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Pulm by Minnie: AH Update > 164: Lung Pathologies (Restrictive, Obstructive, Infectious, Tumors) > Flashcards

164: Lung Pathologies (Restrictive, Obstructive, Infectious, Tumors) Flashcards

Missing MEDIASTINAL

1
Q

Which lung tumors have the best prognosis?

A

Carcinoid tumors

  • Frequently indolent
  • Usually do not metastasize
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2
Q

Describe the histopathology of small cell carcinoma

A
  • Neuroendocrine differentiation
    • May look like the adrenal medulla, pancreatic islets, or c-cells in the thyroid
  • Nuclear moulding
  • Dark uniform nuclei w/o nucleoli
  • High nucleus:cytoplasm ratio (not very much cytoplasm)
  • High-grade tumors
    • Lots of mitotic activity and necrosis
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3
Q

Which part of the lugn is affected by emphysema?

A

Alveolated lung parenchyma

(other obstructive lung diseases affect the larger airways)

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4
Q

Sarcoidosis or hypersensitivity pneumonitis characteristic?

“Loose granulomas”

A

Hypersensitivity pneumonitis

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5
Q

Name the only obstructive lung disease that affects the alveolated lung parenchyma

A

Emphysema

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6
Q

Obstructive or restrictive:

“COPD, Asthma”

A

Obstructive

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7
Q

What exposure is associated wtih malignant mesothelioma?

A

Asbestos

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8
Q

Describe the gross pathology of bacterially-infected lung tissue

A

Firm, congested, heavier than normal (consolidated)

Parenchyma may be heaptized

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9
Q

Most obstructive diseases involve the ____________, while restrictive lung diseases involve the _____________.

A

Most* obstructive diseases involve the large airways**, while restrictive lung diseases involve the **alveolated lung parenchyma.

*excpetion: emphysema is an obstructive disease that involves the alveolated lung parenchyma

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10
Q

What causes bronchiectasis?

A

Anything that can predispose a person to obstruction of the airways

  • Cystic fibrosis
  • Karatagener’s syndrome
  • Repeated infection
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11
Q

The end stage of which lung diseases is honeycomb lung?

A

Restrictive lung diseases

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12
Q

Describe the pathogenesis of acute lung injury

A
  • Damage to pneumocytes and or endothelial cells of teh aveolar septae
  • -> Inflammatory response
  • -> Cytokine release
  • -> Recruitment of inflammatory cells
  • -> Endothelial activation
    • Capillaries become leaky
    • Plasma proteins accumulate in alveolar spaces
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13
Q

Is there a pathology present in this picture?

If so, what is it?

A

Sarcoidosis: well-formed granulomas

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14
Q

What is the prognosis of small cell carcinoma?

A

Bad :(

The 5-year survival rate is <5%

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15
Q

Obstructive or restrictive:

“Sarcoidosis”

A

Restrictive

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16
Q

What are the 3 major classifications of lung tumors?

A

Non-small cell

Small cell

Carcinoid

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17
Q

Is this lung sample normal or abnormal?

If abnormal, what pathology can you identify?

A

The sample is normal

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18
Q

UIP or NSIP characteristic:

“No granulomas”

A

Both

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19
Q

Adenocarcinoma or squamous cell carcinoma characteristic?

Keratinization

A

Squamous cell carcinoma

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20
Q

Describe the histopathology of adenocarcinoma

A
  • Rounded gland formation
  • Single layer of columnar cells
  • Mucin production
  • TTF1 positive
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21
Q

What causes emphysema?

A

Too many proteases and not enough antiproteases

  • Proteases destroy alveolar septae in the lung parenchyma
  • Conditions that result in protease/antiprotease imbalance:
    • Smoking
    • A1T1 deficiency
    • Pre-existing lung scarring
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22
Q

Characteristic of which lung tumor?

High grade: lots of mitotic activity and necrosis

A

Small cell carcinoma

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23
Q

If acute lung injury does not resolve, what could it progress to?

A

Interstitial fibrosis with a restrictive pattern

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24
Q

What are the 3 categories of non-small cell lung carcinoma?

A

Adenocarcinoma

Squamous cell carcinoma

Larce cell carcinoma

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25
Q

What are the most common causes of infectious granuloma?

A
  • Mycobacterial organisms
    • TB, NTM
  • Dimorphic fungi
    • Blastomycosis, histoplasmosis, coccidiomycosis
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26
Q

Is there a pathology present in this picture?

