27 Mediastinal and pleural pathology Flashcards
Inflammatory pleural effusions
- Serous/fibrinous/serofibrinous- 2/2 infection and infarct
- Empyema
- Hemorrhagic- coagulopathy, rickettsial, neoplasms
Pleural effusion
> 15ml in the pleural space
Empyema treatment
Frequently need to remove affected area of pleura “Decortication”
Non-inflammatory Pleural Effusions
Hydrothorax- CHF, cirrhosis, uremia, renal failure
Hemothorax-AAA, trauma
Chylothorax- Milky fluid - lymphatic trauma or occlusion
Fibrous tumor
Polypoid-well circumscribed tumors
Fibroblasts and collagenized stroma- spindle cells with collagen
Benign treated with excision
Clubbing and hypoglycemia
Malignant mesothelioma
Proliferation of mesothelial cells *ASBESTOS or idiopathic Long latency Ferrigenous bodies 18 month survival
Mesothelioma histo
Normal mesothelial appearance- difficult to distinguish from metastatic carcinomas to pleura
- Epitheliod cuboidal appearance
- Spindle cell type with collagen and spindle cells
Pleural mets
More comman than primary pleural malignanccy
usually multinodular and bilateral
blood, lymph, or direct spread
Mediastinal pathology
Inflammatory
-Acute mediastinitis (inflammation from neighboring conditions)
-Granulomatous-Aspergillosis, histoplasmosis, tuberculosis, cryptococus, atypical mycobacteria
- Idiopathic sclerosing
Congenital
Neoplastic
Mediastinal tumors
Anterior- usually thymic ca or growth, Mets
Midde- Mets and percardial/bronchogenic cysts
Posterior- neurogenic tumors
Congenital cyst
Mediastinal cyst
unilocular
simple cuboidal epithelium filled with serous fluid
Thymic hyperplasia
Thymic follicular hyperplasia assosciated with myesthenagravis and autoimmune disorder
-epithelials mixed with lymphocyte follicles
Thymoma
Thymic epithelials
lots of immature T cells
Spindle or round cells as well
Large lobulated circumscribed gray/white thymic tissue
Type A- spindle
Type B- Round
Excise
Thymic carcinoma
Looks like other carcinomas
Diagnosis of exclusion
