LECOM Path Ch 15 Lung
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| Cell that secretes surfactant | type II pneumocyte
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| Bronchioles lack this vs Bronchi | cartilage and submucosal glands
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| Resorption atelectasis is caused by | blocked airpassage
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| Mediastinum shifts ____ resorption atelectasis | towards
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| Mediastinum shifts ____ compression atelectasis | away from
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| Only non-reversable atelectasis | Contractive
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| 2 causes of pulmonary edema | hemodynamic and microvacsular injury
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| Heavy, wet lungs, engorged alveolar capillaries, hemosiderin laden macrophages in alveoli Dx and most common cause | increased hydrostatic pressure and L sided heart failure
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| ALI or ARDS also called | Non-cardiogenic pulmonary edema
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| Histological hallmark of ARDS | diffuse alveolar damage
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| Finding in ARDS after DAD | alveolar hyaline membranes
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| This cell proliferates during resolution of ARDS | type II pneumocyte
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| Presence of these 2 factors implicate endolethium damage in ARDS | endothelin and von Willebrand factor
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| 4 signs implicating epithelial damage in ARDS | blebing, frank necrosis, swelling, vacuolization
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| Cell implicated in damaging lungs in ARDS | neutrophil
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| 4 common causes of ARDS | sepsis, diffuse pulmonary Infx, Gastric aspiration, trauma
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| What do type II pneumocytes give rise to, to re-line the epithelium | type I cells
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| X-ray finding in ARDS | diffuse bilateral infiltrates
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| Acid-base status in ARDS | respiratory acidosis
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| Idiopathic rapidly progressive widespread ALI Name? Age? | Acute Interstitial Pneumonia 50yo
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| Increase in resistance to airflow due to partial or complete obstruction Dx? | Restrictive airway disease
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| Reduced explansion of lung parenchyma and decreased total lung capacity | restrictive disease
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| 4 prototypical obstructive pulmonary diseases | emphysema, chronic bronchitis, asthma, bronchiectasis
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| Grouped to make COPD | emphysema and chronic bronchitis
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| Most causative agent of COPD | cigarette smoking in 90% of Pts but only 10% of smokers develop COPD
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| Restrictive Lung Disease: Total lung capacity | decreased
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| Restrictive Lung Disease: Residual volume | decreased
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| Restrictive Lung Disease: FEV1 sec | decreased
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| Restrictive Lung Disease: FVC | decreased
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| Restrictive Lung Disease: FEV1sec/FVC | normal to increased
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| Restrictive Lung Disease: PaO2 | decreased
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| Restrictive Lung Disease: A-a gradient | increased
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| Obstructive Lung Disease: FEV1sec | decreased
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| Obstructive Lung Disease: FVC | decreased
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| Obstructive Lung Disease: FEV1sec/FVC | decreased
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| Obstructive Lung Disease: PaO2 | decreased
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| Obstructive Lung Disease: A-a gradient | increased
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| Obstructive Lung Disease: Residual Volume | increased
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| Obstructive Lung Disease: Total lung capacity | increased
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| Irreversible enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of their walls WITHOUT obvious fibrosis | emphysema
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| 3 associations with emphysema | cigarette smoking, women, blacks
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| MC type of emphysema | Centriacinar 95%
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| Central or proximal parts of acini affected, sparing distal alveoli Dx | centriacinar emphysema
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| Anatomical location most affected in centriacinar emphysema | upper lobe/apical
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| Walls of centriacinar type emphysema contain ? | black pigment
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| Uniformly enlarged acini from respiratory bronchiole to terminal aalveoli | Panacinar emphysema
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| Anatomical location most affected in panacinar emphysema | lower anterior / bases
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| Panacinar emphysema associated with: | α1-antitrypsin deficiency
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| Centriacinar emphysema is associated with: | heavy smoking
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| Anatomical location most affected in Paraseptal /distal acinar emphysema | upper half/ along the plura
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| Associated with paraseptal/distal acinar emphysema: | spontaneous pneumothorax
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| Anatomical with irregular emphysema: | scarring
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| Location of α1-antitrypsin gene | Chromosome 14 Pi loci
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| Hypothesis of pathogenesis of emphysema | too much neutrophil/protease too little α1-antitrypsin
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| 3 early finding of emphysema | Increase (SIG) smooth muscle, inflammatory cells, Goblet cells
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| 3 most common causes of death from emphysema | respiratory acidosis/coma; right sided heart failure: massive collapse of lungs from pneumothorax
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| Thin, tripoding Pt, with increased AP diameter, dyspneic, breathing through pursed lips Dx and name | emphysema; pink puffer
