Lung Cancer😍

Lung Tumors

Cannonball mets

  • B/L circular, similar sized structures.
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  • M/c primary malignancies
    • CRESP
      • Colorectal Ca
      • Prostate Ca
      • Endometrial Ca/ Choriocarcinoma Ca
      • RCC
      • Synovial CA
  • Canon ball hit ur groin → bleeding from urethra (RCC, Prostate), vagina (endometrial carcinoma) and anus (colorectal cancer)

Benign Lung Tumors

Pulmonary Hamartoma

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  • Most Common Benign Lung Tumor
  • Characteristics:
    • Mnemonic: Hamara tissue, Hamara money, Hamara popcorn
    • "Hamara tissue": Increase in cartilage (normal lung tissue).
    • "Hamara money": Appears as a coin lesion on imaging.
    • "Hamara popcorn": Characteristic popcorn calcification.
  • Clinical Features (C/F):
    • Asymptomatic.
    • May present with cough or hemoptysis.
  • Management (Mx): Excision with VATS.

Malignant Lung Tumors

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  • Most Common Lung Malignancy Overall: 
    • Metastasis (not a primary lung cancer).

Four main primary lung cancers:

Feature
Adenocarcinoma
Squamous Cell Carcinoma
Small Cell Carcinoma/
Oat Cell Carcinoma
Large Cell Carcinoma
Most
Most common Primary lung cancer overall
(in both females > males)
Most common lung cancer in smokers
Most Aggressive

(M>F)
M>F
Smoking Association
Weak/No
Yes
Strongest association with smoking.
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Location
Peripheral
Upper and Central
Central
Peripheral
Genetics/
Mutations
EGFR1,
K-Ras,
Alk mutations
NAPSN 4
P53 mutation
Loss of chromosome 3p, 

L-Myc amplification
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Precancerous Condition
Adenocarcinoma in situ (AIS)
yes
yes
yes
Microscopy/Morphology
Formation of glands lined by pleomorphic cells


EM
- Small microvilli
- Non Branching
(adeNO)
Formation of keratin pearls
→ large atypical cells with hyperchromasia,

desmosomes
Azopardi effect 
(blue blood vessels → due to broken DNA staining walls of blood vessels), 

Salt and pepper chromatin, 

Neurosecretory granules (EM)
Pleomorphic cells
IHC Markers
Napsin A,
MUC1,
TTF-1

P40 >> P63
CK
Neuroendocrine markers:
Synaptophysin,
Chromogranin,
Bombesin,
CD56, CD57, NSE.

New marker for NET: 
INSM1 (nuclear).
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Paraneoplastic Syn.
Migratory thrombophlebitis 
(also Trousseau phenomenon)
Hypercalcemia
(PTHrP related)
Maximum syndromes:

SIADH (m/c)
Cushing's disease, 
Lambert-Eaton syndrome
Acromegaly
Gynechomastia
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• Hypertrophic Pulmonary Osteoarthropathy (Clubbing)

• Marantic endocarditis
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Highly chemosensitive
(fast-growing cancer).
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Mnemonic:

1, 2, 3
(T1-a,b,c)
Small () Adi () &
Large () Boob
Squeeze ()
Adinnu (adenocarcinoma) mukkiyapo (muc1) nappiyil (Napsin A) thatti (TTF1) →
Trousseril (Trousseau) patti

Apo Rash (Kras) vannu → Jaffar (GFR1) 1 alakki (ALK) thannu

adeNO → Non branching

Squeeze cheythapo → Paalu (Pearls, P53, P40, P63) vannu → contain calcium (Calcium ↑↑)
Small (small cell) aggressive (aggressive tumor) sensitive (chemo sensitive) Person

Vehilcle (VHL - 3p) il mike (L myc) vach paadi (Azorpadi)

Net (NET) cherge cheyyan

Sits (SIADH) in cushiion (cushing) and eat (Lambert eaton) with akkrantham (Acromegaly) → salt and pepper ()
Large (large) boobs (gynechomastia) Pleethi (Pleomorphic)
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Lung Cancer Staging

  • T1 Staging (Tumour Size):
Stage
Tumour Size
T1a
<1cm
T1b
1-2cm
T1c
2-3cm
 
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Diagnosis (Dx):

  • Biopsy:
    • Endo-bronchial ultrasound (EBUS) → FNAC
  • PET-CT: For tumour staging.

Radiology

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  • History: Smoker with hemoptysis.
  • IOC: CT.
  • Gold standard: CT guided biopsy.
  • To assess metastasis: PET CT.
  • Spiculated margins are suggestive of malignancy.

Pancoast Tumour

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  • Location: Apex of the lung
  • Squamous cell carcinoma > Small cell
  • Associated Syndromes:
    • Sympathetic chain compressed.
    • Horner's syndrome (ptosis, miosis, enophthalmos, anhydrosis).
  • M/c nerve root compression
    • C8, T1, T2
  • IOC: MRI
  • Management (Mx): Radiotherapy.

Brachial MRI

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  • MRI is IOC for:
    • Pancoast tumor:
      • Brachial plexus invasion (Nerves are better visualised in MRI).
    • Posterior mediastinal mass:
      • Since m.c - Neurogenic tumor.

Pleural Tumor:

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Mesothelioma

  • Origin: Tumor arising from the pleura.
  • Association: Specifically associated with asbestosis exposure.
  • Marker:
    • Calretinin positivity 
    • Cytokeratin 5 & 6
  • Electron Microscopy: Shows long microvilli.
    • Contrast: Adenocarcinoma shows no branching and short microvilli.
  • Mnemonic:
    • Mesa (mesothelioma) nnu asbestos () kaalil (calretinin) veenu
    • long vili vilichu (long villi) 5-6 times
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Cytokeratin 5 and 6 seen in

  • Mesothelioma
  • TNBC

Lepidic Cells in pathology

  • Bronchoalveolar carcinoma → Adenocarcinoma In situ
  • Cardiac myxoma
  • Mnemonic: Leopard is back (BAC → Bronchoalveolar Ca) in car (Cardiac myxoma)
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