Histology of Resp: Pathology Flashcards
What is a ghon focus? [1]
Where are ghon focuses located? [1]
Ghon lesion is the initial tuberculous granuloma formed during primary infection and is not radiologically visible unless it calcifies
The complex is typically located in the subpleural space, or the space between the ribs and the parietal pleura (i.e.,** outer surface of the lungs**), of the upper part of the lower lobe or the lower part of the middle or upper lobes.
Label A-D of this granuloma
What are the cellular components of a granuloma?
Small area of chronic inflammation:
- a collection of macrophages: innate immune response
- accompanied by helper T-cells: adaptive immune response
What type of T helper cells are found in granulomas? [1]
TH1 subtype
Describe that pathophysiology of granuloma formation
- Antigen taken up by macrophage & presented to CD4+ helper T cells
- CD4+ helper T cell convert to TH1 subtype
- TH1 cells screte IL-2 and INy
- T cell proliferation and macrophage activation
- Macrophages and T cells secrete TNFa
- Causes increase in inflammatory cells
- Causes repeat of TH1 cells screte IL-2 and INy etc
What are two types of granuloma?
Caseating and noncaseating
- Caseating granulomas have a central region of necrosis and classically appear “cheese-like” upon biopsy.
- noncaseating granulomas do not have a central region of necrosis and occur more commonly.
Draw a latent state mTB granuloma
Which of the following is lobal pneumonia and which is bronchopneumonia?
Left: Bronchopneuomia
Right: Lobal pneumonia
Which of the following would you be most likely to find a ghon focus in?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which of the following would you be most likely to find a ghon focus in?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which condition do you see hyperplasia of goblet cells in respiratory system? [1]
Asthma
What are a common consequence of prolonged or recurrent inflammation, particularly allergic inflammation in respiratory system? [1]
Nasal polyps are oedematous protrusions of the respiratory mucosa and are a common consequence of prolonged or recurrent inflammation, particularly allergic inflammation.
Describe 3 histological changes seen in asthma Ptx? [3]
Asthma causes:
- SM hyperplasia (due to increase in muscle use
- Basement membrane thickening
- Mucus hyperplasia
Which part of the respiratory system is the main site of SABA action? [1]
Smaller airways in tracheal / bronchial tree: requires smooth muscle to be there (to relax)
Which secretory protein is associated with pathologies such as COPD and asthma? [1]
Which cell secretes? [1]
Secretory protein C16: associated with pathologies such as COPD and asthma.
non-ciliated bronchiolar Clara cells This protein increasingly appears to protect the respiratory tract against oxidative stress and inflammation
Which cell types do you see in TB? [1]
Langhan Cells
What histological changes do you see in bronchitis? [4]
goblet cell metaplasia
mucous plugging
inflammatory cell infiltration (lymphocytes and macrophages)
fibrosis
mucus gland hypertrophy
What histological changes do you see in bronchitis? [4]
goblet cell metaplasia
mucous plugging
inflammatory cell infiltration (lymphocytes and macrophages)
fibrosis
mucus gland hypertrophy
What are the histopatholigcal features of TB? [4]
Langhan cells
immune cell infiltration
granulomas; have central necrosis and cavitation
tissue destruction
Which of the following depicts the Langhan cell in TB Ptx?
A
B
C
D
Which of the following depicts the Langhan cell in TB Ptx?
A
B
C
D
What is a distinguishing feature about Langhan cells? [1]
Multinucleated [1]
What stain do you use to ID TB? [1]
Ziehl-Nielson
Histopathological features in pneumonia? [1]
aggregates of neutrophils (almost like an abscess) in the alveolar
Where are sq cell carcinomas (SCCs) most often found (lung)? [1]
Hilum
Name a risk factor for squamous cell carcinoma [1]
What are histological changes are induced by ^? [2]
Often centrally located close to hilum
Smoking is a risk factor:
- Leads initially to metaplasia (from respiratory to squamous epithelium) then dysplasia.
- Smoke procarcinogens can be converted to carcinogens via P450
What may be indicative of paraneoplastic syndrome due to Squamous Cell Carcinoma? [1]
Hypercalcemia may be indicative of paraneoplastic syndrome due to SCC
Cytological features of Squamous cell C? [3]
- small cells
-
Pleomorphic, Polygonal cells [1]
with high nuclear to cytoplasmic ratio [1]
with island of keratinisation [1](orange, Normal bronchial cells are azure/blue) - Larger tumours may have extensive necrosis
Histopathological features of Cytological features of Squamous cell C? ? [5]
- Small, malignant cells often very large with eonisophilic cytoplams [1] and large vesicular nucleus [1]
- High nuclear:cytoplasm ratio
- Intercellular bridges
- Keratin pearls [1]
Histopathological features of adenocarcinoma? [3]
irregular, closely packed glands effacing normal lung appearance with atypical cells lining the gland lumen
glandular hyperplasia
desmoplastic (fibrotic) stroma around them.
