Pulmonary Diseases Quiz

Questions and Answers

Which immunohistochemical marker is most likely needed to confirm a diagnosis of squamous cell carcinoma in a poorly differentiated carcinoma showing strong CK5/6 staining and absence of TTF-1?

p40 (correct)

Chromogranin

Napsin A

CDX2

What histologic appearance is characterized by increased mitochondrial density and is associated with squamous cell carcinoma?

Papillary growth pattern

Signet-ring cell morphology

Oncocytoid appearance (correct)

Microcystic structure

In which biological process do mutations in KEAP1 and NFE2L2 primarily affect cellular function?

Apoptosis pathways

DNA repair mechanisms

Oxidative stress response (correct)

Cell cycle regulation

What distinguishes basaloid squamous cell carcinoma from other types of squamous cell carcinoma?

Focal staining for neuroendocrine markers Signup and view all the answers

Which of the following markers would be inappropriate to diagnose squamous cell carcinoma?

TTF-1 Signup and view all the answers

What type of lung cancer is characterized by poorly differentiated carcinoma showing positive staining for CK5/6?

Squamous cell carcinoma Signup and view all the answers

Which marker presence helps to solidify a diagnosis of squamous cell carcinoma if CK5/6 is already positive?

p40 Signup and view all the answers

What is the significance of the absence of TTF-1 in a lung biopsy of a 59-year-old male with a lung mass?

Indicates a diagnosis of squamous cell carcinoma Signup and view all the answers

Which condition is primarily characterized by shoulder pain that radiates down the arm in conjunction with a mass in the superior pulmonary sulcus?

Pancoast syndrome Signup and view all the answers

In the context of lung adenocarcinoma in a non-smoker woman, which factor is most significant in her cancer development?

Genetic predisposition Signup and view all the answers

What is the defining characteristic of Pancoast syndrome?

Shoulder pain radiating down the arm Signup and view all the answers

Which symptom is least expected to be a consequence of a Pancoast tumor?

Hemoptysis Signup and view all the answers

Among the risk factors for adenocarcinoma in non-smokers, which is considered a less significant contributor?

Chronic dust exposure Signup and view all the answers

Which of the following is a common misconception regarding lung cancer in non-smokers?

Lung cancer cannot occur in non-smokers Signup and view all the answers

What is commonly associated with Horner syndrome in patients with a lung mass?

Pancoast tumor leading to sympathetic chain involvement Signup and view all the answers

Which risk factor is often attributed to lung adenocarcinoma development in Asian women?

Genetic predisposition Signup and view all the answers

What histological characteristics suggest the presence of adenosquamous carcinoma in a lung tumor?

Both squamous and glandular components are above 10% Signup and view all the answers

In what situation would a lung tumor be classified as adenocarcinoma rather than adenosquamous carcinoma?

When the squamous component comprises less than 10% Signup and view all the answers

What is the most significant associated feature of adenosquamous carcinoma based on its growth location?

Association with lung scarring Signup and view all the answers

What key diagnostic feature would point towards squamous cell carcinoma in a lung biopsy?

Presence of spindle-shaped cells Signup and view all the answers

Which tumor type is characterized by an even distribution of both squamous and glandular components without significant necrosis?

Adenosquamous carcinoma Signup and view all the answers

If a lung tumor shows a predominance of glandular features with minimal squamous differentiation, which classification is most appropriate?

Adenocarcinoma Signup and view all the answers

What immunohistochemical marker would most likely be positive in a diagnosis of squamous cell carcinoma?

p63 Signup and view all the answers

In which lung cancer subtype is necrosis most commonly associated?

Large cell carcinoma Signup and view all the answers

What histological feature is primarily used to differentiate large cell neuroendocrine carcinoma from small cell carcinoma?

Presence of prominent nucleoli Signup and view all the answers

Which immunohistochemical marker is commonly positive in small cell carcinoma despite negative chromogranin expression?

CD56 Signup and view all the answers

In the context of lung tumors, which feature is most indicative of small cell carcinoma?

Extensive nuclear molding of small cells Signup and view all the answers

What is the significance of a high Ki-67 index in a tumor biopsy of a lung mass?

Reflects high cellular proliferation Signup and view all the answers

Which of the following is NOT a characteristic feature of large cell neuroendocrine carcinoma?

Small round cells Signup and view all the answers

What kind of tumor typically exhibits positivity for TTF-1 along with small cells?

