10 - ILD Path

Question 1

main sx of ILD

Answer 1

progressive dyspnea, tachypnea, persistent non productive cough

Question 2

3 ILD categories

Answer 2

fibrotic
granulomatous
alveolar filling

Question 3

fibrotic pattern ILDs

Answer 3

UIP (usual interstitial PNA) / idiopathic pulm fibrosis (IPF)
NSIP (nonspecific interstitial PNA)
pneumoconioses (asbestosis, silicosis)

Question 4

UIP pattern:
location
appearance

Answer 4

subpleural/interlobular septal location

patchy, temporally heterogenous interstitial fibrosis, honeycombing

Question 5

key path buzzword for UIP

Answer 5

temporally heterogenous

Question 6

honeycombing

Answer 6

end stage lung dz
dense collagenous scars > collapse of alveolar walls > cystic spaces lined by epithelial cells filled w/ mucus and inflam cells

Question 7

NSIP pattern

Answer 7

temporally uniform
2 distinct patterns:
cellular inflammatory pattern - lymphoplasmacytic infiltrate, type II pneumocyte hyperplasia, lung architecture preserved
fibrosing pattern - temporally uniform fibrosis

Question 8

pneumoconiosis

Answer 8

lung reaction to inhalation of dust, chemicals, vapors - occupational lung dz like asbestosis or silicosis

Question 9

types of asbestos fibers

Answer 9

amphiboles - straight, more carcinogenic

chrysotile - curved, more commonly used in US

Question 10

asbestos related dzs

Answer 10

asbestosis
fibrous pleural plaques
mesothelioma
lung cancer

Question 11

gross path of asbestosis

Answer 11

subpleural and parenchymal fibrosis favoring lower lobes, +/- honeycomb change

Question 12

micro path of asbestosis

Answer 12

patchy interstitial and subpleural fibrosis, similar to UIP
asbestos bodies (form of ferruginous body)

Question 13

silicosis path

Answer 13

dust filled macrophages (black nodules) > silicotic nodules (birefringent silica particles) and fibrosis
begins around bronchioles
upper lobe dz

Question 14

2 granulomatous ILDs

Answer 14

hypersensitivity pneumonitis

sarcoidosis

Question 15

hypersensitivity pneumonitis microscopic findings

Answer 15

acute - neutrophils in alveoli and resp bronchioles
subacute/chronic - interstitial lymphoplasmacytic infiltrate, ill defined non caseating granulomas, patchy organizing PNA

Question 16

sarcoidosis - what is it

Answer 16

non caseating granulomas in lungs, LNs, liver, spleen, skin, eyes, etc. Most common site is lungs/hilar LNs

thought to be abnl immune reaction in genetically predisposed people

Question 17

sarcoidosis path findings

Answer 17

well formed granulomas w/o necrosis

asteroid bodies and Schaumann bodies (not specific)

Question 18

3 alveolar filling ILDs

Answer 18

COP - cryptogenic organizing PNA
RB-ILD - respiratory bronchiolitis ILD
DIP - desquamative interstitial PNA

Question 19

cryptogenic organizing PNA path

Answer 19

granulation tissue in distal airspaces > plugs distal airways (Masson bodies)
patchy, temporally homogenous
architecture preserved - NO honeycombing

Question 20

respiratory bronchiolitis ILD path

Answer 20

small airways affected
finely pigmented (dusty brown) macrophages
bronchiole wall may have chronic inflam & fibrosis
metaplastic bronchiolar epithelium involves alveolar ducts

Question 21

DIP path

Answer 21

desquamated cells
numerous alveolar macrophages
uniform fibrosis and chronic inflammation of alveolar septa
no honeycombing