LECOM Path Ch 15 Lung

Question Answer
Cell that secretes surfactant type II pneumocyte
Bronchioles lack this vs Bronchi cartilage and submucosal glands
Resorption atelectasis is caused by blocked airpassage
Mediastinum shifts ____ resorption atelectasis towards
Mediastinum shifts ____ compression atelectasis away from
Only non-reversable atelectasis Contractive
2 causes of pulmonary edema hemodynamic and microvacsular injury
Heavy, wet lungs, engorged alveolar capillaries, hemosiderin laden macrophages in alveoli Dx and most common cause increased hydrostatic pressure and L sided heart failure
ALI or ARDS also called Non-cardiogenic pulmonary edema
Histological hallmark of ARDS diffuse alveolar damage
Finding in ARDS after DAD alveolar hyaline membranes
This cell proliferates during resolution of ARDS type II pneumocyte
Presence of these 2 factors implicate endolethium damage in ARDS endothelin and von Willebrand factor
4 signs implicating epithelial damage in ARDS blebing, frank necrosis, swelling, vacuolization
Cell implicated in damaging lungs in ARDS neutrophil
4 common causes of ARDS sepsis, diffuse pulmonary Infx, Gastric aspiration, trauma
What do type II pneumocytes give rise to, to re-line the epithelium type I cells
X-ray finding in ARDS diffuse bilateral infiltrates
Acid-base status in ARDS respiratory acidosis
Idiopathic rapidly progressive widespread ALI Name? Age? Acute Interstitial Pneumonia 50yo
Increase in resistance to airflow due to partial or complete obstruction Dx? Restrictive airway disease
Reduced explansion of lung parenchyma and decreased total lung capacity restrictive disease
4 prototypical obstructive pulmonary diseases emphysema, chronic bronchitis, asthma, bronchiectasis
Grouped to make COPD emphysema and chronic bronchitis
Most causative agent of COPD cigarette smoking in 90% of Pts but only 10% of smokers develop COPD
Restrictive Lung Disease: Total lung capacity decreased
Restrictive Lung Disease: Residual volume decreased
Restrictive Lung Disease: FEV1 sec decreased
Restrictive Lung Disease: FVC decreased
Restrictive Lung Disease: FEV1sec/FVC normal to increased
Restrictive Lung Disease: PaO2 decreased
Restrictive Lung Disease: A-a gradient increased
Obstructive Lung Disease: FEV1sec decreased
Obstructive Lung Disease: FVC decreased
Obstructive Lung Disease: FEV1sec/FVC decreased
Obstructive Lung Disease: PaO2 decreased
Obstructive Lung Disease: A-a gradient increased
Obstructive Lung Disease: Residual Volume increased
Obstructive Lung Disease: Total lung capacity increased
Irreversible enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of their walls WITHOUT obvious fibrosis emphysema
3 associations with emphysema cigarette smoking, women, blacks
MC type of emphysema Centriacinar 95%
Central or proximal parts of acini affected, sparing distal alveoli Dx centriacinar emphysema
Anatomical location most affected in centriacinar emphysema upper lobe/apical
Walls of centriacinar type emphysema contain ? black pigment
Uniformly enlarged acini from respiratory bronchiole to terminal aalveoli Panacinar emphysema
Anatomical location most affected in panacinar emphysema lower anterior / bases
Panacinar emphysema associated with: ?1-antitrypsin deficiency
Centriacinar emphysema is associated with: heavy smoking
Anatomical location most affected in Paraseptal /distal acinar emphysema upper half/ along the plura
Associated with paraseptal/distal acinar emphysema: spontaneous pneumothorax
Anatomical with irregular emphysema: scarring
Location of ?1-antitrypsin gene Chromosome 14 Pi loci
Hypothesis of pathogenesis of emphysema too much neutrophil/protease too little ?1-antitrypsin
3 early finding of emphysema Increase (SIG) smooth muscle, inflammatory cells, Goblet cells
3 most common causes of death from emphysema respiratory acidosis/coma; right sided heart failure: massive collapse of lungs from pneumothorax