Small cell carcinoma Signup and view all the answers

Which tumor is most likely associated with a smoking history in patients?

Small cell carcinoma Signup and view all the answers

In the diagonsis of lung masses, which combination of features is most suggestive of an atypical carcinoid tumor?

Positive chromogranin and moderate mitotic activity Signup and view all the answers

Which lung segment is typically affected in congenital cystic adenomatoid malformation (CCAM)?

One of the upper lobes or the right middle lobe Signup and view all the answers

Which feature is a key characteristic of a large cystic congenital cystic adenomatoid malformation (CCAM)?

Multilocular cystic spaces Signup and view all the answers

How is placental transmogrification visually characterized in emphysematous bullae?

Cystic spaces resembling the structure of chorionic villi Signup and view all the answers

Which congenital cystic lung condition has a strong association with later development of mucinous adenocarcinoma?

Congenital cystic adenomatoid malformation (CCAM) Signup and view all the answers

What distinguishes pulmonary sequestration from other congenital lung abnormalities?

Abnormal lung tissue with its own blood supply disconnected from the bronchial tree Signup and view all the answers

In which scenario is ciliated respiratory epithelium most likely found?

Bronchogenic cyst Signup and view all the answers

Which is the least likely feature seen in a large cystic congenital cystic adenomatoid malformation (CCAM)?

Destruction of alveolar walls Signup and view all the answers

What is a common histological finding in pulmonary sequestration?

Cystic spaces lined by ciliated epithelium Signup and view all the answers

Study Notes

Lung Tumors and Carcinomas

A 70-year-old male with smoking history and asbestos exposure presenting with weight loss, chronic cough, and hemoptysis likely indicates a Pancoast tumor; associated with Pancoast syndrome featuring shoulder pain radiating to the arm.
A 45-year-old non-smoking woman diagnosed with adenocarcinoma may have developed cancer due to genetic predisposition, especially prevalent in women and Asian populations.
Basaloid squamous cell carcinoma is a poorly differentiated variant that shows focal neuroendocrine marker staining but remains predominantly p63 positive, supporting its diagnosis.
A 59-year-old male with a lung mass showing strong CK5/6 and negative TTF-1 staining suggests squamous cell carcinoma; confirmation is achieved with p40 positivity.
Oncocytoid appearance in tumors, marked by increased mitochondrial density, is often associated with squamous cell carcinoma, supported by CK5/6 and p63 positivity.
Genetic mutations in KEAP1 and NFE2L2 in a squamous cell carcinoma patient affect the oxidative stress response, indicating a potential mechanism for tumor development.
Biopsy showing high mitotic activity, necrosis, and positivity for synaptophysin and CD56 (without chromogranin) is indicative of small cell carcinoma.
Small cell carcinoma is identified by small, round cells exhibiting nuclear molding, strong TTF-1 positivity, and necrotic features.
A peripheral lung mass biopsy revealing prominent nucleoli, abundant cytoplasm, and neuroendocrine growth pattern alongside high Ki-67 index confirms neuroendocrine carcinoma diagnosis.
Adenosquamous carcinoma is characterized by simultaneous squamous and glandular components each accounting for at least 10% of the tumor; location and histological presentation guide classification.
Classification based on histological components dictates that a tumor with less than 10% squamous differentiation is classified as adenocarcinoma.
Adenosquamous carcinoma, especially when peripheral, is frequently associated with lung scarring.
In a patient with a large necrotic lung mass and spindle-shaped cells alongside giant cells, pankeratin and p63 positivity leads to a diagnosis of squamous cell carcinoma.

Congenital Cystic Lung Diseases

Large cystic congenital cystic adenomatoid malformation (CCAM) is least likely to involve destruction of alveolar walls compared to other characteristics like multilocular cystic spaces.
Placental transmogrification, seen in emphysematous bullae, is characterized by cystic spaces resembling chorionic villi structure.
Congenital cystic adenomatoid malformation (CCAM) is notably linked to the later development of mucinous adenocarcinoma.
Pulmonary sequestration features abnormal lung tissue with its own blood supply, independent from the bronchial tree, distinguishing it from typical lung tissue pathology.

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Description

This quiz focuses on the presentation and associated findings of pulmonary diseases, particularly in older males with a history of smoking and asbestos exposure. Evaluate your understanding of conditions like Horner syndrome and Pancoast syndrome related to chest masses.