If so, what is it?

A

Sarcoidosis

Shows confluent “naked” granulomas

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27
Q

What does the Reid index measure?

A

The ratio of:

Thickness of submucosal glands/
Distance between bronchial cartilage and the epithelial surface

Reid index >0.4 is consistent with chronic bronchitis

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28
Q

What are the most common causes of viral pneumonia in the community setting?

A

Influenza A and B

RSV

Adenovirus

hMPV

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29
Q

What are the two major categories of obstructive lung disease?

A
  • COPD
    • Emphysema
    • Chronic bronchitis
  • Asthma
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30
Q

What has a better prognosis: Idiopathic UIP or idiopathic NSIP?

A

Idiopathic NSIP

Idiopathic UIP = IPF, median survival is 3 years

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31
Q

How does smoking lead to emphysema?

A

Smoking causes an increase in protease secretion by inflammatory cells and inactivation of antiproteases due to tobacco smoke

Too many proteases = destruction of alveolar septae

-> enlargement of lung spaces -> emphysema

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32
Q

What is TTF1? How can it aid the diagnosis of lung cancer?

A

TTF1 is a protein produced by adenocarcinomas

It is specific for adenocarcinomas of the lung

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33
Q

What are the most common causes of bacterial pneumonia in healthy patients in the community setting?

A
  • Streptococcus pneumoniae*
  • Haemophilus​ influenzae*
  • Moraxella catarrhalis*
  • Staphylococcus aureus*
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34
Q

Long-term, chronic hypersensitivity pneumonitis shows a _________ pattern on HRCT.

A

Long-term, chronic hypersensitivity pneumonitis shows a UIP pattern on HRCT.

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35
Q

Atopic or non-atopic asthma characteristic?

“Trigger = airway irritation due to exercise, cold air, inhaled irritants, or viral infection”

A

Non-atopic asthma

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36
Q

Obstructive or restrictive characteristic:

“Increased lung capacity”

A

Obstructive

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37
Q

Obstructive or restrictive characteristic:

“Rapid expiration of air”

A

Restrictive

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38
Q

Sarcoidosis or hypersensitivity pneumonitis characteristic?

“Lymphoplasmacystic inflammation”

A

Hypersensitivity pneumonitis

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39
Q

Chronic Bronchitis or Asthma characteristic?

“Medial therapy can restore normal physiology”

A

Asthma

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40
Q

UIP or NSIP characteristic:

“Sub-pleural, basilar predominance”

A

UIP

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41
Q

What is the most common form of lung cancer?

A

Adeonocarcinoma

(a type of non-small cell lung carcinoma)

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42
Q

Atopic or non-atopic asthma characteristic?

“Type 1 IgE hypersensitivity reaction”

A

Atopic

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43
Q

Characteristic of which lung tumor?

Low nucleus:cytoplasm ratio

A

Carcinoid tumor

44
Q

What is the prognosis for malignant mestothelioma?

A

<2 year median survival :(

45
Q

Describe the key features of sarcoidosis

A
  • Non-necrotizing granulomatous inflammation
    • Well-formed
    • No lymphocytic inflammation
  • Upper-lobe predominant
  • Idiopathic, systemic granulomatous disease
    • Must rule out infectious etiology to diagnose sarcoidosis
46
Q

What pathologic changes are seen in chronic bronchitis?

A
  • Mucus glad hypertrophy
    • More mucus cells in the bronchial epithelium
    • Increased thickness of the bronchial mucus glands
  • Chronic inflammatory infiltrate
    • Lots of lymphocytes and macrophages
47
Q

Sarcoidosis or hypersensitivity pneumonitis characteristic?

“Associated with infectious etiology”

A

Neither

Sarcoidosis = idiopathic

Hypersensitivity pneumonitis = exposure to organic antigens

48
Q

UIP or NSIP characteristic:

“Temporally and geographically heterogeneous fibrosis”

A

UIP

49
Q

Describe the histology of squamous cell carcinoma

A
  • Keratinization
    • Abundant dense, pink cytoplasm
  • Intracellular bridges (desmosomes) between squamous cells
  • TTF1 negative
50
Q

Describe the pathologic findings of viral pneumonia

A
  • Increased lymphocytes and plasma cells in alveolar septae and interstitium
  • Hyaline membrane and neutrophils may be present if very severe
51
Q

Describe the histopathology of bacterial pneumonia

A
  • Many neutrophils in alveolar spaces
    • Other inflammatory cells may be present too
  • Congestion of capillaries of aleolar septae
  • Hyaline membranes possible
52
Q

Obstructive or restrictive characteristic:

“Difficulty expiring air”

A

Obstructive

53
Q

Adenocarcinoma or squamous cell carcinoma characteristic?

