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Repro-Endo Path Exam Discussion

Title: 34 Path S1 March 10, 2015

34. Upon self-examination, a 53-year-old woman discovers a lump in her right
breast. Physical examination reveals a palpable mass about 1 cm of diameter in
the outer upper quadrant of her right breast. No palpable lymph nodes are found
in the axilla. Mammography reveals an ill-defined, stellated density measuring
1.2 cm in her right breast. Core needle biopsy reveals an invasive ductal
carcinoma. A mastectomy is performed and shows invasive ductal
adenocarcinoma, histologic grade 1. The axillary lymph nodes are negative for
metastases. Estrogen receptors are positive in the tumor tissue and the
HER2/neu is overexpressed. Which of the following is the most important
prognostic factor in this patient?
a. Estrogen receptor status of the tumor tissue
b. Histologic grade of the tumor
*c. Status of axillary lymph nodes
d. Overexpression of HER2/neu
e. Size of the tumor
Title: 35 Path S1 March 10, 2015
35. A 22-year-old woman asks for your advice regarding her risk of developing
breast cancer. Her mother, maternal aunt and maternal grandmother all
developed breast cancer. She would like to know if she has a genetic
predisposition. Laboratory tests for mutations in which of the following genes
would be most likely to answer your patient question?
a. C-myc
*b. BRCA1
c. Estrogen receptor
d. HER2/neu
e. Rb-1
Title: 36 Path S1 March 10, 2015
36. A 24-year-old woman presents with a painless nodule in the lower outer
aspect of her left breast that she had for the past 4 months. The nodule appears
to be freely movable, sharply demarcated from the surrounding parenchyma and
firm. A mammography demonstrates a circumscribed, homogeneous density. A

biopsy of the breast mass is shown.

Which of the following is the most likely diagnosis?

a. Slerosingadenosis
*b. Fibroadenoma
c. Phyllodes tumor
d. Intraductal papilloma
e. Fibrocystic changes
Title: 37 Path S1 March 10, 2015
37. After an abnormal Pap smear, a punch biopsy of cervix is performed in a 37year-old woman. The microscopic findings include hypercromasia, ill defined
cellular borders, irregular nuclear membranes, increased nucleo-cytoplasmic
ratio and loss of polarity involving lower and middle epithelial thirds. What is the
most appropriate pathologic diagnosis?
a. Cervical intraepithelial neoplasia grade I (CIN I)
b. Human papilloma virus (HPV) cytophatic effect
*c. High grade squamous intraepithelial lesion (HSIL)
d. Low grade squamous intraepithelial lesion (LSIL)
e. Cervical severe epithelial dysplasia
Title: 38 Path S1 March 10, 2015
38. A routine Pap smear in a 29-year-old woman shows the morphologic changes
seen in this figure.

These changes are indicative of which of the following?

a. Cytopathic effect of herpes virus
*b. Cytopathic effect of human papilloma virus
c. Presence of chlamydial infection
d. High grade squamous intraepithelial lesion
e. Invasive squamous cell carcinoma

Title: 39 Path S1 March 10, 2015

39. A 25-year-old woman gives birth at 29 weeks of gestation. Within an hour
following delivery, the neonate develops respiratory distress and expires despite
orotracheal intubation and mechanical ventilation 8 hours later. An autopsy
performed revealed firm airless lungs with microscopy as shown:

Which of the following is the fundamental defect in this condition?

*a. Decreased surfactant
b. Pneumocyte I injury
c. Pneumocyte II hyperplasia
d. Alveolo-capillary membrane injury
e. Hypoxemia and Co2 retention
Title: 40 Path S1 March 10, 2015
40. A 20-year-old woman delivers a term baby. The placenta was delivered
complete. The cord is as shown:

Which of the following is the most significant association of this finding?

a. Increased risk of neonatal infection
b. Increased risk of fetal hypoxia
*c. Increased likehood for fetal anomalies
d. Increased likehood for neurologic impairment
e. Normal appearance of umbilical cord
Title: 41 Path S1 March 10, 2015
41. A 21-year-old primigravida has a blood pressure of 150/90 mmHg. Her labor
was induced at 36 weeks of gestation and she delivered a small for gestation
baby with Apgar scores of 6 and 8 at 1 and 5 minutes respectively. No congenital
anomalies were noted. Which of the following is most likely expected in the

a. Acute chorioamnionitis
b. Amnion nodosum
c. Chronic villitis
*d. Placental infarcts
e. Single umbilical artery
Title: 42 Path S1 March 10, 2015
42. A 25-year-old G2P1 woman with no prenatal care comes to the Emergency
Room in labor and delivers a baby as shown:

The placenta has expected weight but is noted to present tiny white nodularities
at the fetal surface that wipe out easily.
Which of the following statements most likely explains fetal and placental
a. Pulmonary hypoplasia
b. Heart malformations
c. Imperforate anus
*d. Bilateral renal dysplasia
e. Tracheal stenosis
Title: 43 Path S1 March 10, 2015
43. A 25-year-old woman presents fever and some cramping pain followed by
passage of foul smelling discharge at 30 weeks of gestation. She has a preterm
labor and the placenta is as shown.

Which of the following microscopic findings is most likely in this placenta?

a. Abundant macrophages with pigment in fetal membranes
b. Fibrinous deposits admixed with fetal squames in fetal membranes
c. Fibrin deposits in fetal membranes
d. Infiltrates of lymphocytes and plasma cells in fetal membranes
*e. Infiltrates of polymorphonuclear cells in fetal membranes

Title: 44 Path S1 March 10, 2015

44. A 20-year-old woman presents with painless vaginal bleeding. A pregnancy
test revealed markedly elevated levels of hCG. During physical examination, the
uterus is larger than the expected for dates and fetal heart sounds are not heard.
A uterine curettage revealed a bunch of vesicles up to 1.5 cm in size and no
gross fetal parts seen. On microscopy, the avascular villi presented marked
circumferential trophoblastic hyperplasia.
Which of the following karyotype would you expect to find in placental tissue?
a. 45, X0
*b. 46, XX
c. 47, XXY
d. 69, XXX
e. 69, XXY
Title: 45 Path S1 March 10, 2015
45. At 27 weeks of gestation, a 30-year-old woman delivers a baby that is small
for gestational age. The baby is admitted to the nursery for cardiopulmonary
monitoring and weight gain. On the 10th day, the baby develops abdominal
distention. Abdominal film reveals distended bowel loops with air of the bowel
wall (pneumatosis intestinalis). The baby died the following day and an autopsy is
Which of the following is most likely found at post mortem examination?
a. Occlusion of the mesenteric arteries
*b. Necrosis of the bowel wall
c. Acute infectious colitis
d. Small bowel stenosis
e. Aganglionosis (Hirschprungs disease)
Title: 46 Path S1 March 10, 2015
46. A 38-year-old woman visits her physician because of fatigue, weakness,
nausea, and constipation of several weeks duration. She says she often feels
lightheaded when she gets out of bed in the morning. Review of symptoms is
otherwise negative. Physical examination reveals patches of hyperpigmentation

on the skin. Relevant laboratory findings are as follows:

Sodium: 126 mEq/L (normal: 135-146)
Bicarbonate: 19 mEq/L (normal: 22-28)
Potassium: 5.2 mEq/L (normal: 3.5-5)
Cortisol: 3.3 mg/dL (normal: 4-24)
Chloride: 97 mEq/L (normal: 95-105)
Which of the following is the most common etiology of the disease this patient
*a. Autoimmune related
b. Granulomatous disease
c. Neoplasm
d. Trauma
e. Hemorrhagic necrosis
Title: 47 Path S1 March 10, 2015
47. A 30-year-old woman visits her physician complaining of tachycardia. She
also reports sweating much more than usual, to the point of soaking her clothes.
Physical examination reveals marked proptosis, and sparse, fine hair. She
appears anxious, and on further questioning reports that her anxiety and feeling
of restlessness have begun to cause problems at her workplace. The microscopic
appearance of the thyroid gland consists of:
a. Large follicles with flattened epithelium and abundant colloid
b. Pseudoinvasion of blood vessels by thyroid epithelium
c. Enlarged colloid-filled thyroid follicles of variable size
d. Nodules of small follicles adjacent to large follicles with intervening fibrous
*e. Hypercellular follicles lined by columnar cells with decreased colloid in the
Title: 91 Path S2 March 10, 2015
91. A nuliparous 26-year-old woman who had several sexual partners is informed
by her gynecologist that her Pap sample has tested positive for human papilloma
virus type 16 infection. Which of the following is the most important factor in the

future development high grade squamous intraepithelial lesion of cervix?

