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Pulmonology > Lung Pathology > Flashcards

Lung Pathology Flashcards

1
Q

What should the normal lung surface look like?

A

smooth, glistening and without adhesions

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2
Q

What should the normal color be of the cut surface of the lung?

A

if fixed - greyish

if fresh - maroon colored without splotches

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3
Q

What is the normal consistency of a lung (grossly)

A

wet, firm, sponge like

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4
Q

Should air spaces in the lung (grossly) be central or peripheral?

A

central

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5
Q

What kind of cells make up the epithelium of the bronchi?

A

ciliated columnar epithelium

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6
Q

How should the submucosa glands appear in the bronchial microscope specimen?

A

indistinct

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7
Q

This pathologic pattern of lung injury is characterized by increasing dyspnea on exertion and hypoxia. The average patient is 55 to 75 years old, and pathologically, the tissue shows fibrosis with temporal and geogrpahic heterogeneity. what is it?

A

usual interstitial pneumonia

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8
Q

autoimmune pneumonias, asbestosis, hypersensitivity pneumonitis, connective tissue disorders, and idiopathic pulmonary fibrosis all generally fall under which category of restrictive lung disease?

A

usual interstitial pneumonia

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9
Q

A pathology specimen shows hypocellular pink collagen in addition to areas with less mature, blue fibrosis. what are these called? what disease is it? Is there inflammation?

A

fibroblastic foci

usual interstitial pneumonia

no inflammation

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10
Q

What are two possible causes of nonspecific interstitial pneumonia?

A

idiopathic or autoimmune

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11
Q

Between UIP and NSIP, which has the better prognosis?

A

NSIP

UIP/IPF is only 3 years

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12
Q

Which pneumonia has inflammation, UIP or NSIP?

A

NSIP

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13
Q

Pathologically, a specimen shows uniform fibrosis and inflammation. What type of restrictive lung disease could this be?

A

NSIP

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14
Q

In whom does sarcoidosis classically appear?

A

young adults and african americans

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15
Q

A pathology specimen shows well formed, naked granulomas without inflammation. There is no evidence of necrosis. What kind of restrictive lung disease could this be?

A

sarcoidosis

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16
Q

A patient presents with a UIP pattern of lung injury (fibroblastic foci without inflammation), progressive dyspnea, and respiratory failure, as well as a fever and cough. What could they have? what do you need to ask about?

A

hypersensitivity pneumonitis

hobbies and work exposures to organic antigens

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17
Q

What is shown here?

A

fibroblastic foci characteristic of UIP

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18
Q

What are the arrows pointing at? What do they show?

A

Fibroblastic foci with temporal heterogeneity

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19
Q

What type of fibrosis is seen?

A

Uniform fibrosis characteristic of NSIP

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20
Q

What kind of process is going on here? what disease is it?

A

Confluent, naked granulomas

sarcoidosis

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21
Q

What kind of granuloma is this?

A

necrotizing infectious granuloma

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22
Q

What kind of granuloma is this?

A

poorly formed, loose granuloma with inflammation

Indicative of hypersensitivity pneumonitis

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23
Q

What kind of process is this an example of?

A

honeycomb lung

end stage restrictive lung disease/fibrosis

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24
Q

What process is this an example of in the lung?

A

honeycomb lung

  • end stage
  • fibrosis with cystic dilation
  • loss of architecture
  • lined with columnar bronchial epithelial cells
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25
Q

What are the main pathologic findings in emphysema/

A

the alveolar septae are destroyed and alveolar spaces are enlarged relative to those seen in a normal lung.

- “floating septae,” fragments of alveolar septae which are detached from the rest of the alveolar framework.

  • no inflammatory infiltrate is generally not seen
  • involvement of the larger airways is minimal.
  • Enlarged alveolar spaces are often visible grossly.
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26
Q

Are the changes seen in emphysema reversible?

A

largely, no

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27
Q

How AIAT deficiency inherited?

A

autosomal recessive

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28
Q

What are the 3 anatomic variants of emphysema?

A

centriacinar

distal acinar

panacinar

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29
Q

Which of the following types of emphysema is most associated with smoking?

centriacinar

panacinar

distal acinar

A

centriacinar

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30
Q

which type of emphysema is most commonly seenin AIAT deficiency ?

centriacinar

panacinar

distal acinar

A

panacinar

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31
Q

Which of the following types of emphysema is associated with pre existing lung scarring?

centriacinar

panacinar

distal acinar

A

distal acinar

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32
Q

What is the clinical definition of chronic bronchitis?

A

productive cough in most days for 3 consecutive months in 2 consecutive years

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33
Q

What is the main pathologic change seen in chronic bronchitis?

A

mucus gland hypertrophy

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34
Q

What is the objective assesment for chronic bronchitis?

A

Reid index

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35
Q

What is the Reid index score that suggests chronic bronchitis?

A

> 0.4

36
Q

How is th Reid index generated to assess chronic bronchitis?

A

The Reid index is a ratio between the thickness of the submucosal glands and the distance between the bronchial cartilage and the surface of the epithelium.

37
Q

what are the permanent changes that can develop in patients with long term asthmaa/

A

epithelial cell damage

smooth muscle hyperplasia

mucus gland hypertrophy

38
Q

What can be seen grossly in asthma that is gross (in every sense of the word)?

