Lung

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Lung
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• Lung Tumors
• MC Neoplasms (90 to 95) carcinomas
• Benign(5 ) - bronchial carcinoids
• Lung cancer - MC diagnosed major cancer in the
  world
• MCC of cancer mortality worldwide
• Genetics small cell carcinomas have more
  frequent alterations in c-MYC and RB
• non-small cell tumors - mutations in RAS and
  p16INK4a
• Majority due to the carcinogenic effects of
  cigarette smoke
• Both initiators (benzoapyrene) and promoters, (
  phenols) are present in smoke
• strongest relationship to smoking - squamous cell
  and small cell carcinoma
• Genetic predisposition - CYP1A1 - increased
  capacity to metabolize procarcinogens
• Age 40 and 70 years (peak 5os 60s)
• Prognosis dismal (5-year survival rate - 15 )

3

• Lung Tumors
• Histological Types
• 1) Squamous Cell Carcinoma
• Most common in male smokers
• Histology Production of keratin with
  Intercellular bridges (epithelial junction)
• 2)Adenocarcinoma (Gland forming)
• Most common type in women and nonsmokers
• Tend to grow more slowly found in the periphery
  of the lung
• 3) Small cell carcinoma (Oat cell carcinoma)
• Highly malignant Strong relationship with
  cigarette smoking
• Associated with Paraneoplastic syndromes
• 4) Large cell undifferentiated or Anaplastic
  carcinoma
• Worst prognosis
• Clinical Features cough, dyspnea weight loss
• Local effectsHorners syndrome, SVC syndrome
  (Pancoast tumor), lung abscess
• Paraneoplastic syndromes

4

• Paraneoplastic syndromes
• Inappropriate ADH( hyponatremia), ACTH
  (Cushings)
• PTH ? Hypercalcemia (Squamous cell carcinoma )
• Calcitonin ?hypocalcemia, Gonadotropin
  ?gynecomastia
• Serotonin ? carcinoid syndrome myopathy
• Lambert-Eaton myasthenic syndrome peripheral
  neuropathy
• Dermopathy (Acanthosis nigricans), Hypertrophic
  osteoarthropathy
• Prognosis Overall 5-year survival lt10
• Small cell carcinomas are un- resectable
• Other tumors
• Bronchioloalveolar Carcinoma (alveolar cell
  carcinoma)
• A rare form of adenocarcinoma
• On chest x-ray looks like bronchopneumonia
• Benign tumors
• Bronchial Carcinoid (bronchial adenoma)
• Benign, formed of small cells
• Seen in young people
• Secondaries in the lungs ( Metastasis)
• very common

5

• Lung Tumors
• Prognosis
• Overall 5-year survival lt10
• Small cell carcinomas are un- resectable
• other tumors
• Bronchioloalveolar Carcinoma (alveolar cell
  carcinoma)
• A rare form of adenocarcinoma
• On chest x-ray looks like bronchopneumonia
• Benign tumor
• Bronchial Carcinoid (bronchial adenoma)
• Benign, formed of small cells
• Seen in young people
• Secondaries in the lungs
• very common
• multiple nodules
• Produce pleural effusion.

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Squamous cell carcinoma

• Squamous cell carcinoma
• centrally located (most of the tumors tends to
  be central)

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Squamous cell carcinoma

• High NC ratio (nucleus is enlarged)
• Large sized cells
• Dark nucleoli hyperchromatic
• Abnormal mitosis

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Adenocarcinoma
Adenocarcinomas - found in the periphery)
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Small cell carcinoma (Oat cell carcinoma)
Gross

• Small cell undifferentiated carcinoma
• Strongest relationship to smoking
• Worst prognosis

10
Small cell carcinoma (Oat cell carcinoma)

• Very dark staining cells
• Cant demarcate the edges of cells
• Has squeezing artifact effect cells being so
  soft, get pushed against each other and crush
  each other

Histology
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Bronchioloalveolar Carcinoma (alveolar cell
carcinoma)

• Variant of Adenocarcinoma
• Alveoli are lined by tall columnar malignant
  cells and notice that the alveolar walls are not
  destroyed

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Neuroendocrine tumors
Bronchial carcinoid
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Hamartomas
Secondaries in the lungs
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Metastases from a renal cell carcinoma