Lung Path Images Flashcards
bacterial pna
This is a Gram-stained sputum sample from a patient with this lesion. Note the many polymorphonuclear leukocytes and diplococci (pneumococci). These bacteria are responsible for the majority of cases.
bacterial pna
This is a photo of a left lung from a patient who died of this lesion. The lower lobe is gray yellow. If you could feel it, it would be very firm and solid, in contrast to the spongy feel of normal lung tissue. This is the gray hepatization stage. The upper lobe is deep red, representing congestion, secondary to the adjacent inflammatory process and is more aereated.
bacterial pna
What one sees in a microscopic section of gray hepatization is shown in this image. Alveoli are filled with PMNs and fibrin. The alveolar capillaries are congested
bacterial pna
A high power magnification including partial views of two alveoli. Note the fibrin strands.
bacterial pna
This is a gross section of lung showing the patchy nature of consolidation in some cases. Notice the congestion in the lung parenchyma.
bacterial pna
A very low power (4x) microphotograph of your glass slide. This demonstrates the correlation between the gross appearance of patchy areas of consolidation and the multifocal sites of inflammation
bacterial pna
Two areas of suppuration are seen on both sides of the slide. The intervening areas are relatively uninvolved except for some increase in neutrophils in the alveoli.
aspergillosis fungal infection
Aspergillus fungus ball in lung.
aspergillosis fungal infection
Invasive aspergillosis in lung. Notice the hemorrhage into the tissue and blockage of vessels.
aspergillosis fungal infection
Invasive Aspergillus demonstrating many dichotomous branching hyphae with septation.
aspergillosis fungal infection
. Lung form an 8 week old with Aspergillus infection on GMS stain
The fungal septate hyphae branch at 45° and may form fruiting bodies in a cavity.
aspergillosis fungal infection
Lung Aspergillus H&E 100 X note the pleomorphic and 45 degree angle branching septate hyphae
HIV-associated respiratory tract infections: CMV anf maybe PCP
Lower power view of Lung showing both the CMV, hemorrhage, and a foamy exudate suggesting an additional pathogen.
HIV-associated respiratory tract infections: CMV
Liver, medium power: Nuclear and cytoplasmic inclusions on CMV infected bile duct epithelium
HIV-associated respiratory tract infections: CMV
High power of CMV infected cell demonstrating both nuclear and cytoplasmic inclusions.
HIV-associated respiratory tract infections: Pneumocystis jirovecii pneumonia
Medium power view of area of foamy exudate produced by pneumocystis infection.
HIV-associated respiratory tract infections: pneumocystis
Higher power of lung in area of foamy exudate reveals pneumocystis on GMS stain
HIV-associated respiratory tract infections: Histoplasma capsulatum
This PAS stained slide reveals the characteristic narrow neck budding of Histoplasma capsulatum H. (X 400)
HIV-associated respiratory tract infections: H. capsulatum
This GMS of H. capsulatum demonstrates that it can present as a collapsed yeast cell and can, in some instances where organisms are few in number, be difficult to distinguish from PCP. (X 330)
Asthma (RAD)
At autopsy, a lung section showed bronchi distended with a mucus plug.
Asthma (RAD)
A higher magnification shows luminal mucin admixed with numerous inflammatory cells.
Asthma (RAD)
A section of a bronchus shows marked subepithelial fibrosis and mucosal inflammation (Rubin’s Pathology, fig. 12-40, with permission).
Asthma (RAD)
This section shows a mucin plug in association with submucosal glandular and smooth muscle hyperplasia (Rubin’s Pathology, fig. 12-40, with permission).
Obstructive pulmonary diseases: Emphysema
The thin section of lung on the left shows mild centrilobular involvement. The lung on the right demonstrates severe centriacinar changes that at the apex appear to involve whole acini. Note that emphysema is worse in the upper lobes of the lung than it is in the lower, thus in this case is best classified as centriacinar. This is because most of the ventilation and therefore interaction with toxic chemicals; occurs in the upper part of the lung
Obstructive pulmonary diseases: Emphysema
Note the destruction and loss of alveolar septae in this disease (right half of the Image) compared with a normal lung.
Obstructive pulmonary diseases: Emphysema
This is a gross picture of centriacinar involvement. Note the deposition of anthracotic pigment around respiratory bronchioles and the large bullae at the apex. Bullae can rupture and cause a pneumothorax.
HIV-associated respiratory tract infections: Pneumocystis jirovecii pneumonia
causes diffuse or patchy pneumonia; may have co-existing CMV or other infections
Alveolar spaces filled with pink, foamy amorphous material composed of proliferating fungi and cell debris
Fungi are 4-6 microns, cup/boat shaped cysts
Also mild inflammatory reaction with fibrin exudate, hyaline membranes
restrictive lung diseases: “honeycomb” lung
restrictive lung diseases: many eventually lead to extensive fibrosis. The gross appearance, as seen here in a patient with organizing diffuse alveolar damage, is known as “honeycomb” lung because of the appearance of the irregular air spaces between bands of dense fibrous connective tissue.
