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Chapter 31. Pathology of Lung Tumors

Smokers are at increased risk for which of the following?

a. Bronchogenic carcinoma, small cell carcinoma variant

b. Bronchogenic carcinoma, bronchioloalveolar carcinoma variant

c. Malignant mesothelioma

d. Bronchial carcinoid tumor

e. Pulmonary hamartoma

The most correct answer is a, small cell carcinoma variant of bronchogenic carcinoma.

None of the other possible answers (b, c, d, or e) shows a significant association with smoking.

Which of the following findings adversely affects the prognosis of bronchial carcinoid tumor?

a. Growth pattern obstructing bronchial lumen

b. Growth pattern as mucosal plaque

c. Two or more mitotic figures per high-power field

d. History of smoking

e. History of asbestos exposure

The most correct answer is c, two or more mitotic figures per high-power field.

Increased mitotic activity distinguishes atypical from typical carcinoid tumor. The prognosis of atypical carcinoid tumor is worse than that of typical carcinoid tumor. The pattern of growth (answers a and b) does not significantly alter prognosis directly; however, there could be an indirect influence by a growth pattern that makes excision difficult. Smoking and asbestos exposure have no significant relationship to the development of or prognosis of carcinoid tumor.

Which of the following is a finding that would be most useful in distinguishing carcinoid tumor from small cell carcinoma?

a. The presence of cytoplasmic dense core granules in neoplastic cells

b. Immunohistochemical positivity for keratin

c. Immunohistochemical positivity for synaptophysin

d. Immunohistochemical positivity for chromogranin

e. Monotonous cells with round nuclei growing in cords and trabeculae separated by delicate fibrous connective tissue septa

The most correct answer is e, monotonous cells with round nuclei growing in cords and trabeculae separated by delicate fibrous connective tissue septa.

Answers a, b, c, and d are features that small cell carcinoma shares with carcinoid tumor, reflecting the epithelial (answer b) and neuroendocrine (answers a, c, and d) nature of both neoplasms.

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