block 21 lung tumors

8/3/2019 Block 21 Lung Tumors

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Lung Unit


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Alveolus


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TUMORS OF THE LUNG

Histological classification

Primary tumors

Bronchogenic tumors

Non-bronchogenic tumor

Secondary tumors (metastasis)


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The incidence of the bronchogenic

tumors

1. Non-small cell lung Ca (NSCLC): 70-75%

a. SCC: 25 30 %

b. AdenoCa, including bronchioloalveolarcarcinoma: 30 35 %

c. Large cell Ca: 10 15 %

2. Small Cell Lung Ca (SCLC) : 20 25 %

3. Combined : 5 1 0 %

- SCC + adenoCa

- SCC + SCLC


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BronchogenicCarcinoma


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a b

c d


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a. Squamous cell ca.: men >> women, smoking history

central bronchus

squamous metaplasia-displasia-Ca

b. Adenocarcinoma : bronchial/ bronchioloalveolar type

Women >> men, non smokers

pheripherally location

grow more slowly than SCC

c. Small cell ca : Highly malignant tumor

smokers, Hilar/ central

EM: neurosecretory granules

high response to chemotherapy

d. Large cell ca : Undifferentiated ca


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Cytologic diagnoses of lung cancer

a. Sputum specimen

b. FNA of Lnn : small cell ca


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Clinical Relevances of Lung Cancer

Bronchogenic carcinoma

Silent, insidious lesion (become unresectable before theyproduce symptoms)

Prognosis is bad when these symptoms appear: hoarseness,

chest pain, superior vena cava syndrome, pericardial or

pleural effusion persistent segmental atelectasis/pneumonitis Very often the tumor presents with symptoms due to

metastasis to the brain (mental or neurologic changes), liver

(hepatomegali), or bone (pain)

NSCLCs have a better prognosis (lobectomy is possible when

the tumor is detected before local spread or metastasis) than

SCLCs


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Clinical Relevances of Lung Cancer

Paraneoplastic Syndromes

1. Hypercalcemia due to secretion of parathyroid hormone-related peptide --- SCC

2. Cushing syndrome (increased production of ACTH)

3. Syndrome of inappropriate secretion of antidiuretic

hormone (SIADH)4. Neuromuscular syndrome, including a myasthenic

syndrome, peripheral neuropathy, and polymyositis.

5. Clubbing of the fingers and hypertrophic pulmonary

steoarthropathy6. Hemtologic manifestation: migratory thrombophlebitis,

nonbacterial endocarditis, and dic --- adenocarcinoma

2,3,4,5, ----- small cell carcinoma


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Bronchioloalveolar carcinoma

Terminal bronchoalveolar regionPeripheral portion of the lung

Males = females, all ages( 3rd decade- advanced years)


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BRONCHIAL CARCINOID

General remarks

Arise from Kulchitsky cells (neuroendocrine cells lining

the bronchial mucosa)

Occasionally occur in part of MEN

Appear in early age (peak 40 years)

1-5% of all pulmonary neoplasms

Mostly resectable and curable (not their neurondocrine

counterpart : small cell carcinoma)


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BRONCHIAL CARCINOID

PATHOLOGY Small tumor : 3-4 cm

- polypoid

- penetrate the bronchial wall:- collar- button lesion

Microscopical features:

- nests of uniform round cells

EM: dense-core granules

IHC: serotonin, NSE, calcitonin etc


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BRONCHIAL CARCINOID


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SECONDARY TUMORS ( METASTASIS)


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Pleural tumors

Neoplasma:Mesothelioma


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Lymphnodestations


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Lymphnode stations

Lymphnode stations are

shown projected onto a

chest-roentgenogram


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SCCarcinoma in situ

Nogross mucosal abnormalities

Bronchial washing

Bronchial brushing

SCC in situ


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Early invasive SCC

SCC in situ with foci of early invasion (nodular

thickening)

