14 - Vascular and Neoplastic Disorders

How does a pulmonary embolism compromise the RS and CVS?

RS: A gas exchange failure via V/Q mismatch because blood can’t get to the alveoli

CVS: Backup of blood from the lungs to the right-sided heart which can cause right sided heart failure and lead to inadequate blood reaching the left side

Most common cause of pulmonary embolism

Deep vein thrombosis

What color will an infarct of lung tissue be, and where is this most common?

Red, aka a “red infarct”, most commonly seen at the ชายปอด, or the periphery of the lung

Saddle embolus

Blocks the bifurcation of both pulmonary arteries, but not always lethal because it depends on the degree of obstruction

The majority of PE cases are ___

Asymptomatic

Nasopharyngeal carcinoma types

1. Keratinizing squamous cell carcinoma

2. Non-keratinizing squamous cell carcinomas(Differentiated and non-differentiated)

3. Basaloid squamous cell carcinomas(Most rare)

3 main associations with nasopharyngeal carcinomas

1. EBV

2. Southeast asia

3. Nitrosamines

Keratinizing vs nonkeratinizing nasopharyngeal carcinoma differences

1. Keratinizing type is weakly associated w EBV and responds poorly to radiotherapy

2. Nonkeratinizing type is strongly associated with EBV and respond well to radiotherapy(But the undifferentiated type is more common)

How do we often discover a nasopharyngeal carcinoma?

• Lymphadenopathy, specifically posterior cervical chain

• Nasal obstruction/discharge, epistaxis, otitis media/hearing loss

Laryngeal neoplasm symptoms

• Hoarseness(If vocal cords affected)

• Stridor(Signals significant growth)

• Dysphagia/odynophagia

• Cervical lymphadenopathy/weight loss(If malignant)

Main types of laryngeal neoplasms

1. Squamous papilloma

2. Squamous cell carcinoma

Laryngeal squamous papilloma

• Meaning

• Cause

• What do we call it when there are multiple?

• Benign neoplasm of squamous cells that forms finger-like projections(raspberry/cauli-flower like)

• HPV types 6 and 11

• Papillomatosis

Laryngeal squamous cell carcinoma

• Meaning

• Cause

• Malignant tumor arising from epithelial cells

• Smoking

Main cause of lung cancers

Smoking

Lung cancer classification

1. Non-small cell lung carcinoma(NSCLC): Adenocarcinoma(malignant tumor of glandular epithelial cell origin) and squamous cell carcinoma(malignant tumor of squamous epithelial cells)

2. Small cell lung carcinoma(SCLC): From neuroendocrine cells

Adenocarcinoma demographic key points

Associated with smoking but also the most common subtype in non-smokers

Small cell lung carcinoma demographic key points

Virtually always smoking related

Mutations we typically see in lung adenocarcinoma patients

• Smokers

• Never-smokers

• KRAS + p16 & p53 mutations

• EGFR mutation

Lung cancer in never-smokers

• Most common type

• Most common demographic

• Treatment

• Adenocarcinoma

• Asian women

• Targetable oncogenic alterations like EGFR

Lung adenocarcinoma subtypes

1. Non-mucinous: Most common, TTF-1 positive(IHC marker)

2. Mucinous: 3-5%, resembles goblet cells, TTF-1 negative, associated w KRAS mutations

What condition can invasive mucinous adenocarcinoma look like?

Pneumonia, metastasis of cancers from places like intestines

Is mucinous or non-mucinous adenocarcinooma more dangerous?

Mucinous

Where in the lung are adenocarcinomas and squamous cell carcinomas typically located?

Peripherally vs centrally

SCLC

• Stands for

• Origin

• Mechanism/behavior

• Markers

• Staging

• Small cell lung carcinoma

• Neuroendocrine cells of the lung

• Aggressive and metastasis happens early

• Synaptophysin, chromogranin A

• Limited(Tumor on one side, and spread only to lymphs w/in the lung’s system on that side) vs extensive

Primary mesothelioma

• Origin cell

• Risk factor

• Symptoms

• Mesothelium

• Asbestos exposure(But often arises 20-40 years after)

• Pleural effusion, unilateral chest pain, dyspnea

Secondary mesothelioma

• Origin cell

• Risk factor

• Symptoms

• Metastasis

• Lung and breast cancer

• Pleural effusion, unilateral chest pain, dyspnea

Diagnostic pathway for pleural CA

1. Suspected pleural effusion

2. Thoracentesis: Needle to draw sample/relieve symptoms

3. Cytology: Looking for malignant cells