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| Emphysema can lead to this cascade w/ poor prognosis | cor pulmonale then congestive heart failure from pulmonary HTN
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| 2 collateral routes for filling from behind an obstruction | pores of Kohn, and canals of Lambert
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| Large apical subplural blebs larger than 1cm Dx | Bullus Emphysema
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| Filling of stroma/mediastinum /subcutaneous tissue with air from torn alveoli Dx? | interstitial emphysema
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| Persistent cough w/ sputum x 3 months in at least 2 years, without other cause | Chronic bronchitis
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| Earliest feature of Chronic bronchitis | hypersecretion of mucus in lare airways w/ hypertrophy of submucosal glands in trachea and bronchi
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| Physiologic cause of early chronic bronchitis Sxs | hypersecretion/obstruction in small airways
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| Reid index; describe | ratio of thickness of mucus gland layer to thickness of wall between epithelium and cartilage
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| Normal Reid index and increased or decreased in chronic bronchitis | 0.4; increased in chronic bronchitis
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| Lymphocytes in airways, enlargement of mucus glands in trachea and bronci Dx | Chronic bronchitis
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| Heavyset smoker Pt, Hypercapnia, hypoxia, mild cyanosis Dx and name | chronic bronchitis; Blue Bloater
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| Age of onset: Bronchitis ; Emphysema | Bronchitis: 40-45 Emphy.: 50-75
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| Cough: Bronchitis ; Emphysema | Bronchitis: Early-lots of sputum Emphy.: late- little sputum
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| Infections Bronchitis ; Emphysema | Bronchitis: Common Emphy.: Occasional
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| Respiratory Insufficiency in : Bronchitis ; Emphysema | Bronchitis: Repeated Emphy.: Terminal
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| Cor Pulmonale in : Bronchitis ; Emphysema | Bronchitis: Common Emphy.: Rare, terminal
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| Radiograph findings: Bronchitis ; Emphysema | Bronchitis: prominent vessels and big heart Emphy.: hyperinflation and small heart
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| MC type of asthma and type of hypersensitivity reaction | Atopic Asthma; Type I IgE-mediated
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| Pt with negative RAST, respiratory distress common with viral Infx | Non-Atopic Asthma
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| Child, chronic rhinitis, and nasal polyps, respiratory distress and urticarial. What was the Pt given? | Asprin
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| Cell implicated in atopic asthma as being hypersensitive and cytokines produced by them | TH2; IL-4, IL-5, IL-13
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| 2 difinitive mediators of acute asthma | leukotrienes CDE and acetylcholine
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| Chromosome and gene linked to asthma | Chromosome 5q; IL13 genes
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| BUZZ: Curshman spirals Dx and what are they | asthma, spiral mucus plug with shed epithelial cells
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| Lungs with numerous eosinophils with Charcot-Leyden crystals Dx and what are they | Asthma, granules collect to form galectin-10 crystals
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| 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
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| 2 bugs mostly found in children w. bronchiectasis | H. flu, and Pseudomonas Aeruginosa
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| Irreversible dilation of bronchi and bronchioles | bronchiectasis
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| 4 usual bacteria causing bronchiectasis | mycobacterium tuberculosis, Staph aureus, H. flu, Pseudomonas
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| 3 viruses causing bronchiectasis | adenovirus, influenza, HIV
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| Fungi causing bronchiectasis | Aspergillus
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| Most common underlying cause of bronchiectasis in USA | cystic fibrosis
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| Kartagener Syndrome cause and 3 associations | missing/short dynein arm in cilia; bronchiectasis, sinusitis, situs inversus
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| Most common area affected by bronchiectasis | lower lobes
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| X-ray: browded bronchial markings extending to periphery Dx? | bronchiectasis
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| Severe, persistent cough in a CF Pt, copious bloody foul smelling sputum Dx | bronchiectasis
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| Growth factor that is implicated as the “driving factor” in IPF and cell that releases it | TGF-β1; type I pneumocyte
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| Cobblestoned pleural surface of lung, lower lobe predominant fibrosis in subpleural regions and interlobular septa | IPF
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| Patchy interstitial fibrosis of different age, with fibroblastic foci | IPF
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| Dense fibrosis forming cystic spaces lined by hyperplastic Type II pneumocytes. BUZZ? | honeycomb fibrosis; IPF
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| Chronic interstitial inflammation, large amount of lymphocytes in uniform or patchy distribution | NSIP cellular pattern
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| Diffuse or patchy interstitial fibrosis without honeycombing, fibroblastic foci, or temporal heterogeneity | NSIP fibrosing pattern
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| 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
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| Effects of this inhaled substance are significantly increased by contaminant tobacco smoking | asbestos
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| Simple CWP affects which regions preferentially | upper lobe and upper portion of lower lobes adjacent to respiratory bronchioles
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| Coal macule and noodule Micro and difference | carbon-laden marcrophages; nodule has delicate network of collagen fibers
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| Dilation of adjacent alveoli, ccentrilobular emphysema, with collections of carbon-laden macrophages w/ delicate collagen network Dx? | simple CWP with centrilobular emphysema
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| 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
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| What does CWP make Pt’s more susceptible to? | really nothing has been proven (maybe emphysema?)
