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Pathology > Chapter 15- Lungs > Flashcards

Chapter 15- Lungs Flashcards

1
Q

Where do the lungs form from?

A

Central wall of the foregut

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2
Q

What is the morphological difference between bronchi and bronchioles?

A

Bronchi have cartilage and subepithelial mucous glands (bronchioles have neither)

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3
Q

What type of epithelium makes up the respiratory tree?

A

Psuedostratified columnar ciliated epithelium

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4
Q

What part of the respiratory doesn’t possess respiratory epithelium?

A

The vocal cords

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5
Q

What are the two types of alveolar epithelium and their functions?

A
  1. Type I pneumocytes- gas exchange

2. Type II pneumocytes- surfactant synthesis

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6
Q

When are Type II pneumocytes properly formed?

A

After 28wks gestation

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7
Q

What are the congenital anomalies of the lungs?

A
  1. Pulmonary hypoplasia- small lungs due to compression/impeded expansion
  2. Foregut cysts- abnormal detachment of primitive foregut
  3. Pulmonary sequestration- parts of lung lack connection to the airway system
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8
Q

What are the types of foregut cysts and their characteristics?

A
  1. Branchial cleft- on lateral aspect, lined by squamous cells
  2. Bronchogenic cysts- lined by ciliated respiratory epithelium, can contain cartilage, mucous glands, etc
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9
Q

What is the most common form of foregut cyst?

A

Branchial cleft

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10
Q

What are the types of pulmonary sequestration and where do they occur?

A
  1. Extralobar- external to lungs

2. Intralobar- within lung parenchyma

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11
Q

What is atelectasis?

A

Lung collapse

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12
Q

What are the two categories of atelectasis and what distinguishes them?

A
  1. Neonatal- incomplete lung expansion

2. Acquired- collapse of a previously inflated lung

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13
Q

What are the forms of acquired atelectasis and their characteristics?

A
  1. Resorption- complete airway obstruction
  2. Compression- pleural space expanded by fluid
  3. Contraction- local/generalized fibrotic changes
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14
Q

Where does the mediastinum shift in the different types of acquired atelectasis?

A

Resorption- towards the collapsed lung

Compression- away from the collapsed lung

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15
Q

What is pulmonary edema caused by?

A

Increased hydrostatic pressure or capillary permeability

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16
Q

What is the lung morphology of chronic congestion?

A

Brown and firm with interstitial fibrosis

Hemosiderin laden macs/heart failure cells

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17
Q

What are the hemodynamic causes of pulmonary edema?

A
  1. Increased hydrostatic pressure
  2. Decreases oncotic pressure
  3. Lymphatic obstruction
  4. Edema due to alveolar wall injury
  5. Direct injury
  6. Indirect injury
  7. Undetermined origin (high altitude)
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18
Q

What is acute lung injury (ALI)?

A

Inflammation associated with increased pulmonary vascular permeability due to endothelial and epithelial cell death

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19
Q

What is the severe form of ALI?

A

Acute respiratory distress syndrome (ARDS)

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20
Q

What is the histological presentation of ALI?

A

Diffuse alveolar damage

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21
Q

What are the causes of ALI?

A

Infection

Trauma

Toxic exposure

Pancreatitis

Uremia

Immune reactions

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22
Q

What is acute interstitial pneumonia?

A

ALI with the absence of etiology

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23
Q

What is the morphology of the lungs in ALI?

A

Firm, red, boggy and heavy

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24
Q

What is the pathology of obstructive pulmonary disease?

