{"id":6617,"date":"2021-09-13T21:03:25","date_gmt":"2021-09-13T19:03:25","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/pathology\/respiratory-system\/atelectasis\/"},"modified":"2021-09-13T21:03:40","modified_gmt":"2021-09-13T19:03:40","slug":"atelectasis","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/pathology\/respiratory-system\/atelectasis\/","title":{"rendered":"Atelectasis"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Introduction<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Benign or <strong>malignant<\/strong><ul><li>Primary or metastatic<\/li><\/ul><\/li><li>\u2642 &gt; \u2640 (except adenocarcinoma)<\/li><li>Sampling<ul><li><strong>Bronchial brush cytology<\/strong><\/li><li>Bronchial washing fluid analysis<\/li><li><strong>Endoscopic transbronchial biopsy<\/strong><\/li><li>Transbronchial biopsy<ul><li>Much riskier (fatal bleeding, pneumothorax)<\/li><\/ul><\/li><\/ul><\/li><li>Paraneoplastic syndromes are common in lung cancer<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Benign tumors<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Hamartochondroma<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Most common benign lung tumor<\/li><li>Hamartoma refers to a developmental anomaly, which is not the case in this lesion, as it is a <strong>true neoplasm<\/strong><\/li><li>Small, superficial, well-circumscribed tumor consisting of fat, cartilage, fibrous tissue, and blood vessels<\/li><li>Appear as &#8220;coin-lesions&#8221; on chest x-rays<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Other examples for benign tumors:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Squamous epithelial papilloma<\/li><li>Bronchial gland adenomas<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Malignant tumors<sup>3<\/sup><\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Most common malignant tumors of the lung are&nbsp;<strong>metastatic tumors<\/strong><\/li><li>Most common&nbsp;<strong>primary tumors<\/strong> of the lung are&nbsp;<strong>carcinomas&nbsp;<\/strong>(95%), arising from the bronchoalveolar epithelium<ul><li>The rest are carcinoids, mesenchymal malignancies, lymphomas, and benign tumors<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Risk factors<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Smoking <\/strong>and air pollution<\/li><li>Exposure to irradiation, asbestos, radon, and chemotherapy<\/li><li>Risk factors amplify one another:<ul><li>Exposure to asbestos increases the risk of lung cancer 5-fold, while smoking and asbestos exposure increases it 55-fold<\/li><\/ul><\/li><li>Genetics<ul><li>Some individuals are more susceptible to lung cancer<\/li><li>The mechanism is believed to be involved with P450 gene polymorphisms which allow easier production of carcinogens from inhaled particles<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Molecular background<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Inactivation of tumor suppressor genes<\/strong><ul><li>Genes located on <strong>3p chromosome<\/strong><\/li><li><strong>p53<\/strong><\/li><\/ul><\/li><li><strong>EGFR<\/strong><ul><li>Constant activation of TK pathway leading to uncontrolled proliferation<\/li><li>Seen in 30% of adenocarcinomas<ul><li>Mostly in non-mucinous types<\/li><\/ul><\/li><li>Downstream participants of the pathway are often mutated<ul><li><strong>KRAS<\/strong><\/li><li>ALK<\/li><li>ROS1<\/li><li>These mutations are mutually exclusive with EGFR mutations<ul><li>Generally, either EGFR or the downstream participator, usually not together<\/li><\/ul><\/li><\/ul><\/li><li>Therapies include TK inhibitors<ul><li>KRAS mutation is an indicator of TK inhibitor resistance<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC)<sup>1,2<\/sup><\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">To this day, lung carcinomas are classified to either SCLC (15% of lung cancer cases) or NSCLC (85%).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Originally described by their microscopic morphology &#8212; either the cells were small (SCLC) or not (NSCLC)<\/li><li>It has been observed that most SCLC cases have already metastasized at the point of diagnosis (compared to NSCLC)<ul><li>Meaning a much worse prognosis for SCLC<\/li><\/ul><\/li><li>SCLC responds well to chemotherapy<\/li><li>NSCLC respond poorly to chemotherapy, surgical removal of the tumor is required<\/li><li><strong>In 2015, the WHO has proposed a new classification system<\/strong><ul><li>Based on histopathological and immunohistochemical findings<\/li><li>The major types of carcinomas include:<ul><li><strong>Adenocarcinoma<\/strong><\/li><li><strong>Squamous cell carcinoma<\/strong><\/li><li><strong>Small cell carcinoma <\/strong>(a subtype of neuroendocrine