Transcript The lung and the Upper Respiratory Tract

The lung and the Upper
Respiratory Tract
Lung Tumors
Lung tumors : General features
Most are malignant.
Metastatitc neoplasms are most
common.
Types
Bronchogenic Carcinoma.
Bronchial carcinoids.
Lymphoma.
Hamartoma
Bronchogenic carcinoma
1. Squamous cell carcinoma ( most
common)
Non small cell
2. Adenocarcinoma
1. Bronchial derived
2. Broncheoloalveolar
3. Larger cell carcinoma
4. Small cell (oat cell) carcinoma.
carcinoma
Bronchogenic Carcinoma
Leading case of cancer death (M/F)
Increase in women and decreasing in men.
Age: old adult.
Etiology:
– smoking of cigarettes ( amount/ years).
– Asbestosis
– Uranium and radiation
– Air pollution
– Radon
Molecular pathology
Non-Small Cell Lung Carcinomas (NSCLC)
70-75% of all lung Ca cases:
– p16/CDKN2A & K-RAS mutations,
– p53 mutation ( inhibit apoptosis).
Small Cell Lung Carcinoma (CSLC) 20-25%,
TP53
& RB gene mutations ( deregulate cell cycle).
Squamous cell carcinoma
Central tumor
Arising from Squamous cell ( often from
main bronchus)
Smoking is main etiology also caused by
radon.
p53 mutation and overexpression of
epidermal growth-factor receptor very
common.
Morphology: next
Squamous cell carcinoma: The neoplasm is very firm
and has a pale white to tan cut surface. Central
necrosis is frequently seen.
Central necrosis
Micro: nests of polygonal
cells with pink cytoplasm and distinct cell borders
with intercellular bridges and keratin pearl.
Adenocarcinoma
Peripheral tumor.
Sex: female. Age: much younger
person.
Types:
– Bronchial derived: occur in the site of
previous scar (scar carcinoma). Not clearly
linked to smoking.
– Bronchoalveolar Ca: Not related to
smoking. Multiple tumor, present as
pneumonia.
Adenocarcinoma : peripheral tumor
K-RAS mutations are seen primarily in adenocarcinoma.
Adenocarcinoma:
The glandular structures formed by this neoplasm +
mucin production ( mucin stained purple with PAS)
Bronchioloalveolar carcinoma
Appears as pneumonic
consolidation.
Well differentiated
tumor: better
prognosis.
Bronchioloalveolar carcinoma is composed of
columnar cells that proliferate along the
framework of alveolar septae.
Small Cell Carcinoma: central tumor
Central tumor. Aka- oat cell carcinoma
Origin: Neuroendocrine argentaffin (Kulchitsky)
cells.
Smoking is main etiology
Gene: p53 and RB tumor suppressor genes +
over expression of the anti-apoptotic gene
BCL2.
Poor prognosis.
Gross: This tumor has
a soft, lobulated, white
to tan appearance.
Micro: sheets of blue cells are regular,
and round molded nuclei and a
moderate amount of eosinophilic
cytoplasm.
Blue round cells
Large cell carcinoma
Micro:
large anaplastic cells.
Poor prognosis
Relax your eyes
Next topic : Clinical features of tumors
Clinical
Common presentation: Cough, hemoptysis,
weight loss.
Clubbing of the fingers.
Others:
– Due to spread of tumor
– Due to paraneoplastic syndromes
Clinical: Due to spread of tumor
Local lymph nodes metastasis;
– Supraclavicular node (Virchow node).
Distant : Brain, Liver ,Bone.
– Adrenals cortex (Addison’s diseasedeficiency of cortical hormones- skin &
mucosa hyper pigmentation)
Others
Superior Vena caval syndrome (common in small cell
carcinoma, followed by squamous cell Ca.)
– Congestion of veins of neck, face: red
– Engorges jugular vein- edema in arms.
Hoarseness: recurrent laryngeal nerve invasion (
with apical tumor).
Acanthosis nigricans: black, thick skin with skin
tags= axillae, groin etc (common in adenocarcinoma).
Clinical: Due to spread of tumor
Horner syndrome ( in Pancoast tumor ):
– Seen in apical tumors due to involvement of
cervical sympathetic plexus.
– Features are:
Ipsilateral enophthalmos.
Ptosis, Meiosis.
Anhidrosis.
Clinical: Due to paraneoplastic syndromes
Squamous cell
carcinoma
Secret PTH like hormone >
Hypercalcemia→ renal calculi
Small cell
carcinoma
Secret ACTH>Cushing syndrome=
weight gain, hypertension. Skin
pigmentation
Secret ADH > SIADH >
Hyponatremia= cerebral edema
Other Paraneoplastic syndromes in bronchogenic
carcinoma
Hematologic manifestations (In adenocarcinoma).
– Migratory thrombophlebitis.
Lambert-Eaton myasthenic syndrome ( In Small
cell carcinoma: muscle weakness is caused by
auto-antibodies directed to the neuronal calcium
channel) .
Calcitonin, causing hypocalcemia.
Bronchial Carcinoid
Origin: Kulchitsy cells: a neuroendocrine cells
that line the bronchial mucosa.
Age: mean around 40.
Gross: yellow polypoid mass.
Micro:
– LM: Salt pepper.
– EM: Dense core neurosecretory granules in
their cytoplasm
Microscopy
Dense core granules
Salt pepper
Presentation of Carcinoid
Benign carcinoid:
– Cough.
– Hemoptysis, bronchiectasis.
– Recurrent bronchial & pulmonary
infections.
Malignant carcinoid: liver mets. and Secret
serotonin > carcinoid syndrome: diarrhea
and flushing on skin.
Hamartoma
coin lesion
Common
Less than 2 cm.
Micro: haphazard lung
tissue and cartilage.
Clinical: Present as a
"coin lesion" on X-ray.
d/d of coin lesion
Granuloma are multiple.
Metastatic Cancer to the lungs
Multiple variably-sized masses are
seen in all lung fields.
Next Topic
Mesothelioma
Pleural effusion
Malignant Mesothelioma
Site: The visceral or the parietal pleura.
Carcinogen: asbestosis- amphiboles by reactive
free radicals.
Morphology:
– Asbestos bodied are found in the tumor.
– Lung gets ensheathed by tumor tissue may
produce cicatrisation and atelectasis.
Diagnosis of malignant mesothelioma
Positive staining with:
Acid mucopolysaccharide
Keratin
Electron microscopy (EM): presence of long
microvilli and abundant tonofilaments.
Pleural effusion
Empyema- Pus in pleural cavity following
abscess.
Chylothorax : Chyle (lymph)=
– It is a Milky white fluid due to tumor emboli
in lymphatic or in Lymphoma.
All patient present with respiratory distress, relieved when the
effusion in drained by thoracentesis .
Pneumothorax
Def: air in pleural cavity
Types:
– Traumatic: Trauma
– Spontaneous: rupture of paraseptal bulla
– Tension : due to shift of the mediastinum
from the midline.
Tracheal shifting to other side , and hyperresonant
lung on side of injury.
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