copy of lung tumours - copy
Post on 04-Jun-2018
226 Views
Preview:
TRANSCRIPT
-
8/13/2019 Copy of Lung Tumours - Copy
1/56
1
LUNG TUMOURS
http://images.google.com/imgres?imgurl=http://www.atpm.com/11.02/nature/images/pinky-flowers.jpg&imgrefurl=http://www.atpm.com/11.02/nature/pinky-flowers.shtml&h=1245&w=1600&sz=344&tbnid=cqHn-iC89clDLM:&tbnh=116&tbnw=150&hl=en&start=5&prev=/images%3Fq%3Dflowers%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
8/13/2019 Copy of Lung Tumours - Copy
2/56
2
Alveoli contain type I and IIpneumocytes
Type I pneumocytes: 95%,flattenedType II pneumocytes: 5%,produce surfactant (lamellarbodies on EM), involved inrepair if type I destroyed
Bronchial-bronchioalvearepithelium contains gobletcells, neuroendocrine(Kultschitskys) cells, serouscells, basal cells, Clara cellsand ciliated cells
-
8/13/2019 Copy of Lung Tumours - Copy
3/56
3
ORIGIN
Carcinomas/adenomas Epithelial tumours B ron ch ial su rface cel l Gob let cel l Bro nch ial g land ce l l Clara cell Type II alveolar epith elial c el l Neuroendocrine tumours - Kultschitskys cells Sarcomas/benign soft tissue tumours - Mesenchymal
tissue (Connective tissue Blood vessels, lymphatics, cartilage) Hematological lymphomas others
-
8/13/2019 Copy of Lung Tumours - Copy
4/56
4
BENIGN LESIONS TUMOURS AND TUMOUR-LIKE LESIONS
CONGENITAL CYSTS BRONCHOGENIC CYSTS
BRONCHOPULMONARYSEQUESTRATION
ADENOCHONDROMA
SOFT TISSUE TUMOURS HAMARTOMAS
http://images.google.com/imgres?imgurl=http://sprott.physics.wisc.edu/fractals/collect/1999/flowers.JPG&imgrefurl=http://sprott.physics.wisc.edu/fractals/collect/1999/&h=480&w=640&sz=91&tbnid=rgpmus4bCjwPlM:&tbnh=101&tbnw=135&hl=en&start=8&prev=/images%3Fq%3Dflowers%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
8/13/2019 Copy of Lung Tumours - Copy
5/56
5
HAMARTOMA
Incidental finding atautopsy in a 64-year-old male with liver
cirrhosis.1.2 cmnodule.parenchymaof the RUL
coin lesion on xray
-
8/13/2019 Copy of Lung Tumours - Copy
6/56
6
HISTOLOGY
abnormaladmixture ofpulmonary tissuecomponents
Fat cartilage Fibrous tissue
Smooth muscle
-
8/13/2019 Copy of Lung Tumours - Copy
7/56
7
CARCINOID TUMOURS also called well-differentiated neuroendocrine carcinoma
-
8/13/2019 Copy of Lung Tumours - Copy
8/56
8
CARCINOID
May be associatedwith MEN syndrome
micro : Rosettes,
trabecular, solid
-
8/13/2019 Copy of Lung Tumours - Copy
9/56
9
CARCINOID
Typical carcinoid:
-
8/13/2019 Copy of Lung Tumours - Copy
10/56
10
MALIGNANT TUMOURS OF THELUNGS
Risk factors Smoking- 80% in active smokers ,direct
statistical correlation between death ratefrom lung cancer and total amount ofcigerettes smoked
95% of lung tumors are bronchogenic ca
bronchial carcinoids mesenchymal miscellaneous neoplasms Peaks at ages 50-69 years; 2% occur before age 40
-
8/13/2019 Copy of Lung Tumours - Copy
11/56
11
CLASSIFICATIONClassification : broad classification is non-small cell carcinoma (80%) versus small cell carcinoma (20%)50% of non-small cell carcinomas are metastatic at diagnosis vs. 80% of small cell carcinomas
