

- Hyperthyroidism