ILD

Question 1

Pulmonary acinus (singuler)

Answer 1

Functional unit of lung where gas exchange takes place
ducts
sacs
alveoli

Question 2

definition of lobule (important anatomic unit of lung)

Answer 2

lung parenchyma bounded by pleura and interlobular spetae (venules and lymphatics)
5-8 acini per lobule
in the center of a lobule the bronchioles are found associated with arterioles and lymphatics

Question 3

where are they ?
artery
veins

Answer 3

arteries close to bronchioles, in center of lobule

veins are around lobules

Question 4

The interstitial tissue of the lung provides a supporting framework for the airways, vessels and alveolar airspaces. It can be considered in two interconnecting “compartments”:

Answer 4

parenchyml and non parenchymal

Question 5

parenchymal

Answer 5

in the alveolar wall and surrounding small vessels and lymphatics where gas exchange occurs

Question 6

non parenchymal

Answer 6

in the pleura, interlobular septa and surrounding the large vessels and airways (center of lobule). No gas exchange

Question 7

T or F : ILD patterns a disease specific

Answer 7

false

The patterns often overlap and are a mixed. The final diagnosis is a clinico-radiologic and pathological correlation

Question 8

AIP
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Acute interstitial pneomonitis

Answer 8

DAD
acute
everywhere
unknown

Diffuse alveolar damage

Question 9

IPF
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Idiopathic pulmonary fibrosis

Answer 9

UIP
Years to dev
Lower lobes
Unknown

Usual interstitial pneumonitis

Question 10

Asbestosis
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Answer 10

often UIP
Years to dev
lower lobes
exposure to asbestos fibers

Question 11

CTD associated
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

CTD = connective tissue disease

Answer 11

NSIP, UIP, or OP
acute to chronic
anywhere, more often lower lobes
associated with CTD

Question 12

Idiopathic NSIP
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Answer 12

NSIP
subacute to chronic
lower lobe
unknown

Question 13

Sarcoidosis
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Answer 13

granulomatous
years to dev
typically upper lobes
unclear

Question 14

Hypersensitivity pneumonitis
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Answer 14

granulomatous
acute to chronic
typically upper lobes
exposure to antigens

Question 15

COP
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

cryptogenic organizing pneumonitis

Answer 15

OP
Subacute
Patchy distribution
Unknown

Question 16

Treatment related (medications, radiation therapy)
what is pathological pattern ?
time course?
zonal predominance ?
Etiology ?

Answer 16

mixed patterns
acute to chronic
anywhere
exposure to drugs, chemotherapy, radiation therapy

Question 17

UIP pattern : 2 main features

Answer 17

1. spatial heterogeneity
2. Temporal heterogeneity

Question 18

NSIP pattern : 2 main features

Answer 18

1. Diffuse (spatial homo)
2. uniform (temporal homo) inflammation and/or fibrosis

Question 19

sarcoidosis characterized by

Answer 19

Non-necrotizing granulomas that follow bronchovascular bundles and lymphatics

Question 20

UIP pattern histo
1. spatial hetero
2. temporal hetero

Answer 20

Patchy fibrosis that is found in the subpleural and paraseptal compartments
Unaffected (“spared”) areas (centrilobular)

End-stage remodeling: loss of lung architecture due to dense fibrosis, bronchiolar metaplasia and smooth muscle hyperplasia (microscopic “honeycombing”)
Early-stage remodeling: loose fibroblastic bodies in the interstium

Very little inflammation outside areas of honeycombing
No granulomas, no hyaline membranes

Question 21

asbestosis CT scan
(comment différencier de IPF?)

Answer 21

calcified plaque on pleura
en plus du early honeycombing

Question 22

OP pattern
histo

Answer 22

Active fibroblastic tissue (fibroblasts and loose connective tissue) inside the alveolar spaces
Usually bronchiolocentric
Inflammatory cells in interstitium

Question 23

DAD pattern
histo

Answer 23

edema, epithelial necrosis, hyaline membranes in alveoli

Question 24

NSIP pattern

Answer 24

• Diffuse (pan-lobular), uniform widening of interstitium with usually just focal intra-alveolar component
• Lung architecture is preserved

Question 25

3 main pattern of NSIP

Answer 25

Cellular NSIP: interstium infiltrated by chronic inflammatory cells (lymphocytes and plasma cells)
Fibrotic NSIP: uniform interstitial fibrosis of alveolar walls
Mixed NSIP

Question 26

Granulomatous disease (2)

Answer 26

sarcoidosis
hypersensitivity penomonitis