Many have mixed histologic subtypes
-
8/13/2019 Copy of Lung Tumours - Copy
12/56
12
Gross/anatomic
HILAR TYPE ARISES IN THE MAINBRONCHUS OR ONE OF ITSSEGMENTAL BRANCHES IN THE HILARPARTS OF THE LUNGS
PERIPHERAL TYPE
-
8/13/2019 Copy of Lung Tumours - Copy
13/56
13
-
8/13/2019 Copy of Lung Tumours - Copy
14/56
14
Sputum cytology
-
8/13/2019 Copy of Lung Tumours - Copy
15/56
15
Clinical features due to local effects
pneumonia,abscess,lung collapse = obstruction lipid pneumonia = obstruction, accumulation of
cellular lipid in macrophages
pleural effusion =pleural spread hoarseness = recurrent laryngeal nerve invasion dysphagia :oes invasion diaphragm paralysis :phrenic nerve rib destruction :chest wall invasion pericarditis ,tamponade:
-
8/13/2019 Copy of Lung Tumours - Copy
16/56
16
Systemic symptoms : Cancer cachexia =TNF,IL-I,INF-gamma,proteolysis inducing factor, Lambert-Eaton myasthenic syndrome (muscle
weakness due to antibodies to neuronal calciumchannel),
sensory peripheral neuropathy, acanthosis nigricans, leukemoid reaction, hypertrophic pulmonary osteoarthropathy (clubbing), superior vena cava syndrome (compression/invasion of
SVC causes venous congestion, circulatory compromise, dusky head, arm edema), pain
in distribution of ulnar nerve Horners syndrome (enophthalmos, ptosis, miosis,
anhidrosis) due to apical lung tumors called Pancoasttumors
-
8/13/2019 Copy of Lung Tumours - Copy
17/56
17
PARANEOPLASTIC SYNDROMES
ADH ACTH
PARATHORMONE,PT RELATEDPEPTIDE ,PGE,SOME CYTOKINES CALCITONIN,GONANDOTROPHINS
SEROTONIN,BRADYKININ
http://images.google.com/imgres?imgurl=http://7art-screensavers.com/flowers/2004-08-19-flowers-photos/Dahlia-decorative-two-white-flowers.jpg&imgrefurl=http://www.7art-screensavers.com/flowers.shtml&h=768&w=1024&sz=107&tbnid=dUzBBGEBArjU8M:&tbnh=112&tbnw=150&hl=en&start=1&prev=/images%3Fq%3Dflowers%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
8/13/2019 Copy of Lung Tumours - Copy
18/56
18
relative risk of smokers vs. nonsmokers is 10:1;increases to 20:1 for >40 cigarettes/day;risk is strongly related to number of cigarettes smoked,described in pack years (number of packs per day x number of years smoking)
-
8/13/2019 Copy of Lung Tumours - Copy
19/56
19
-
8/13/2019 Copy of Lung Tumours - Copy
20/56
-
8/13/2019 Copy of Lung Tumours - Copy
21/56
2121
Tobacco use
Petroleum products
Atmospheric pollutionasbestos
Genetic
RISK FACTORS
Radon
RadiationURANIUM MINERS
Vitamin A deficiency
Chronic scarring(SCAR CANCERS
radiation exposure, uranium (RR with uranium exposure is 4:1 for nonsmokers, 10:1 for smokers vs. general population);asbestos (RR with asbestos exposure is 5:1 for nonsmokers, 50-90:1 for smokers vs. general population),exposure to nickel, chromate, coal, mustard gas, arsenic, beryllium, iron, vinyl chloride, radon radiation, gold minersCauses of death for asbestos workers are: 20% lung cancer, 10% mesothelioma, 10% GI carcinomas
-
