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Monthly Archives: April 2010
Lung Cancer
Lung Cancer
Causes of Lung Cancer
Smoking including passive exposure to cigarette smoke
Radiation from uranium and radon
Metals such as arsenic, chromium, nickel
Granulomatous diseases such as sarcoidosis
Lung fibrosis
Scleroderma
Air pollution
Signs and Symptoms
Cough, most common and worry about a chronic cough that changes in character
Difficulty breathing, Chest pain, Coughing up blood, Finger nail changes termed clubing, Anorexia, Weight loss, Anemia, Fever
Investigations and Screening
Imaging: Chest X-ray, CT chest and upper abdomen scan, PET scan, bone scan
Sputum Cytology
Tissue Biopsy by bronchoscopy, percutaneous, mediastinoscopy
Lung Cancer Interesting points:
2/3 of primary lung cancer is found in the upper lungs
2/3 of metastases found in the lower lungs – believed to be due to transport of tumor cells through the blood to the lower ares of the lungs as there is more blood flow in the lower areas of the lungs.
Lung Cancer Treatments and Therapy
There is currently no role for chemotherapy alone, only in combination with other treatments.
Common Lung Cancer Chemotherapy
1) cisplatin and etoposide
2) paclitaxel, vinorelbine, and gemcitabine
3) new biologic’s which are drugs that target specific molecules include the Epidermal growth factor inhibitor (Geritirdb)
Lung Cancer Chemotherapy Complications
- bleeding, blood cell suppression leading to anemia and neutropenia, tumour lysis syndrome, infection
Specific Chemothearpy Side-Effects
- hemorrhagic cystitis (cyclophosphamide)
- cardiotoxicity (doxorubicin)
- renal toxicity (cisplatin)
- peripheral neuropathy (vincristine)
Lung Cancer Cure
Only chance for cure is resection when tumour is still localized
Lung Cancer Surgery Mortality Rates
- 6% if pneumonectomy
- 3% if lobectomy
- 1% if segmentectomy
Lung Cancer Prognosis
5-year survival rates for different subtypes
- squamous 25%
- adenocarcinoma 12%
- largerge cell carcinoma 13%
- small cell lung cancer 1%
Posted in Lung
Tagged , adenocarcinoma, causes of lung cancer, chemotherapy, complications, cure, investigations, large cell, Lung, lung cancer, prognosis, screening, side effects, signs, small cell, squamous lung cancer, symptoms, therapy, treatment
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Bronchoalveolar Carcinoma
Bronchoalveolar Carcinoma
- a form of lung adenocarcinorna that grows along the alveolar wall
- found in the periphery
- can arise at sites of previous lung scarring due to past inflammation or damage
Clinical presentation
- similar to other lung cancers
- not aggressive but often diffuse involving many different areas of the lung
- metastasis occurs late
Treatment and prognosis
- solitary lesions are resectable
- if resected there is a 60% 5-year survival rate
- around a quarter of patients are cured.
Posted in Lung
Tagged , Bronchoalveolar cancer, Bronchoalveolar Carcinoma, clinical presentation, lung adenocarcinoma, lung cancer, prognosis, scar, surgery, treatment
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Tumor Vascular Invasion
Tumor Vascular Invasion
Lung Tissue
Lung Tissue
Metastatic Renal Cell Carcinoma
Metastatic Renal Cell Carcinoma to the Lung
Malignant Mesothelioma
Malignant Mesothelioma
Posted in Lung
Tagged , Lung, malignant, malignant mesothelioma, mesothelial cells, mesothelioma
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Sarcoidosis
Sarcoidosis
- sarcoidosis is a form of granulomatous inflammation
Posted in Lung
Tagged , giant cells, granuloma, granulomatous inflammation, Inflammation, Lung, sarcoid, sarcoidosis
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Follicular Lymphoma
Follicular Lymphoma
Also known as Follicular Center Lymphoma, and Small Cleaved Mixed or Large Cell Lymphoma
Clinical Information
- affects adults (average age 55 years)
- very common non-Hodgkin’s Lymphoma (around 40% of all non-Hodgkin’s Lymphoma)
- presents in a late stage often, with disseminated disease
- prognosis poor as follicular lymphoma is slow growing and does not respond well to treatments and few cells are actively dividing – not curable
- commonly (80%) transforms to an aggressive lymphoma, diffuse large B cell lymphoma
Classification in the working formulation
1. Follicular small cleaved, mixed, large, or small non-cleaved cells
Classification in WHO/ REAL
1. Mature B cell neoplasm-Follicular centre B-cell lymphoma
Genetic changes
1. t(14;18) (q32;q21)
2. Rearrangements of BCL6 on chromosome 3q27
3. t(2;18) (p12;q21)
4. +7
5. +18
6. 6q23-26
7. p53 at 17p13
Pathogenesis
1. Translocation of bcl-2 on chromosome 18 to IgH on chromosome 14 causes overexpression of bcl-2, an anti-apoptotic gene. Continual production of bcl-2 allows for continued survival of follicular centre cells (prevention of apoptosis) in the germinal centre. May allow for accumulation of further mutations that allow for progression to high grade lymphoma.
