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  #1  
Old 01-20-2013
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Lungs Which type of lung cancer?

A 78-year-old man is seen in the doctor’s office for a nonproductive cough, 9-kg (20-lb) unintentional weight loss, and bilateral breast enlargement, all occurring within the past 6 months. He has smoked two packs per day for the past 40 years. His past medical history is otherwise unremarkable, and he takes no medications. His temperature is 36.7°C (98.1°F), blood pressure is 125/85 mm Hg, pulse is 68/min and regular, respiratory rate is 15/min, and oxygen saturation is 99% on room air. There are crackles at the left lower lung field and a ridge of symmetric glandular tissue (1 cm in
diameter) around the nipple-areolar complexes of both breasts. Complete blood cell count shows a WBC count of 6000/mm³ hemoglobin of 14.7 g/dL, and platelet count of 210,000/mm³. All other laboratory results are normal.
X-ray of the chest shows a focal 5-cm mass lesion in the left lower lung corroborated by CT scan. Which of the following is most likely histologic type of lung cancer present in this patient?

(A) Adenocarcinoma
(B) Bronchoalveolar cell carcinoma
(C) Large cell carcinoma
(D) Small cell carcinoma
(E) Squamous cell carcinoma
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Old 01-20-2013
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(C) Large cell carcinoma

Quote:
Large cell>>>>> Large Breast

Squamous cell >>>> SCamous

Small cell>>>>> Everything else
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Old 01-20-2013
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(C) Large cell carcinoma
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Old 01-21-2013
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The correct answer is C. Primary lung cancer is the leading cause of cancer death. The most significant risk factor is smoking because it raises the lifetime relative risk of lung cancer 10- to 30-fold when compared with the lifetime risk of nonsmokers. Patients with lung cancer can present with cough, hemoptysis, chest pain, and unintentional weight loss. Physical examination may reveal crackles or atelectasis.Lung cancer is usually fi rst noted as a nodule on x-ray of the chest but is best defi ned on CT.Fine-needle aspiration under CT guidance or bronchoscopy with biopsy or brushings can usually establish the histologic diagnosis. Gynecomastia,defined as the benign proliferation of glandular tissue in the male breast and seen clinically as a fi rm mass extending concentrically from the nipple-areolar complex, is a feature of large cell carcinoma. Large cell carcinoma behaves similarly to poorly differentiated non-small cell lung cancer and may produce β-human chorionic gonadotropin (β-hCG), resulting in gynecomastia, milky nipple discharge,and elevated serum concentrations of plasma β-hCG. Large cell carcinoma of the lung carries a poor prognosis (mean survival of 7–19 months) and has often metastasized at the time of diagnosis.
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Old 01-21-2013
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Does anyone know the mechanism behind this?

a.How does ectopic beta-hCg production results in gynecomastia?
b. Is it safe to assume that via the same mechanism as above, gynecomastia would also be a feature of: gastric carcinoma, renal cell carcinoma, hepatoma?
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Old 01-21-2013
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Quote:
Originally Posted by kb_1 View Post
Does anyone know the mechanism behind this?

a.How does ectopic beta-hCg production results in gynecomastia?
b. Is it safe to assume that via the same mechanism as above, gynecomastia would also be a feature of: gastric carcinoma, renal cell carcinoma, hepatoma?
Here is an excellent article about Gynaecomastia

Most cases of gynecomastia result from an imbalance between estrogenic (stimulatory) and androgenic (inhibitory) effects on the breast.

Quote:
Tumors producing chorionic gonadotropin. The placental hormone human chorionic gonadotropin (hCG) is similar to LH in both its structure and its action on the testis. Thus, elevated serum levels of hCG disproportionately stimulate normal Leydig cells of the testis to secrete increased amounts of estradiol. In addition, many hCG-secreting tumors can take up estrogen precursors from the circulation and aromatize them into active estrogens.
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Old 01-22-2013
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Thanks a lot Novobiocin for the fantastic article.
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Old 01-22-2013
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Default uh. doubt.

Quote:
Originally Posted by Novobiocin View Post
(C) Large cell carcinoma
..@novobiocin- large cell- there'll be somethin abt the breast in history.
squamous?... what's scamous??
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Old 01-22-2013
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Quote:
Originally Posted by dr rookie View Post
..@novobiocin- large cell- there'll be somethin abt the breast in history.
squamous?... what's scamous??
Squamous cell carcinoma.......Increased production of parathyroid hormone related peptides which causes increased stimulation of parathyroid leading to hypercalcemia.......so thats why scamous.
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ah!..thanks!
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Old 01-24-2013
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Small cell>>>>> Everything else???what?
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Quote:
Originally Posted by Novobiocin View Post
Here is an excellent article about Gynaecomastia

Thus, elevated serum levels of hCG disproportionately stimulate normal Leydig cells of the testis to secrete increased amounts of estradiol.
Thanks for the expl. But Some clarification needed.
Doesn't the leydig cells make testosterone, and not estrogen as stated above?
Estrogen is made from testosterone by aromatisation.

So since the alpha component of hCG is similar to LH(and fsh and tsh too, but no role here I guess), a lot of Testosterone should be secreted which gets aromatised in the periphery, causing stromal hyperplasia of the breast = gynecmastia.
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