8/13/2019 Copy of Lung Tumours - Copy
22/56
22
PRECURSOR LESIONS Squamous dysplasia Carcinoma-in-situ Atypical adenomatous hyperplasia Diffuse idiopathic neuroendocrine cell hyperplasia NOTE not all cases progress to
invasive cancer impossible to distinguish between
preinvasive lesions that are likelyto progress and those that willremain localized
-
8/13/2019 Copy of Lung Tumours - Copy
23/56
23
SQUAMOUS METAPLASIA
-
8/13/2019 Copy of Lung Tumours - Copy
24/56
24
CARCINOMA-IN-SITU
-
8/13/2019 Copy of Lung Tumours - Copy
25/56
2525
Proto- oncogenes Cancer suppressorgenes
apoptosis DNA repairgenes(MMR)
Cell cycle check
Genetic changes
-
8/13/2019 Copy of Lung Tumours - Copy
26/56
26
-
8/13/2019 Copy of Lung Tumours - Copy
27/56
27
MOLECULAR GENETICS
10-20 GENETIC MUTATIONS HAVEOCCURRED BY THE TIME TUMOUR IS
APPARENT
FIELD EFFECT : GENETIC CHANGES IELOSS OF CHR 3p MATERIAL CAN BE FOUNDIN BENIGN BRONCHIAL EPITHELIUM IN PTSWITH LC AND IN SMOKERS
SMALL CELL CA : P53,C-MYC,RB NON SMALL CELL CA : P53,RAS,P16INK4a
-
8/13/2019 Copy of Lung Tumours - Copy
28/56
2828
limitless replicative potential (immortality);
P53,C-MYC,RBSMALL CELL CA
P53,RAS,P16INK4aNON SMALL CELL CA
-
8/13/2019 Copy of Lung Tumours - Copy
29/56
29
Many more mutations leading to mets
I am migrating to the brain ,very overcrowded here
-
8/13/2019 Copy of Lung Tumours - Copy
30/56
30
Indications Non-Small Cell Lung Cancer Principal Targets Cell growth (EGFR and a variety
of mutant forms of EGFR [e.g.,T790M], HER2)
Angiogenesis (VEGFR) EGFR and HER2 are targets forapproved cancer therapies.
Signaling through VEGF/VEGFRis the target of an approvedcancer therapy.
EGFR is mutationally activated in a subset of non-small cell lungcancer patients, and some EGFRmutations are associated withresistance to erlotinib andgefitinib.
MOLECULAR TARGETS FOR TREATMENT
-
8/13/2019 Copy of Lung Tumours - Copy
31/56
31
GROSS APPEARANCE
LUNG CANCER ARISING IN MAINBRONCHUS
NARROWING ANDOCCLUDING THELUMEN
YELLOWISH -WHITE
-
8/13/2019 Copy of Lung Tumours - Copy
32/56
32
GROSS
NECROSIS HAEMORRHAGE CAVITATORY
LESION
-
8/13/2019 Copy of Lung Tumours - Copy
33/56
33
-
8/13/2019 Copy of Lung Tumours - Copy
34/56
34
SQUAMOUS CELL CARCINOMAHISTOLOGY
-
8/13/2019 Copy of Lung Tumours - Copy
35/56
35
SPREAD
DIRECT :lung,mediastinum,pericardium,heart,pleura ,vertibrae ,cervical sympathetic chain
LYMPHATIC :hilar nodes, tracheobronchial
mediastinum,cervical,supraclavicular, axillary BLOOD: adrenal,brain, TRANSCOELOMIC
-
8/13/2019 Copy of Lung Tumours - Copy
36/56
36
SMALL CELL CARCINOMA
cytology
-
8/13/2019 Copy of Lung Tumours - Copy
37/56
37
SMALL CELL CARCINOMA
-
8/13/2019 Copy of Lung Tumours - Copy
38/56
38
SMALL CELL CARCINOMA
accounts for about 20-30% of all lungcancers- older, male:female ratio 4:1, related to
cigarette smokers- high-grade and rapid growth- secrete a large amount of polypeptide
hormones, APUD SYSTEM
This produces extra-pulmonarymanifestations ie ectopicadrenocorticotrophin syndrome.