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| FA Blue: Dust cell ? | alveolar macrophage with carbon in it
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| Most prevalent chronic occupational disease in the world? | silicosis
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| 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
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| Mine worker died from blunt force trauma to the head Autopsy: tiny, discrete pale->blackened nodules in the upper lungs Dx? | early chronic Silicosis
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| FA Blue: Eggshell calcifications in hilar LNs Dx? | Silicosis
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| 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
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| Silicosis: 3 characteristic findings | fibrotic lesions in hilar LNs, Eggshell calcifications, birefringent particles in nodules
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| Silicosis increases Pt’s susceptibility to ? | tuberculosis and CA?
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| Silica particles are said to release this from macrophages, initiating fibrosis | TNF
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| Typical Silico-tuberulosis nodule appearance | Collagenous nodule with central caseation
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| More common? Amphibole or serpentine asbestos | Serpentine
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| More pathogenic? Amphibole or serpentine asbestos | amphibole
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| Lung carcinoma increase w/ asbestos exposure | 5 fold
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| Lung carcinoma increase w/ asbestos esposure and smoking | 55 fold
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| Diffuse pulmonary interstitial fibrosis is Dx. How to tell if asbestos is responsible? | presence of asbestos bodies
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| Describe asbestos body microscopically | golden-brown fusiform or beaded rods, translucent center and iron positive
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| Single asbestos body found in biopsy of Diffuse pulmonary interstitial fibrosis. Pathogenic? | No, common in normal people
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| Ferruginous body? What is it? | iron-protein coated inorganic inhaled particulates
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| Fibroblastic foci with varying degrees of fibrosis, progressing to honeycomb areas. DDx? | UIP and asbestosis
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| Better prognosis UIP or NSIP? | NSIP
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| Region preferentially affected by asbestosis | lower lobes and subpleural
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| Most common finding in asbestos exposed patients? What is it composed of? | pleural plaques of collagen and often calcium
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| MCC of Pleural plaques? | asbestos exposure
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| Pleural plaques are made of and contain what? | collagen and calcium, NO ASBESTOS BODIES
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| Increased risk of mesothelioma with asbestos exposure? | 1000 fold
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| What is more common with asbestos exposure | lung carcinoma and mesothelioma
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| What is more common in Asbestos +smoking than just asbestos | lung carcinoma (not mesothelioma)
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| X-ray: irregular, bilateral lower lobe linear densities, and circumscribed density over R hemidiaphragm Dx? And cause? | asbestosis and pleural plaque from asbestos exposure
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| Sarcoidosis is Dx by? | exclusion; r/o other granulomatous diseases
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| Sarcoidosis is driven by this cell and the cytokines it releases | CD4+ Helper T-cells; IL-2, IFN-γ
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| Typical description of sarcoid lesion in any tissue | noncaseating granuloma with tightly clustered epi-cells and Langhan or foreign body giant cells
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| Mikulicz syndrome | bilateral sarcoidosis of parotid/submaxillary/sublingual glands
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| Sarcoid Pt cc? x-ray? | SOB, cough, hemoptysis, CP; Bilateral hilar lymphadenopathy
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| 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
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| 3 findings consistent with Hypersensitivity Pneumonitis | interstitial pneumonitis w/ lymphs, plasma cells and macrophages; noncaseating cranuloma; interstitial fibrosis
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| What type(s) of hypersensitivity reaction is Hypersensitivity Pneumonitis | Type III and IV
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| Farmers Lung, what is responsible? | actinomyces spores
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| This attracts eosinophils | IL-5
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| 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
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| Rapid onset Fever, dyspnea, hypoxemic respiratory failure, diffuse lung infiltrates of >255 Eos. Dx and Tx? | Acute eosinophilic pneumonia w. respiratory failure; corticosteroids
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| 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
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| 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
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| DIP without the pneumocyte destruction and hypertrophy | respiratory bronchiolitis-associated interstitial lung disease
