Lung Pathology Flashcards
What should the normal lung surface look like?
smooth, glistening and without adhesions
What should the normal color be of the cut surface of the lung?
if fixed - greyish
if fresh - maroon colored without splotches
What is the normal consistency of a lung (grossly)
wet, firm, sponge like
Should air spaces in the lung (grossly) be central or peripheral?
central
What kind of cells make up the epithelium of the bronchi?
ciliated columnar epithelium
How should the submucosa glands appear in the bronchial microscope specimen?
indistinct
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?
usual interstitial pneumonia
autoimmune pneumonias, asbestosis, hypersensitivity pneumonitis, connective tissue disorders, and idiopathic pulmonary fibrosis all generally fall under which category of restrictive lung disease?
usual interstitial pneumonia
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?
fibroblastic foci
usual interstitial pneumonia
no inflammation
What are two possible causes of nonspecific interstitial pneumonia?
idiopathic or autoimmune
Between UIP and NSIP, which has the better prognosis?
NSIP
UIP/IPF is only 3 years
Which pneumonia has inflammation, UIP or NSIP?
NSIP
Pathologically, a specimen shows uniform fibrosis and inflammation. What type of restrictive lung disease could this be?
NSIP
In whom does sarcoidosis classically appear?
young adults and african americans
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?
sarcoidosis
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?
hypersensitivity pneumonitis
hobbies and work exposures to organic antigens
What is shown here?
fibroblastic foci characteristic of UIP
What are the arrows pointing at? What do they show?
Fibroblastic foci with temporal heterogeneity
What type of fibrosis is seen?
Uniform fibrosis characteristic of NSIP
What kind of process is going on here? what disease is it?
Confluent, naked granulomas
sarcoidosis
What kind of granuloma is this?
necrotizing infectious granuloma
What kind of granuloma is this?
poorly formed, loose granuloma with inflammation
Indicative of hypersensitivity pneumonitis
What kind of process is this an example of?
honeycomb lung
end stage restrictive lung disease/fibrosis
What process is this an example of in the lung?
honeycomb lung
- end stage
- fibrosis with cystic dilation
- loss of architecture
- lined with columnar bronchial epithelial cells
What are the main pathologic findings in emphysema/
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.
Are the changes seen in emphysema reversible?
largely, no
How AIAT deficiency inherited?
autosomal recessive
What are the 3 anatomic variants of emphysema?
centriacinar
distal acinar
panacinar
Which of the following types of emphysema is most associated with smoking?
centriacinar
panacinar
distal acinar
centriacinar
which type of emphysema is most commonly seenin AIAT deficiency ?
centriacinar
panacinar
distal acinar
panacinar
Which of the following types of emphysema is associated with pre existing lung scarring?
centriacinar
panacinar
distal acinar
distal acinar
What is the clinical definition of chronic bronchitis?
productive cough in most days for 3 consecutive months in 2 consecutive years
What is the main pathologic change seen in chronic bronchitis?
mucus gland hypertrophy
What is the objective assesment for chronic bronchitis?
Reid index
What is the Reid index score that suggests chronic bronchitis?
> 0.4
How is th Reid index generated to assess chronic bronchitis?
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.
what are the permanent changes that can develop in patients with long term asthmaa/
epithelial cell damage
smooth muscle hyperplasia
mucus gland hypertrophy
What can be seen grossly in asthma that is gross (in every sense of the word)?
mucus casts that take the shape of the bronchial tree
What are churchman’s spirals? what are they associated with?
spiral structures seen microscopically in the mucus of severe asthma patients
What disease is associated with charcot leyden crystals? what are they?
asthma
eosinophilic infiltrate which make crystals from degranulation
What is the pathologic correlate for lung damage?
diffuse alveolar damage
What is the classic finding for DAD?
hyaline membranes along alveolar septae
what are hyaline membranes composed of in DAD?
