All of the following increase the risk for tracheal stenosis EXCEPT:
Intubation-related risk factors include prolonged intubation; high tracheostomy through the first tracheal ring or cricothyroid membrane; transverse rather than vertical incision on the trachea; oversized tracheostomy tube; prior tracheostomy or intubation; and traumatic intubation. Stenosis is also more common in older patients, in females, after radiation, or after excessive corticosteroid therapy, and in the setting of concomitant diseases such as autoimmune disorders, severe reflux disease, or obstructive sleep apnea and the setting of severe respiratory failure. However, even a properly placed tracheostomy can lead to tracheal stenosis because of scarring and local injury. Mild ulceration and stenosis are frequently seen after tracheostomy removal. Use of the smallest tracheostomy tube possible, rapid downsizing, and a vertical tracheal incision minimize the risk for posttracheostomy stenosis.
Adenoid cystic carcinomas:
Squamous cell carcinomas often present with regional lymph node metastases and are frequently unresectable at presentation. Their biologic behavior is similar to that of squamous cell carcinoma of the lung. Adenoid cystic carcinomas, a type of salivary gland tumor, are generally slow-growing, spread submucosally, and tend to infiltrate along nerve sheaths and within the tracheal wall. Although indolent in nature, adenoid cystic carcinomas are malignant and can spread to regional lymph nodes, lung, and bone. Squamous cell carcinoma and adenoid cystic carcinomas represent approximately 65% of all tracheal neoplasms. The remaining 35% comprises small cell carcinomas, mucoepidermoid carcinomas, adenocarcinomas, lymphomas, and others.
ostoperative mortality, which occurs in up to 10% of patients, is associated with the length of tracheal resection, use of laryngeal release, the type of resection, and the histologic type of the cancer. Factors associated with improved longterm survival include complete resection and use of radiation as adjuvant therapy in the setting of incomplete resection. Due to their radiosensitivity, radiotherapy is frequently given postoperatively after resection of both adenoid cystic carcinomas and squamous cell carcinomas. A dose of 50 Gray or greater is usual. Nodal positivity does not seem to be associated with worse survival. Survival at 5 and 10 years is much better for adenoid cystic (73 and 57%, respectively) than for tracheal cancers (47 and 36%, respectively; P <0.05). For patients with unresectable tumors, radiation may be given as the primary therapy to improve local control, but is rarely curative. For recurrent airway compromise, stenting or laser therapies should be considered part of the treatment algorithm.
Which of the following is NOT a non-small-cell tumor of the lung?
The term non-small-cell lung carcinoma (NSCLC) includes many tumor cell types, including large cell, squamous cell, and adenocarcinoma. Historically, these subtypes were considered to be a uniform group based on limited understanding of the distinct clinical behaviors of the subtypes as well as the fact that there were few treatment options available. With increasing understanding of the molecular biology underlying these tumor subtypes, however, the approach to diagnosis and management and the terminology used in describing these tumors is evolving rapidly.
The most common pattern of benign calcification in hamartomas is:
Computed tomography ( CT) findings characteristic of benign lesions include small size, calcification within the nodule, and stability over time. Four patterns of benign calcification are common: diffuse, solid, central, and laminated or "popcorn:' Granulomatous infections, such as tuberculosis, can demonstrate the first three patterns, whereas the popcorn pattern is most common in hamartomas. In areas of endemic granulomatous disease, differentiating benign versus malignant can be challenging. Infectious granulomas arising from a variety of organisms account for 70 to 80% of this type of benign solitary nodules; hamartomas are the next most common single cause, accounting for about 10%.
For an adenocarcinoma that has pleural invasion, tumor necrosis, and has lymphovascular invasion the correct subtype is:
If lymphovascular invasion, pleural invasion, tumor necrosis, or more than 5 mm of invasion are noted in a lesion that has lepidic growth as its predominant component, minimally invasive adenocarcinoma (MIA) is excluded and the lesion is called lepidic predominant adenocarcinoma (LPA), and the size of the invasive component is recorded for the T stage.
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