A

mucus casts that take the shape of the bronchial tree

39
Q

What are churchman’s spirals? what are they associated with?

A

spiral structures seen microscopically in the mucus of severe asthma patients

40
Q

What disease is associated with charcot leyden crystals? what are they?

A

asthma

eosinophilic infiltrate which make crystals from degranulation

41
Q

What is the pathologic correlate for lung damage?

A

diffuse alveolar damage

42
Q

What is the classic finding for DAD?

A

hyaline membranes along alveolar septae

43
Q

what are hyaline membranes composed of in DAD?

A

fibrin, protein and necrotic pneumocytes due to inflammation

44
Q

What is a common cause of pneumonia in chronic alcoholics?

A

klebsiella pneumoniae

45
Q

What is the distribution pattern of bronchopneumonia?

A

patchy

46
Q

What is the distribution pattern in lobar pneumonia?

A

confluent pattern, usually involving entire lobe

47
Q

What is different about areas of lung that have bacterial pneumonia (grossly)?

A

tends to be heavier, firm and congested

48
Q

How does one describe the quality of tissue in gross pathology for bacterial pneumonia?

A

hepatization (firm and liver like consistency )

49
Q

What is the main microscopic finding for bacterial pneumonia?

A

neutrophilic inflammation in alveolar spaces

congested capillaries

hyaline membranes

50
Q

Other than in DAD, where are hyaline membranes found?

A

bacterial and severe viral pneumonia

51
Q

What is the predominant microscopic finding for viral pneumonia?

A

lymphocytosis and plasma cells in alveolar septae

52
Q

what is a characteristic viral cytopathic effect of CMV pneumonia?

A

large intranuclear inclusions (owls eye inclusions) made up of viral particles

53
Q

what is a characteristic viral cytopathic effect of herpese pneumonia?

A

pale glassy chromatin in epithelial cells, nuclear moulding and multinucleated cells

54
Q

What are granulomas made out of? (cell type)

A

epithelioid histiocytes

55
Q

Whenever you see a granuloma on lung path, what is your next step?

A

silver stain for fungal organisms and AFB for mycobacteria

56
Q

Are adenocarcinomas central or peripheral?

A

both

57
Q

What cancer is defined microscopically by rounded gland formation, columnar cells, and mucin production?

A

adenocarcinomas

58
Q

Which non small cell lung carcinoma is TTF1 positive?

A

adenocarcinoma

59
Q

What kind of cancer common to smokers tends to be cystic and centrally placed?

A

squamous cell carcinoma

60
Q

What cancer type is it very important to identify driver mutations for to guide therapy/

A

adenocarcinomas

61
Q

Which cancer is defined by classic morphological findings of keratinization and intracellular bridges?

A

squamous cell carcinoma

62
Q

What kind of cancer is commonly presenting with bulky metastases to lymph nodes and distal areas/

A

small cell carcinoma

63
Q

Which cancer type has very poor prognosis despite good initial response to chemo?

A

small cell carcinoma

64
Q

This kind of cancer is defined by very high nuclear to cytoplasmic ratios, lots of mitotic spindles, necrosis, nuclear molding, and dark uniform nuclei without nucleoli

A

small cell carcinoma

65
Q

What kind of cancer discussed in class is typically found in non smokers and very indolent?

A

carcinoid tumor

66
Q

What kind of cancer tends to be central and endobronchial?

A

carcinoid tumors

67
Q

What two types of cancer demonstrate neuro endocrine differentiation by electron microscopy and immunohistochemistry?

A

small cell carcinomas and carcinoid tumors

68
Q

What tumor type is defined by nested growth patterns, abundant cytoplasm, and “salt and pepper” chromatin?

A

carcinoid tumors

69
Q

Malignant mesotheliomas can have microscopic presentations that are similar to which other types of lung cancer?

A

adenoarcinomas or malignant spindle cell sarcomas

70
Q

Identify the 3 cell types here and where this is from:

A

Hassal’s corpuscle

lymphocytes

adepocytes

thymus

71
Q

What are the common anterior mediastinal masses? (3 T;s)

A

thymomas

teratomas

terrible lymphomas

72
Q

Between a thymoma and a thymus carcinoma, which one has higher malignancy?

A

thymic carcinoma

73
Q

What is this?

A

thymoma

74
Q

What is this?

A

thymic carcinoma

75
Q

What is the most common kind of mediastinal mass?

A

metastatic lung carcinoma to the middle mediastinum

76
Q

What is this?

A

nerve sheath tumor (schwanomma or malignant)

77
Q

What is this? what is the name for the appearance of the blood vessels?

A

paraganglioma

zellballen

78
Q

Where are most neurogenic tumors found in the mediastinum?

A

posterior mediastinum (schwanommas, malignant nerve sheat tumors, paragangliomas)

79
Q

What is this?

A

adenocarcinoma

80
Q

What is this?

A

adenocarcinoma with mucin

81
Q

What is this?

A

adenocarcinoma with TTF 1 positive (brown)

82
Q

What is this?

A

squamous cell carcinoma with keratinization

83
Q

what is this?

A

squamous cell carcinoma with intracellular bridges

84
Q

What is this?

A

small cell carcinoma

85
Q

What is this?

A

carcinoid tumor

86
Q

What is this?

A

epithelioid malignant mesothelioma

87
Q

What is this?

A

sarcomatoid malignant mesothelioma

Pulmonology (35 decks)

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