Tricky one

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Tricky one

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jean robert
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02/01/08 - 07:50 AM

55 y.o. patient with a 60-pack/year smoking history of multiple bacterial lung infections presents with a nonproductive chronic cough for the past three months. A routine chest x-ray demonstrates a 3-cm circular lesion near the apex of the right lung. CT-guided biopsy of the lesion demonstrates a malignant tumor. Which of the following types of cancer is most likely to be present?

a) Adenocarcinoma

b) Bronchioalveolar carcinoma

c) Large cell carcinoma

d) Oat cell carcinoma

e) Squamous cell carcinoma

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nerve09
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02/01/08 - 09:36 AM

E. squamous cell carcinoma
the apical region indicates the pancoast tumor which's complication of SCC..SCC is usually found in hilar region n also associated with smokers..

angel23
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02/01/08 - 10:16 AM

oat cell CA and squamous cell CA involve centre more i.e bronchus...hav strong relation to smoking
adenoCA and bronchioalveolar CA present mainly at periphery involving alveoli....
do not hav tht strong ass with smoking
large cell CA mostly are anaplastic type which spread to hilar lymph nodes,apex(pancoast tumour)and metastise.....
so i l go with C(large cell CA)

jerker
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02/01/08 - 11:06 AM

peripheral with smoking.
A)adenocarcinoma

Tiff
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02/01/08 - 04:29 PM

new_n_lost
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02/01/08 - 08:29 PM

Smoker with Multiple infections and a large mass on periphery => c) Large cell carcinoma

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pr20
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02/02/08 - 11:54 AM

A.Adenocarcinoma
Adenocarcinoma is the most common type of lung cancer in smokers as well as non-smokers.
History of multiple bacterial lung infections---->can cause destruction of lung tissue and scarring---->adenocarcinoma is the common type associated with scarring in the lung tissue.

jean robert
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02/02/08 - 11:52 PM

Correct Answer: A

Tumors that arise peripherally and cause coin lesions include adenocarcinoma, bronchioalveolar carcinoma, and large cell carcinoma. This patient has had multiple lung infections in the past, suggesting previous scarring of lung tissue. Of these, ADENOCARCINOMA is the form specifically associated with LUNG SCARRING related to old granulomatous disease, old chronic obstructive lung disease, or other old damage to the lungs.

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new_n_lost
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02/03/08 - 12:42 AM

Hey jean can you post the rest of the explanation that would be nice. Damn cos smoking association hasnt been made with Adeno uptil now

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nerve09
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02/03/08 - 01:00 AM

#10

hmm i was wrong disapproval

jean robert
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02/03/08 - 01:04 AM

#11

Here is the explanation

Bronchioalveolar carcinoma (choice B) is the lung cancer that is not associated with smoking.

Large cell carcinoma (choice C) is an aggresive, undifferentiated form of lung cancer.

Oat cell ( small cell) carcinoma (choice D) is the lung cancer that can commonly cause paraneoplastic syndromes such as SIADH and Cushing syndrome

Squamous cell carcinoma of the lung (choice E) classically manifests as cavitary lung lesion that histologically reveals keratin pearls; it s also the type most associated with hypercalcemia

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new_n_lost
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02/03/08 - 01:17 AM

#12

Thanks mate

I know but this bugs me so far i havent been to find one single source which says that Adeno can be found in smokers but will keep looking. Will report on this soon.

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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."

nerve09
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02/03/08 - 01:22 AM

#13

hey aftr i found i was wrong..i went to luk bak..but thr's no mention of adeno in association with smoking shaking head

n also apical tumors indicate pancoast tumor...
so cd u plz tel me wat was ur refernce ??

jean robert
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02/03/08 - 01:28 AM

#14

"Adenocarcinoma is peripherally located and more common in women.

Adenocarcinoma is associated with cigarette smoking. It may develop in scars or spread along alveolar walls and mimic lobar pneumonia (bronchioalveolar)"

Rapid Review Pathology. 2nd edition pp323 Table 16-5.

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nerve09
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02/03/08 - 01:37 AM

#15

thanks jean smiling face

..but im stil not convinced with it disapproval

i ll go chk up again..never mind..
but thanks anyway nod

new_n_lost
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02/03/08 - 02:01 AM

#16

jean robert wrote:
"Adenocarcinoma is peripherally located and more common in women.

Adenocarcinoma is associated with cigarette smoking. It may develop in scars or spread along alveolar walls and mimic lobar pneumonia (bronchioalveolar)"

Rapid Review Pathology. 2nd edition pp323 Table 16-5.

damn i now hate myself for not remmebering RR damn

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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."

SmokyWaters
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02/05/08 - 03:18 PM

#17

yes it is associated with smoking. True
although not that strongly as SCLC and sq. CLC.

I remember reading this question somewhere grin

I got tricked too but then the scarring theory put over here needs a separate study to check if adeno due to scarring is more common than squamous due to smoking. anyways whatever grin

n who cares..its not goni to be there on usmle exam for sure grin

Ig F
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02/09/08 - 08:14 AM

#18

yeah Adenocarcinoma is associated with smoking and found in the periphery of the lung..it is more common these dayz because of the filters present in the cigarettes as the large paricled are filtered but small particle stay in the smoke and they travel up to the periphery.......

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