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Pathology > Lung Histopath > Flashcards

Lung Histopath Flashcards

1
Q

What is the pathology of chronic bronchitis?

A

Dilatation of bronchi & excess mucus production

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2
Q

Aetiology of chronic bronchitis (2)

A

Tobacco smoke

pollution

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3
Q

Clinical features of chronic bronchitis

A

Productive cough for 3 months over 2 years

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4
Q

Histological features chronic bronchitis (3)

A

Airway dilatation
Goblet cell hyperplasia
Hypertrophy of mucous glands

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5
Q

Complications of chronic bronchitis (3)

A

Recurrent infections
chronic hypoxia
pulmonary HTN

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6
Q

Pathology of bronchiectasis

A

Airway dilatation & scarring

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7
Q

Clinical features of bronchiectasis (3)

A

Purulent sputum
cough
fever

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8
Q

Histological features of bronchiectasis

A

Permanent dilatation of bronchi

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9
Q

Complications of bronchiectasis (4)

A

recurrent infections
haemoptysis
amyloidosis
pulmonary HTN

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10
Q

Pathology of asthma

A

SM cell hyperplasia
excess mucus
inflammation

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11
Q

Aetiology of asthma

A

Immunogenic: allergens, drugs, cold air, exercise

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12
Q

Clinical features of asthma (3)

A

Episodic cough
Wheezing
SOB

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13
Q

Histological features of asthma (2)

A

Curschmann spirals - whorls of shed epithelium

Charcot Leyden crystals - eosinophils degraded in mucous plugs

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14
Q

Complications of asthma (2)

A

Death, chronic asthma

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15
Q

Pathology of emphysema

A

Affects acinus (distal to terminal bronchioles), wall destruction, airspace enlargement

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16
Q

Aetiology of emphysema (2)

A

Smoking

A1AT deficiency

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17
Q

Clinical features of emphysema (2)

A

cough

SOB

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18
Q

Histological feature of emphysema

A

Loss of alveolar parenchyma (distal to terminal bronchiole)

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19
Q

Complications of emphysema (3)

A

Pneumothorax
Resp failure
Pulmonary HTN

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20
Q

Causes of bronchiectasis (6)

A

Post-infectious
Abnormal host defence - hypogammaglobulinaemia
Ciliary dyskinesia (primary = Kartagener’s)
Asthma
CF
Secondary to bronchiolar disease

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21
Q

What is the characteristics of all interstitial lung diseases?

A

Inflammation & fibrosis of the pulmonary connective tissue (particulary the interstitium of the alveolar wall)

End stage all have HONEYCOMB LUNG

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22
Q

Interstitial lung disease shows features of RESTRICTIVE lung disease on spirometry, name 3:

A

Decreased CO diffusion capacity
reduced lung compliance
reduced lung volume

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23
Q

Interstitial lung disease presents with: (3)

A

SOB
cyanosis, pulmonary HTN & corpulmonale
End-inspiratory crackles

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24
Q

Causes of fibrosing interstitial lung disease: (6)

A 
IPF
Pneumoconiosis
Radiation induced pneumonitis
Drug induced
Cryptogenic organizing pneumonia 
associated with connective tissue disease
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25
Q

Causes of granulomatous interstitial lung disease (3)

A

Sarcoid
EAA
Associated with vasculitides e.g. Wegener’s, Churg-Strauss, microscopic polyangitis

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26
Q

2 other categories of interstitial lung disease

A

eosinophillic

Smoking related

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27
Q

Is IPF more common in males or females?

A

Males

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28
Q

Histology of IPF (3)

A

Pattern of fibrosis = USUAL INTERSTITIAL PNEUMONIA - progressive patchy interstitial fibrosis
Hyperplasia of type 2 pneumocytes, causing HONEYCOMB FIBROSIS (beginning at peripery of lobule)

29
Q

Clinical presentation of IPF (4)

A

SOB
Non-productive cough
Hypoxaemia - whcih causes pulmonary HTN +/- Cor pulmonale
clubbing

30
Q

Treatment of IPF (3) & impact on survival

A

Steroids
cyclophosphamide
Azathioprine
little impact on survival

31
Q

What is pneumoconiosis?

A

An occupational lung disease, whereby inhalation of mineral dusts/ inorganic particles leads to a non-neoplastic lung rxn

32
Q

In pneumoconiosis which lobe of lung is most commonly affected?

A

Upper lobe e.g. Coal workers, Silicosis

33
Q

In Asbestosis which lobe is affected?

A

Usually lower lobe, and it can cause malignant as well as benign lesions e.g. adenocarcinoma, mesothelioma

34
Q

What is a granuloma?

A

A collection of histiocytes + macrophages +/- multi-nucleate giant cells (cells of macrophage lineages fused together)

35
Q

EAA/ Hypersensitvity pneumonitis/ Cryptogenic organising pneumonia/ Bronchiolitis obliterans organising pneumonia (BOOP). What are these conditions?