Thin, tripoding Pt, with increased AP diameter, dyspneic, breathing through pursed lips Dx and name emphysema; pink puffer
Emphysema can lead to this cascade w/ poor prognosis cor pulmonale then congestive heart failure from pulmonary HTN
2 collateral routes for filling from behind an obstruction pores of Kohn, and canals of Lambert
Large apical subplural blebs larger than 1cm Dx Bullus Emphysema
Filling of stroma/mediastinum /subcutaneous tissue with air from torn alveoli Dx? interstitial emphysema
Persistent cough w/ sputum x 3 months in at least 2 years, without other cause Chronic bronchitis
Earliest feature of Chronic bronchitis hypersecretion of mucus in lare airways w/ hypertrophy of submucosal glands in trachea and bronchi
Physiologic cause of early chronic bronchitis Sxs hypersecretion/obstruction in small airways
Reid index; describe ratio of thickness of mucus gland layer to thickness of wall between epithelium and cartilage
Normal Reid index and increased or decreased in chronic bronchitis 0.4; increased in chronic bronchitis
Lymphocytes in airways, enlargement of mucus glands in trachea and bronci Dx Chronic bronchitis
Heavyset smoker Pt, Hypercapnia, hypoxia, mild cyanosis Dx and name chronic bronchitis; Blue Bloater
Age of onset: Bronchitis ; Emphysema Bronchitis: 40-45 Emphy.: 50-75
Cough: Bronchitis ; Emphysema Bronchitis: Early-lots of sputum Emphy.: late- little sputum
Infections Bronchitis ; Emphysema Bronchitis: Common Emphy.: Occasional
Respiratory Insufficiency in : Bronchitis ; Emphysema Bronchitis: Repeated Emphy.: Terminal
Cor Pulmonale in : Bronchitis ; Emphysema Bronchitis: Common Emphy.: Rare, terminal
Radiograph findings: Bronchitis ; Emphysema Bronchitis: prominent vessels and big heart Emphy.: hyperinflation and small heart
MC type of asthma and type of hypersensitivity reaction Atopic Asthma; Type I IgE-mediated
Pt with negative RAST, respiratory distress common with viral Infx Non-Atopic Asthma
Child, chronic rhinitis, and nasal polyps, respiratory distress and urticarial. What was the Pt given? Asprin
Cell implicated in atopic asthma as being hypersensitive and cytokines produced by them TH2; IL-4, IL-5, IL-13
2 difinitive mediators of acute asthma leukotrienes CDE and acetylcholine
Chromosome and gene linked to asthma Chromosome 5q; IL13 genes
BUZZ: Curshman spirals Dx and what are they asthma, spiral mucus plug with shed epithelial cells
Lungs with numerous eosinophils with Charcot-Leyden crystals Dx and what are they Asthma, granules collect to form galectin-10 crystals
5 characteristics of asthmatic “airway remodeling” – thickening of wall – deposition of collage I and III under BM collagen IV- increased vascularity – hyper-plasia –trophic mucus glands and bronchial smooth muscle
2 bugs mostly found in children w. bronchiectasis H. flu, and Pseudomonas Aeruginosa
Irreversible dilation of bronchi and bronchioles bronchiectasis
4 usual bacteria causing bronchiectasis mycobacterium tuberculosis, Staph aureus, H. flu, Pseudomonas
3 viruses causing bronchiectasis adenovirus, influenza, HIV
Fungi causing bronchiectasis Aspergillus
Most common underlying cause of bronchiectasis in USA cystic fibrosis
Kartagener Syndrome cause and 3 associations missing/short dynein arm in cilia; bronchiectasis, sinusitis, situs inversus
Most common area affected by bronchiectasis lower lobes
X-ray: browded bronchial markings extending to periphery Dx? bronchiectasis
Severe, persistent cough in a CF Pt, copious bloody foul smelling sputum Dx bronchiectasis
Growth factor that is implicated as the “driving factor” in IPF and cell that releases it TGF-?1; type I pneumocyte
Cobblestoned pleural surface of lung, lower lobe predominant fibrosis in subpleural regions and interlobular septa IPF
Patchy interstitial fibrosis of different age, with fibroblastic foci IPF
Dense fibrosis forming cystic spaces lined by hyperplastic Type II pneumocytes. BUZZ? honeycomb fibrosis; IPF