A

Increased airflow resistance

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25
What are the types of obstructive pulmonary diseases?
1. Emphysema 2. Chronic bronchitis 3. Asthma 4. Bronchiectasis
26
What is the pathology of restrictive pulmonary diseases?
Reduced expansion of the lung parenchyma and decreased total lung capacity
27
What is the cause of emphysema?
Irreversible enlargement of airspaces Alveolar wall destruction with minimal fibrosis
28
What are the characteristics of patients with emphysema?
Barrel chested and dyspneic Sit hunched Breathe through pursed lips
29
What is the key to diagnosis of emphysema?
Impaired expiratory airflow via spirometry
30
Emphysema and chronic bronchitis together are termed what?
COPD
31
What are the types of emphysema and their characteristics?
1. Centriacinar- occurs in central/proximal areas of upper lobes, smokers 2. Panacinar- uniform, in lower zones, alpha1-antitrypsin deficiency 3. Distal acinar- distal acinus, adjacent to fibrosis/scars, spontaneous pneumothorax 4. Airspace enlargement with fibrosis- associated with scarring, irregular emphysema
32
What is the morphology of emphysema in young smokers?
Small airway inflammation Goblet cell hyperplasia Inflammatory infiltrates in bronchial walls Muscle hypertrophy (wall thickening)
33
What is the function of alpha1-antitrypsin?
Inhibits proteases Protects tissues from inflammatory enzymes
34
What is the definition of chronic bronchitis?
Persistent cough with sputum production for at least three months in at least two consecutive years No other identifiable cause apparent
35
What is the morphology of chronic bronchitis?
Chronic irritation by inhaled substances Mucous gland hypertrophy Goblet cell metaplasia in bronchiolar epithelium Bronchiolitis- wall thickening (fibrosis and muscle hypertrophy)
36
What can long term chronic bronchitis lead to?
Acute decline in lung function Cor pulmonale Heart failure Respiratory epithelial dysplasia with malignant transformation
37
What is the morphology of asthma?
Episodic bronchocontriction Inflammation of bronchial walls Increased mucous secretion Airway remodelling Curschmann spirals- whorled mucous plugs Charcot-Leyden crystals- eosinophilic granule debris
38
What are the types of asthma?
1. Atopic/allergic- Type I mediated hypersensitivity (IgE) Nonatopic- respiratory infections, chemical irritants, drugs
39
What is the morphology of bronchiectasis?
Abnormal dilation of airways due to necrotizing infection Scarring Fibrous pleural adhesions
40
What can cause bronchiectasis?
Congenital or hereditary conditions Infections Bronchial obstruction Chronic inflammatory diseases (RA, SLE, IBD, COPD)
41
What are chronic diffuse interstitial (restrictive) pulmonary diseases characterized by?
Inflammation Interstitial tissue fibrosis Reduced lung capacity, volume and compliance without obstruction
42
Where do restrictive pulmonary diseases occur?
1. Chronic interstitial and infiltrative diseases | 2. Chest wall disorders
43
What are the major categories of restrictive pulmonary diseases?
1. Fibrosing 2. Granulomatous 3. Eosinophilic 4. Smoking related 5. Other
44
What are the restrictive pulmonary fibrosing diseases?
1. Idiopathic pulmonary fibrosis 2. Nonspecific interstitial pneumonia 3. Cryptogenic organizing pneumonia 4. Pulmonary involvement in autoimmune diseases 5. Pneumoconioses 6. Asbestos related diseases
45
What are the characteristics of idiopathic pulmonary fibrosis?
Progressive, patchy interstitial fibrosis Heterogeneity (new fibroblastic foci with older areas of fibrosis) Honeycomb lung- bands of fibrous tissue Usual interstitial pneumonia histologically
46
What is the pathology of idiopathic pulmonary fibrosis?
Epithelial injury/activation Immune response Pro-fibrogenic factors
47
How does nonspecific interstitial pneumonia differ from IPF?
Diffusely fibrosing Lacks heterogeneity Better prognosis
48
What is the morphology of cryptogenic organizing pneumonia?
Masson bodies- loose, fibrous tissue plugs No interstitial fibrosis or honeycombing
49
What is the cause of pneumoconioses?
Neoplastic lung reaction to inhaled foreign particles
50
What does the development of pneumoconioses depend on?
Amount of dust retained Size, shape and particle buoyancy Physiochemical reactivity and solubility Addition affects
51
What are two common forms of pneumoconioses?
1. Coal workers’- massive fibrosis | 2. Silicosis- nodular fibrosis
52
What is coal workers’ pneumoconioses also known as?
Anthracosis
53
What form of silicon dioxide is more fibrogenic?
Crystalline
54
What is the pathology of asbestos related diseases?
Pleural plaques and effusions Lung carcinoma, mesothelioma, laryngeal cancer
55
What affects the disease causing capacity of asbestos?
Size, shape and solubility
56
What is a key morphological feature of asbestos related disease?
Asbestos bodies- golden brown beaded rods with a translucent centre
57
What are the types of pulmonary restrictive granulomatous diseases and their characteristics?
1. Sarcoidosis- systemic, bilateral, noncaseating, disease of exclusion 2. Hypersensitivity pneumonitis- caused by inhaled dust or Ags, affects alveoli
58
What are the different forms of hypersensitivity pneumonitis?
1. Farmer’s lung- actinomycete spores 2. Pigeon breeders’ lung 3. Humidifier or air conditioner lung
