LUNG PATHOLOGY -2

Question 1

List 3 IHC markers that would confirm a diagnosis of small cell carcinoma

Deborah Dalmeida MD

Answer 1

Chromogranin

Neuron specific enolase

Synaptophysin

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Question 2

Which of the following points represents a restrictive lung disease?

Deborah Dalmeida MD

Answer 2

D

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Question 3

Features of carcinoid syndrome

Deborah Dalmeida MD

Answer 3

Bronchospasm

Flushing

Diarrhea

Right sided heart murmur

Deborah Dalmeida MD

Question 4

Where do the tumor cells grow in bronchioloalveolar carcinoma?

Deborah Dalmeida MD

Answer 4

along the walls of pre existing alveoli – lepidic pattern

Deborah Dalmeida MD

Question 5

What’s your diagnosis?

List the 3 most common conditions responsible for this appearance.

Deborah Dalmeida MD

Answer 5

Cannon ball metastases

Commonest primary sites: Breast > colon>renal

Deborah Dalmeida MD

Question 6

What’s the cell of origin of these tumor cells?

Deborah Dalmeida MD

Answer 6

Neuroendocrine Kulchitsky cells

Deborah Dalmeida MD

Question 7

Highly malignant neoplasm a/w heavy exposure to asbestos

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Answer 7

Mesothelioma

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Question 8

What’s your diagnosis?

Central mass

Light microscopy: organoid arrangement of tumor cells

Electron microscopy - dense-core granules

Flushing

Diarrhea

Deborah Dalmeida MD

Answer 8

Carcinoid Tumor

Deborah Dalmeida MD

Question 9

Tall, thin males around the age of 20

Smoking

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Answer 9

Primary spontaneous Pneumothorax

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Question 10

List the possible structures that may be possibly involved in Pancoast tumor.

Deborah Dalmeida MD

Answer 10

• Recurrent laryngeal nerve - hoarseness
• Stellate ganglion à Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)
• Superior vena cava - SVC syndrome
• Brachiocephalic vein
• Brachial plexus

Deborah Dalmeida MD

Question 11

central tumor

organoid, trabecular, palisading, ribbon, or rosette-like arrangements of cells separated by a delicate fibrovascular stroma

Electron microscopy shows dense core granules

Deborah Dalmeida MD

Answer 11

Carcinoid Tumor

Deborah Dalmeida MD

Question 12

1. The lung carcinoma most commonly associated with ectopic hormone production as part of paraneoplastic syndrome
2. List two ectopic hormone syndromes occuring as a part of paraneoplastic syndromes

Deborah Dalmeida MD

Answer 12

1. Small cell Carcinoma (Oat cell carcinoma)
2. Ectopic ACTH and SIADH

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Question 13

Central mass

small round or polygonal cells in clusters with salt and pepper pattern of nuclear chromatin

Electron microscopy- dense core neurosecretory granules

Deborah Dalmeida MD

Answer 13

Small cell carcinoma (Oat cell carcinoma)

Deborah Dalmeida MD

Question 14

peripheral, solitary, well circumscribed,

solitary coin lesion on the CXR

Deborah Dalmeida MD

Answer 14

Pulmonary Hamartoma

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Question 15

Why would you get Horner Syndrome secondary to a lung tumor?

Features of Horner Syndrome?

Deborah Dalmeida MD

Answer 15

Involvement of sympathetic ganglia

Ptosis, miosis, anhydrosis, enophthalmos, loss of cilisospinal reflex

Deborah Dalmeida MD

Question 16

Which of the following points represents an obstructive disease?

Deborah Dalmeida MD

Answer 16

A

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Question 17

central mass

association with smoking

gray white

tendency to cavitate

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Answer 17

Squamous cell carcinoma

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Question 18

1. Hypercalcemia is seen occuring as a paraneoplastic syndrome with which subtype of lung carcinoma
2. What is the substance being elaborated causing hypercalcemia?

Deborah Dalmeida MD

Answer 18

1. Squamous cell carcinoma
2. Parathyroid hormone-related peptide

Deborah Dalmeida MD

Question 19

peripherally located mass

non smokers, women

positive for thyroid transcription factor-1 (TTF-1)

80% contain mucin.

Deborah Dalmeida MD

Answer 19

adenocarcinoma

Deborah Dalmeida MD

Question 20

List 3 causes for the condition shown in the attached image

Deborah Dalmeida MD

Answer 20

• malignancy invading/compressing the SVC (eg, mediastinal mass, Pancoast tumor)
• thrombosis from indwelling catheters

Deborah Dalmeida MD

Question 21

What is this ?

Periosteal new bone formation, Clubbing, Arthritis

Deborah Dalmeida MD

Answer 21

Hypertrophic osteoarthropathy

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Question 22

Xaxis represents number of breaths per minute

Y axis represents the work of breathing

Does this graph represent a restrictive or an obstructive effect?

Deborah Dalmeida MD

Answer 22

Restrictive defect

Deborah Dalmeida MD

Question 23

Xaxis represents number of breaths per minute

Y axis represents the work of breathing

Does this graph represent a restrictive or an obstructive effect?

Deborah Dalmeida MD

Answer 23

Obstructive

Deborah Dalmeida MD