Chapter 13: Lecture lung part 2 Flashcards
Moving on from infectious diseases, tuberculosis is a very important one. What is it caused by?
Mycobacteria
Is tuberculosis contagious?
Yes! very!
Where is tuberculosis common (geographically)?
In Afrika, in The Netherlands we keep it contained to identify which patients have it, and minimize the risk of infecting others
After how many years can someone with tuberculosis die?
A couple of years (before treatment was available)
What is the hallmark of tuberculosis
Granuloma and giant cells, with necrosis, formed by Langerhans cells
(Macrophages activated by IFN-γ differentiate into the “epithelioid histiocytes” that aggregate to form granulomas; some epithelioid cells may fuse to form giant cells.)
Protection against infection is done be mechanical (1), immunological (2) and fagocytical (3) mechanisms. What are these mechanisms?
- Mechanical: mucociliairy transport, coughing reflex
- Immunological: IgA secretion in bronchial mucus, Humoral and cellular immune respons (BALT)
- Phagocytosis: alveolar macrophages, neutrophillic granulocyte
What causes that one patient becomes sick because of an infection and the other doesn’t?
The dose and the pathogenicity virulence of the pathogen, and the host’s health state (however, in regard to corona, it is still very unclear why some patients have mild, and others have severe symptoms)
How was the corona virus through the pathology department mostly investigated?
Post-mortem, with autopsy
Is there diffuse alveolar damage in COVID-10 patients?
Yes
The lecturer told us about a study with covid that he did, what did he find?
Profound inflammatory changes in all areas of the brain, but no virus! So there is an inflammatory respons that influences the brain
If we would make a graph, where on the x-axis there is a timeline (1930s-2010s), and on the y-axis the amount of death rates for lung and bronchitis. How would this graph look?
You would see a high increase of amount of deaths, reaching it’s peak at 1990s, but then a decrease. This correlates with the smoking habits of the population (for illustration see p64 of the lecture)
Lung cancer comes in 4th in place (of incidences) of all cancers (for both males/females). Still it is the most important cause of death in The Netherlands. How?
Because the mortality is high(er than the others such as breast, skin and prostate)
What is the main risk factor of lung cancer?
Smoking
Lung cancer can present in many ways and can look very different. What are some histologic classifications that are/can be made? (don’t learn by heart)
Adenocarcinoma, squamous cell carcinoma, large cell carcinoma, neuroendocrine carcinoma, mixed carcinomas, other unusual morphologic variants (sarcomatoid/spindle/giant) This is for illustration
What is the order of most - least frequent primary malignant epithelial lung tumors?
- 50-60%: Adenocarcinoma - 25-30%: Squamous cell carcinoma - 10-15%: Small cell carcinoma - 1-5%: Carcinoid - 10%: Large cell carcinoma (you have to know the first three / should be able to recognize them)
How does a papillary adenocarcinoma look like? you only need to know what an adenocarcinoma looks like, these are just for illustration
How does a acinar adenocarcinoma look like?
(top right:
- lepicidic (not discussed)
- papillary adenocarcinoma)
(forms glandular structures)
How does a micro papillary adenocarcinoma look like?
(top right:
- lepicidic (not discussed)
- papillary adenocarcinoma
- acinar adenocarcinoma
- micropapillary adenocarcinoma)
Where does squamous cell carcinoma occur, and because of what?
In the central part of the lung, at the main bronchus, and 98% are smokers
How does a squamous cell carcinoma look like under the light/electron microscopy?
Large lesions may undergo central necrosis, giving rise to cavitation. The preneoplastic lesions that antedate, and usually accompany, invasive squamous cell carcinoma are well characterized
What (sub)type are small cell carcinoma?
neuroendocrine carcinoma
Why is it important to recognize small cell carcinoma?
Because it has very different treatment than e.g. squamous, it is more aggressive (2-4 months to live without treatment)
How is small cell lung cancer treated?
Chemotherapie, most patients don’t survive well on surgery (5 year survival is 2%) (cause is also >98% smoking)
In 2004 there was a ground-breaking study that showed that a subgroup of patients with non-small-cell lung cancer have specific mutations in the EGFR gene. What do these mutations lead to?
Increased growth factor signaling and confer susceptibility to the inhibitor
How can the mutation in the EGFR gene be used as a treatment?
Tyrosine-kinase inhibitors can be administered (and there is a clinical responsiveness!)
If we would make a graph where an x amount of mutations is shown per cancer, we would see that lung cancer has the highest amount of mutations. Why is that?
Substances in sigarettes bind/damage the DNA, causing for more mutations
What you need to know is that squamous cell can be identified under the microscope, because…
There is squamous cell differentiation
What you need to know is that adenocarcinoma cell can be identified under the microscope, because…
There is adenoma cell differentiation
What is the hallmark of interstitial lung disease? A. Increased mucin production B. Stiffening of the lung C. Lymphadenopathy D. Mastcelldegranulation
B. Stiffening of the lung
Which of the mentioned diseases is a restrictive lung disease: A. Asbestosis B. Chronic bronchitis C. Emphysema D. Asthma
A. Asbestosis
True/false: PDL1 expression on tumor cells as a predictor for response to checkpoint inhibitor therapy
True