carcinoma)<\/li><li><strong>Large cell carcinoma<\/strong><\/li><\/ul><\/li><li>However, this doesn&#8217;t mean that the SCLC\/NSCLC classification should be disregarded, as it is still widely in use<\/li><\/ul><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><tbody><tr><td>&nbsp;<\/td><td><strong>SCLC<\/strong><\/td><td><strong>NSCLC<\/strong><\/td><\/tr><tr><td>Frequency<\/td><td>15%<\/td><td>75%<\/td><\/tr><tr><td>Treatment<\/td><td>Chemotherapy<\/td><td>Surgery<\/td><\/tr><tr><td>Special characteristics<\/td><td>Early metastasis (before diagnosis)<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Adenocarcinoma<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>The most common type of lung cancer today (in both smokers and non-smokers)<\/li><li>Arises in the periphery<\/li><li>Grows slowly<\/li><li>\u2642 &lt; \u2640 (an exception)<\/li><li>Readily metastasize<ul><li>Brain<\/li><\/ul><\/li><li>30% of adenocarcinomas show EGFR mutations<\/li><li>Based on the 2015 WHO classification, can be further divided into:<ul><li>Lepidic, acinar, papillary, solid, mucinous types etc<ul><li><strong>Mucinous types<\/strong><ul><li>Generally bigger<\/li><li>Show <strong>KRAS<\/strong> gene mutation (not EGFR)<\/li><\/ul><\/li><li><strong>Non-mucinous<\/strong><ul><li>Show <strong>EGFR<\/strong> mutation (not KRAS)<\/li><\/ul><\/li><\/ul><\/li><li><strong>Preinvasive lesions:<\/strong><ul><li>Atypical adenomatous hyperplasia (AAH)<ul><li>&lt;5mm in size<\/li><\/ul><\/li><li>Adenocarcinoma in-situ (AIS)<ul><li>&lt;3cm in size<\/li><li>Spans through the entire epithelium without crossing the basal lamina &#8212; no tissue destruction&nbsp;<strong>yet<\/strong><\/li><li>If treated (resection) &#8212; 100% survival rate<\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Squamous cell carcinoma<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Closely correlated with smoking<\/li><li>Grows slowly<ul><li>Symptomatic when the tumor begins to obstruct the lumen of the major bronchus, causing atelectasis and invading the nearby tissue<\/li><\/ul><\/li><li>Tend to arise centrally in the epithelium of major bronchi<ul><li>Often preceded by squamous metaplasia or dysplasia -&gt; carcinoma in situ<\/li><\/ul><\/li><li>Histologically,&nbsp;<strong>keratin pearls&nbsp;<\/strong>can be seen<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Small cell carcinoma (a subtype of neuroendocrine carcinoma)<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ul class=\"wp-block-list\"><li>Closely correlated with smoking<\/li><li>Arises from stem cells of the respiratory epithelium<\/li><li>Centrally located masses that invade nearby tissue<ul><li>Necrosis may be present<\/li><\/ul><\/li><li>Readily metastasize<ul><li>By the time of diagnosis, most likely that the tumor has metastasized (lymph nodes)<\/li><\/ul><\/li><li>Sensitive to chemotherapy<\/li><li>Histologically:<ul><li>Small, round or fusiform shaped tumor cells<\/li><li>&#8220;Crush artifact&#8221; &#8212; Tumor cells are very fragile and are damaged by the slightest compression<\/li><li>&#8220;Salt and pepper&#8221; chromatin appearance<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Large cell carcinoma<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Undifferentiated malignant epithelial cells<\/li><li>Arises in the periphery<\/li><li>Show no features of neuroendocrine carcinoma or glandular\/squamous differentiation<\/li><li>The cells are large, with a large and prominent nuclei<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><tbody><tr><td>&nbsp;<\/td><td><strong>Adenocarcinoma<\/strong><\/td><td><strong>Squamous cell carcinoma<\/strong><\/td><td><strong>Small cell carcinoma<\/strong><\/td><td><strong>Large cell carcinoma<\/strong><\/td><\/tr><tr><td>Location<\/td><td>Peripherally<\/td><td>Centrally<\/td><td>Centrally<\/td><td>Peripherally<\/td><\/tr><tr><td>Striking characteristics<\/td><td>Mucous production (mucinous type)EGFR and KRAS mutations<\/td><td>Keratin pearls<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Carcinoids<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<ul class=\"wp-block-list\"><li>Considered malignant, but shows very low-risk and excellent prognosis<\/li><li><strong>Well-differentiated<\/strong><\/li><li><strong>Grows slowly<\/strong><ul><li>Symptomatic when the tumor begins to obstruct the lumen of a bronchus<\/li><\/ul><\/li><li>Common in non-smokers<\/li><li>Can be typical or atypical<ul><li>Better prognosis for typical carcinoids<\/li><\/ul><\/li><li><strong>Neuroendocrine origin<\/strong><ul><li>Described as low-grade neuroendocrine carcinoma (compared to SCLC which is high-grade)<\/li><li>Composed of cells that contain dense-core neurosecretory granules<ul><li>Thought to arise from Kulchitsky cells of the bronchial