Histopathology 21: Respiratory Pathology Flashcards by Sophie Wouters

What does pulmonary oedema look like on histology ?

Intra-alveolar fluid

heavy watery lungs

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What is the name of the neonatal disease in which preterm babies have insufficient surfactant production ?

Hyaline membrane disease of the newborn

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“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

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List 4 acute changes to the airways in asthma ?

Bronchospasm
Oedema
Hyperaemia
Inflammation

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List 4 chronic changes to the airways in asthma ?

Muscular hypertrophy
Airway narrowing
Goblet cell hyperplasia
Scarring

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What are the histological findings of asthma ?

Eosinophils and mast cells 
Hypertrophic goblet cells 
Dilated vessels
Thick muscular layer 
Charcot-Leyden Crystals

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What are the histological findings of Chronic bronchitis?

Dilated airways
Mucous gland hyperplasia
Goblet cell hyperplasia
Mild inflammation

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What are the histological findings of emphysema ?

Centrilobular damage to alveolar tissue

Panacinar (if alpha 1 anti trypsin deficiency)

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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

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List histological features of Bronchopneumonia ?

Patchy bronchial/peri bronchial distribution often the lower lobes
Acute inflammation surrounding airways and in alveoli

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List histological features of lobar pneumonia ?

Widespread fibrinosuppurative consolidation

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Which tumours tend to arise in the airways ?

Squamous cell carcinomas

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Which tumours tend to arise in the peripheral alveolar spaces ?

Adenocarcinomas

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Which tumours tend to arise in the lung pleura ?

Mesothelioma

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Which tumours tend to arise centrally or peripherally ?

Small cell lung cancer

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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

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Which mutations are more common in smokers and non-smokers with adenocarcinomas of the lungs?

Smokers - K ras

Non-smokers - EGFR

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Which has the worse prognosis: small cell lung cancer or non-small cell lung cancers ?

Small cell lung cancers

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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