Chronic interstitial inflammation, large amount of lymphocytes in uniform or patchy distribution NSIP cellular pattern
Diffuse or patchy interstitial fibrosis without honeycombing, fibroblastic foci, or temporal heterogeneity NSIP fibrosing pattern
Pt: Cough, dyspnea X-ray: peribronchial patchy airspace consolidation Micro: polypoid plugs of loose connective tissue in alveolar ducts Dx? And BUZZ? Cryptogenic Organizing Pneumonia and Masson Bodies
Effects of this inhaled substance are significantly increased by contaminant tobacco smoking asbestos
Simple CWP affects which regions preferentially upper lobe and upper portion of lower lobes adjacent to respiratory bronchioles
Coal macule and noodule Micro and difference carbon-laden marcrophages; nodule has delicate network of collagen fibers
Dilation of adjacent alveoli, ccentrilobular emphysema, with collections of carbon-laden macrophages w/ delicate collagen network Dx? simple CWP with centrilobular emphysema
Multiple lesions >2cm in upper lobes with necrotic centers, surrounded by dense collagen and dark pigment Dx and cause ? Complicated CWP or PMF in coal workers
What does CWP make Pt’s more susceptible to? really nothing has been proven (maybe emphysema?)
FA Blue: Dust cell ? alveolar macrophage with carbon in it
Most prevalent chronic occupational disease in the world? silicosis
Pt with new job as Sand blaster for 6 mo with abundant lipoprotein rich material in alveoli diagnosed with alveolar proteinosis. What is the real Dx? Acute Silicosis
Mine worker died from blunt force trauma to the head Autopsy: tiny, discrete pale->blackened nodules in the upper lungs Dx? early chronic Silicosis
FA Blue: Eggshell calcifications in hilar LNs Dx? Silicosis
PMF: massive upper lobe nodules, concentric layers of hyalinized collagen surrounded by dense capsule of more condensed collagen. How to Dx the cause? polarized microscopy shows birefringent silica particles
Silicosis: 3 characteristic findings fibrotic lesions in hilar LNs, Eggshell calcifications, birefringent particles in nodules
Silicosis increases Pt’s susceptibility to ? tuberculosis and CA?
Silica particles are said to release this from macrophages, initiating fibrosis TNF
Typical Silico-tuberulosis nodule appearance Collagenous nodule with central caseation
More common? Amphibole or serpentine asbestos Serpentine
More pathogenic? Amphibole or serpentine asbestos amphibole
Lung carcinoma increase w/ asbestos exposure 5 fold
Lung carcinoma increase w/ asbestos esposure and smoking 55 fold
Diffuse pulmonary interstitial fibrosis is Dx. How to tell if asbestos is responsible? presence of asbestos bodies
Describe asbestos body microscopically golden-brown fusiform or beaded rods, translucent center and iron positive
Single asbestos body found in biopsy of Diffuse pulmonary interstitial fibrosis. Pathogenic? No, common in normal people
Ferruginous body? What is it? iron-protein coated inorganic inhaled particulates
Fibroblastic foci with varying degrees of fibrosis, progressing to honeycomb areas. DDx? UIP and asbestosis
Better prognosis UIP or NSIP? NSIP
Region preferentially affected by asbestosis lower lobes and subpleural
Most common finding in asbestos exposed patients? What is it composed of? pleural plaques of collagen and often calcium
MCC of Pleural plaques? asbestos exposure
Pleural plaques are made of and contain what? collagen and calcium, NO ASBESTOS BODIES
Increased risk of mesothelioma with asbestos exposure? 1000 fold
What is more common with asbestos exposure lung carcinoma and mesothelioma
What is more common in Asbestos +smoking than just asbestos lung carcinoma (not mesothelioma)
X-ray: irregular, bilateral lower lobe linear densities, and circumscribed density over R hemidiaphragm Dx? And cause? asbestosis and pleural plaque from asbestos exposure
Sarcoidosis is Dx by? exclusion; r/o other granulomatous diseases
Sarcoidosis is driven by this cell and the cytokines it releases CD4+ Helper T-cells; IL-2, IFN-?