a. Presence of koilocytotic changes in the cervical Pap smear
*b. Presence of viral DNA integrated into the host genoma
c. Presence of the virus in the cytoplasm of the infected cell
d. Presence of viral DNA in the free episomal form
e. Presence of cervical intraepithelial neoplasia grade 1in punch biopsy
Title: 92 Path S2 March 10, 2015
92. A 61-year-old childless woman noticed a blood-tinged vaginal discharge.
Bimanual pelvic examination reveals a normal-sized uterus with no palpable
tubo-ovarian masses. There are no cervical erosion or masses. She is
overweight and review of systems shows that she has hypertension and type II
diabetes mellitus treated with insulin. An endometrial biopsy is most likely to
show which of the following uterine Path S2 March 10, 2015ologies?
a. Clear cell carcinoma
*b. Endometrioid carcinoma
c. Squamous cell carcinoma
d. Leiomyosarcoma
e. Serous carcinoma
Title: 93 Path S2 March 10, 2015
93. A 41-year-old multiparous woman, presents with symptomatic anemia and
history of menometrorrhagia. On physical examination she has a markedly
enlarged, multinodular uterus. The exocervix is smooth and glistening. What is
the most likely cause of her bleeding?
a. Severe adenomyosis
b. Endocervical polyps
c. Endometrial polyps
d. Endometriosis
*e. Leiomyomas
Title: 94 Path S2 March 10, 2015
94. A 56-year-old woman presents with anemia and history of menorrhagia. The
opened hysterectomy specimen is shown in the figure.

On Micro S2 March 10, 2015scopic examination, there is hypercellularity, diffuse

severe cytologicatypia, high mitotic rate and tumoral cell necrosis. What is the
most likely cause of her bleeding?
a. Endometrial polyp
b. Endometrial sarcoma
c. Leiomyomas
*d. Leiomyosarcoma
e. Carcinosarcoma
Title: 95 Path S2 March 10, 2015
95. A 19-year-old woman with increased abdominal girth is found with a left
ovarian mass by sonogram. The surgical specimen measures 14 cm in diameter.
The mass is predominantly solid with areas of necrosis, contains hair, grumous
material, bone and cartilage. Micro S2 March 10, 2015scopically it also contains
primitive neuroepithelium. This tumor is best diagnosed as:
*a. Immature teratoma
b. Mature cystic teratoma
c. Mature solid teratoma
d. Specialized teratoma
e. Struma ovary

Title: 96 Path S2 March 10, 2015

96. A 28-year-old man noticed that his hands and feet have been getting large.
Also a relative told him that his jaw had gotten much more prominent since he
had seen him 3 years ago. He went to see the doctor and his work-up revealed a
mass in his pituitary. When the neurosurgeon removed the mass, the Path S2
March 10, 2015ologist told him the mass was neoplastic and that the cells were
uniform and contained numerous acidophilic granules. If this mass had not been
removed which of the following would have been most likely to develop?
a. Chronic diarrhea and bone tumors
b. Hypoparathyroidism and increased pigmentation of the skin

*c. Osteoporosis and diabetes

d. Pancreatitis and pulmonary fibrosis
e. Pheochromocytoma and renal failure
Title: 97 Path S2 March 10, 2015
97. A 19-year-old tall man with a history of neuromas in his larynx and oral cavity
is found to have a chromaffin cell tumor in his adrenal gland. His father died 12
years ago of thyroid cancer. This patient likely has which of the following genetic
a. Chromosome 1p35 deletion
b. Chromosome 11q13 deletion
c. Overexpression of the PRAD1 oncogene
*d. Point mutation of the RET oncogene
e. Recombination of the NTRK1 gene
Title: 98 Path S2 March 10, 2015
98. An adrenal gland from a 50-year-old patient with truncal obesity, cutaneous
bruising, acne, generalized edema, and hypertension contains a 2-cm cortical
nodule that is sharply demarcated from the surrounding cortex. The nodule
contains uniform-appearing cells. The adrenal nodule most likely represents
a. Carcinoma
*b. Adenoma
c. Hyperplastic nodule
d. Metastatic carcinoma
e. Pheochromocytoma
Title: 99 Path S2 March 10, 2015
99. A 55-year-old woman who smokes presents to her family physician because
of weight gain. She has gained about 9 kg (20 lb) since her last visit 6 months
ago. On physical examination, her face is puffy. She has cutaneous striae over
the lower abdomen. Her temperature is 37C, pulse is 70/min, respirations are
16/min, and blood pressure is 160/80 mm Hg. Laboratory testing reveals elevated
levels of cortisol and adrenocorticotropic hormone (ACTH), and suppression of
ACTH secretion with high-dose, but not low-dose, dexamethasone. Which of the

