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Chapter 31. Pathology of Lung Tumors
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Smokers are at increased risk for which of the following?
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a. Bronchogenic carcinoma, small cell carcinoma variant
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b. Bronchogenic carcinoma, bronchioloalveolar carcinoma variant
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c. Malignant mesothelioma
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d. Bronchial carcinoid tumor
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The most correct answer is a, small cell carcinoma variant of bronchogenic carcinoma.
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None of the other possible answers (b, c, d, or e) shows a significant association with smoking.
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Which of the following findings adversely affects the prognosis of bronchial carcinoid tumor?
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a. Growth pattern obstructing bronchial lumen
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b. Growth pattern as mucosal plaque
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c. Two or more mitotic figures per high-power field
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e. History of asbestos exposure
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The most correct answer is c, two or more mitotic figures per high-power field.
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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.
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Which of the following is a finding that would be most useful in distinguishing carcinoid tumor from small cell carcinoma?
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a. The presence of cytoplasmic dense core granules in neoplastic cells
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b. Immunohistochemical positivity for keratin
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c. Immunohistochemical positivity for synaptophysin
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d. Immunohistochemical positivity for chromogranin
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e. Monotonous cells with round nuclei growing in cords and trabeculae separated by delicate fibrous connective tissue septa
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The most correct answer is e, monotonous cells with round nuclei growing in cords and trabeculae separated by delicate fibrous connective tissue septa.
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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.