Typical description of sarcoid lesion in any tissue noncaseating granuloma with tightly clustered epi-cells and Langhan or foreign body giant cells
Mikulicz syndrome bilateral sarcoidosis of parotid/submaxillary/sublingual glands
Sarcoid Pt cc? x-ray? SOB, cough, hemoptysis, CP; Bilateral hilar lymphadenopathy
Pt with cough, night sweats and fatigue, hilar and mediastinal LA with some calcifications. Broch biopsy shows giant cells, non-caseating granuloma, Schaumann and asteroid bodies Dx? sarcoidosis
3 findings consistent with Hypersensitivity Pneumonitis interstitial pneumonitis w/ lymphs, plasma cells and macrophages; noncaseating cranuloma; interstitial fibrosis
What type(s) of hypersensitivity reaction is Hypersensitivity Pneumonitis Type III and IV
Farmers Lung, what is responsible? actinomyces spores
This attracts eosinophils IL-5
Irregular shaped shadows in lung fields on CT scan, thickened alveolar septa from infiltrates of eosinophils, peripheral eosinophilia, no noted vasculitis, fibrosis, or necrosis Simple pulmonary eosinophilia
Rapid onset Fever, dyspnea, hypoxemic respiratory failure, diffuse lung infiltrates of >255 Eos. Dx and Tx? Acute eosinophilic pneumonia w. respiratory failure; corticosteroids
Focal cellular consolidation of peripheral lung substance, lymphs and eos in alveoli and septal walls, F, night sweats, dyspnea Dx and Tx? Chronic eosinophilia pneumonia and Corticosteroids
Numerous smokers’ macrophages in the airspace w/ iron and lamellar bodies made of surfactant, thickened alveolar septa with lymph infiltrates and plump cuboidal pneumocytes lining the septa Desquamative Interstitial Pneumonia DIP
DIP without the pneumocyte destruction and hypertrophy respiratory bronchiolitis-associated interstitial lung disease
Bilateral, patchy, asymmetrical pulmonary opacifications, lavage reveals acellular granular PAS+ in alveolar sat_flash_1s Dx? PAP Pulmonary Alveolar Proteinosis
Pulmonary infarcts usually affect what part of the lung 75% lower lobes
Emboli vs post mortem clot differentiation Lines of Zahn; white lines
Physical finding in PE friction rub
Pulmonary BP is usually what ratio of normal BP? 1/8
Pulmonary HTn is Dx at what PBP/SBP ration? 1/4
5 classification of Pulmonary HTN Pulm. Arterial HTN; P-HTN w/ L heart disease; P-HTN w/ lung disease/hypoxemia; P-HTN 2* multiple emboli; and misc. P-HTN
Changes in pulmonary arteries with P-HTN medial hypertrophy, intimal fibrosis, arteriosclerosis, more prominent in the arterioles.