following is the most likely cause of these laboratory results?

*a. Corticotroph adenoma of the anterior pituitary
b. Bilateral nodular adrenocortical hyperplasia
c. Functioning adenoma of the right adrenal cortex
d. Functioning adrenal carcinoma
e. Small cell carcinoma of the lung
Title: 100 Path S2 March 10, 2015
100. A 14-year-old boy presents for a routine exam. Urinalysis discloses 3+
glucosuria. He admits frequent urination, accompanied by a 10-kg (22-lb) weight
loss over the past few months. His parents note that he had a flu-like illness 5
months ago. His blood glucose is 230 mg/dl. Which of the following best explains
the Path S2 March 10, 2015ogenesis of hyperglycemia in this patient?
a. Peripheral insulin resistance
b. Excess dietary glucose
c. Irregular insulin secretion
*d. Islet cell destruction
e. Increased peripheral insulin uptake
Title: 101 Path S2 March 10, 2015
101. A 25-year-old woman has an automobile accident and hits her head with the
steering column. After being rushed to the hospital, a computed tomography (CT)
scan shows substantial impingement of the pituitary stalk. Which of the following
is most likely to continue functioning normally?
a. Adrenal glands
b. Mammary glands
c. Ovaries
*d. Parathyroid glands
e. Thyroid glands
Title: 102 Path S2 March 10, 2015
102. Following a viral pneumonia, a 40-year-old woman has an enlarged, painful
thyroid gland along with a serum thyroxine level of 10.5 mcg/mL of four weeks
duration. Several months later, she has no symptoms and the thyroxine level is

normal. Which of the following is a distinctive histoPath S2 March 10, 2015ologic

feature of the disease this patient had?
a. Hurtle cell metaplasia
b. Psammoma bodies
*c. Multinucleated giant cells
d. Lymphoid follicles
e. Follicular cell hyperplasia
Title: 103 Path S2 March 10, 2015
103. A 48-year-old asymptomatic man presents with a palpable, firm, 2-cm neck
mass. A fine-needle aspirate of the lesion reveals cells with abundant, lightly
staining cytoplasm and pale, hollow-appearing nuclei. The high power Micro S2
March 10, 2015scopic appearance is as shown.

Given this appearance, which of the following statements is most accurate?

a. The neoplasm is benign
b. Immunoperoxidases staining for calcitonin is positive
*c. The prognosis is generally good
d. The patient has relatives with a similar condition
e. The patient has nodular goiter
Title: 104 Path S2 March 10, 2015
104. A 59-year-old man with history of obesity, myocardial infarction, retinal
detachment, and foot ulcers presents to the emergency room with numbness and
tingling in his lower extremities. He has been receiving dialysis for the past 2
years. His hemoglobin A1c level is increased.
Which of the following describes the glomerular Path S2 March 10, 2015ology
most likely seen on light Micro S2 March 10, 2015scopy of this patients kidneys?
a. Diffuse capillary and basement membrane thickening
b. Enlarged hypercellular glomeruli with neutrophils
*c. Nodular glomerulosclerosis with thickened basement membrane
d. Segmental sclerosis with hyalinosis

