JCU MB4 Term 1 Week 6 (Lung Cancer)

1

61-year-old smoker. Sputum cytology shown. What is the diagnosis?

Sputum - lung squamous cell carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous cell carcinoma

  Lung abscesses


Very well differentiated, microscopy shows keratin pearl (stains red).

2

61-year-old smoker. Sputum cytology shown. What is the diagnosis?

Sputum - Lung Small Cell Carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


Streaks are characteristics of small cell carcinomas in sputum smears, although it is easily identified by the many small, rounded, dark-blue staining cells.

3

59-year-old female, non-smoker. Lung gross specimen shown. What is the diagnosis?

Lung - Adenocarcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


Adenocarcinomas typically start distally, more common in females. This particular specimen is likely from a smoker due to the visible anthracotic deposits.

4

59-year-old, lung carcinoma. No metastasis. What is the stage?

Lung adenocarcinoma


  T1

  T2

  T3

  T4

  T5


Note ruler across the top, showing that the tumour exceeds 3cm. The tumour extends to the border of the lung, making this a T3 stage tumour. The full staging classification is:

  • TX - Positive malignant cytology results, no lesion seen
  • T1 - Diameter smaller than or equal to 3cm
  • T2 - Diameter greater than 3cm
  • T3 - Extension to pleura, chest wall, diaphragm, pericardium, with 2cm of carina or total atelectasis
  • T4 - Invasion of mediastinal organs (e.g. oesphagus, trachea, great vessels, heart), malignant pleural effusion or satellite nodules within the primary lobe

5

59-year-old female smoker. Lung gross specimen shown. What is the diagnosis?

Lung Squamous cell carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


The tumour is centrally located and well circumscribed and the patient is a smoker, making this more likely to be squamous cell carcinoma. It does not exhibit peribronchial spread (characteristic of small cell) or distal origin (adenocarcinoma).

6

61-year-old smoker. Lung biopsy shown. What is the diagnosis?

Lung microscopy - adenocarcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


Note moderately well differentiated tissue with multiple gland-like structures.

7

28-year-old with history of fever, weight loss and haemoptysis. What is the diagnosis?

Miliary Tuberculosos


  Centrilobular emphysema

  Adenocarcinmoa

  Metastatic deposits

  Lung abscesses

  Miliary tuberculosis


Note the diffuse nodules indicated by the arrows. Metastatic cancer is unlikely given the age and small size of lesions.

8

61-year-old smoker. Lung biopsy is shown. What is the diagnosis?

Lung microscopy - Squamous cell carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses

9

69-year-old with history of weight loss and an enlarged Virchow's node. Gross lung speciment shown. What is the diagnosis?

Lung - metastatic deposits


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


Widespread, well demarcated lesions around 1cm in diameter. If lesions are solitary or few, these may be removable via surgery.

10

69-year-old non-smoker. Sputum microscopy shown. What is the diagnosis?

Sputum - adenocarcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


Microscopy shows glandular clusters with large prominent nucleoli in cells.

11

66-year-old smoker. Pictures show microscopy from lung FNAB. What is the diagnosis?

Lung microscopy - small cell carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Lung abscesses


Note many small blue-pigmented cells. The blue streaks are commonly seen in SCC because the cells become very fragile and they tend to fracture and the nuclear material 'streak' across the slides.

12

69-year-old smoker. Chest X-ray shown. What is the diagnosis?

CXR - Lung Metastases


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Aspergillosis (fungal balls)


Typical 'cannonball' shadows.

13

66-year-old female non smoker. Lung biopsy shown. What is the diagnosis?

Lung microscopy - adenocarcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Anaplastic carcinoma


Glandular structures are visible (compressed due to handling of sample prior to slides).

14

66-year-old female smoker. Lung biopsy shown. What is the diagnosis?

Lung microscopy - small cell carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Metastatic deposits

  Squamous carcinoma

  Anaplastic carcinoma


If you can place two or three lymphocytes into each cancer cell only, it is probably an SCC. Otherwise it is a non-SCC.

16

45-year-old male chronic productive cough. Gross lung specimen shown. What is the diagnosis?

Lung - bronchiectasis


  Chronic bronchitis

  Bronchiectasis

  Small cell carcinoma

  Lung NSCC

  Panlobular emphysema


You can see the bronchi extend almost all the to surface of the pleura. There is also peribronchial fibrosis (but no hilar mass, likely because the patient is too young).

17

34-year-old male, high fever. Lung biopsy shown. What is the diagnosis?

Bronchopneumonia


  Squamous cell carcinoma

  Bronchopneumonia

  Interstitial pneumonia

  Lung abscess

  Small cell carcinoma


Alveoli are filled with extensive inflammatory infiltrate. Alveolar septae are widened, but the inflammation within the alveoli would not be consistent with interstitial pneumonia.

18

42-year-old male smoker. Presents with dyspnoea. Lung biopsy shown. What is the diagnosis?

Lung microscopy - centrilobular emphysema


  Lobar pneumonia

  Panlobular emphysema

  Centrolobular emphysema

  Chronic bronchitis

  Broncho pneumonia


Isolated large areas of alveolar destruction (main one central in image) with intervening normally structured alveoli.

19

42-year-old female smoker. History of weight loss. Gross lung specimen shown. What is the diagnosis?

Lung - Adenocarcinoma


  Squamous cell carcinoma

  Small cell carcinoma

  Tuberculosis

  Lung abscess

  Adenocarcinoma


Solid well-circumscribed mass, distal origin/location. TB is usually in the upper lobe.

20

54-year-old male, history of dyspnoea. Lung biopsy shown. What is the diagnosis?

Lung microscopy - interstitial pneumonia


  Lobar pneumonia

  Bronchopneumonia

  Interstitial pneumonia

  Fungal pneumonia

  Carcinomatous pneumonia


Note widened alveolar septae with inflammatory cells. Alveolar spaces are clear, making lobar/bronchopneumonia less likely.

21

42-year-old male presents with history of dyspnoea and haemoptysis. Gross lung specimen shown. What is the diagnosis?

Lung - small cell carcinoma


  Squamous cell carcinoma

  Metastatic carcinoma

  Small cell carcinoma

  Large cell carcinoma

  Adenocarcinoma


Perihilar spread from central location, lacks defined border.

22

29-year-old male, high fever, cough, dyspnoea. Chest X-Ray shown. What is the likely etiologic agent?

CXR - Lobar pneumonia


  Streptococcus pneumonia

  Staphylococcus aureus

  Haemophilus influenzae

  Escherichia coli

  Pseudomonas aeruginosa


Staphylococcus aureus typically produces a 'snowstorm' appearance in the lung with small abscess-like lesions.

23

62-year-old male presents with Cushing's Syndrome. Gross lung specimen shown. What is the diagnosis?

Lung - Small Cell Carcinoma


  Small cell carcinoma

  Adenocarcinoma

  Bronchiectasis

  Anaplastic carcinoma

  Squamous carcinoma

24

Lung small cell carcinoma typically responds well to:


  Chemotherapy

  Radiotherapy

  Surgery

  No treatment is highly effective


Without treatment, patients can be expected to live no longer than 6-12 months.