Histopathology 21: Respiratory Pathology Flashcards
What does pulmonary oedema look like on histology ?
Intra-alveolar fluid
heavy watery lungs
What is the name of the neonatal disease in which preterm babies have insufficient surfactant production ?
Hyaline membrane disease of the newborn
“On post-mortem examination of the lungs they are heavier than normal, expanded and firm. They are plumb coloured and airless”
Which disease does this describe ?
Acute lung injuries: ARDS or hyaline membrane disease of the newborn
List 4 acute changes to the airways in asthma ?
Bronchospasm
Oedema
Hyperaemia
Inflammation
List 4 chronic changes to the airways in asthma ?
Muscular hypertrophy
Airway narrowing
Goblet cell hyperplasia
Scarring
What are the histological findings of asthma ?
Eosinophils and mast cells Hypertrophic goblet cells Dilated vessels Thick muscular layer Charcot-Leyden Crystals
What are the histological findings of Chronic bronchitis?
Dilated airways
Mucous gland hyperplasia
Goblet cell hyperplasia
Mild inflammation
What are the histological findings of emphysema ?
Centrilobular damage to alveolar tissue
Panacinar (if alpha 1 anti trypsin deficiency)
List 5 pathologies seen with cystic fibrosis ?
Lungs- Thick mucous with recurrent infections G.I tract- meconium ileus Pancreas - pancreatitis Liver - cirrhosis Male reproductive system - Infertility
List histological features of Bronchopneumonia ?
Patchy bronchial/peri bronchial distribution often the lower lobes
Acute inflammation surrounding airways and in alveoli
List histological features of lobar pneumonia ?
Widespread fibrinosuppurative consolidation
Which tumours tend to arise in the airways ?
Squamous cell carcinomas
Which tumours tend to arise in the peripheral alveolar spaces ?
Adenocarcinomas
Which tumours tend to arise in the lung pleura ?
Mesothelioma
Which tumours tend to arise centrally or peripherally ?
Small cell lung cancer
Which lung cancers are more associated with smokers than non-smokers ?
Squamous cell carcinomas and small cell carcinomas
Whereas non-smokers tend to get adenocarcinomas
Which mutations are more common in smokers and non-smokers with adenocarcinomas of the lungs?
Smokers - K ras
Non-smokers - EGFR
Which has the worse prognosis: small cell lung cancer or non-small cell lung cancers ?
Small cell lung cancers
What is hypogammaglobulinaemia ?
An Immune disorder characterised by a reduction in all types of gamma globulins e.g antibodies that form part of the immune response.
Congenital, iatrogenic
SCID, Wiskott-Aldrich syndrome, CLL, nephrotic syndrome
Which cancer is associated with asbestos exposure ?
Mesothelioma
Which 3 cancers are considered NSCLC
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
List 3 congenital causes of bronchiectasis ?
- CF
- Primary colliery dyskinesia
- Hypogammaglobulinaemia
- Yellow nail syndrome
List 3 fibrosing causes of interstitial lung disease ?
- Idiopathic pulmonary fibrosis
- Pneumoconiosis
- Radiation pneumonitis
List 2 granulomatous causes of interstitial lung disease?
- Sarcoidosis
- extrinsic allergic alveolitis
Which part of the lung does asbestosis tend to affect ?
- Lower lobe
List 2 examples of extrinsic allergic alveolitis ?
- Farmer’s lung
- Pigeon fancier’s lung
List 3 examples of pneumoconiosis ?
- Coal worker’s lung
- Silicosis
- asbestosis
How is Extrinsic allergic alveolitis different to pneumoconiosis ?
- Pneumoconiosis is caused by inhalation of mineral dust or inorganic particles leading to fibrosis
- EAA is caused by inhalation of organic antigens which cause an allergic response leading to fibrosis
- EAA has allergic symptoms when exposed to the organic antigen- SOB, fever, chest pain
causes of pulmonary oedema
left heart failure
alveolar injury (drug, inhalation, pancreatitis)
neurogenic following head injury
high altitude
causes of acute lung injury / diffuse alveolar damage
cause of rapid onset respiratory failure
adults - ARDS
- infection
- aspiration
- trauma
- inhaled irritant gases
- shock
- blood transfusions
- DIC
- drug overdose
what is hyaline membrane disease of the newborn
insufficient surfactant production in premature babies
diffuse alveolar damage
lungs heavy, firm, plump coloured, airless
lungs congested - exudative phase - develop hyaline membranes - organising pneumonia
features of COPD
chronic bronchitis and emphysema
80% are smokers
airway and alveolar pathology leading to progressive airway obstruction
features of chronic bronchitis
cough productive of sputum for most days for at least 3 months over 2 consecutive years
complications: recurrent infections, chronic respiratory failure, cor pulmonale, increased risk of lung cancer
features fo emphysema
permanent loss of the alveolar parenchyma distal to the terminal bronchiole
- smoking
- alpha-1 antitrypsin deficiency
- rare = cadmium exposure
complications:
- bullae
- respiratory failure
- pulmonary hypertension and RHF
features of bronchiectasis
permanent, abnormal dilation of the bronchi with inflammation and fibrosis extending into adjacent parenchyma
complications:
- recurrent infections
- haemoptysis
- pulmonary hypertension and R sided heart failure
- amyloidosis
features of CF
autosomal recessive
chromosome 7q3 = CFTR gene
delta F508 = most common mutation
generalised disorder of the exocrine glands - results in abnormally thick mucus secretions
recurrent lung infections - S pneumonia, H influenxae, P aeruginosa, B cepacia
lung transplant will prolong survival
causes of CAP
strep pneumoniae
haemophilus inflenzae
mycoplasma
causes of HAP
gram -ves eg klebsiella, pseudomonas
features of lobar pneumonia
95% S. pneumoniae
widespread fibrosuppurative consolidation
congestion - red hepatisation - grey hepatisation - resolution
features of granulomatous lung infection
granuloma = collection of macrophages and multi-nucleate giant cells
necrotisisng/ non-necrotising
think of TB
features of pulmonary thromboembolism
small emboli present with pleuritic chest pain or chronic progressive SOB due to pulmonary hypertension
large emboli - sudden death, acute RHF, cardiogenic shock
list types of lung tumours
most common are epithelial
non- small cell = SCC, adenocarcinoma, large cell carcinoma
small cell carcinoma
multistep pathway to developing lung cancer
metaplasia
dysplasia
carcinoma in situ
invasive carcinoma
what are the main molecular mutations involved in development of adenocarcinoma
K ras mutation
DNA methylation
p53
cytology of adenocarcinoma
glandular differentiation
features of cell carcinoma
associated with smoking often central near the bronchi presents with advanced disease poor prognosis can cause paraneoplastic syndromes p53 and RB1 mutations
features of mesothelioma
malignant tumour of the pleura
asbestos exposure
long lag
fatal
