Exam 2 Path Flashcards
Stages of lobar pneumonia
congestion
red hepatization
gray hepatization
resolution
Common causes of exacerbation of COPD (bugs)
haemophilus influenza
moraxella catarrhalis
Sputum in klebsiella pneumonia and reason why
gelatinous sputum
viscid capsular polysaccharide
Findings with atypical pneumonia
ulcerative bronchitis
viral infection with necrosis of epithelium
Complications of atypical pneumonia
Reye syndrome (virus + aspirin)
hepatic failure
noninflammatory encephalitis
Chronic pneumonia findings
granulomatous inflammation
immunocompetent pts
Findings with histoplasma
epithelioid granulomas
caseation necrosis with coalescence
tree bark appearance after tx
Findings with blastomyces dermatitidis
upper lungs
supparative granulomas
FIndings with coccidioidis immitis
erythema nodosum/erythema multiforme
spherules
macrophages/giant cells with endospores
Pulmonary diseases with HIV
below CD4 of 200- pneumocystic jirvocii
below CD4 of 50- CMV/MAC
Characteristics of idiopathic pulmonary fibrosis
hyperplasia of type II pneumocytes
fibroblast proliferation
TGF-beta driven process
from repeated cycles of injury
Tx of IPF
lung transplant
Appearance of IPF
cobblestone pleural surface
lower lobe
fibrosis (blue is early, pink is late)
Histo findings of IPF
smooth m. hyperplasia
squamous hyperplasia
Cryptogenic organizing pneumonia
aka BOOP
polypoid plugs of CT (Masson bodies)
no interstitial fibrosis
Anthracosis
coal macules/nodules
from pollution and carbon dust
asymptomatic
upper lungs
Coal Worker’s Pneumoconioses
dilation of alveoli
over may years over 2cm black scars
adjacent to respiratory bronchioles
no increase in cancer risk
Silicosis
foundries/sandblasters/stone cutters
decades of exposure
slow nodular fibrosis
Silicosis pathogenesis
crystalline silicone cause macrophage mediator release
fibroblasts/TNF/IL/ROS/cytokines cause damage
FIndings with silicosis
fine nodularity in upper lobes
progresses even with exposure removed
increased TB susceptibility
calcification of hilar LN’s
Histo of silicosis
hyalinized collagen
polarized light with birefringent needle like spicules
Types of abestos
serpentine- flexible, curly, soluble
amphiboles- straight, rigid, mesothelioma, more damaging
Risk of abestosis
increased bronchogenic carcinoma and mesothelioma
Pathogenesis of abestosis
macrophages ingest and release mediators
fibrosis distorts architecture (honeycombing)
Findings with abestosis
lower lobes
golden-brown, fusiform rods (coated with Fe)
pleural plaques
Caplan syndrome
Rheumatoid arthritis + pneumoconioses rheumatoid nodules (pallisading granulomatous inflammation)
Sarcoidosis
noncaseating granulomas
increased in females/blacks/Southeast
immune disregulation
Findings with sarcoidosis
hilar lymphadenopathy skin lesions uveitis phalangeal bone involvement lacrimal/salivary gland involvement
Microscopic exam of sarcoidosis
noncaseating granulomas
Schaumann bodies/Asteroid bodies
granulomata of spleen and liver
distribution along bronchi/lymphatics
Hypersensitivity pneumonitis
removal of agent stops progression from prolonged exposure to organic dusts type III hypersensitivity (immune complexes) noncaseating granulomas (type IV HS)
Simple pulmonary eosinophilia
Loeffler syndrome
transient pulmonary lesions
increased eosinophils in serum
intrapulmonary densities on CT
Tropical eosinophilia
infection of Wuchereria bancrofti
only in tropical regions
hypersenitivity reaction
Desquamative interstitial pneumonia
assc with smoking
4th/5th decade
dyspnea/dry cough
Microscopy of DIP
intra-alveolar macrophage collections
dusty brown pigment
granular iron
emphysema/thick septa
Pulmonary alveolar proteinosis
asymmetric pulmonary opacifications
accumulation of acellular surfactant
anti-GM-CSF Ab in acquired causes
Pulmonary alveolar proteinosis sx
abundant gelatinous sputum with cough
increased risk of secondary infections
increased wt/size of lungs
granular precipitate in alveoli
Genetics with lung carcinoma
p53-small and nonsmall cell lung ca
cMYC/RB-small cell carcinoma
p16/RAS-nonsmall cell carcinoma
other genes-EGFR/HER-2neu
Finding with squamous cell carcinoma of the lung
intracellular bridging
keratinization
hypercalcemia
Adenocarcinoma characteristics
most common lung cancer
peripheral location/pleural puckering
no smoking assc
signet ring lesions
Bronchioloalveolar carcinoma findings
lepidic growth
noninvasive/nondestructive pattern
preserved architecture
Small cell carcinoma characteristics
in central airways
early metastasis/rapid growth
assc with smoking
paraneoplastic syndromes
Findings with small cell carcinoma
salt and pepper chromatin
round/oval cells
extensive necrosis
Large cell carcinoma characteristics
undifferentiated squamous or adenocarinomas aggressive peripheral lungs spherical tumor anaplastic cells
Carcinoid tumors
function lesions secreting hormones (5HT) can be resected do not metastasize
Hamartoma
normal tissue in an abnormal spot
coin lesion on x-ray
often hyaline/CT/bone
Inflammatory myofibroblastic tumor
in children
peripheral mass with calcium deposits
anaplastic lymphoma kinase gene
Metastatic tumors to the lung
most common type of lung cancer
cannonball lesions
Solitary fibrous tumor
attached to pleura via pedicle
Whorls of reticulin/collagen
interspersed spindle cells
confined to pleural surface
Malignant mesothelioma
assc with abestos
abestos bodies/plaques
20-50yrs after exposure
low survival
Other areas with mesothelioma
peritoneum
pericardium
tunica vaginalis
genital tract
Indication for bilateral lung transplant
cystic fibrosis
bronchiectasis
remove infectious reservoir
Contraindication for lung transplant
maligancy
Infections post lung transplant
first couple weeks-bacterial
3-12mo post-candida/aspergillus
