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CPR II Exam 2 > Chapter 15: Pneumonia in Immunosuppressed; Lung Transplants; Tumors > Flashcards

Chapter 15: Pneumonia in Immunosuppressed; Lung Transplants; Tumors Flashcards

1
Q

List 3 common causes of diffuse pulmonary infiltrates in an immunocompromised host?

A
  • CMV
  • Pneumocystis jiroveci
  • Drug rxn
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2
Q

List 5 common causes of focal pulmonary infiltrates in immunocompromised hosts

A
  • Gram-negative bacterial infections
  • S. aureus
  • Aspergillus
  • Candida
  • Malignancy
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3
Q

What is the hallmark finding of MAC infections in patients with immunosuppressed (i.e., HIV, elderly, transplant); morphology of the organism?

A
  • Abundant ACID-FAST bacilli within macrophages
  • Thin mycobacteria seen as slender red forms
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4
Q

Common sx’s of pt with HIV who become infected with MAC?

A

Fever + drenching night sweats + weight loss

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5
Q

What is the most common opportunistic infection of AIDS patients?

A

Pneumocystis jiroveci pneumonia

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6
Q

Opportunistic infections are common causes of pneumonia in HIV pt’s, but what are 4 of the more common “usual” bacteria that may be seen?

A
  • S. pneumoniae
  • S. aureus
  • -* H. influenzae
  • Gram-negative rods
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7
Q

As a general rule of thumb which organisms causing infection in HIV pt’s are more likely with a CD4 count >200, <200, and <50?

A
  • >200 = bacterial and tubercular infections
  • <200 = Pneumocystis pneumonia
  • <50 = CMV, fungal, and Mycobacterium avium complex
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8
Q

What is most likely seen on CXR of pt with HIV infected with Pneumocystis jiroveci?

A
  • Diffuse BILATERAL interstitial infiltrates
  • Can also be focal or show nothing!
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9
Q

What is the characteristic morphology of the yeast, Pneumocystis jiroveci?

A

Cup-shaped yeast forms

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10
Q

Which type of organism is the most common cause of pulmonary infection in the early post-transplant period (first few weeks)?

A

Bacterial

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11
Q

Since acute rejection following a lung transplant has a similar picture to infections, diagnosis relies on what?

A

Transbronchial biopsy

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12
Q

What is the morphology of acute rejection of a lung transplant that differentiates it from an infection?

A

Rejection shows mononuclear infiltates around small vessels, in submucosa of airways, or both

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13
Q

What is the major morphological pattern of damage seen with chronic rejection following a lung transplant?

A

Bronchiolitis obliterans –> fibrosis causing partial or complete occlusion of small airways WITH or WITHOUT active inflammation

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14
Q

What age is the peak incidence of lung cancer seen?

A

50-60 y/o

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15
Q

Large areas of “benign” respiratory mucosa being mutagenized by exposure to carcinogens in tobacco smoke is known as what?

A

“Field effect“

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16
Q

Deletions of which 3 chromosomal loci and 3 genes are seen as early events in the squamous cell carcinoma of the lung

A
  • 3p and 9p (site of CDKN2A gene –> product = p16)
  • -* 17p (site of TP53 gene)
  • -* Loss of RB tumor suppressor
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17
Q

Amplification of which gene has been associated with squamous cell carcinoma of the lung?

A

FGFR1

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18
Q

Which type of lung cancer shows the strongest association with smoking?

A

Small cell carcinoma

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19
Q

Loss of function mutations in which 2 genes and chromosome are seen with small cell carcinoma of the lung?

A
  • TP53
  • RB
  • Chromosome 3p deletions
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20
Q

Amplification of which gene is associated with small cell carcinoma of the lung?

A

MYC family

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21
Q

Oncogenic gain of function mutations in which 5 RTK genes are associated with Adenocarcinoma of the lung?

Tumors without RTK mutations often have mutation in which gene?

A
  • RTK mutation = EGFR + ALK + ROS + MET and RET
  • Non-RTK = KRAS
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22
Q

Lung cancers in never smokers are more common in which sex and are most often what type of cancer?

A
  • Women
  • Adenocarcinoma
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23
Q

Lung cancers in never smokers are more likely to have mutations in which gene and never have mutations in what?

A
  • More likely to have EGFR mutations; sometimes TP53
  • NEVER have KRAS mutations
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24
Q

Which type of lung cancer is more commonly arising in the peripheral lung and which in the central/hilar lung?

A
  • Peripheral = adenocarcinoma
  • Central/hilar = squamous cell carcinoma
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25
Q

Which precursor lesion is characterized by dysplastic pneumocytes lining alveolar walls that are mildly fibrotic?

