Online Super Specialty questions on Lung, Thorax and Mediastinum
Q) Paraneoplastic syndrome with small cell lung carcinoma
a) SIADH
b) Cushings
c) Hypercalcemia
Ans a)
SIADH is most commonly seen with SCLC. Both intrathoracic and extrathoracic malignancies have been associated with SIADH, with SCLC usually identified as the most common cause. ref Devita below table 122.2
Presence of SIADH in (11%) patients with SCLC,
The most common tumors associated with ectopic ACTH production are SCLC and bronchial carcinoids
The incidence of hypercalcemia in patients with lung cancer ranges from 2%-6% at the initial diagnosis to 8%-12% throughout the course of the disease
Q) Stage 2 lung ca with positive lymph node underwent sleeve resection. What to be done post op? (AIIMS onco 2021) a) Prophylactic cranial irradiation b) Chemotherapy (platin based) c) Surveillance
d) Chemo RT
Ans B Chemo
Early stage Cancer (No) - Upfront surgery
Stage I or II or T3No treatment is surgery Plus chemo
Stage IIIa Chemo RT + minus Surgery
Ref Anderson 333
Q) 4X 4 cm mass in anterior mediastinum in a 45 years old male will most probably be A. Thymoma B. Lymphoma C. Neurogenic tumor D. Bronchial cysts
Ans a)
Answer A
Ref sabiston page 1607
Mediastinal masses differ between adults and children.
The most common mediastinal masses in adults are thymomas and thymic cysts (26.5%), neurogenic tumors (20.0%), other cysts (16.1%), germ cell tumors (13.8%), and lymphomas (12.7%).
In a combined series of 718 children with mediastinal masses, neurogenic tumors (41.6%), germ cell tumors (13.5%), primary cysts (13.4%), and lymphomas (13.4%) were diagnosed most frequently.
Pericardial cysts and thymomas are uncommon in children.
Malignant mediastinal neoplasms account for 25% to 50% of mediastinal masses in adults.
Lymphomas, thymomas, germ cell tumors, primary carcinomas, and neurogenic tumors are the most common. Primary carcinomas of the mediastinum constitute up to 10% of primary mediastinal masses and need to be differentiated from malignant thymomas, germ cell tumors, carcinoid tumors, lymphomas, mediastinal extension of bronchogenic carcinomas, and metastatic tumors, which may have a similar appearance by light microscopy.
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Q4) 50-year-old male with 1 x1 cm mass in the Peripheral part of the right lung was resected with clear margins. histopathology was suggestive of Adenocarcinoma and there was no lymph nodes positive what will be the further management A. Observe B. Adjuvant RT C. Adjuvant CT D. EGFR testing
Answer 4) D
Ref NCCN guidelines. All patients of lung cancer adenocarcinoma should be tested for EGFR. EGFR mutations occur in nearly 10% of NSCLCs. EGFR mutations predict response to EGFR–tyrosine kinase inhibitors
(TKIs).
Q5) All are true about squamous cell carcinoma of lung except?
a) Central lesion
b) Most are Cavitatory lesion
c) Associated with smoking
d) Worst prognosis
ANs 5 d
Lung cancers are
a) small cell
b) Non small cell ( Adenocarcinoma, Squmaous carcinoma )
Squamous carcinoma typically appears as a cavitating tumour. (10% are cavitatory)
65% are central, tumor remains localized and there is less systemic spread
Small cell lung cancers tend to metastasise early to lymph nodes and by blood-borne spread. they have the worst prognosis
Q6 ) All are true about pulmonary carcinoid except?
a) Atypical carcinoid is more common
b) Surgery is done with curative intent
c) Atypical carcinoids are peripheral
d) Typical carcinoids have lymph node metastasis and require lymphadenectomy
Ans6 a) MOst common is Typical carcinoids
Small cell carcinomas of lung are of three types
a) Well-differentiated, benign/typical carcinoid tumor ( Most common)
b) intermediate less differentiated atypical carcinoids or neuroendocrine carcinomas
c) undifferentiated malignant small cell carcinoma
Metastases are rare, and surgery is frequently curative.
Neuroendocrine carcinomas or atypical carcinoids occur more peripherally than typical carcinoids and have a more aggressive course
ref anderson page 328, sabiston page 1600
Q7) SVC syndrome with Thymic Carcinoma stage ( WHOB3) WHat will be the management?
A)Chemo radiotherapy followed by surgery
b) Definitive chemoradiotherapy
c) Chemotherapy followed by surgery and radiotherapy
d) Surgery Alone
Ans 7 c Chemo followed by Surgery and PORT
WHO classificaton
Type A thymoma. This is also called spindle cell thymoma or medullary thymoma. The chance of recovery for people with type A thymoma is good. Nearly 100% of people with this type live at least 15 years after diagnosis.
Type AB thymoma. Also called mixed thymoma, type AB thymoma is similar to type A thymoma. However, type AB thymoma has lymphocytes in the tumor. The chance of recovery for people with type AB thymoma is also good. About 90% of people with this type live at least 15 years after diagnosis.
Type B1 thymoma. This is also known as lymphocyte-rich thymoma, lymphocytic thymoma, predominantly cortical thymoma, and organoid thymoma. This type of thymoma has many lymphocytes in the tumor, but the cells of the thymus appear healthy. The chance of recovery for people with type B1 thymoma is also good. About 90% of people with this type live at least 20 years after diagnosis.
Type B2 thymoma. Type B2 thymoma is also known as cortical thymoma and polygonal cell thymoma. This type of thymoma also has many lymphocytes, like type B1 thymoma. However, the thymus cells do not appear healthy. About 60% of people with this type live at least 20 years after diagnosis.
Type B3 thymoma. Type B3 thymoma is also known as epithelial thymoma, atypical thymoma, squamoid thymoma, and well-differentiated thymic carcinoma. This type of thymoma has few lymphocytes, and the thymus cells look abnormal. Approximately 40% of people with this type live at least 20 years after diagnosis.
Thymic carcinoma (Type C thymoma). Thymic carcinoma is more aggressive. Thymic carcinoma cells do not look like healthy thymus cells but like cancers that start in other parts of the body. This type of tumor is often advanced when diagnosed. About 35% of people with thymic carcinoma live at least 5 years after diagnosis. Around 28% of people with thymic carcinoma live at least 10 years.
Management
Neoadjuvant systemic therapy is utilized for those with potential resectable, unresectable, and recurrent disease. This is generally chemotherapy.
Role of Post Op Radiotherapy ( PORT)
In stage I (Masaoka stage I-II) thymomas with invasion into the mediastinal fat or pleura, PORT is recommended if there are high-risk features present (larger tumor size, microscopic, or grossly positive margins).
In stage II-III (Masaoka stage III) thymomas, PORT is indicated due to the higher recurrence risk