Lesions in certain P-HTNs with tufts of capillary formation spanning lumens plexifor lesion
Mutation in this gene coding for a receptor lead to a common cause of P-HTN BMPR2
Major causes of secondary P-HTN hypoxemia and respiratory acidosis
Goodpasture Syndrome most common in age? Sex? 10-20yo males
Cause of Goodpasture Syndrome autoantibodies to the ?3-chain of collagen IV
Necrotizing hemorrhagic interstitial pneumonitis, 20yo white male smoker Dx? And what happens next? Goodpasture; renal failure
Linear deposits on basement membrane of septal walls w/ necrosis of alveolar walls Goodpasture
10yo boy, cough, hemoptysis, anemia, diffuse pulmonary infiltration, blood in alveoli, no anti-basement membrane antibodies Dx? Ideopathic pulmonary hemosiderosis
Hemoptysis, bronch biopsy: poorly formed granulomas and capillaritis Dx? Wegner granulomatosis
MCC of acute, typical community acquired pneumonia? Describe Strep Pneumonia; gram + “lancet” diplococci
MCC of exacerbation of COPD H. flu
Child had “the flu” and started to feel a little better, then came down with patchy lobular consolidation on CXR. Child very sick with fibrin-rich exudate Dx? Describe H. influenza; pleomorphic gram – rod, IgA protease, attachment pili
H. Influenza in the blood, capsulated or no? yes
Second most common bacterial cause of COPD exacerbation Moraxella Cattarrhalis
Child has the flu, then pneumonia. X-ray shows empyema. Most likely cause. Staph Aureus
Alcoholic, pneumonia, thick gelatinous sputum Dx? And Description Klebsiella pneumonia; Gram negative
Pneumonia in CF Pt, yellow-green sputum Pseudomonas aeruginosa
Kidney transplant Pt, visits trashy uncle with crappy AC. Gets deadly pneumonia Dx? legionella pneumophila
4 stages in order for lobar pneumonia? congestions, red hepatization, grey hepatization, resolution
MCC of community acquired atypical pneumonia Mycoplasma pneumonia
Red/blue congested area of lung, with smooth pleura, and interstitial inflammation, mostly lymphs atypical pneumonia
Children get what influenza type(s) B, C
Deadly bird flu serotype H5N1
2 MC groups of Hospital-Acquired Pneumonias Enterobacteriaceae, Pseudamonas, Staph. Aureus
2 common results of aspiration pneumonia death or abscess
2 common Gram + causes of lung abscess formation Strep family and Staph Aureus
Most frequent mode of introduction of abscess forming bacteria to the lung aspirations
Most likely causative organisms of post-pneumonia abscess Step Pneumoniae, Staph. Aureus, K.pneumoniae
Typical presentation of aspiration abscess R sided singular
Typical presentation of post-pneumonia multiple, basal, scattered
Fungi found along the Ohio/Mississippi river and in the Caribbean Histoplasma
Fungi found in the central and southeastern united states Blastomyces
Fungi found Southwest, Far west, and Mexico Coccidioides
Fungi from bird or bat dropping Histoplasma
Difference in Dx of Coccidioides and Histoplasma intra-macrophage Dx of small thin walled yeast for histoplasma and large, thick walled, non-budding sphere filled with endospores for Coccidioides
Epitheliod cell granuloma in apex of lung, undergoing caseating necrosis DDx? Coccidioides and histoplasma
Tree-bark appearance of healed granuloma in lung histoplasma
Granuloma with caseating necrosis, large spere with endospores in macrophages on biopsy Dx? Coccidioides
Granuloma with caseating necrosis, small, thin walled yeast in macrophages on biopsy. Dx? Histoplasma
Suppurative granuloma with extracellular thick walled round budding yeast with a nuclei on biopsy Dx? Blastomyces
Viral pneumonia in immunocompromised host CMV
Opportunistic fungal infection in Immunocompromised Pneumocystis jiroveci