A

Atypical adenomatous hyperplasia

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26
Q

Which precursor lesion is composed entirely of dysplatic cells growing confluently along pre-existing alveolar septae; and may or may not hav intracellular mucin?

A

Adenocarcinoma in situ

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27
Q

Majority of adenocarcinomas of the lung express which transcription factor required for normal lung development?

A

Thyroid transcription factor-1

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28
Q

Which tumor of the lung tends to spread aerogenously, forming satellite tumors and may consolidate an entire lobe mimicking lobar pneumonia?

A

Mucinous ADENOCARCINOMA

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29
Q

What is the characteristic histologly of squamous cell carcinoma?

A

Keratin pearls and/or intracellular bridges

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30
Q

Via cytology which color will the cytoplasm be if keratin is present and is indicative of SCC?

A

Orange cytoplasm

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31
Q

Which type of lung tumor is almost always metastatic at time of presentation and is best treated with specific chemotherapies/radiation?

A

Small cell *neuroendocrine* carcinoma

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32
Q

What is the most aggressive lung tumor with no known preinvasive phase?

A

Small cell *neuroendocrine* carcinoma

33
Q

What is the histology of the chromatin, cytoplasm, nucleus, and nucleoli like with small cell carcinoma of the lung?

A
  • Small cells w/ scant cytoplasm
  • Finely granular (BLUE) nuclear chromatin (salt and pepper pattern)
  • Absent nucleoli
  • Necrosis is COMMON and often extensive
34
Q

What is a more ominous change squamous metaplasia or dysplasia?

A

Dysplasia

35
Q

Basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells (Azzopardi effect) is common with what lung tumor?

A

Small cell carcinoma

36
Q

Which 3 markers are found in the neurosecretory granules of small cell carcinomas of the lungs?

A
  • Chromogranin
  • Synaptophysin
  • CD57
37
Q

Via immunohistochemistry high levels of which anti-apoptotic protein can be demonstrated in small cell carcinomas of the lung?

A

BCL2

38
Q

Early distant spread of lung carcinoma generally occurs via which 2 pathways; which carcinoma specifically metastasizes late?

A
  • Lymphatic and hematogenous
  • Squamous cell carcinoma spreads late
39
Q

What are the 4 favored sites of metastasis for lung carcinomas?

A
  • Adrenals
  • Liver
  • Brain
  • Bone
40
Q

Which 3 LN’s are common sites of metastasis for lung carcinoma?

A
  • Bronchial
  • Tracheal
  • Mediastinal
41
Q

What may partial or total obstruction caused by a lung carcinoma cause?

A
  • Partial –> focal emphysema
  • Total –> atelectasis
42
Q

Impaired drainage of the airways caused by lung carcinomas is a common cause of what?

A

SEVERE suppurative or ulcerative bronchitis or bronchiectasis

43
Q

Venous congestion of the head and arm w/ circulatory compromise caused by an underlying lung carcinoma is known as what?

A

SVC syndrome

44
Q

Phrenic nerve invasion by lung tumor is associated with what?

A

Diaphragm paralysis

45
Q

Activating mutations of which gene in lung cancers is associated with a worse prognosis regardless of tx?

A

KRAS

46
Q

Release of PTHrP leading to paraneoplastic hypercalcemia is associated with what type of lung tumor?

A

Squamous cell carcinoma

47
Q

Which 2 hormones may be secreted by small cell carcinomas and what does each cause

A
  • ADH —> SIADH
  • ACTH —> Cushing Syndrome
48
Q

What are 2 systemic nervous system related syndromes that may be associated with lung tumors?

A
  • Lambert-Eaton myasthenic syndrome –> auto-abs against Ca2+ channels –> muscle weakness
  • Peripheral neuropathy –> usually purely sensory
49
Q

What is a dermatologic manfiestation that may be associated with lung tumors?

A

Acanthosis nigricans

50
Q

What characteristic of Lambert-Eaton Syndrome distinguishes it from Myasthenia Gravis?

A

Sx’s IMPROVE w/ more movement throughout the day

51
Q

Apical lung cancers (pancoast tumors) in the superior pulmonary sulcus tend to invade which neural structures around the trachea and produce what signs/sx’s?

A
  • Invade cervical sympathetic plexus
  • Severe pain in the distribution of the ulnar nerve
  • Horner syndrome –> enophthalmos + ptosis + miosis + anhidrosis
52
Q

What are 2 hematologic abnormalities that may be assocaited with lung tumors?

A
  • Leukemoid rxns
  • Trousseau syndrome (DVT and thromboembolism)
53
Q

What is a peculiar abnormality of connective tissue associated with lung tumors and what is seen with this?

A

Hypertrophic pulmonary osteoarthropathy –> clubbing of fingers

54
Q

Lambert-Eaton Syndrome is most often associated with what tumor of the lung?