A

Group of IMMUNE MEDIATED lung disorders, caused by prolonged exposure to inhaled ORGANIC ags, which results in widespread ALVEOLAR INFLAMMATION (contrast with asthma - bronchi)
EAA is typically an occupational health disease

36
Q

What is seen in histology of EAA etc? (2)

A

GRANULOMA formation and organising pneumonia - polypoid plugs of loose connective tissue within alveoli/ bronchioles

37
Q

What is the acute presentation of EAA & how doews it present? (5)

A

Inhalation of antigenic dust in sensitized individual

Systemic sympoms - fevers, chills, cough, SOB, chest pain (within hours of exposure) Settles by next day

38
Q

Presentation of chronic EAA? (4)

A

Persistent PRODUCTIVE cough
SOB
Clubbing
severe weight loss

39
Q 
Farmer's lung
Pigeon fancier's lung
Humidifier's lung
Malt-workers lung
Cheese washer's lung
A

mouldy hay/grain/silage
proteins in excreta/ feathers
Heated water reservoirs
Germinating barley - aspergillus clavatus/fumigatus
Mouldy cheese - aspergillus clavatus/ penicillium casei

Early recognition > removal of ag > prevents progression to fibrosis

40
Q

Bronchopneumonia

A

Patchy bronchial distribution

low virulence organisms

41
Q

Lobar pneumonia, 4 stages

A

Fibrinosuppurative consolidation

1) Consolidation
2) Red hepatisation (neutrophilia)
3) Grey hepatisation (fibrosis)
4) resolution

42
Q

Atypical Pneumonia

A

Interstitial pneumonitis

No alveolar inflammation

43
Q

Risk factors for SCC (3)

A

Smoking
Male
Highest rate of p53/ c-myc mutations

44
Q

Histology of SCC (2)

A 
Keratinisation
intercellular pricks (desmosomes)
45
Q

Cytology of SCC (1)

A

squamous cells

46
Q

Progression of SCC (6)

A

Epithelium > hyperplasia > metaplasia > dysplasia > angiosquamous dysplasia > carcinoma in situ > invasive carcinoma

47
Q

In which group is adenocarcinoma of lungs most common?

A

Women & non-smokers

(a malignant epithelial tumour with glandular differentiation or mucin production) usually occurs peripherally

48
Q

Histology of adenocarcinoma of lungs (1)

A

Glandular differentiation (and mucin production)

49
Q

Cytology of adenocarcinoma of lungs (1)

A

Cells containing mucin vacuoles

50
Q

What molecular mutation is sometimes seen in adenocarcinoma of lungs

A

EGFR mutations (treated with TK inhibitors)

51
Q

Small cell carcinoma common location? Arises from which cells?

A

Centrally from proximal bronchi

neuroendocrine cells

52
Q

Small cell carcinoma is associated with: (3)

A

ectopic ACTH
Lambert-Eaton
cerebellar degeneration

53
Q

Small cell carcinoma has strong relationship to smoking, what mutations are common? (2)

A

p53 & RB1

54
Q

Large cell carcinoma - what is it?

A

poorly differentiated epithelial tumour - large cells, large & prominent nuclei (poor prognosis)

55
Q

Histology of large cell carcinoma?

A

no evidence of glandular or squamous differentiation

56
Q

Paraneoplastic syndromes occur due to large cell carcinoma, give 5 examples:

A 
ADH
ACTH
PTH
PTHrP
Calcitonin
57
Q

ERCC1 mutation associated with which cancer?

A

NSCLC - pooer response to cisplatin

58
Q

EGFR mutation associated with which cancer?

A

Adeno - treat with anti-EGFR (TK inhibitors)

59
Q

Kras mutations associated with which cancer?

A

Adeno/squamous, poor prognosis (does not respond to TKI)

60
Q

EML4-ALK mutation associated with which cancer?

A

Adeno usually - no benefit from TKI

61
Q

Clinical presentation of mesothelioma (3)

A

Chest pain
SOB
Pleural effusion (extensive)

62
Q

Risk factors for PE (4) & Virchows triad

A 
Female
Immobile
Cardiac disease
Cancer
Virchow's = blood stasis + damage to endothelium + increased coagulation
63
Q

Complications of large PE (3)

A

Acute cor pulmonale
cardiogenic shock
death

64
Q

Complications of small PE (2)

A

Can be silent

can cause peripheral wedge infarctions

65
Q

What is defined as pulmonary HTN?

A

pressure > 25 mmHg at rest

66
Q

Causes of secondary pulmonary HTN? Pre-cap (2), cap (1), post-cap (1)

A

Pre-capillary: Hypoxia/ embolus
Capillary: Pulmonary fibrosis
Post capillary: Left heart disease

67
Q

Pulmonary HTN is most common in which group?

A

Females 20-40

68
Q

Complications of pulmonary HTN (3)

A

RHF > venous congestion of organs, nutmeg liver, peripheral oedema

69
Q

Main histology of pulmonary oedema

A

Iron laden macrophages (aka heart failure cells)

Pathology (20 decks)

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