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| Bilateral, patchy, asymmetrical pulmonary opacifications, lavage reveals acellular granular PAS+ in alveolar contents Dx? | PAP Pulmonary Alveolar Proteinosis
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| Pulmonary infarcts usually affect what part of the lung 75% | lower lobes
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| Emboli vs post mortem clot differentiation | Lines of Zahn; white lines
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| Physical finding in PE | friction rub
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| Pulmonary BP is usually what ratio of normal BP? | 1/8
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| Pulmonary HTn is Dx at what PBP/SBP ration? | 1/4
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| 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
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| Changes in pulmonary arteries with P-HTN | medial hypertrophy, intimal fibrosis, arteriosclerosis, more prominent in the arterioles.
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| Lesions in certain P-HTNs with tufts of capillary formation spanning lumens | plexifor lesion
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| Mutation in this gene coding for a receptor lead to a common cause of P-HTN | BMPR2
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| Major causes of secondary P-HTN | hypoxemia and respiratory acidosis
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| Goodpasture Syndrome most common in age? Sex? | 10-20yo males
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| Cause of Goodpasture Syndrome | autoantibodies to the α3-chain of collagen IV
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| Necrotizing hemorrhagic interstitial pneumonitis, 20yo white male smoker Dx? And what happens next? | Goodpasture; renal failure
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| Linear deposits on basement membrane of septal walls w/ necrosis of alveolar walls | Goodpasture
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| 10yo boy, cough, hemoptysis, anemia, diffuse pulmonary infiltration, blood in alveoli, no anti-basement membrane antibodies Dx? | Ideopathic pulmonary hemosiderosis
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| Hemoptysis, bronch biopsy: poorly formed granulomas and capillaritis Dx? | Wegner granulomatosis
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| MCC of acute, typical community acquired pneumonia? Describe | Strep Pneumonia; gram + “lancet” diplococci
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| MCC of exacerbation of COPD | H. flu
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| 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
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| H. Influenza in the blood, capsulated or no? | yes
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| Second most common bacterial cause of COPD exacerbation | Moraxella Cattarrhalis
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| Child has the flu, then pneumonia. X-ray shows empyema. Most likely cause. | Staph Aureus
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| Alcoholic, pneumonia, thick gelatinous sputum Dx? And Description | Klebsiella pneumonia; Gram negative
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| Pneumonia in CF Pt, yellow-green sputum | Pseudomonas aeruginosa
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| Kidney transplant Pt, visits trashy uncle with crappy AC. Gets deadly pneumonia Dx? | legionella pneumophila
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| 4 stages in order for lobar pneumonia? | congestions, red hepatization, grey hepatization, resolution
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| MCC of community acquired atypical pneumonia | Mycoplasma pneumonia
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| Red/blue congested area of lung, with smooth pleura, and interstitial inflammation, mostly lymphs | atypical pneumonia
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| Children get what influenza type(s) | B, C
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| Deadly bird flu serotype | H5N1
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| 2 MC groups of Hospital-Acquired Pneumonias | Enterobacteriaceae, Pseudamonas, Staph. Aureus
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| 2 common results of aspiration pneumonia | death or abscess
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| 2 common Gram + causes of lung abscess formation | Strep family and Staph Aureus
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| Most frequent mode of introduction of abscess forming bacteria to the lung | aspirations
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| Most likely causative organisms of post-pneumonia abscess | Step Pneumoniae, Staph. Aureus, K.pneumoniae
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| Typical presentation of aspiration abscess | R sided singular
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| Typical presentation of post-pneumonia | multiple, basal, scattered
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| Fungi found along the Ohio/Mississippi river and in the Caribbean | Histoplasma
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| Fungi found in the central and southeastern united states | Blastomyces
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| Fungi found Southwest, Far west, and Mexico | Coccidioides
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| Fungi from bird or bat dropping | Histoplasma
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| 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
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| Epitheliod cell granuloma in apex of lung, undergoing caseating necrosis DDx? | Coccidioides and histoplasma
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| Tree-bark appearance of healed granuloma in lung | histoplasma
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| Granuloma with caseating necrosis, large spere with endospores in macrophages on biopsy Dx? | Coccidioides