fibrin, protein and necrotic pneumocytes due to inflammation
What is a common cause of pneumonia in chronic alcoholics?
klebsiella pneumoniae
What is the distribution pattern of bronchopneumonia?
patchy
What is the distribution pattern in lobar pneumonia?
confluent pattern, usually involving entire lobe
What is different about areas of lung that have bacterial pneumonia (grossly)?
tends to be heavier, firm and congested
How does one describe the quality of tissue in gross pathology for bacterial pneumonia?
hepatization (firm and liver like consistency )
What is the main microscopic finding for bacterial pneumonia?
neutrophilic inflammation in alveolar spaces
congested capillaries
hyaline membranes
Other than in DAD, where are hyaline membranes found?
bacterial and severe viral pneumonia
What is the predominant microscopic finding for viral pneumonia?
lymphocytosis and plasma cells in alveolar septae
what is a characteristic viral cytopathic effect of CMV pneumonia?
large intranuclear inclusions (owls eye inclusions) made up of viral particles
what is a characteristic viral cytopathic effect of herpese pneumonia?
pale glassy chromatin in epithelial cells, nuclear moulding and multinucleated cells
What are granulomas made out of? (cell type)
epithelioid histiocytes
Whenever you see a granuloma on lung path, what is your next step?
silver stain for fungal organisms and AFB for mycobacteria
Are adenocarcinomas central or peripheral?
both
What cancer is defined microscopically by rounded gland formation, columnar cells, and mucin production?
adenocarcinomas
Which non small cell lung carcinoma is TTF1 positive?
adenocarcinoma
What kind of cancer common to smokers tends to be cystic and centrally placed?
squamous cell carcinoma
What cancer type is it very important to identify driver mutations for to guide therapy/
adenocarcinomas
Which cancer is defined by classic morphological findings of keratinization and intracellular bridges?
squamous cell carcinoma
What kind of cancer is commonly presenting with bulky metastases to lymph nodes and distal areas/
small cell carcinoma
Which cancer type has very poor prognosis despite good initial response to chemo?
small cell carcinoma
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
small cell carcinoma
What kind of cancer discussed in class is typically found in non smokers and very indolent?
carcinoid tumor
What kind of cancer tends to be central and endobronchial?
carcinoid tumors
What two types of cancer demonstrate neuro endocrine differentiation by electron microscopy and immunohistochemistry?
small cell carcinomas and carcinoid tumors
What tumor type is defined by nested growth patterns, abundant cytoplasm, and “salt and pepper” chromatin?
carcinoid tumors
Malignant mesotheliomas can have microscopic presentations that are similar to which other types of lung cancer?
adenoarcinomas or malignant spindle cell sarcomas
Identify the 3 cell types here and where this is from:
Hassal’s corpuscle
lymphocytes
adepocytes
thymus
What are the common anterior mediastinal masses? (3 T;s)
thymomas
teratomas
terrible lymphomas
Between a thymoma and a thymus carcinoma, which one has higher malignancy?
thymic carcinoma
What is this?
thymoma
What is this?
thymic carcinoma
What is the most common kind of mediastinal mass?
metastatic lung carcinoma to the middle mediastinum
What is this?
nerve sheath tumor (schwanomma or malignant)
What is this? what is the name for the appearance of the blood vessels?
paraganglioma
zellballen
Where are most neurogenic tumors found in the mediastinum?
posterior mediastinum (schwanommas, malignant nerve sheat tumors, paragangliomas)
What is this?
adenocarcinoma
What is this?
adenocarcinoma with mucin
What is this?
adenocarcinoma with TTF 1 positive (brown)
What is this?
squamous cell carcinoma with keratinization
what is this?
squamous cell carcinoma with intracellular bridges
What is this?
small cell carcinoma
What is this?
carcinoid tumor
What is this?
epithelioid malignant mesothelioma
What is this?
sarcomatoid malignant mesothelioma