epithelium<\/li><li>Begins as diffused hyperplasia<\/li><\/ul><\/li><li>Rarely secrete hormonally active polypeptides (carcinoid syndrome, a paraneoplastic syndrome)<ul><li>Symptoms include diarrhea, flushing, and cyanosis<\/li><\/ul><\/li><\/ul><\/li><li>Classification:<ul><li>&lt;2 mitoses per 10 HPF and Ki-67 (proliferation marker) labeling index &lt; 2%<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Metastasis to the lung (secondary tumors)<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<p class=\"wp-block-paragraph\">Metastases of cancer to the lung is common in different types of carcinomas arising in a variety of organs:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Breast<\/li><li>GIT<\/li><li>Kidney<\/li><li>Prostate<\/li><li>Skin (melanoma)<\/li><li>Bone<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_14\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Spreading<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_14\">\n\n\n<p class=\"wp-block-paragraph\">Lung cancer tends to spread to the surrounding lymph nodes and tissues, causing a variety of symptoms and syndromes:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In advanced stages, extend to the pleura and the pericardium and can cause effusion<ul><li><strong>Pleural carcinosis<\/strong> (or <strong>carcinomatosis<\/strong>)<\/li><\/ul><\/li><li>May compress vessels (vena cava syndrome)<\/li><li>Tumors extending to the lung apex may invade the brachial and cervical plexus &#8212; <strong>Pancoast tumors<\/strong><ul><li>Often destroy the first two ribs and thoracic vertebrae<\/li><li><strong>Horner syndrome<\/strong><ul><li><strong>Ipsilateral enophthalmos<\/strong> &#8212; Retraction of the eye into the eyelid<\/li><li><strong>Ptosis&nbsp;<\/strong>&#8212; Drooping of the eyelid<\/li><li><strong>Miosis&nbsp;<\/strong>&#8212; Pupil constriction<\/li><li><strong>Anhidrosis&nbsp;<\/strong>&#8212; Inability to sweat<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">1.Gazdar A. Should we continue to use the term non-small-cell lung cancer? <em>Ann Oncol<\/em>. 2010;21(Suppl 7):vii225-vii229. [<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4542692\" target=\"_blank\" rel=\"noreferrer noopener\">PMC<\/a>]2.Testa U, Castelli G, Pelosi E. Lung Cancers: Molecular Characterization, Clonal Heterogeneity and Evolution, and Cancer Stem Cells. <em>Cancers<\/em>. 2018;10(8):248. doi:<a href=\"https:\/\/doi.org\/10.3390\/cancers10080248\" target=\"_blank\" rel=\"noreferrer noopener\">10.3390\/cancers10080248<\/a>3.O. Leslie K, R. Wick M. <em>Practical Pulmonary Pathology: A Diagnostic Approach E-Book<\/em>. Elsevier Health Sciences; 2017.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Introduction<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Benign tumors<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Hamartochondroma<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Malignant tumors<sup>3<\/sup><\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Risk factors<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Molecular background<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC)<sup>1,2<\/sup><\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Adenocarcinoma<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Squamous cell carcinoma<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Small cell carcinoma (a subtype of neuroendocrine carcinoma)<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Large cell carcinoma<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Carcinoids<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Metastasis to the lung (secondary tumors)<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Spreading<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Introduction Benign or malignant Primary or metastatic \u2642 &gt; \u2640 (except adenocarcinoma) Sampling Bronchial brush cytology Bronchial washing fluid analysis Endoscopic transbronchial biopsy Transbronchial biopsy Much riskier (fatal bleeding, pneumothorax) Paraneoplastic syndromes are common in lung cancer Benign tumors Hamartochondroma Most common benign lung tumor Hamartoma refers to a developmental anomaly, which is not the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":6615,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6617","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Atelectasis &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/pathology\/respiratory-system\/atelectasis\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/pathology\\\/respiratory-system\\\/atelectasis\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/pathology\\\/respiratory-system\\\/atelectasis\\\/\",\"name\":\"Atelectasis &#8211; 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