Histopathological features of small cell carcinoma? [3]
malignant neuroendocrine neoplasm found centrally in the lung
small oval rounded cells with scarce cytoplasm and irregular borders: morphology where can only see nuclei - looks like nuclei molding
extensive necrosis
mitosis ++++++++++++++
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
*resp epithelium with goblet cell hyperplasia
eosinophils in lam prop +++
thickened BM
SM hypertrophy
mucous in lumen*
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Under the microscope multinucleate giant cells and granulomatosis are seen
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Multiple mitotic figures are identified as well as scattered apoptotic tumor cells. The finely dispersed or salt and pepper chromatin with no distinct nucleoli is apparent in many of the cells, although the crush artifact caused by the biopsy process can make this feature more difficult to distinguish. The small cells lie among a background of delicate stroma that is sparse compared to the dense sheet of tumor cells
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Caseous necrosis and granulomatosis
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Describe the pathological changes that you would expect to see in the lungs of a smoker. [3]
- many dust cells (macrophages that have taken up carbon particles.
- damage to the cilia that typically lines the airways, an increase in mucous-producing cells, squamous metaplasia, (protective adaptation)
- Metaplastic and dysplastic structural changes could eventually lead to lung cancer.
Premature children do not produce adequate amounts of pulmonary surfactant. Name two cells that are involved and explain why this greatly increases the risk of death. What would you expect to see on a histological preparation of lung tissue from such an infant? [3]
Type II pneumocytes and Clara cells are both involved in surfactant production.
The lung tissue histology of such an infant would appear with collapsed alveoli. [1]
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Which pathology is depicted here?
Pneumonia
TB
Small cell carcinoma
Asthma
Squamous cell carnicoma
Squamous cell carcinoma, well differentiated: epithelium shows marked keratinization and minimal nuclear pleomorphism.
What pathology is shown here? [1]
Emphysema
Abnormal enlargement of air spaces distal to the terminal bronchioles characterized by destruction of the alveolar septa with little or no fibrosis
What changes do COPD small airways undergo with developement on the disease? [1]
COPD small airways demonstrate marked remodelling, with the overall thickness of the airway wall increased compared to smokers without airflow limitation
- epithelial changes
- mucoid plugs
- increased density of inflammatory cell
- smooth muscle hyperplasia and fibrosis
What is the metastasis shown here?
metastatic small cell carcinoma - blue cluster
note:
- orange myeloid precursors
- fat cells
- blue erythoid precursors
- megakaryocytes
Investigating eosinophil levels in blood would help ID which pathology?
Asthma
Pneumonia
Pleural effusion
Mesothelioma
Carcinoma
Tuberculosis
Investigating eosinophil levels in blood would help ID which pathology?
Asthma
Pneumonia
Pleural effusion
Mesothelioma
Carcinoma
Tuberculosis
Which of the following micrographs is from an adenocarcinoma?
A
B
C
Which of the following micrographs is from an adenocarcinoma?
A
B
C
The photmicrograph shows alveoli with the arrow pointing to increased neutrophils within the alveoli. What is likely disease?
A: Asthma
B: Bronchial pneumonia
C: Lobar pneumonia
D: Neoplasia
E: None of the above
The photmicrograph shows alveoli with the arrow pointing to increased neutrophils within the alveoli. What is likely disease?
A: Asthma
B: Bronchial pneumonia
C: Lobar pneumonia
D: Neoplasia
E: None of the above
The photmicrograph shows bronchial wall from an asthma patient, what tissue abnormality is highlighted by the black arrow?
A: Basement membrane thickening
B: Eosinophilia
C: Goblet cell hyperplasia
D: Mucus secretion
E: Muscular hyperplasia
A: Basement membrane thickening
B: Eosinophilia
C: Goblet cell hyperplasia
D: Mucus secretion
**E: Muscular hyperplasia **
What is the structure labelled with a star?
A: Alveolus
B: Bronchus
C: Bronchiole
D: Terminal Bronchiole
E: Trachea
What is the structure labelled with a star?
A: Alveolus
B: Bronchus
C: Bronchiole
D: Terminal Bronchiole
E: Trachea
Which of the following arrows shows a thickened basement membrane in asthma patient?
A
B
C
D
Which of the following arrows shows a thickened basement membrane?
A
B
C
D
Which of the following arrows shows smooth muscle hypertrophy
?
A
B
C
D
Which of the following arrows shows smooth muscle hypertrophy?
A
B
C
D
Which of the following arrows shows smooth eosinophils in lamina propria and epithelium?
A
B
C
D
Which of the following arrows shows smooth eosinophils in lamina propria and epithelium?Which of the following arrows shows pseudostratified columnar epithelium with goblet cell hyperplasia ?
A
B
C
D
What is the diagnosis from this histology?
Adenocarnioma
Small cell cancer
Squamous cell cancer
What is the diagnosis from this histology?
Adenocarnioma
Small cell cancer : morphology where can only see nuclei - looks like nuclei molding
Squamous cell cancer
