LUNG

TUMOURS

-K. Padma

SYNOPSIS
Classification of Lung Tumours
Etiology & Molecular Pathogenesis
Clinical Manifestations
Precursor Lesions
Morphological Features of
Squamous Cell CA
Adenocarcinoma
Bronchioalveolar CA
Small Cell CA
Large Cell CA
Paraneoplastic Syndromes
Staging of Cancer

CLASSIFICATION OF LUNG CARCINOMAS

I. SQUAMOUS CELL CARCINOMA
II. SMALL CELL CARCINOMA
(Combined)

III. ADENOCARCINOMA
(Papillary, Acinar/ Solid with Mucin/ Mixed)

IV. LARGE CELL CARCINOMA

(Large Cell Neuroendocrine Carcinoma)

V. ADENOSQUAMOUS CARCINOMA
VI. CARCINOID TUMOUS (Typical or atypical)
VII.CARCINOMAS OF SALIVARY GLAND TYPE
VIII.UNCLASSIFIED

ETIOLOGY
BENIGN
BRONCHIAL
EPITHELIUM

STEPWISE
GENETIC
ABNORMALITY

NEOPLASTI
C
TISSUE

CIGARETTE
SMOKING

STATISTICAL EVIDENCE

Nearly 87% of lung carcinomas occur in active smo

Smokers have anywhere between 10-fold to 60-fold

increased risk of developing cancer.

Over 3000 die every year due to passive smoke.

There is a proven association between

lung cancer developing and the following
risk factors:
The amount of daily smoking

The tendency to inhale

Duration of smoking habit

THE GENETIC CHANGE

:C > T: A Mutations in the p53 gene are a frequen

olecular fingerprint, probably due to Benzylpyrene,
e of the many carcinogens in cigarette
moke.

INDUSTRIAL HAZARDS- URANIUM

INDUSTRIAL HAZARDS- ASBESTOS

AIR POLLUTION - RADON

MOLECULAR PATHOGENESIS

minant oncogenes involved in pathogenesis of

ng carcinoma:
c- MYC
KRAS
EGFR
c- MET
c- KIT
t has also been noted that non-smokers tend to hav
tations in EGFR mutations, while smokers have
AS and p53 mutations.

MOLECULAR PATHOGENESIS

monly deleted/inactivated Oncosuppresor Gene

3, RB1, p16 (INK4a), and multiple loci on 3p

ation of Signal Transduction Molecules:

ERK , STAT5, Paxillin, KRAS

ial Clustering (Genetic Susceptibility):

polymorphisms of CYP1A1 gene

SMALL CELL CARCINOMA

BCL2
RB1
Association

3p
p53
MYCN/L
C-KIT
0

10

20

30

40

50

60

70

80

90

100

NON-SMALL CELL CARCINOMA

P16 (INK4a)

P53

Association

KRAS

EGFR
0

10

20

30

40

50

60

70

80

PRECURSOR LESIONS

Squamous Dysplasia and Carcinoma-in-situ

Atypical Adenomatous Hyperplasia

Diffuse Idiopathic Pulmonary Neuro endocrine Cell
Hyperplasia

SQUAMOUS CELL CARCINOMA

More common in men

Closely correlated with
smoking history

URSOR LESIONS- GOBLET CELL HYPERPL

PRECURSOR LESIONS: BASAL CELL

HYPERPLASIA

PRECURSOR LESIONS SQUAMOU

METAP

ECURSOR LESIONS CARCINOMA IN-SITU

QUAMOUS CELL CA- MICROSCOPIC PICTUR

ADENOCARCINOMA
More common in WOMEN and NONSMOKERS
It is a malignant epithelial tumour with
glandular differentiation or mucin production
by tumour cells.
May grow in
acinar/papillary/bronchioalveolar/solid with
mucin forming patterns.

rsor Lesion: Atypical Adenomatous Hype

BRONCHIO-ALVEOLAR CARCINOMA
Occurring in lung parenchyma in terminal
bronchio-alveolar regions.

CHIO-ALVEOLAR CARCINOMA- GROSS PIC

NCHIO-ALVEOLAR CA- MICROSCOPIC PICT

Brochioalveolar carcinoma is of 2 types:

Mucinous (Satellite Tumours)
Non-Mucinous

SMALL CELL CARCINOMA

Highly malignant tumor, associated with
smoking
Epithelial cells are relatively small, with
scant cytoplasm, ill-defined cell borders,
finely granular nuclear chromatin (SALT AND
PEPPER PATTERN) and absent nucleoli.

MALL CELL CARCINOMA- GROSS PICTURE

LL CELL CARCINOMA- MICROSCOPIC PICT

LARGE CELL CARCINOMA

An undifferentiated, malignant epithelial
tumour that lacks glandular features of smallcell carcinoma or glandular/squamous
pattern.
Large Cell Neuro-Endocrine Carcinoma: A
sub-variant, that can be recognized by
organoid nesting, trabecular, rosette-like and
palisading patterns (neuro-endocrine
differentiation)

ARGE CELL CARCINOMA- GROSS PICTURE

CELL NEURO-ENDOCRINE CA- MICROSCOPIC PI

STAGING OF LUNG TUMOURS

A uniform TNM system for staging lung
tumours on
the basis of anatomical extent and time of
diagnosis is extremely useful to predict a
prognosis, as well as to compare results.

PARANEOPLASTIC SYNDROMES
Lung Carcinoma is associated with several
paraneoplastic syndromes. Hormones and
hormone-like factors elaborated include:
Antidiuretic Hormone (ADH) : inducing
hyponatremia
ACTH : causes Cushing Syndrome
Parathormone, PgE : hypercalcemia often
associated
Calcitonin : causing hypocalcemia

MAJOR PRESENTING COMPLAINTS

80
70
60
50
40
30
20
10
0

Percentage

CLINICAL FEATURES
Pneumonia, abscess
Lipoid Pneumonia
Pleural Effusion

PATHOLOGICAL BASIS
Obstruction of airway
Accumulation of foamy
macrophages
Invading Tumour

Hoarseness
Dysphagia

Recurrent Laryngeal Nerve

Invasion
Esophagal Invasion

Diaphragm Paralysis
SVC Syndrome
Horner Syndrome

Phrenic Nerve Invasion

Compression by tumour
Pancoast Tumours

Lambert-Eaton
Myasthenic Syndrome

peripheral neuropathy