e. Wire-loop appearance with subendothelial basement membrane deposits

Title: 144 Path S3 March 10, 2015
144. A sexually active 30-year-old man develops several veruccae on the penis.
The papillary lesions are found to be multiple and to involve the perineum and
perianal regions as well. A penis biopsy demonstrates proliferating squamous
epithelium, acanthosis and koilocytosis. Inflammation is chronic but minimal.
What would be the recommended diagnosis using the LATS terminology?
a. Condylomaacuminatum (LSIL)
b. Sexually transmitted genital warts
c. High grade squamous intraepithelial lesion (HSIL)
*d. Low grade squamous intraepithelial lesion (PeIN1)
e. Human papilloma virus infection
Title: 145 Path S3 March 10, 2015
145. Abnormal uterine bleeding for several months prompts a 64-year-old obese
woman to see her physician. This patient has never been pregnant and went
through menopause 12 years previously. The physician refers the patient to a
gynecologist, who performs and endometrial biopsy diagnosed as endometrial
hyperplasia. A total abdominal hysterectomy and bilateral salpingooophorectomy is performed. The right ovary is a solid and cystic mass; the Micro
S3 March 10, 2015scopic findings are shown in the figure.

What is the pathologic diagnosis of this ovarian tumor?

a. Brenner tumor
b. Fibrothecoma
*c. Granulosa cell tumor
d. Krukenberg tumor
e. Serous cystadenocarcinoma
Title: 146 Path S3 March 10, 2015
146. A 23-year-old nulliparous married woman presents with the complaint of
being "too hairy". Her history includes irregular menstrual cycles, worsening
acne, and hair growth on the face, breasts, and lower abdomen. She is on no

medications. She otherwise feels well. Which is the most likely cause for this
group of signs/symptoms?
a. Endometriosis
b. Constitutional hirsutism
*c. Polycystic ovarian disease
d. Sertoli-Leydig cell tumor of the ovary
e. Pelvic inflammatory disease
Title: 147 Path S3 March 10, 2015
147. A 23-year-old man visits the urologist because he has noticed that his left
testis is increasing in size. Physical examination discloses a mass in that testis.
Serologic tests show marked elevation of human chorionic gonadotrophin (HCG)
and alpha-fetoprotein (AFP). Based on these clinical presentation, what is the
most probable diagnosis?
a. Choriocarcinoma
b. Classic Seminoma
c. Endodermal sinus tumor (yolk sac tumor)
*d. Mixed germ cell tumor
e. Sertoli-Leydig cell tumor
Title: 148 Path S3 March 10, 2015
148. A 49-year-old woman has noted a pressure sensation, in her pelvic region
for several months. An ultrasound examination reveals a 15-cm multiloculated
cystic mass in the left adnexal region. An exploratory laparotomy with
subsequent left salpingo-oophorectomy is performed. The mass is shown in the

What is the most probable diagnosis?

a. Policystic ovary
*b. Ovarian cystadenoma
c. Cystic mesothelioma
d. Mature cystic teratoma
e. Endometriotic cyst

Title: 149 Path S3 March 10, 2015

149. A 74-year-old asymptomatic man is found with slightly elevated serum PSA
(5 ng/dL). The rectal prostatic exam reveals a non-enlarged gland with focal
hardening. A transrectal sonogram confirms the presence of a peripheral nodule.
Several core needle biopsies of the prostate are performed. The Micro S3 March
10, 2015scopic findings are shown in the figure.

What is the pathologic diagnosis?

*a. Adenocarcinoma of prostate
b. Chronic prostatitis
c. Granulomatous prostatitis
d. Metastatic colon adenocarcinoma
e. Prostatic nodular hyperplasia
Title: 150 Path S3 March 10, 2015
150. A 12-year-old girl was referred for evaluation of short stature. Both parents
were above the 50th percentile for height. The child has been complaining of
headaches. Fundoscopic examination reveals papilledema. Computed
tomography (CT) scan demonstrates a mass overlying the optic chiasm. Surgical
resection of the mass yields a multiloculated cystic and solid tumor containing
dark brown oily fluid. This tumor is thought to arise from clusters of cells derived
from which of the following structures?
a. Hypothalamus
b. Pineal gland
c. Posterior pituitary gland
*d. Rathkes pouch
e. Superior colliculus
Title: 151 Path S3 March 10, 2015
151. The image represents the adrenal gland removed to a 55-year-old man with