e. differences between reactive hyperplasia in a lymph node and follicular lymphoma
1. Follicular lymphoma demonstrates growth of neoplastic follicles through lymph node capsule (with splitting of capsule) and may demonstrate growth into extracapsular adipose tissue. (Follicles of reactive hyperplasia will not demonstrate growth into extracapsular tissue and will not demonstrate capsular splitting).
2. Follicular lymphoma demonstrates expansion of germinal centre (evident on reticulin stain or CD21/CD23 stain). (No expansion of germinal centre in reactive hyperplasia).
3. Germinal centres are devoid of tingible body macrophages in follicular lymphoma. (Tingible body macrophages present in reactive hyperplasia).
4. Obliteration of cortical sinuses, with involvement of paracortical, interfollicular and medullary zones by malignant cells with cleaved/convoluted nuclei in follicular lymphoma, which is absent in reactive hyperplasia.
5. Follicles in follicular lymphoma are not variable in size (as in a reactive lymph node)
6. Follicles in follicular lymphoma demonstrate a disruption in architecture (lack of eccentricity with pale centre and darker periphery as seen in reactive hyperplasia).
7. Presence of bcl-2 staining within germinal centres of follicular lymphoma. (Absent in reactive hyperplasia).
Sites of Involvement
- lymph nodes, bone marrow and spleen are all common
- involvement of blood is uncommon
Microscopy
- follicular pattern, with back-to-back follicles lacking follicle polarization and consisting of small lymphocytes
- there is also a diffuse variant which does not have a follicular pattern
- follicle consists of centrocytes and centroblasts
- no tingle-body macrophages are present (as the cells are immortal to death signals, as they are over-expressing bcl-2)
- low mitotic rate
- stroma is usually scant and compressed between follicles
- mantle zone is scant or compressed
Centrocytes
- small cleaved follicular center cells
Centroblasts
- large noncleaved follicular center cells
Follicular Lymphoma
Follicular lymphoma showing back to back follicles with loss of normal lymph nodes architecture.
Follicular Lymphoma
Higher power view of follicle in follicular lymphoma displaying abnormal lymphocytes and lack of tingle-body macrophages. There is also an irregular mantle zone.
CD20 Immunohistochemistry
CD20 immunohistochemistry in follicular lymphoma is positive, demonstrating that the malignant lymphocytes are B cells.
CD20 Immunohistochemistry
CD20 staining the membranes of the malignant clonal follicular lymphoma B cells, which have overtaken the lymph node forming large areas lacking T cells (which do not stain).
BCL-2 Immunohistochemistry
BCL-2 immunostaining follicle center cells in follicular lymphoma. Follicle center cells should not express BCL-2 normally, as it is an anti-apoptotsis protein. In follicular lymphoma, the malignant lymphocytes express BCL-2 and escape death. BCL-2 positive follicles are seen in follicular lymphoma.
BCL-2 Follicular Lymphoma
BCL-2 immunohistochemistry highlighting malignant follicle center B cells in a case of follicular lymphoma. Notice the dark nuclear staining with BCL-2.
Posted in Lymphoma
Tagged , bcl-2, cd20, follicular lymphoma, immunohistochemistry, Lymph Node, Lymphoma
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Mantle Cell Lymphoma
Mantle Cell Lymphoma
CD5 Immunohistochemistry
Cyclin D1 Immunohistochemistry
CD20 Immunohistochemistry
Posted in Lymphoma
Tagged , Cancer, cd20, cd5, cyclin d1, immunohistochemistry, Lymph Node, Lymphoma, mantle cell lymphoma
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