-
8/13/2019 Copy of Lung Tumours - Copy
39/56
39
SMALL CELL CARCINOMA
Site :major bronchi and periphery ,subepithelial alongthe bronchus, peribronchial growth in supporting tissueand lymphatics
- Gross white, fleshy, soft
- Spread: along bronchus distally and proximally, into lungparenchyma to mediastinum or pleura, causing pleuralseeding, pleural effusion, involvement of diaphragm andchest wall
- mediastinal LN involvement occurs early
- Treatment complete excision for non-small cell lungcarcinoma; radiation therapy (usually not-curative),chemotherapy (rarely curative, even for small cellcarcinoma)
-
8/13/2019 Copy of Lung Tumours - Copy
40/56
40
BAL CYTOLOGY
-
8/13/2019 Copy of Lung Tumours - Copy
41/56
41
ADENOCARCINOMAaccounts for about 50% of all lung cancers, most
common type in women and non smokers male:female ratio is about 2:1 less strongly associated with cigarette smoking they bear similarity to secondary tumours and must be
distinguished CT scans and other investigations to check for
presence of a primary- commonly arises around scar
tissue associated with asbestos exposure k-ras mutation
-
8/13/2019 Copy of Lung Tumours - Copy
42/56
42
ADENOCARCINOMA Gross :
grey to tan, firm or soft depending ondesmoplasia
necrosis may be present commonly invade pleura and mediastinal
lymph nodes often metastasize to the brain and bones. direct invasion into the thoracic wall
-
8/13/2019 Copy of Lung Tumours - Copy
43/56
43
Subtypes: /origin
B ron ch ial su rface ce ll typ e w i th l i t t le/nom u c i n
Gob let cel l typ e
B ron ch ial g land ce ll type Clara c el l ty p e Typ e II alveolar epith el ial c el l typ e
Hepatoid A denoc arc inom a of fetal lung type
-
8/13/2019 Copy of Lung Tumours - Copy
44/56
44
glandular diff shape and size differentiation
mucin production intracytoplasmic/
glandular mucin
desmoplasticstroma
micro
-
8/13/2019 Copy of Lung Tumours - Copy
45/56
45
PERIPHERAL ADENOCARCINOMA
ORIGINATE FROMSMALL PERIPHERALBRONCHIOLE
SINGLE OR MULTIPLE PNEUMONIA-LIKE
CONSOLIDATION OFLARGE PART OF LUNG
GREYISH AND MUCOID
-
8/13/2019 Copy of Lung Tumours - Copy
46/56
46
BRONCHIOLOALVEOLAR CA
o arises from terminal bronchioles oralveolar walls
o wide age distribution, associated withcigarette smoking
o periphery, subpleural, no evidence ofstromal, vascular or pleural invasionStage I
o are curable if < 2 cm
-
8/13/2019 Copy of Lung Tumours - Copy
47/56
47
SPECIAL STAINS
Positive stains: mucin, low molecular weightkeratin (CK7), EMA, CEA, TTF1 (72%),surfactant apoprotein (50%), mesothelin (50%),vimentin (9%), S100 (Langerhans cells), p53,
CD57/Leu7 (50% of well/moderatelydifferentiated tumors), calretinin (11%) Negative stains: CK20, vimentin (usually),
keratin 5 (usually), P504S EM: goblet cells, mucus cells, nonciliated
bronchiolar cells, Clara cells DD: melanoma (may be mucin positive)
-
8/13/2019 Copy of Lung Tumours - Copy
48/56
48
-
8/13/2019 Copy of Lung Tumours - Copy
49/56
49
Large cell carcinoma
o periphery > centralo males > femaleso smokingo spherical, well-defined, homogeneous fleshyo necrosis: ++o metastasizes earlyo thoracic wall is frequently involved
-
8/13/2019 Copy of Lung Tumours - Copy
50/56
50
Large cell carcinoma
large cells: >diameter of 3lymphocytes
o solid nests, polygonalcells, well defined cellborders
-
8/13/2019 Copy of Lung Tumours - Copy
51/56
51
PLEURAL TUMOURS
Benignmesothelioma
mesothelial cells Resection curative Malignant asbestos SV 40 association. Chest pains ,recurrent
effusions dyspnoea
MICROSCOPY MALIGNANT
-
8/13/2019 Copy of Lung Tumours - Copy
52/56
52
MICROSCOPY MALIGNANTMESOTHELIOMA
SARCOMATOID
-
8/13/2019 Copy of Lung Tumours - Copy
53/56
53
MESOTHELIOMA EPITHELIALTYPE
-
8/13/2019 Copy of Lung Tumours - Copy
54/56
54
METASTATIC TUMOURS
Cannon-ballsecondaries
Osteogenic sar,
neuroblastomas ,wilmmm,lymphomas,leuk
-
8/13/2019 Copy of Lung Tumours - Copy
55/56
55
METS
CANNON-BALLSECONDARIES
-
8/13/2019 Copy of Lung Tumours - Copy
56/56
56
THANK YOU
top related