Histopathology - Lung Pathology Flashcards by Annie Rees

What are some obstructive lung diseases?

Chronic bronchitis
Bronchiectasis
Asthma
Emphysema
Small airway disease/bronchiolitis

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What is the pathology, aetiology + histological features of bronchitis?

P = Dilation of the airways + excess mucus production
A = tobacco smoke, air pollution
H = Dilation of airways, goblet cell hyperplasia, hypertrophy of mucous glands

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What is the pathology, aetiology + histological features of bronchiectasis?

P = Airway dilatation + scarring
A = Recurrent infections (e.g. CF, primary ciliary dyskinesia)
H = Permanent fibrotic dilatation of the bronchi with mucous plugging

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What is the pathology, aetiology + histological features of asthma?

P = Widespread airway constriction due to mast cell degranulation
A = Immunologic, allergens, drugs, cold air, exercise
H = SM cell hypertrophy, goblet cell hyperplasia, eosinophilia, Curschmann spirals, Charcot-Leyden crystals

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What is the pathology, aetiology + histological features of emphysema?

P = airspace enlargement, wall destruction
A = tobacco smoke, α1-AT deficiency
H = Loss of alveolar parenchyma distal to terminal bronchiole

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What is the pathology, aetiology + clinical features of bronchiolitis?

P = inflammatory scarring/obliteration
A = tobacco smoke, air pollutants
C = dyspnoea, cough

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What is the pathophysiology of cystic fibrosis?

AR mutation in CTFR gene affects Cl ion transport, leading to abnormally thick secretions
Secretions allow growth of bacteria, causing frequent lung infections, resulting in bronchiectasis
Multisystem disease as secretions affect other organs (e.g. pancreatic insufficency = malabsorption)

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What pathogen is commonly seen in patients with lung infections in cystic fibrosis?

Pseudomonas Aeruginosa

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What is interstitial lung disease?

Group of >200 disease characterised by inflammation + fibrosis of pulmonary connective tissue, accounting for 15% of resp disease burden

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What typical features are seen in interstitial lung disease

Restrictive picture (spirometry)
Chronic SOB
Fine-end inspiratory crackles
cyanosis
pulmonary HTN
Cor pulmonale

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In advanced interstitial lung idease, what is seen on a CT CAP?

Ground glass/honeycomb appearance

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What are the different types + categories of interstitial lung disease?

Fibrosing:
- Idiopathic pulmonary fibrosis
- Pneumoconiosis
- A/w connective tissue disease
- Drug-induced
- Radiation pneumonitis

Granulomatous:
- Sarcoid
- Extrinsic allergic alveolitis
- A/w vasculitides

Eoisinophilic

Smoking-related

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What is the clinical picture of patient with idiopathic pulmonary fibrosis?

Male
40-70y
Exertional dyspnoea
Non-productive cough
Clubbing

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How is idiopathic pulmonary fibrosis diagnosed and managed?

D: high resolution CT +/- niopsy
T: Steroids, cyclophosphamide, azathioprine, pirfenidone

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What is pneumoconiosis + its typical presentation?

Occupational lung disease causes by inhalation of minerla dusts or inorganic particles
Coal miners
Predilection for upper lobes

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What is asbestosis + its typical presentation?

Fibrosis resulting from asbestos exposure
Affects lower lobes

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What is a granuloma?

A collection of histiocytes, macrophages +/- multinucleate giant cells

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What is extrinsic allergic alveolitis/pneumonitis etc. examples of?

Group of immune-mediated lung disorders caused by intense/prolonged exposure to inhaled organic antigens causing widespread alveolar inflammation

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What is seen on histology for extrinsic allergic alveolitis?

Presence of polypoid plugs of loose connective tissue within alveoli/bronchioles
Granuloma formation + organising pneumonia

What are some typical features of bronchopneumonia?

Patchy bronchial/peri-bronchial distribution
Low virulence organisms
Elderly + frail people

What are some typical features of lobar pneumonia?

Fibrosuppurative consolidations
High virulence organisms (e.g. Strep. pneumoniae = rust-coloured sputum)

What stages are seen in lobar pneumonia?

Consolidation
Red hepatisation (neutrophilia)
Grey hepatisation (fibrosis)
Reolution

What are some typical features of atypical pneumonia?

Interstital pneumonitis
No intra-alveolar inflammation
Chronic + progressing fibrosing disease of lung

What are some tumours of the lung + their prevalence?

Squamous cell carcinoma (30-50%)
Adenocarcinoma (20-30%)
Small cell carcinoma (20-25%)
Large cell carcinoma (10-15%)

What are the risk factors, mutations, location and histological findings of Squamous Cell Carcinoma?

- RFs: Male, SMOKING - M: p53/c-myc - L: Proximal bronchi, local spread with late metastases - H: sQaumous = hyperQualcaemia (of malignancy), Qeratin pearls (keratinisation), cell Qonnections (intercellular prickles)

What is adenocarcinoma of the lung, its risk factors, location and histological findings?

