at 3 - Pathology in Clinical Practice Flashcards
Histologically what difference would be seen between UIP and NSIP?
UIP = usually interstitial pneumonia
- basal changes
- peripheral/subpleural
- not much ground glass
- honeycombing
- nil on antibodies
NSIP = non specific interstitial pneumonia
- anything non specific
- generally better prognosis than classical UIP
- no honeycombing, only mild inflammatory changes
What are the 3 classifications of causes of granulpmatous lung disease?
Bugs - TB, fungi
inflammatory - sarcoidosis, extrinsic allergic alveolitis
Vasculitic - churg strauss, wegeners, poluartetisis nodosa
What is sarcoidosis?
Which population is it most common in?
What is the rule of 1/3rds?
multi system disease of unknown aetiology non-caseating granulomas more common in afro-caribbean 1/3 get better without treatment 1/3 get better with short treatment 1/3 need long term treatment
What would you see on a CXR of pulmonary sarcoidosis?
bilateral hilar lymphanopathy
infiltrates - ground glass appearance
fibrosis - anywhere in the lungs
What are some examples of extra pulmonary aspects of sacrcoidosis/
skin eyes heart neuro liver
What is EAA?
extrinsic allergic alveolitis
granulomatis disease
caused by inhalation of organic particles e.g. hay, bird proteins, fungi
antibody formation and T cell sensitisation –> hypersensitivity
How is EAA diagnosed?
What is the treatment?
idenfication of potential antigen
CXR and HRCT –> underlying fibrosis
blood - precipitins, Normal IgE (as hypersensitivty)
resolution/improvement after cessation of exposure
antigen avoidance
steroids
What is vasculitis?
Give examples
inflammation of blood vessels
may obstruct vessels or cause bleeding
often multi systemic, commonly renal
Wegener’s granulomatosis
Goodpasture’s disease
One of the most common complications of vasculitis is pulmonary haemorrhage.
How would a patient with this present?
dyspnoa haemoptysis looks opaque on CXR PFTs show high gas transfer visualise at bronchoscopy
What are the clinical features of lung cancer?
smoker haemoptysis weight loss dyspnoea cough chest pain hoarse voice
What 4 things do you need to know about the lung cancer once you know it’s there?
which lobe? local spread metastatic spread tissue diagnosis - biopsy specific tumour markers - tumours may have mutations in their DNA which response to treatment
What are the 2 basic types of lung cancer?
How do you find out which one the patient has?
Why is it important to find this out?
non small cell carcinoma - 80% cases
small cell carcinoma -20%
tissue biopsy
need to know cell type to guide treatment
What can a bronchoscopy do?
Visualisation and sampling (limited by anatomy)
Brushing
Washing
Biopsy
What techniques are used for staging and tissue diagnosis?
EBUS = endobronchial ultrasound to sample lymph nodes
Cervical mediastinoscopy = sample lymph nodes in mediastinum
How are non-small cell and small cell lung cancers classified?
Non-small cell TNM Tumour = size Number of lymph nodes involved Metasases = present or not
Small cell
limited or extensive
How are non-small cell and small cell lung cancers managed?
Non-small cell
- surgey, radiotherapy, chemotherapy
Small cell
- chemotherpay, cranial radiotherapy (prevent metastases
- more aggressive so not eligible for surgery
What are some local complications of lung cancer?
What are the symptoms of these complications?
SVC obstruction - fixed raised IJV pressure - lips cyanosed - collaterals visible on skin Horners syndrome - interruption of the cervical sympthetic chain - ptosis, miosis, enopthalmos Recurrent laryngeal nerve palsy - paralysis of vocal cords --> hoarse voice Pleura involved --> pleural fluid
How does lung cancer spread?
What are the common locations of spread?
via lymphatics or blood
commonly pleura, brain and bone
What are the clinical features of pleural effusion?
SOB pain? of underlying cause reduced expansion dull percussion note reduced vocal resonance
Where does the pleural fluid come from in a pleural effusion?
leakage into pleural space - non-respiratory pathologies
produced by pathology in the pleural space - cancer/infection
decreased removal from the pleural space - lymph obstruction
What is the difference between transudates and exudates?
When is each seen?
Which would be bilateral PE and which would be unilateral?
Transudates = protoein30g/l
unilateral
malignancy and infection
What are the main causes of exudative plural effusion?
MR BALDY SPIT
- bronchial cancer
- abscesses
- pneumonia
- TB
How are PE’s investigated and managed?
Tap fluid –> protein, glucose, cells, culture To determine cause
Aspirate and Drain
What 2 things can exposure to asbestos cause?
benign - plaques and effusion
asbestosis - fibrosis, 43% clubbed
What is the treatment for asbestosis?
avoid further exposure and stop smoking
steroids don’t work!
What is mesothelioma?
What are the typical syndromes that are different from a lung cancer?
What is the treatment?
Most common complication of asbestosis
Cancer of the pleura
pain
chemotherapy, radiotherapy (can spread only needle tract), surgery to remove plura, immuno/gene therapy