● Dense interstitial and peribronchial fibrosis and smooth muscle
● Reduced alveolar capillaries
● Marked medial hyperplasia of pulmonary arteries and arterioles
● Cystically dilated alveoli
● May have mucinous metaplasia of lining epithelium with atypia
acute lung injury: diffuse alveolar damage
The defining morphologic feature of diffuse alveolar damage are the hyaline membranes, well seen in this view. The interstitium is congested and edematous, another typical feature. The spindle cells applied to the hyaline membrane are probably metaplastic alveolar lining cells.
Obstructive pulmonary diseases: Emphysema
Fig Robbins 7th ed. Comparison of centrilobular and panacinar emphysema.
acute lung injury: diffuse alveolar damage
Low magnification view of lung to show diffuse distribution of the lesion (hyaline membranes, edema and inflammation in this case.Diffuse alveolar damage represents the pathologic counterpart of the adult respiratory syndrome
acute lung injury: diffuse alveolar damage
Extensive interstitial and intra-alveolar fibrosis, seen here, can supervene within approximately a week from onset.
acute lung injury: diffuse alveolar damage
High power view of a neonatal lung with hyaline membrane formation associated with respiratory distress syndrome in newborns.
Asthma (RAD): Mucus spirals (Curschmann’s spirals)
Mucus spirals (Curschmann’s spirals)
increased eosinophils may result in Charcot-Leyden crystals, which result from the degranulated eosinophils, or Curschmann spirals (whorled mucous plugs).
tuberculosis
The delayed hypersensitivity reaction to the mycobacteria is manifested as a positive reaction to the PPD antigen. The induration in this patient’s forearm measures 12 mm. Any induration >10 mm is considered positive in an immune competent patient.
tuberculosis.
A sputum smear from a patient with a cavitary lesion stained with an acid-fast stain. The bacilli appear red. The absence of tubercle bacilli does not necessarily rule out the disease since, in non-cavitary lesions, the organisms will not have a channel for drainage (“closed” case).
tuberculosis.
A. This is a section from the apex of a lung showing cavitary fibrocaseous necrosis. Secondary tuberculosis typically localizes in the apical portions of the lung (TB bacilli are strict aerobes and prefer high O2 tension) and tends to cavitate. This sets up the process of dissemination to other areas of the lung and lymph nodes as well as outside the body. This patient then becomes infectious to other persons and is a so-called “open” case of tuberculosis. (Rubin and Farber, Fig 12-21
B). In contrast, primary TB is characterized by the Ghon complex. This demonstrates a characteristic Ghon: complex-circumscribed peripherally located, caseous granulomas in the lower lobe of the lungs with associated caseous granulomas in the hilar lymph nodes. Note the overlying tuberculous pleuritis.
tuberculosis.
This shows the typical microscopic picture of a caseating granuloma or a soft granuloma, the hallmark of this disease. The central area of necrosis is surrounded by the characteristic epithelioid histiocytes.
tuberculosis.
This also shows the typical microscopic picture of a caseating granuloma or a soft granuloma. The central area of necrosis is surrounded by the characteristic epithelioid histiocytes. Numerous Langhans type giant cells are seen at the periphery of the central necrotic area.
sarcoidosis vs tuberculosis
Contrast a well-formed epithelioid granuloma without necrosis seen in sarcoidosis on the left with a necrotizing granuloma shown on the right.
tuberculosis: pott’s syndrome
The CXR shows mediastinal widening at the level of T6-T8, suggestive of a mass. The lung fields are clear. Vascular markings are visible, but these are normal. On lateral radiograph there was evidence of vertebral destruction in the classic anterior wedge formation with intervertebral disk involvement. This man consulted a physician because of backache. Symptoms may long precede radiographic changes although isotope bone scanning can provide a more sensitive method for detecting bone involvement.
tuberculosis: horners syndrome
Notice the ptosis and lateral deviation of the left eye caused by unopposed action of the lateral rectus. This patient was recovering from meningitis satisfactorily when he developed these changes. Cranial nerve palsies are among the commonest complications of meningeal involvement since the lesions are most marked at the base of the brain.
Sarcoidosis, interstitial lung disease (restrictive)
This gross photo of lung and trachea shows multiple enlarged paratracheal nodes. Bilateral hilar lymph nodes and the lung parenchyma are the most commonly involved organs in this disease.
Sarcoidosis, interstitial lung disease (restrictive)
A high power view of a well-formed, epithelioid non-necrotizing granuloma.
Sarcoidosis, interstitial lung disease (restrictive)
. Contrast the well-formed epithelioid granuloma in this case (left panel) with the necrotizing granuloma of an infectious process (right panel).