59
What is pulmonary eosinophilia characterized by?
Interstitial or alveolar eosinophil infiltrates
60
What are the types of pulmonary eosinophilia?
1. Acute with respiratory failure 2. Simple (Loeffler syndrome) 3. Tropical 4. Secondary 5. Idiopathic chronic eosinophilic pneumonia
61
What are the types of pulmonary restrictive smoking related diseases and their characteristics?
1. Desquamative interstitial pneumonia- intra-alveolar brown smoker’s macs, mild inflammation, minimal fibrosis 2. Respiratory bronchiolitis associated interstitial lung disease- patchy smoker’s macs with peribronchiolar inflammation and mild fibrosis 3. Pulmonary Langerhans cell histiocytosis- focal collections of Langerhans cells, progressive fibrosis
62
What is the pathology of pulmonary alveolar proteinosis (PAP)?
Surfactant accumulation in alveoli and bronchioles
63
What pulmonary disorders involve the vascular system?
1. PE and infarction 2. Pulmonary hypertension 3. Diffuse pulmonary hemorrhage syndromes
64
What leads to PE and infarction?
Hypercoaguable states Respiratory compromise- lack of perfusion Hemodynamic compromise- increased pulmonary arterial resistance
65
What causes pulmonary hypertension?
1. Chronic obstructive or interstitial lung disease 2. Congenital or acquired heart disease with LSHF 3. Recurrent PE 4. Connective tissue diseases 5. Obstructive sleep apnea 6. Rare idiopathic or familial forms
66
What are the different groups of pulmonary hypertension?
1. Pulmonary arterial 2. Secondary to LSHF 3. From lung parenchymal disease 4. Chronic thromboembolic 5. Multifactorial
67
What are different types of diffuse pulmonary hemorrhage syndromes?
1. Goodpasture’s- BM destruction, necrotizing hemorrhagic interstitial pneumonitis 2. Idiopathic pulmonary hemosiderosis- children with alveolar hemorrhage 3. Wegner granulomatosis- vasculitis, hemoptysis
68
What are pneumonias classified by?
Specific etiologic agents or clinical setting
69
What are the two patterns of bronchopneumonia?
1. Lobular- patchy | 2. Lobar- large portion or entire lobe
70
What are the stages of inflammatory response in lobar bronchopneumonia?
1. Congestion- vascular engorgement 2. Red hepatization- exudation 3. Grey hepatization- RBC disintegration 4. Resolution- exudate broken down
71
What infectious organisms are commonly seen in the gross room?
Tb Histoplasmosis Blastomycosis Coccidioidomycosis
72
What are the major complications of lung transplantation?
Infection and rejection
73
When do 50% of all patients experience chronic rejection of lung transplants?
3-5yrs
74
What cancer has the highest mortality?
Lung
75
What type are 95% of lung cancers?
Carcinomas
76
What polymorphism increases the risk of developing lung cancer with smoking?
P450 mono-oxygenase
77
What are the precursor lesions associated with lung cancer?
Squamous cell dysplasia and carcinoma in situ Atypical adenomatous hyperplasia Adenocarcinoma in situ Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
78
What is the most common lung cancer?
Adenocarcinoma
79
What are the characteristics of adenocarcinoma of the lung?
Peripheral mass Leptic pattern- tumour cells crawl along alveolar septae Small, metastasize early Nodules surrounding mass are physically connected
80
What precursor lesions are associated with adenocarcinoma of the lung?
Atypical adenomatous hyperplasia Adenocarcinoma in situ
81
What are the characteristics of squamous cell carcinoma of the lung?
Occur in or near hilum Large masses Associated with smoking
82
What precursor lesions are associated with squamous cell carcinoma of the lung?
Squamous metaplasia or dysplasia
83
What is the most malignant lung cancer?
Small cell carcinoma
84
What are the characteristics of SCC?
Central or hilar Small cells with scant cytoplasm, salt and pepper chromatin, nuclear molding Abundant necrosis Neuroendocrine features Always high grade Associated with smoking
85
What is SCC treated with?
Chemo
86
What are the characteristics of large cell carcinoma?
Undifferentiated neoplasm
87
What lung cancers can metastasize?
All
88
What is the most common site of lung cell metastasis?
Adrenals
89
What are secondary pathologies of lung cancers?
Superior vena cava syndrome- edema or head and arm Paraneoplastic syndrome- hormone release from tumour
90
What can diffuse idiopathic pulmonary neuroendocrine cell hyperplasia develop?
Tumourlets (benign cysts) Carcinoids
91
What is the most common site of metastatic cancer development?
Lungs
92
What can cause pleural effusions?
1. Increased hydrostatic pressure 2. Increased vascular permeability 3. Decreased oncotic pressure 4. Increased negative intrapheural pressure 5. Decreased lymphatic drainage
93
What is pneumothorax?
Air or gas in the pleural cavity
94
What is tension pneumothorax?
Defect that allows air to enter the lung during inspiration but prevents its exit Compression on contralateral lung and mediastinum
95
Are pleural tumours normally metastatic?
Yes
96
What are the types of pleural tumours?
1. Solitary fibrous- dense, rarely malignant 2. Malignant mesothelioma- spreads to pleural space, effusion, lung ensheathed by tumour tissue, related to asbestos exposure

Pathology (25 decks)

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