Respiratory 03 – Bronchiogenic CA Pathogenesis:

Definition:
Lung cancer

Classification:

Aetiology:
1) Smoking/industrial hazards/air pollution
2) Molecular genetic mutation

Pathology / Epidermiology:
Squamous Cell CA Adeno CA Large cell CA Small cell CA
Epidermiology Men > women Women > men Smoking
smoking non-smoking
Origin Arise centrally in major Peripherally located Peripherally located Centrally & peripherally located
bronchi
Other features 4 types: acinar, papillary, solid with High mitosis
mucus secretion, bronchioalveolar
1) Slow growth 1) Grow slowly and smaller masses Maglinant tumour Highly maglinant, associated with
2) Distal atelectasis & 2) Metastasise widely at early stage ectopic hormone production
infection
Gross 1) Produce Grey-white, firm, cauliflower-like intraparenchymal mass
2) Focal areas of hemorrhage & neceosis
3) Penetrate to bronchus, pleral cavity, or bronchial,tracheal,
pericardial LN

**Green based is Adeno CA

Central necrosis-Cavitation Central necrosis-Cavitation

histo 1) Well-differentiated ~ 1) Grow along pre-existing 1) Undifferentiated 1) Small round cell with scanty
show keratin pearl structures w/out destruction of 2) large nuclei, prominent cytoplasm
alveolar structure nucleoli, moderate 2) smaller than mature
2) Don’t show proof of stromal, amount of cytoplasm lymphocytes
vascular or pleural invasion 3) cells grow in clusters
3) Pleomorphic gland forming
adenocarcinoma

2) Poor-differentiated ~
minimal residual cell
features

~Occurs in peripheral portions of the lung

~ Grow along preexisting structures without destruction of alveolar
architecture
~ No evidence of stromal, vascular or pleural invasion

Bronchilaveolar CA:
~ Arise from terminal bronchioloalveolar regions
 - Adrenocorticotropic hormone (ACTH) – Cushing syndrome
- Parathormone, parathyroid hormone-related peptide – hypercalcemia
- Calcitonin – hypocalcemia
- Gonadotropins – gynecomastia
- Serotonin & bradykinin – carcinoid syndrome

Other systemic menifestation:

- myasthenic syndrome
- peripheral neuropathy
- dermatologic abnormalities – acanthosis nigricans
Sign & Symptoms: - hematologic menifestation – leukemoid reaction
Symptoms: - hypertrophic pulmonary osteoarthropathy – clubbing of fingers
~hemoptysis
~chest pain Carcinoid Tumours:
~loss of weight
~anorexia & malaise & fatigue Definition:
~hoarseness Neuroendocrine tumour
Sign:
~ finger clubbing Epidermiology:
~paraneoplastic syn - 1% - 5 % of all lung tumours
(production of hormone or hormone like substance) - Age – younger than 40
~Horner syn (miosis, ptosis, anhidrosis) - Sex – equal distribution

Investigation: Type:
CXR: ~ Typical and atypical carcinoid tumours
~mass±hilar adenopathy ~ Typical carcinoid – no p53 mutation or BCL2/BAX imbalance
~pleural effusion
~atelectasis Gross Morphology:
~Squamous,large & small cell – central mass ~ Central or peripheral
~Adeno – peripheral mass ~ Central tumour – small finger like or polypoid mass which project into
Chest CT: better view lumen of bronchus, or collar button lesion
Sputum cytology ~ Peripheral tumour – solid and nodular
Biopsy
Histology
Management / Treatment: ~ Organoid, trabecular, palisading, ribbon or rosette-like arrangements of
Non-small cell lung cancer – surgery cells separated by a delicated fibrovascular stroma
Small cell lung cancer – chemotherapy ~ Individual cell – regular, uniform round nuclei, moderate amount of
cytoplasm
Complication:
Complication Pathological basis
Rib destruction Chest wall invasion
SVC syndrome SVC compression by tumor
Horner syndrome Sympathetic ganglia invasion
Pericarditis, Pericardial tamponade Pericardial involvement
pneumonia, abscess Tumor obstruction of airway
Lobar collapse
Lipid pneumonia Tumor obstruction by
accumulation of cellular lipid
Pleural effusion Tumor spread into pleura
Hoarseness Recurrent laryngeal N invasion
Dysphagia Oesophageal invasion
Diaphragm paralysis Phrenic nerve invasion

Prognosis:
5 years of survival - 5%
Paraneoplastic syndrome:

Etiology:
Production of hormone & hormone like

Substance:
- Antidiuretic hormone (ADH) – hyponatremia