TTF1 negative

A

Squamous cell carcinoma

54
Q

Chronic Bronchitis or Asthma characteristic?

“Eosinophilic infiltrate”

A

Asthma

55
Q

Describe the characterisitics of chronic asthma

A

Basement membrane thickening

Smooth muscle hypertrophy and hyperplasia

Goblet cell (mucus gland) hyperplasia

56
Q

Which non-small cell lung carcinoma is most strongly associated with a history of smoking?

A

Squamous cell carcinoma

57
Q

Atopic or non-atopic asthma characteristic?

“Trigger = environmental allergen”

A

Atopic asthma

58
Q

Obstructive or restrictive characteristic:

“End stage = honeycomb lung”

A

Restrictive

59
Q

Characteristic of which lung tumor?

Keratinization

A

Squamous cell carcinoma (non-small cell)

60
Q

What is the underlying pathology of asthma?

A

Chronic inflammation

  • Surrounds the larger and smaller airways
  • Inflammatory infiltrate contains eosinophils, Th2 lymphocytes, leukotrienes
61
Q

What is status asthmaticus?

A

Severe acute asthma

Attacks wtihout return to normal - can be fatal

62
Q

Sarcoidosis or hypersensitivity pneumonitis characteristic?

“Presents with fever and cough”

A

Hypersensitivity penumonitis

63
Q

Obstructive or restrictive characteristic:

“Increased elastic recoil of the lung parenchyma”

A

Restrictive

64
Q

UIP or NSIP characteristic:

“Microcscopic honeycombing may be present”

A

UIP

65
Q

Which lung cancers occur most commonly in smokers?

A

Squamous cell carcinoma (non-small cell)

Small cell carcinoma

66
Q

What are the pathologic findings of acute lung injury?

A

Diffuse alvolar damage (DAD)

  • Intra-alveolar dense, pink hyaline membrane
    • Made up of necrotic cells + fibers + plasma proteins
  • High numbers of inflammatory cells
67
Q

What etiologies are associated with an NSIP pattern?

A
  • Autoimmune
  • Connective tissue disease
  • Idiopathic
68
Q

What is bronchiectasis?

A

Irreversible dilation of the airways

  • Airways are bigger than the accompanying blood vessel
  • Walls are repeatedly destroyed and hollowed out
  • Bronchi become plugged wtih mucus containing acute and chronic inflammatory cells
  • Not a disease, but a process that can complicate other diseases
    • Ex: Cystic Fibrosis
69
Q

What defines chronic bronchitis?

A

A productive cough on most days in 3 consecutive months of 2 consecutive years

70
Q

Adenocarcinoma or squamous cell carcinoma characteristic?

TTF1 positive

A

Adenocarcinoma

71
Q

Describe the viscious cycle of bronchiectasis

A

Obstruction due to inflammation -> Infection -> Bronchial wall destruction -> Rinse and repeate

72
Q

Where are mesothelial cells located?

A

They line the pleural and peritoneal cavites

73
Q

Characteristic of which lung tumor?

Mitotic figures and necrosis are rare

A

Carcinoid tumors

74
Q

Obstructive or restrictive characteristic:

“Fibrosis, diffuse inflammatory infiltrate”

A

Restrictive

75
Q

What cells are common in the infiltrate of a person with infectious granulomas?

A

Lymphocytic infiltrate

76
Q

UIP or NSIP characteristic:

“Temporally and geographically uniform fibrosis”

A

NSIP

77
Q

Is there a pathology present in this picture?

If so, what is it?

A

UIP

Shows geographic and temporal heterogeneity

78
Q

Describe the key features of acute or subacute hypersensitivity pneumonitis

A
  • Loose/poorly-formed granulomas
  • Lymphoplasmacystic infiltrate
  • Associated with exposure to organic antigens
    • Animals, plants, bacteria
    • Special stains and cultures required for diagnosis
79
Q

Describe the key features of chronic hypersensitivity pneumonitis

A

UIP pattern

  • Honeycombing
  • Geographically and temporally heterogeneous fibrosis
80
Q

What etiologies are associated wtih a UIP pattern of lung disease?