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| Granuloma with caseating necrosis, small, thin walled yeast in macrophages on biopsy. Dx? | Histoplasma
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| Suppurative granuloma with extracellular thick walled round budding yeast with a nuclei on biopsy Dx? | Blastomyces
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| Viral pneumonia in immunocompromised host | CMV
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| Opportunistic fungal infection in Immunocompromised | Pneumocystis jiroveci
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| Opportunistic bacterial pneumonia in immunocompromised | Mycobacterium avium-intracellulare
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| Common type of infection of HIV Pt at CD4 >200 | bacterial and tuberculosis
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| Common pneumonia in HIV when CD4 <200 but >50 | Pneumocystis jiroveci
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| Common pneumonia in HIV when CD4 <50 | CMV and M.avium-intracellulare
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| MCC of early lung transplant infections | bacteria
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| MC timeframe for lung transplant infection? | 3-12 months
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| MC fungal infections in post lung transplant Pt? | Candida and aspergillus
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| Lung transplant Pt, biopsy with lymphs and plasma cells around small vessels and in the submucosa Dx? | Acute rejection
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| Lung transplant Pt, Biopsy: dissufe patchy fibrous occlusion of small airways, with very little inflammatory cells. Dx and type? | bronchiolitis obliterans and chronic rejection
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| 90-95% of lung tumors are carcinomas MCC of cancer mortality world wide | lung cancer
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| Lung Cancer presentation age | 40-70; peak 50-60
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| Lung tumor of smokers shows this preference for gene mutation | G:C>T:A in the p53 gene
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| MC malignancy in those exposed to asbestos | lung cancer
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| 5 oncogenes common in lung cancer | c-MYC, c-MET, c-KIT, KRAS, EGFR
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| 4 common deletions or inactivations in lung cancer | p53, RB1, p16(INK4a), loci on 3p
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| MC mutations in small cell lung cancer | 3p(100%), RB(90%), p53(90%) BCL2(90%)
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| MC mutations in non-small cell lung cancer | p16(INK4a) (70%), p53(50%)
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| C-KIT: how is it altered in majority of lung cancers | overexpressed not mutated
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| Gene altered in familial clustering of lung cancer | CPY1A1
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| Lung cancer in a non-smoker. Sex? Type? Mutations present? And absent? | Women; adenocarcinoma; EGFR mutation; lack KRAS and p53 changes
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| MC form of lung cancer in women | adenocarcinoma
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| 2 MC lung cancers in men | adenocarcinoma, squamous cell carcinoma
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| 2 MC types of lung cancer in smokers | squamous cell and small cell
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| Small Cell carcinoma Mets likely? Response to chemo? | highly metastatic; high initial response to chemo
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| Non-Small cell carcinoma Mets likely? Response to chemo? | less often metastatic; less responsive to chemo
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| Cancer in peripheral lung most likely | adenocarcinoma
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| Squamous cell carcinoma: early or late extra-thoracic metastasis? | late
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| 5 most common mets location for primary lung cancer, in order | hilar lymph nodes, adrenals, liver, brain, bone
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| Most Common Lung Cancer | Metastatic
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| 2 common positive substances in adenocarcinomas of the lung | muscin and TTF-1
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| Adenocarcinoma: size? Mets rate? | Small, slow growing; metastasize widely and early
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| Type of adenocarcinoma with better outcome | “Scar” bronceoalveolar type
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| KRAS mutation, think this type of lung cancer | adenocarcinoma
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| Female, non-smoker, Asian. Lung cancer Dx. Type and mutation common? | adenocarcinoma and EGFR
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| 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
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| 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
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| Man, smoker, central cavitary lung tumor. MCC? | Squamous cell carcinoma
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| Squamous cell carcinoma. Most likely stain positive for what? | p53
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| MC mutation in squamous cell carcinoma? | p53
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| Overexpression with no mutation of this can be seen in 80% of squamous cell carcinoma | EGFR
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| Lung mass with cells staining positive for keratin. Darkly eosinophilic cytoplasm. Dx? | squamous cell carcinoma
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| 2 histologic hallmarks of squamous cell carcinoma | keratinization and or intercellular bridges.