Sarcoidosis, interstitial lung disease (restrictive)
This fibrotic lung is small and solid. The nodular contour gives rise to the term “pulmonary cirrhosis.” A variety of diseases can lead to pulmonary fibrosis.
Sarcoidosis, interstitial lung disease (restrictive)
A high-power photomicrograph demonstrates distortion of the normal architecture and loss of normally thin alveolar-capillary interface.
Sarcoidosis, interstitial lung disease (restrictive)
May also involve central nervous system, heart and kidneys.
Pulmonary HTN
Multiple small emboli will eventually reduce the capillary bed and increase the pressure in the pulmonary artery.
Pulmonary HTN
H&E. A case of scleroderma with myxomatous intimal thickening obliterating the lumen.
Pulmonary HTN
Elastin stain, A and B, Fibromuscular hypertrophy and plexiform lesions. This patient died of an untreated ventricular septal defect leading to severe pulmonary hypertension.
Malignant Mesotheliomas
CXR from this case showing opacification of the right lower lung zone due to a malignant pleural effusion. This is a frequent clinical presentation of this tumor but it can also occur in association with other types of malignancy
Malignant Mesotheliomas
. Gross: The lung is totally encased by a thick pleural “rind.” This demonstrates the classic appearance of malignant pleural mesothelioma. There is coexistent interstitial pulmonary fibrosis, especially in the lower lobe. Coexistent asbestosis is seen uncommonly (< 25% of cases) in association with primary malignancy of the pleura
Malignant Mesotheliomas
This lung has been bisected. Note the extension of the tumor into all the interlobar fissures and the presence of tumor metastases in the hilar lymph nodes.
Malignant Mesotheliomas
Histologic features of a mixed type. The tumor exhibits features of both the epithelial and sarcomatoid patterns.
Malignant Mesotheliomas
Macroscopic appearance of the lung from an advanced case of interstitial involvement. Notice the predominant lower lobe involvement as well as the severe overlying visceral pleural fibrosis with extension into the interlobar fissure.
Malignant Mesotheliomas
In this section from a grossly fibrotic lower lobe there is marked alveolar septal fibrosis. Additionally, numerous brown fibrous structures (asbestos bodies) are identified within an alveolus in the center of the Image. The presence of asbestos bodies + interstitial fibrosis signifies the diagnosis of asbestosis.
Malignant Mesotheliomas
A sputum specimen from this case. Note the characteristic, dumbbell-shaped asbestos body composed of a thin (almost invisible), central asbestos fiber surrounded by a ring-like coat of ferritin. Asbestos bodies stain prominently with the iron (Prussian blue). For this reason, asbestos bodies are often referred to as “ferruginous bodies.”
Malignant Mesotheliomas
CXR from a patient with advanced asbestosis demonstrating a bilateral “honeycomb” pattern of irregular opacities.
Malignant Mesotheliomas
This shows a chest cavity at autopsy with the chest contents removed. Note the presence on the inner aspect of the ribs of multiple, irregular, white parietal pleural plaques.
Malignant Mesotheliomas
Parietal pleural plaques are characterized histologically by acellular areas of dense hyalinized collagen arranged in a very characteristic “basket-weave” pattern.
bronchogenic carcinoma: squamous cell carcinoma
The white mass here is a typical lesion arising from one of the large bronchi.
bronchogenic carcinoma: squamous cell carcinoma
The microscopic section of this squamous cell carcinoma shows nests of malignant squamous cells and keratin formation and intercellular bridges (desmosomes).
bronchogenic carcinoma: adenocarcinoma
Pleural surface of a lung with an underlying adenocarcinoma. The tumor is present just beneath the depressed scar at the arrow
bronchogenic carcinoma: adenocarcinoma
Upon sectioning, this irregular infiltrating mass is found just beneath the pleural scar. This is typical of adenocarcinomas of the lung that are located in the periphery of the lung, often associated with an old pleural scar. An incidental finding in this image is the presence of local emphysematous bullae. This represents an example of irregular (focal) emphysema, which is frequently associated with pleural scarring.
bronchogenic carcinoma: adenocarcinoma
Low magnification, adenocarcinoma: The tumor cells form irregular glandsassociated with desmoplastic stroma.
small cell carcinoma of the lungs
Tumor arising from a bronchus and prominent hilar lymphadenopathy
small cell carcinoma of the lungs
Medium magnification: There is no squamous or glandular differentiation. The tumor cells have minimal cytoplasm, the nuclei are molded and the cells resemble somewhat irregular lymphocytes or oats, hence the term, “oat cell carcinoma,” otherwise called a small cell undifferentiated carcinoma.
Classification of lung tumors
Bacterial pneumonia
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Pulmonary tuberculosis
.
diffuse alveolar damage (ALI/ARDS)
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Malignant Mesothelioma and Asbestosis
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Non-small cell bronchogenic carcinoma
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small cell carcinoma of the lung
.
