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Pathology - S2B1 - 5 Lung Neoplasia


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T or F: Primary Lung Cancer is the most common cancer killer in both men and women
T or F: Incidence of lung cancer is declining in women but increasing in men
False: it is increasing in women but decreasing in men
What is the most common cause of Lung Cancer?
List 5 causes of Lung Cancer
1. Tobacco
2. Asbestos
3. Uranium mining (radon gas)
4. Ionizing radiation
5. Air pollution
What 3 things can Tumor obstruction of the airway cause
1. Pneumonia
2. Abscess
3. Lobar collapse
How does Lipid Pneumonia occur?

Tumor obstruction causes accumulation of cellular lipid in foamy macrophages distally to the obstruction
What 3 things does bloody pleural effusion suggest?


How can a Lung tumor cause Hoarseness and hiccups?
by invading and compressing the Recurrent Laryngeal Nerve
How can lung tumors cause Dysphagia?
Esophageal invasion
How can lung tumors cause Diaphragm paralysis?
Phrenic nerve invasion
How can lung tumors cause Rib destruction
by invading the chest wall

Describe the "Superior Vena Cava Syndrome"
Compression of the SVC resulting in:
-facial swelling
- dilation of veins of the head, neck, and upper extremities
What is Horner's Syndrome?
1. Ptosis = drooping upper eyelid

2. Miosis = constricted pupil

3. Anhidrosis = decreased sweating
How can lung tumors cause Horner's Syndrome?
Invading and compressing the Superior Cervical Ganglion
What are the 2 pathological classifications of malignant lung neoplasia?
Small cell carcinoma

Non-small cell carcinoma
-Squamous cell
-Large cell
Lung cancer that shows a high initial response to chemotherapy and why
Small cell carcinoma b/c it grows very fast
Which types of lung carcinomas are most closely related to smoking?
Squamous cell carcinoma

Small cell carcinoma
Which lung neoplasia is considered inoperable?
Small cell carcinoma
Where do most lung neoplasias tend to grow? What is the exception?
Centrally = in and about the hilus of the lung = Bronchogenic

What is the one lung cancer not necessarily associated with smoking?
What is the giveaway when looking at an H&E of Squamous cell carcinoma?
Keratin Pearl
What two lung neoplasms typically occur in a peripheral location in the lung?

Large cell carcinoma
What do Adenocarcinomas tend to secrete?
Lung neoplasm that develops on a site of prior pulmonary inflammation or injury (Scar carcinoma)
Adenocarcinoma (Bronchial-derived)
Lung neoplasm that arises from terminal bronchioles and spread along the alveolar walls as columnar tumor cells
Bronchiolo-alveolar carcinoma
What is the survival rate for Bronchiolo-alveolar carcinoma?
25% vs. 10% rate for 5 years
Lung neoplasm that looks like lobar pneumonia in CXR but does not resolve with antibiotic therapy
Bronchiolo-alveolar carcinoma
Lung neoplasia that probably represents undifferentiated Squamous cell carcinomas and adenocarcinomas
Large cell carcinoma
Lung neoplasm that occurs almost exclusively in smokers
Small cell (oat cell) carcinoma
What are most benign tumors in the lungs?
Hamartomas = neoplasm in an organ that is composed of tissue elements normally found at that site, but growing in a haphazard mass
Lung neoplasm that tends to cavitate

Squamous cell carcinoma

outgrows its blood supply
Lung neoplasm that arises from Neuroendocrine cells (Kulchitsky cells)
Small cell carcinoma
Lung tumor that may ectopically secrete PTH-related protein

What does it cause?
Squamous cell carcinoma

Lung tumor that may ectopically secrete ADH or ACTH
Small cell carcinoma
What is the 5-year survival for all histologic subtypes of Lung Neoplasms?
T or F: greater than 50% of malignant lung neoplasms involve the CNS at the time of diagnosis
What does ectopic ACTH syndrome cause?
Cushing Syndrome = weight gain, excessive sweating, etc
What does ectopic ADH cause?
Hyponatremia = fluid overload and decreased plasma concentration of sodium
Represent 1-5% of all lung tumors, and are often benign, neuroendocrine tumors
Bronchial carcinoids
What is the 5-year survival rate for Bronchial Carcinoid?
What can Bronchial Carcinoid cause?
Carcinoid syndrome
What is Carcinoid syndrome?
1. Skin flushing
2. Diarrhea
3. Cyanosis

*due to carcinoid tumor secreting Serotonin
**Liver metastasis must occur to produce the syndrome
What would ectopic Calcitonin secretion cause?

*Calcitonin = secreted by thyroid parafollicular cells in response to hypercalcemia = decreases bone resorption
Paraneoplastic syndrome: What is Eaton-Lambert syndrome caused by?
auto-ab's against neuronal calcium channels = muscle weakness
Paraneoplastic syndrome: What ectopic secretion would cause Gynecomastia?
Gonadotropins = LH and FSH
Where are Pancoasts tumors located? What do they cause?
Superior pulmonary sulcus = extreme apex of the lung

Horner's Syndrome due to compressing the Cervical sympathetic plexus
List the 2 main histological subtypes of neuroendocrine tumors of the lungs
1. Carcinoid

2. Small cell carcinoma of the lung
What does the Pancoast tumur invade?
T1 intercostal nerve and Superior Cervial ganglion, leading to T1 motor and sensory deficits
What is the major symptom of Pancoast tumor?
Horner syndrome
-Pupillary constriction
-ptosis of eyelid
What are the most common malignant lung tumors?
Metastatic from other sites
Where will 50% of primary lung tumors eventually metastasize to?
What are the most common sites of Metastasis of Lung Neoplasms?
1. Hilar Lymph nodes
2. Adrenal glands
3. Liver, brain, bone
T or F: non-small cell cancers have a better prognosis than small cell carninomas

What type of Brochogenic Carcinoma is this?
Squamous cell Carcinoma
-"Keratin pearl"

What type of Bronchogenic Carcinoma is this?
What tips you off?

It is located in the periphery

What type of Lung cancer is this?

What type of Lung Cancer is this?

What type of lung cancer is this?
Bronchiolo-alveolar carcinoma = tall columnar epithelial cells line the alveoli walls

What type of Lung Cancer is this?
Small cell carcinoma = "oat cell"

What type of Lung Cancer?
How do you know?
Large Cell Carcinoma

Large anaplastic cells without evidence of differentiation

What cancer is this?
How do you know?

Carcinomatous and Sarcomatous elements

What lung cancer is this?
How do you know?
Bronchial Carcinoid
Small, round, Uniform cells growing in nests

Lung Cancer seen here that can occur multifocally and can mimic pneumonic consolidation
Bronchiolo-alveolar Carcinoma

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