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| MC genetic changes in Small cell carcinoma | p53 and RB1 mutations, high levels of BCL2
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| Small cell carcinoma stains positively for this “CD” and the reason? | CD57; neuroendocrine origin
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|
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| Small cell carcinoma: how aggressive? Mets? Surgical candidate? | most aggressive; widely metastasizing; not likely cureable by surgery
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| 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”
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| Small Cell: smoking associated? | very highly associated: 99% are smokers
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| Lung mass biopsy: cells with large nuclei, prominent nucleoli, moderate amount of cytoplasm, no glands, no squamous cells. Dx? | Large Cell Carcinoma
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|
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| P53, RB1, high levels of BCL2, neuroendocrine stains+, and organoid/ palisading/ rosette/ trabecular growth patterns. Dx? | Large cell carcinoma
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|
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| Venous congestion and edema of head, neck, and arm Dx and cause? | superior vena cava syndrome; invasive lung carcinoma into superior vena cava
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|
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| Bronchioloalveolar carcinoma: invasive? Metastatic? | non-invasive: non-metastatic: kills by suffocation if not resected
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|
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| Tumor <2cm, no pleura/mainstem involvement | T1a
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||||
| Tumor 2-3 cm, no pleura/mainstem involvement | T1b
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|
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| Tumor 3-5cm or mainstem involcemnt 2cm from carina | T2a
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|
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| Tumor 5-7cm or lobar atelectasis | T2b
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|
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| Tumor >7cm | T3
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|
||||
| Tumor involving any surrounding pleura, entire lung atelectasis, or nodules in same lobe | T3
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|
||||
| Tumor with nodules in different ipsilateral lobe | T4
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|
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| Tumor invading any other organ or structure | T4
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| N0 | no mets
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||||
| N1 | ipsilateral hilar or peribronchial node involvement
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|
||||
| N2 | ipsilateral mediastinal or sub-carinal nodes
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|
||||
| N3 | any supraclavicular/scalene node or contralateral hilar or peribronchial node
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|
||||
| M0 | No distant mets
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|
||||
| M1a | contralateral lobe/pleura nodule/ malignant effusion/
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|
||||
| M1b | distant mets
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|
||||
| Stage Ia | T1 N0 M0
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|
||||
| Stage Ib | T2 N0 M0
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|
||||
| Stage IIa | T1 N1 M0
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|
||||
| Stage IIb (1) | T2 N1 M0
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|
||||
| Stage IIb (2) | T3 N0 M0
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|
||||
| Stage IIIa (1) | T1-3 N2 M0
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|
||||
| Stage IIIa (2) | T3 N1 M0
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|
||||
| Stage IIIb (1) | Any T N3 M0
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|
||||
| Stage IIIb (2) | T3 N2 M0
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|
||||
| Stage IIIb (3) | T4 Any N M0
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|
||||
| Stage IV | Any T Any N M1
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|
||||
| Increased ACTh or ADH points to which lung cancer? | Small Cell
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|
||||
| Hypercalcemia points to which lung cancer? | Squamous cell
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|
||||
| Lung tumor in someone younger than 40, non-smoker Think___ | neuroendocrine, carcinoid
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|
||||
| Collar-button lesion Dx? | carcinoid tumor
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|
||||
| 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
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|
||||
| 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
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|
||||
| Carcinoid tumor with Sxs: diarrhea, flushing, and cyanosis Dx? Also seen with? | Carcinoid syndrome; Small and Large cell carcinomas
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|
||||
| Lung with multiple discrete tumors throughout, peripheral and central. Dx? | metastatic lung cancer
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|
||||
| 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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