A

Small cell carcinoma

55
Q

Trousseau sign (migratory thrombophlebitis) is most often associated with what type of lung tumor?

A

Adenocarcinoma

56
Q

What is the main difference between Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) and Carcinoid tumors?

A
  • SIZE!!!
  • DIPNECH = very small, <5mm —> “Tumorlets”
  • Carcinoid tumor = 5mm or larger
57
Q

Why is it important to differentiate DIPNECH from Carcinoid tumors?

A

Carcinoid tumors have ability to metastasize

58
Q

Which tumor of the lungs grows as fingerlike or spherical polypoid masses that commonly project into the lumen of the bronchus and may produce so-called collar-button lesions?

A

Carcinoid tumor

59
Q

Which lung tumor is characterized by organoid, trabecular, palisading, ribbon, or rosette-like arrangements of cells w/ uniform round nuclei and abundant cytoplasm separated by a delicate fibrovascular stroma?

A

Carcinoid tumor

60
Q

What are features of atypical carcinoid tumors (neuroendocrine tumor grade 2) which differ from typical carcinoid tumors (grade 1)?

A
  • ↑↑↑ mitotic activity
  • NECROSIS (typical carcinoids lack necrosis)
  • Disordered growth
  • ↑↑↑ rate of metastasis w/ LOWER survival
61
Q

Immunohistochemical stains of carcinoid tumors may be positive for what 4 markers?

A
  • Serotonin
  • Neuron-specific enolase
  • Calcitonin
  • Bombesin
62
Q

What are clinical features of carcinoid tumors which may result from their intraluminal growth?

A
  • Persistent cough
  • Hemoptysis
  • Impairment of drainage of resp. pathways –> 2’ infections
  • Bronchiectasis
  • Emphysema
  • Atelectasis
63
Q

What are the sx’s of Carcinoid Syndrome?

A
  • Flushing
  • Diarrhea
  • Cyanosis
64
Q

What is the prognosis like for typical carcinoid vs. atypical carinoid tumors?

A
  • Typical have 5-year survival of 95%
  • Atypical have 5-year survival of 70%
65
Q

What is a feature that can be seen on CXR and CT that points to metastasis TO the lung?

A

Multiple discrete nodules (cannonball lesions) scattered throughout all lobes

66
Q

How are lung hamartomas most often discovered and how do they appear?

A
  • Incidental finding on CXR
  • Appear as rounded, radio-opacity (“coin lesion”)
67
Q

What do pulmonary hamartomas consist of?

A

Nodules of CT; most often cartilage, also fat and fibrous tissue; intersected by epithelial clefts

68
Q

Which 2 chromosomal aberrations are associated with lung hamartomas?

A
  • 6p21
  • 12q14-q15
69
Q

Lymphangioleiomyomatosis is a lung disorder occurring almost exclusively in whom?

A

Young women

70
Q

Which markers are expressed by Lymphangioleiomyomatosis?

A

Melanoma, like HMB-45 and smooth muscle cells

71
Q

Lymphangioleiomyomatosis is characterized by proliferation of which cells and what does this create morphologically?

A

Perivascular epithelioid cells –> CYSTIC, emphysema-like dilation of terminal air spaces, thickening of interstitium, and obstruction of lymph vessles

72
Q

Lymphangioleiomyomatosis is associated with loss of function of which tumor suppressor; this tumor suppressor is normally a negative regulator of what?

A

TSC2 –> neg. regulator of mTOR activity

73
Q

What is the only definitive tx currently available for Lymphangioleiomyomatosis?

A

Lung transplant

74
Q

Diffuse involvement of both lungs with cystic, emphysem-like dilation of airspaces in Lymphangioleiomyomatosis, may present with what complication?

A

Pneumothorax

75
Q

The strong tendency for Lymphangioleiomyomatosis to affect young women suggests what hormone contributes to proliferation of perivascular epithelioid cells?

A

Estrogen

76
Q

Inflammatory myofibroblastic tumors, though rare, is more common in whom; presents how?

A
  • Children
  • Fever + cough + chest pain + hemoptysis
  • May be asymptomatic
77
Q

Imaging of a child with suspected Inflammatory myofibroblastic tumor will show what?

A

Single (rarely multiple) round, well-defined, peripheral mass that often has calcium deposits

78
Q

Inflammatory myofibroblastic tumors are associated with activating rearrangements of which gene and on which chromosome?

A

ALK gene on chromosome 2p23

79
Q

Growth of contiguous tumors (aka direct continuity) into the lungs most often occurs with what 2 types of tumors?

A
  • Esophageal carcinomas
  • Mediastinal lymphomas

CPR II Exam 2 (23 decks)

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