Malignant epithelial tumour with glandular differentiation of mucin-production - RFs: Women + non-smokers - L: Peripherally (type 2 pneumocytes in alveoli) + metastasizes early - H: glandular differentiation (gland formation + mucin production)

What are the risk factors, mutations, location and histological findings of Small Cell Carcinoma + its associations?

- RFs: Smoking - M: p53 + RB1 - L: Centrally, proximal bronchi + rapid metastases - H: Small, poorly differentiated "oat cells" (kulchitsky cell) - A: SIADH, Cushing's Lambert-Eaton

What is large cell carcinoma and it's histological findings?

- Poorly differentiated malignant epithelial tumour - H: No evidence of glandular or squamous differentiation

What are some paraneoplastic syndromes?

- ADH --> SIADH (small cell) - ACTH --> Cushing's syndrome (Small cell) - PTH/PTHrP --> primary hyperparathyroidism, hypercalcaemia + bone pain (squamous cell) - Calcitonin --> hypocalcaemia - Serotonin --> Carcinoid syndrome (flushing, diarrhoea, bronchoconstriction) - Bradykinin --> cough

How is lung cancer staged?

- Tumour (T1-4): based on size, invasion of pleura, pericardium - LN metastasis (N0-2): N0 = no involvement, N1/2 = involvement, dependant on extent - Distant Mets (M0/1): Tumour spread to distant sites

Where does mesothelioma originate, where does it spread and what is its typical presentation?

- Arises from parietal/visceral pleura - Spreads in pleural space - Presentation: extensive pleural effusion, chest pain, dyspnoea

What is a pulmonary embolus?

The embolisation of a peripheral thrombus to the lung

What are some RFs for developing a PE?

- Female - Immobility - Cardiac disease - Cancer - Primary + Secondary hypercoagulable states

What are the different types of emboli and how do they differ?

- Large Emboli: Impact in main pulmonary arteries leads to acute cor pulmonale, cardiogenic shock + death if >60% pulmonary bed occluded - Small Emboli: Silent or cause peripheral wedge infarctions. Repeated infarctions = pulmonary HTN - Non-thrombotic emboli: Bone marrow, amniotic fluid, tumour, air, foreign body

What is the term used to describe a large emboli occluding the pulmonary trunk?

Saddle embolus

What is pulmonary hypertension?

Mean pulmonary arterial pressure >25mmHg at rest

What are the different classes of pulmonary hypertension and how do they differ?

- Class 1: Pulmonary arterial hypertension - most common in women 20-40yrs (Causes: idiopathic, hereditary, congenital HD) - Class 2: Due to left heart disease (e.g. valve disease) - Class 3: Due to lung disease (e.g. ILD) - Class 4: Chronic thromboembolic pulmonary hypertension (e.g. due to many clots over time which causes fibrosis) - Class 5: With unclear multifactorial mechanisms (e.g. metabolic/systemic/haematological disorders)

What is the pathophysiology of pulmonary hypertension?

- Pre-capillary: chronic hypoxia/embolus - Capillary: Pulmonary fibrosis - Post-capillary: Left heart disease/veno-occlusive disease - Pulmonary vasoconstriction of arterioles: intimal fibrosis, thickened walls

What are some complications of pulmonary hypertension?

RHF - venous congestion of organs (nutmeg liver), peripheral oedema

What is pulmonary oedema, its aetiology + histology?

Intra-alveolar fluid accumulation leads to poor gas exchange Aetiology: - LHF Histology: - Intra-alveolar fluid - Iron laden macrophages

What is diffuse alveolar damage, its complications + histology?

Acute damage to alveoli (alveolar epithelium) leading to exudative inflammatory reaction, rapid onoset of respiratory failure + requiring ventilation in ITU Cx: - ARDS - Hyaline Membrane Disease (HMD) in neonates Histology: - Lung expanded, firm, plum-coloured, airless

What is seen on the CXR of diffuse alveolar damage?

White out of all lung fields

What is COPD, it's symptoms, causes + histological findings?

Chronic bronchitis + emphysema Sx: - Frequent coughing - Wheezing - Excessive sputum - SOB Causes: - Smoking - α-1 antitrypsin deficiency (SOB + liver Sx) Histo: - Neutrophilic infiltration into airways - Loss of alveoli, elastic fibres + lung parenchyma

What is cystic fibrosis, its inheritance, complications + histological findings?

AR mutation in CFTR gene on Chr 7 Cx: - Recurrent lung infections - Pancreatic insufficiency - Malabsorption Histo: - Mucous clogged airways - Inflammatory cell infiltration

What is the mechanism of action of cystic fibrosis?

- Mutation on CFTR gene (Chr 7) leads to defective ion transport - Excessive resorption of water from secretions of exocrine glands - Abnormally thick mucous secretions - Affects all organ systems