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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
Q

What are the types of obstructive pulmonary diseases?

A
  1. Emphysema
  2. Chronic bronchitis
  3. Asthma
  4. Bronchiectasis
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26
Q

What is the pathology of restrictive pulmonary diseases?

A

Reduced expansion of the lung parenchyma and decreased total lung capacity

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27
Q

What is the cause of emphysema?

A

Irreversible enlargement of airspaces

Alveolar wall destruction with minimal fibrosis

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28
Q

What are the characteristics of patients with emphysema?

A

Barrel chested and dyspneic

Sit hunched

Breathe through pursed lips

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29
Q

What is the key to diagnosis of emphysema?

A

Impaired expiratory airflow via spirometry

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30
Q

Emphysema and chronic bronchitis together are termed what?

A

COPD

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31
Q

What are the types of emphysema and their characteristics?

A
  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
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32
Q

What is the morphology of emphysema in young smokers?

A

Small airway inflammation

Goblet cell hyperplasia

Inflammatory infiltrates in bronchial walls

Muscle hypertrophy (wall thickening)

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33
Q

What is the function of alpha1-antitrypsin?

A

Inhibits proteases

Protects tissues from inflammatory enzymes

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34
Q

What is the definition of chronic bronchitis?

A

Persistent cough with sputum production for at least three months in at least two consecutive years

No other identifiable cause apparent

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35
Q

What is the morphology of chronic bronchitis?

A

Chronic irritation by inhaled substances

Mucous gland hypertrophy

Goblet cell metaplasia in bronchiolar epithelium

Bronchiolitis- wall thickening (fibrosis and muscle hypertrophy)

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36
Q

What can long term chronic bronchitis lead to?

A

Acute decline in lung function

Cor pulmonale

Heart failure

Respiratory epithelial dysplasia with malignant transformation

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37
Q

What is the morphology of asthma?

A

Episodic bronchocontriction

Inflammation of bronchial walls

Increased mucous secretion

Airway remodelling

Curschmann spirals- whorled mucous plugs

Charcot-Leyden crystals- eosinophilic granule debris

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38
Q

What are the types of asthma?

A
  1. Atopic/allergic- Type I mediated hypersensitivity (IgE)

Nonatopic- respiratory infections, chemical irritants, drugs

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39
Q

What is the morphology of bronchiectasis?

A

Abnormal dilation of airways due to necrotizing infection

Scarring

Fibrous pleural adhesions

40
Q

What can cause bronchiectasis?

A

Congenital or hereditary conditions

Infections

Bronchial obstruction

Chronic inflammatory diseases (RA, SLE, IBD, COPD)

41
Q

What are chronic diffuse interstitial (restrictive) pulmonary diseases characterized by?

A

Inflammation

Interstitial tissue fibrosis

Reduced lung capacity, volume and compliance without obstruction

42
Q

Where do restrictive pulmonary diseases occur?

A
  1. Chronic interstitial and infiltrative diseases

2. Chest wall disorders

43
Q

What are the major categories of restrictive pulmonary diseases?

A
  1. Fibrosing
  2. Granulomatous
  3. Eosinophilic
  4. Smoking related
  5. Other
44
Q

What are the restrictive pulmonary fibrosing diseases?

A
  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
Q

What are the characteristics of idiopathic pulmonary fibrosis?

A

Progressive, patchy interstitial fibrosis

Heterogeneity (new fibroblastic foci with older areas of fibrosis)

Honeycomb lung- bands of fibrous tissue

Usual interstitial pneumonia histologically

46
Q

What is the pathology of idiopathic pulmonary fibrosis?

A

Epithelial injury/activation

Immune response

Pro-fibrogenic factors

47
Q

How does nonspecific interstitial pneumonia differ from IPF?

A

Diffusely fibrosing

Lacks heterogeneity

Better prognosis

48
Q

What is the morphology of cryptogenic organizing pneumonia?

A

Masson bodies- loose, fibrous tissue plugs

No interstitial fibrosis or honeycombing

49
Q

What is the cause of pneumoconioses?

A

Neoplastic lung reaction to inhaled foreign particles

50
Q

What does the development of pneumoconioses depend on?

A

Amount of dust retained

Size, shape and particle buoyancy

Physiochemical reactivity and solubility

Addition affects

51
Q

What are two common forms of pneumoconioses?

A
  1. Coal workers’- massive fibrosis

2. Silicosis- nodular fibrosis

52
Q

What is coal workers’ pneumoconioses also known as?

A

Anthracosis

53
Q

What form of silicon dioxide is more fibrogenic?

A

Crystalline

54
Q

What is the pathology of asbestos related diseases?

A

Pleural plaques and effusions

Lung carcinoma, mesothelioma, laryngeal cancer

55
Q

What affects the disease causing capacity of asbestos?

A

Size, shape and solubility

56
Q

What is a key morphological feature of asbestos related disease?

A

Asbestos bodies- golden brown beaded rods with a translucent centre

57
Q

What are the types of pulmonary restrictive granulomatous diseases and their characteristics?

A
  1. Sarcoidosis- systemic, bilateral, noncaseating, disease of exclusion
  2. Hypersensitivity pneumonitis- caused by inhaled dust or Ags, affects alveoli
58
Q

What are the different forms of hypersensitivity pneumonitis?

