Page 397 - Concise Pathology for Exam Preparation ( PDFDrive )

382 SECTION II Diseases of Organ Systems

Fibrovascular septum
separating nests of
tumour cells

Round-to-oval tumour
cells showing scanty
cytoplasm and
hyperchromatic
crowded nuclei

FIGURE 13.7. Section from small cell carcinoma of lung showing round-to-oval tumour cells
with scanty cytoplasm and hyperchromatic crowded nuclei (H&E; 4003).

4. Large cell carcinoma
(a) Large anaplastic polygonal cells with vesicular nuclei (thought to be undifferentiated
squamous and adenocarcinomas which can no longer be recognized on light microscopy)
(b) Variants: Giant cell, clear cell, spindle cell and large cell neuroendocrine carcinoma

About 10% lung carcinomas have a combined morphology with two or more histo-
logical types.
Consequences of Bronchogenic Carcinoma

• Emphysema (due to partial obstruction of airways by the tumour)
• Atelectasis (due to total obstruction of airways by the tumour)
• Suppurative/ulcerative bronchitis or bronchiectasis or pulmonary abscess (due to im-
paired drainage of airways)
• Venous congestion or dusky head (due to compression or invasion of superior vena cava)
• Haemoptysis (due to haemorrhage from tumour in the airway)
• Pleural effusion, pericarditis or tamponade (due to extension of tumour to pleural/
pericardial sac)
• Apical tumours invade into brachial or cervical sympathetic plexus causing pain in the
region of ulnar nerve or Horner syndrome (ipsilateral enophthalmos, ptosis, miosis
and anhidrosis). May be accompanied by destruction of first and second ribs and
sometimes thoracic vertebrae (Pancoast syndrome).
• Hoarseness (due to recurrent laryngeal nerve invasion), dysphagia (due to oesophageal
invasion) and diaphragmatic paralysis (due to phrenic nerve invasion)

Diagnosis of Lung Carcinoma
Common Symptoms:

Cough, weight loss, chest pain and dyspnoea
Investigations

• X-ray chest
• Ultrasound or C.T. guided FNAC/biopsy

Paraneoplastic Syndromes Associated with Bronchogenic Carcinoma

Various hormones or hormone-like substances are secreted by bronchogenic carcinoma, eg,
• ADH leading to hypernatraemia
• ACTH leading to Cushing syndrome

mebooksfree.com