Opportunistic bacterial pneumonia in immunocompromised Mycobacterium avium-intracellulare
Common type of infection of HIV Pt at CD4 >200 bacterial and tuberculosis
Common pneumonia in HIV when CD4 <200 but >50 Pneumocystis jiroveci
Common pneumonia in HIV when CD4 <50 CMV and M.avium-intracellulare
MCC of early lung transplant infections bacteria
MC timeframe for lung transplant infection? 3-12 months
MC fungal infections in post lung transplant Pt? Candida and aspergillus
Lung transplant Pt, biopsy with lymphs and plasma cells around small vessels and in the submucosa Dx? Acute rejection
Lung transplant Pt, Biopsy: dissufe patchy fibrous occlusion of small airways, with very little inflammatory cells. Dx and type? bronchiolitis obliterans and chronic rejection
90-95% of lung tumors are carcinomas
MCC of cancer mortality world wide
lung cancer
Lung Cancer presentation age 40-70; peak 50-60
Lung tumor of smokers shows this preference for gene mutation G:C>T:A in the p53 gene
MC malignancy in those exposed to asbestos lung cancer
5 oncogenes common in lung cancer c-MYC, c-MET, c-KIT, KRAS, EGFR
4 common deletions or inactivations in lung cancer p53, RB1, p16(INK4a), loci on 3p
MC mutations in small cell lung cancer 3p(100%), RB(90%), p53(90%) BCL2(90%)
MC mutations in non-small cell lung cancer p16(INK4a) (70%), p53(50%)
C-KIT: how is it altered in majority of lung cancers overexpressed not mutated
Gene altered in familial clustering of lung cancer CPY1A1
Lung cancer in a non-smoker. Sex? Type? Mutations present? And absent? Women; adenocarcinoma; EGFR mutation; lack KRAS and p53 changes
MC form of lung cancer in women adenocarcinoma
2 MC lung cancers in men adenocarcinoma, squamous cell carcinoma
2 MC types of lung cancer in smokers squamous cell and small cell
Small Cell carcinoma Mets likely? Response to chemo? highly metastatic; high initial response to chemo
Non-Small cell carcinoma Mets likely? Response to chemo? less often metastatic; less responsive to chemo
Cancer in peripheral lung most likely adenocarcinoma
Squamous cell carcinoma: early or late extra-thoracic metastasis? late
5 most common mets location for primary lung cancer, in order hilar lymph nodes, adrenals, liver, brain, bone
Most Common Lung Cancer Metastatic
2 common positive substances in adenocarcinomas of the lung muscin and TTF-1
Adenocarcinoma: size? Mets rate? Small, slow growing; metastasize widely and early
Type of adenocarcinoma with better outcome “Scar” bronceoalveolar type
KRAS mutation, think this type of lung cancer adenocarcinoma
Female, non-smoker, Asian. Lung cancer Dx. Type and mutation common? adenocarcinoma and EGFR
Peripheral lung nodule made of columnar, peg shaped cells, that were spreading across the pre-existing lung architecture. The tumor was removed surgically. Dx? And likelihood of the Pt surviving? non-mucinous broncioalveolar carcinoma. Excellent 5 year prognosis
Lobar pneumonia on x-ray. Biopsy: tall, columnar cells, with cytoplasmic and intra-alveolar muscin growing along alveolar septa without destruction. Dx? And 5-year prognosis post surgery? Mucinous broncheoalveolar carcinoma, poor surgical candidate
Man, smoker, central cavitary lung tumor. MCC? Squamous cell carcinoma
Squamous cell carcinoma. Most likely stain positive for what? p53
MC mutation in squamous cell carcinoma? p53
Overexpression with no mutation of this can be seen in 80% of squamous cell carcinoma EGFR
Lung mass with cells staining positive for keratin. Darkly eosinophilic cytoplasm. Dx? squamous cell carcinoma
2 histologic hallmarks of squamous cell carcinoma keratinization and or intercellular bridges.