A
  1. Farmer’s lung- actinomycete spores
  2. Pigeon breeders’ lung
  3. Humidifier or air conditioner lung
59
Q

What is pulmonary eosinophilia characterized by?

A

Interstitial or alveolar eosinophil infiltrates

60
Q

What are the types of pulmonary eosinophilia?

A
  1. Acute with respiratory failure
  2. Simple (Loeffler syndrome)
  3. Tropical
  4. Secondary
  5. Idiopathic chronic eosinophilic pneumonia
61
Q

What are the types of pulmonary restrictive smoking related diseases and their characteristics?

A
  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
Q

What is the pathology of pulmonary alveolar proteinosis (PAP)?

A

Surfactant accumulation in alveoli and bronchioles

63
Q

What pulmonary disorders involve the vascular system?

A
  1. PE and infarction
  2. Pulmonary hypertension
  3. Diffuse pulmonary hemorrhage syndromes
64
Q

What leads to PE and infarction?

A

Hypercoaguable states

Respiratory compromise- lack of perfusion

Hemodynamic compromise- increased pulmonary arterial resistance

65
Q

What causes pulmonary hypertension?

A
  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
Q

What are the different groups of pulmonary hypertension?

A
  1. Pulmonary arterial
  2. Secondary to LSHF
  3. From lung parenchymal disease
  4. Chronic thromboembolic
  5. Multifactorial
67
Q

What are different types of diffuse pulmonary hemorrhage syndromes?

A
  1. Goodpasture’s- BM destruction, necrotizing hemorrhagic interstitial pneumonitis
  2. Idiopathic pulmonary hemosiderosis- children with alveolar hemorrhage
  3. Wegner granulomatosis- vasculitis, hemoptysis
68
Q

What are pneumonias classified by?

A

Specific etiologic agents or clinical setting

69
Q

What are the two patterns of bronchopneumonia?

A
  1. Lobular- patchy

2. Lobar- large portion or entire lobe

70
Q

What are the stages of inflammatory response in lobar bronchopneumonia?

A
  1. Congestion- vascular engorgement
  2. Red hepatization- exudation
  3. Grey hepatization- RBC disintegration
  4. Resolution- exudate broken down
71
Q

What infectious organisms are commonly seen in the gross room?

A

Tb

Histoplasmosis

Blastomycosis

Coccidioidomycosis

72
Q

What are the major complications of lung transplantation?

A

Infection and rejection

73
Q

When do 50% of all patients experience chronic rejection of lung transplants?

A

3-5yrs

74
Q

What cancer has the highest mortality?

A

Lung

75
Q

What type are 95% of lung cancers?

A

Carcinomas

76
Q

What polymorphism increases the risk of developing lung cancer with smoking?

A

P450 mono-oxygenase

77
Q

What are the precursor lesions associated with lung cancer?

A

Squamous cell dysplasia and carcinoma in situ

Atypical adenomatous hyperplasia

Adenocarcinoma in situ

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

78
Q

What is the most common lung cancer?

A

Adenocarcinoma

79
Q

What are the characteristics of adenocarcinoma of the lung?

A

Peripheral mass

Leptic pattern- tumour cells crawl along alveolar septae

Small, metastasize early

Nodules surrounding mass are physically connected

80
Q

What precursor lesions are associated with adenocarcinoma of the lung?

A

Atypical adenomatous hyperplasia

Adenocarcinoma in situ

81
Q

What are the characteristics of squamous cell carcinoma of the lung?

A

Occur in or near hilum

Large masses

Associated with smoking

82
Q

What precursor lesions are associated with squamous cell carcinoma of the lung?

A

Squamous metaplasia or dysplasia

83
Q

What is the most malignant lung cancer?

A

Small cell carcinoma

84
Q

What are the characteristics of SCC?

A

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
Q

What is SCC treated with?

A

Chemo

86
Q

What are the characteristics of large cell carcinoma?

A

Undifferentiated neoplasm

87
Q

What lung cancers can metastasize?

A

All

88
Q

What is the most common site of lung cell metastasis?

A

Adrenals

89
Q

What are secondary pathologies of lung cancers?

A

Superior vena cava syndrome- edema or head and arm

Paraneoplastic syndrome- hormone release from tumour

90
Q

What can diffuse idiopathic pulmonary neuroendocrine cell hyperplasia develop?

A

Tumourlets (benign cysts)

Carcinoids

91
Q

What is the most common site of metastatic cancer development?

A

Lungs

92
Q

What can cause pleural effusions?

A
  1. Increased hydrostatic pressure
  2. Increased vascular permeability
  3. Decreased oncotic pressure
  4. Increased negative intrapheural pressure
  5. Decreased lymphatic drainage
93
Q

What is pneumothorax?

A

Air or gas in the pleural cavity

94
Q

What is tension pneumothorax?

A

Defect that allows air to enter the lung during inspiration but prevents its exit

Compression on contralateral lung and mediastinum

95
Q

Are pleural tumours normally metastatic?

A

Yes

96
Q

What are the types of pleural tumours?

A
  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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