Early invasive scc


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SCC

Endobronchial SCC


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Well differentiated SCC

Keratin mass


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SCC moderately differentiated

Individual cell keratinization

Pearl formation


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SCC moderately differentiated

Pearl formation

Central squamous differentiation


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SCC poorly differentiatedDense eosinophilic cytoplasm


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Adenocarcinoma

This lobectomy specimen shows a lobulated, somewhat glistening mass


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AdenocarcinomaWell differentiated


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AdenocarcinomaModerately differentiated


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AdenocarcinomaPoorly differentiated


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AdenocarcinomaCytology

3 dimension cell group, vacuolization


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Bronchioloalveolar Carcinoma (BAC)Nonmucinous type

Upper lobe is almost entirely consolidated by mucinous BAC, architecture is maintained,

and there is an absence of necrosis and hemorrhage


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Bronchioloalveolar Carcinoma(BAC)Nonmucinous type


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Bronchioloalveolar Carcinoma(BAC)Mucinous type


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Pattern ofSpread

1. Direct extention to adjecent structure

2. Aerogenous spread

3. Lymphatic spread

4. Hematogenous dissemination

5. Pleural seeding


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Pattern of Spread 1.Direct extention


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Pattern of Spread2.Aerogenous dissemination


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Pattern of Spread 3. Lymphangitic spread


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Pattern of Spread 5.Pleural seeding


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The Border of the Metastasis Tumor Mass

Alveolar soft part sarcoma,well circumscribed

with pushing border. Metastases often have

this appearance.

Irregular border: a nodule of metastatic leio-

myosarcoma extends into the interstitium of

the surrounding lung


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Pattern ofMetastasis

1. Milliary & Lymphangitic metastasis2. Multinodular metastasis

3. Cannonball metastasis

4. Lymphangitic metastasis

5. Endobronchial metastasis

6. Intra-arterial metastasis

7. Pleural metastasis

8. Interstitial metastasis9. Cavitary metastasis


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Miliary & Lymphangitic Metastasis

-Numerous minute nodules and larger area of ill-defined consolidation

-Tthickening of the of small blood vessel, interlobular septa, and airways


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Multinodular metastasis

Yellow appearance to the metastatic nodules:abundant fat content of primary tumor: renal-

cell carcinoma

Black appearance in some nodules: primaryTumor is malignant melanoma


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Cannonball metastasis

Primary tumor: osteogenic sarcoma.A variety of tumors: sarcoma,renal cell Ca, malignant melanoma, colorectal Ca, may produce this appearance


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Lymphangitic metastasis

Primary tumor: leiomyosarcoma. Note the ar-

borizing pattern produced by tumor within

Perivascular lymphatics

Metastatic breast Ca. the perivascular lymphatics

are markedly dilated and filled with clump of

tumor cells


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Endobronchial metastasis

A nodular lesion protrudes into bronchial lumen


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Endobronchial metastasis

A submucosal nodule of metastatic rhabdomyo-sarcoma produces nodular protrusion of the

bronchial mucosa into the lumen

Microscopic involvement of the airway is farMore common than gross or clinically apparent

involvement


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Intra-arterial metastasis

The tumor embolus is coiled in worm-likefashion within the lumen of the artery Carcinomatous embolus in the lumen of smallartery

P fM i


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Pleural metastasis

Diffuse pleural metastasis simulating meso-

thelioma, the primary tumor is renal cell ca.

Solid ring of the tumor occupies the pleural

surface.

Pleural metrastasis of adenocarcinoma

mimicking mesothelioma


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Interstitial metastasis

Interstitial metastasis of thymic carcinoid tumor nodular appearance.

Metastatic sarcomas more commonly adopt anInterstitial pattern than epithelial tumors.


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Cavitary metastasis

The primary tumor: teratoma of the testis

undergo cavitary changes when it metasta-sizes to the lung.

The hemorrhagic tumor has undergone

multifocal cavitation.

block 21 lung tumors

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