MC genetic changes in Small cell carcinoma p53 and RB1 mutations, high levels of BCL2
Small cell carcinoma stains positively for this “CD” and the reason? CD57; neuroendocrine origin
Small cell carcinoma: how aggressive? Mets? Surgical candidate? most aggressive; widely metastasizing; not likely cureable by surgery
Lung mass biopsy: ill defined boarder, “salt and pepper pattern” chromatin, cells in clusters, extensive necrosis Dx? And another characteristic finding w/ stain? small cell carcinoma; basophilic vascular walls from DNA of apoptosed cells, “Azzopardi effect”
Small Cell: smoking associated? very highly associated: 99% are smokers
Lung mass biopsy: cells with large nuclei, prominent nucleoli, moderate amount of cytoplasm, no glands, no squamous cells. Dx? Large Cell Carcinoma
P53, RB1, high levels of BCL2, neuroendocrine stains+, and organoid/ palisading/ rosette/ trabecular growth patterns. Dx? Large cell carcinoma
Venous congestion and edema of head, neck, and arm Dx and cause? superior vena cava syndrome; invasive lung carcinoma into superior vena cava
Bronchioloalveolar carcinoma: invasive? Metastatic? non-invasive: non-metastatic: kills by suffocation if not resected
Tumor <2cm, no pleura/mainstem involvement T1a
Tumor 2-3 cm, no pleura/mainstem involvement T1b
Tumor 3-5cm or mainstem involcemnt 2cm from carina T2a
Tumor 5-7cm or lobar atelectasis T2b
Tumor >7cm T3
Tumor involving any surrounding pleura, entire lung atelectasis, or nodules in same lobe T3
Tumor with nodules in different ipsilateral lobe T4
Tumor invading any other organ or structure T4
N0 no mets
N1 ipsilateral hilar or peribronchial node involvement
N2 ipsilateral mediastinal or sub-carinal nodes
N3 any supraclavicular/scalene node or contralateral hilar or peribronchial node
M0 No distant mets
M1a contralateral lobe/pleura nodule/ malignant effusion/
M1b distant mets
Stage Ia T1 N0 M0
Stage Ib T2 N0 M0
Stage IIa T1 N1 M0
Stage IIb (1) T2 N1 M0
Stage IIb (2) T3 N0 M0
Stage IIIa (1) T1-3 N2 M0
Stage IIIa (2) T3 N1 M0
Stage IIIb (1) Any T N3 M0
Stage IIIb (2) T3 N2 M0
Stage IIIb (3) T4 Any N M0
Stage IV Any T Any N M1
Increased ACTh or ADH points to which lung cancer? Small Cell
Hypercalcemia points to which lung cancer? Squamous cell
Lung tumor in someone younger than 40, non-smoker Think___ neuroendocrine, carcinoid
Collar-button lesion Dx? carcinoid tumor
Finger-like mass in main stem bronchi, with intact mucosa overlying, Biopsy: uniform round nuclei, moserate eosinophilic cytoplasm, no necrosis, 1 mitoses per 10hpf Dx? typical carcinoid tumor
Finger-like mass in main stem bronchi, with intact mucosa overlying, Biopsy: uniform round nuclei with prominent nucleoli, moderate eosinophilic cytoplasm, necrotic foci, 5 mitoses per 10hpf Dx? atypical carcinoid tumor
Carcinoid tumor with Sxs: diarrhea, flushing, and cyanosis Dx? Also seen with? Carcinoid syndrome; Small and Large cell carcinomas
Lung with multiple discrete tumors throughout, peripheral and central. Dx? metastatic lung cancer
Mutations common in mesothelioma Chromosomal deletions 1p,3p,6q,9p, or 22q EVEN Q
Mesothelioma prognosis 50% dead in 1 year, rare to live 2 years
Positive stain of acid mucopolysaccharide, and perinuclear keratin stain, long microvilli on EM Dx? mesothelioma

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