A
  • Autoimmune
  • Asbestos exposure
  • Hypersensitivity
  • IPF if all else is ruled out
81
Q

Adenocarcinoma or squamous cell carcinoma characteristic?

Mucin production

A

Adenocarcinoma

82
Q

Obstructive or restrictive characteristic:

“Decreased lung capacity”

A

Restrictive

83
Q

Charcot Leyden crystals are seen in which airway pathology?

A

Asthma

Charcot leyden crystals are formed from the products of eosinophil degradation

84
Q

Is there a pathology present in this picture?

If so, what is it?

A

This is a normal lung!

85
Q

Adenocarcinoma or squamous cell carcinoma characteristic?

Single layer of columnar cells

A

Adenocarcinoma

86
Q

Describe the histopathology of carcinoid tumors

A
  • Neuroendocrine differentiation
  • Nested/cord-like growth pattern
  • Abundant cytoplasm
  • Nuclei are bland with granular “salt and pepper” chromatin
  • Mitotic figures and necrosis are rare (because they are indolent, very slow growing)
87
Q

What is the most common cause of bacterial pneumonia in cystic fibrosis?

A

Pseudomonas aeruginosa

88
Q

What are the characteristic findings of pneumonia caused by Herpes viruses?

A
  • Pale glassy chromatin
  • Nuclear moulding
  • Multinucleation
  • Margination of chromatin
89
Q

Chronic Bronchitis or Asthma characteristic?

“Infiltrate contains lots of lymphocytes and macrophages”

A

Chronic bronchitis

90
Q

Viral pneumonia caused by which viruses is usually only seen in immunocompromised patients?

A

CMV

Herpes viruses

91
Q

Describe the key features of a Usual Interstitial Pneumonia (UIP) pattern

A
  • Fibrosis: Temporally and geographically heterogeneous
    • Fibrosis and normal lung may be adjacent
    • Mature and less mature fibrosis may be adjacent
  • Sub-pleural predominance
  • Basilar predominance
  • No granulomas
92
Q

Obstructive or restrictive characteristic:

“Decreased elastic recoil of the lung parenchyma”

A

Obstructive

93
Q

Characteristic of which lung tumor?

Neuroendocrine differentiation

A

Small cell carcinoma

Carcinoid tumor

94
Q

Describe the key features of a Nonspecific Interstitial Pneumonia (NSIP) pattern

A
  • Fibrosis: Temporally and geographically uniform
  • No granulomas
95
Q

Sarcoidosis or hypersensitivity pneumonitis characteristic?

“Well-formed, tightly-packed granulomas”

A

Sarcoidosis

96
Q

What are the most common causes of bacterial pneumonia in the hospital setting?

A
  • Staphylococcus aureus*
  • Gram negative enteric bacteria*
97
Q

How is large cell carcinoma diagnosed?

A

By excluding squamous cell carcinoma and adenocarcinoma

Large cell carcinoma tumors are poorly differentiated, and they do not have features of adenocarcinoma, squamous cell carcinoma, or small cell carcinoma

98
Q

Describe the presentation of bronchiectasis

A

Chronic productive cough with foul-smelling sputum

99
Q

Describe the gross pathology of bronchiectasis

A

Large airspaces in the periphery of the lung

(normally, you would only find large airspaces centrally)

100
Q

What is the difference between bronchopneumonia and lobar penumonia?

A
  • Bronchopneumonia has a patchy distribution
  • Lobar pneumonia has a confluent pattern, may infect the entire lung
101
Q

Characteristic of which lung tumor?

High nucleus:cytoplasm ratio

A

Small cell carcinoma

102
Q

Describe the gross pathology of malignant mesothelioma

A

Thick, pale, fibrous rind around normal lung parenchyma

103
Q

Is there a pathology present in this picture?

If so, what is it?

A

NSIP

Shows uniform fibrosis

104
Q

What are the characteristic findings of pneumonia caused by CMV?

A

Intranuclear “owl eye” inclusions

Usually only immunocompromised patients have pneumonia caused by CMV

105
Q

Almost all cases of chronic bronchitis are related to _______

A

Almost all cases of chronic bronchitis are related to smoking

Pulm by Minnie: AH Update (34 decks)

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