Key laboratory findings include:

serum cortisol at 8AM = 15 Micro S3 March 10, 2015gram/dL (normal: 6-23)
plasma rennin activity = 1.2 ng/mL/hr (normal: 1.9-3.7)
serum aldosterone = 44 ng/dL (normal: 4.0 31)
serum potassium = 2.9 mmol/L (normal: 3.3 5.0)
Which of the following is the most likely diagnosis?
a. Cushings syndrome
b. Adrenal cortical carcinoma
c. Multiple endocrine neoplasia, type 1
d. Metastatic carcinoma
*e. Conns syndrome
Title: 152 Path S3 March 10, 2015
152. A 45-year-old woman presents with an anterior necks mass. Her medical
history is significant for fatigue, menstrual abnormalities, and a goiter. Biopsy of
the neck mass demonstrates a solid lymphoid neoplasm. Which of the following
thyroid conditions most likely preceded the development of lymphoma in this
a. Follicular thyroid carcinoma
b. Graves disease
*c. Hashimoto thyroiditis
d. Nodular goiter
e. Papillary thyroid carcinoma
Title: 153 Path S3 March 10, 2015
153. A 20-year-old man has noticed a palpable mass on the right neck side. He is
asymptomatic with no risk factors for thyroid cancer. The patient is euthyroid. A
fine needle aspiration biopsy is performed and the pathologist report is consistent
with a follicular neoplasm. A right hemithyroidectomy is performed and a
representative image is shown.

Which of the following is a distinctive histopathologic feature to properly

categorize this neoplasm?

*a. Careful capsule evaluation is necessary to ruled out Follicular Carcinoma

b. It is a rare neoplasm derived from C cells
c. It is a poorly differentiated highly malignant tumor
d. Branching papillae and Psammoma bodies are abundant
e. It is composed by small cells with abundant intervening amyloid stroma
Title: 154 Path S3 March 10, 2015
154. A patient with history of pheochromocytoma develops a neck mass.
Resection of the neck mass demonstrates a multifocal tumor with hemorrhage,
necrosis, and spread outside the thyroid capsule. The tumor is composed of
polygonal cells in nests. Homogeneous pinkish deposits that stain with Congo
red are seen within the cellular component. The polygonal cells would most
probably secrete which of the following?
*a. Calcitonin
b. Parathyroid hormone
c. Thyroid-stimulating hormone (TSH)
d. Thyroxine (T4)
e. Thyroglobulin
Title: 155 Path S3 March 10, 2015
155. A 45-year-old man with a recent history of bizarre behavior is seen by a
psychiatrist, who recommends evaluation of his endocrine status. On physical
examination, the patient appears moderately obese, with mild hypertension, facial
acne, fat accumulation in the supraclavicular fossae and a protuberant abdomen.
Laboratory studies demonstrate a neutrophilic leukocytosis, with a decrease in
the percentage of lymphocytes and an absence of eosinophils. The hematocrit
and hemoglobin are normal. There is a mild hypokalemia and mild metabolic
alkalosis. The fasting serum glucose is whiting the reference range, but on a 2hour glucose tolerance test, both the 60 min and 120-min samples had glucose
concentrations greater than 200 mg/dL. Laboratory studies show free urinary
cortisol of 150 g/24 h (normal= 10-100 g/24 h). Which of the following
questions would be of most help in establishing a diagnosis?
a. Are you experiencing muscle weakness
b. Are you experiencing shortness of breath

*c. Are you receiving corticosteroids for some other disease

d. Do you have a family history of endocrine neoplasia
e. Have you received recent blood transfusions
Title: 156 Path S3 March 10, 2015
156. A 2-year-old child is brought to the emergency department because of
abdominal pain. On physical examination he has a right inguinal hernia with
incarceration of a loop of small intestine. A laparotomy is performed and the
defect is closed. The tissue from the hernia sac is excised. The surgical
pathology report indicates the presence of a focus of adrenal cortex in the
excised hernia sac. Which of the following is the most likely diagnosis?
a. Congenital adrenal hyperplasia
b. Adrenal cortical carcinoma metastases
*c. Incidental ectopia
d. Risk for subsequent adrenocortical insufficiency
e.Multiple endocrine neoplasia syndrome
Title: 157 Path S3 March 10, 2015
157. A 65-year-old man presents with bone pain and is found to have
hypocalcemia and increased parathyroid hormone. Surgical exploration of his
neck finds all four of his parathyroid glands to be enlarged. Which of the following
disorders is the most likely cause of this patients enlarged parathyroid glands?
a. Primary hyperplasia
b. Parathyroid adenoma
*c. Chronic renal failure
d. Parathyroid carcinoma
e. Lung carcinoma