Lung: Pneumoconiosis, Tumors Flashcards
Silicosis increases chances of
TB and Lung cancer
6 disease processes of ASBESTOSIS
- Pleural plaques: local and diffused
- Pleural effusion: recurrent
- Parenchymal interstitial fibrosis
- Lung cancer
- Mesothelioma: pleural and peritoneum
- Laryngeal cancer
Smoking in asbestosis increases risk of what cancer, and has no effect on what?
Increases- lung cancer
No effect- mesothelioma
Pneumoconiosis definition
- Non neoplastic reaction
- To inhalation of
- MINERAL DUST
- inorganic, organic particulates, chemical fumes, vapours
- Encountered at work place
What is Caplan syndrome
Rheumatoid pneumoconiosis
Combination of RA and pneumoconiosis especially with
- Anthracosis
- Silicosis
- Asbestosis
What causes
- Siderosis
- Baritosis
- Stannosis
- Farmers lung
- Bagassosis
- Bird breeders lung
- Byssinosis
- Iron oxide
- BaSO4
- Tin oxide
- Mouldy hay
- Bagasse: fibrous remains after juice extraction from SUGARCANE and SORGHUM
- 🐦 droppings
- Cotton, flax, hemp
Most dangerous particle size
Why?
1-5 um
Because they can reach terminal airways and settle in their lining
Effect of particle size on pneumoconiosis
Small- rapid onset acute lung injury
Large- resist dissolution and may persist within parenchyma for years and cause chronic disease
Spectrum of coal workers pneumoconiosis
- Asymptomatic anthracosis
- Simple CWP
- Complicated CWP/ PMF (progressive massive fibrosis)
Silica admixed with coal dust favours which disease of CWP spectrum
PMF
Asymptomatic anthracosis
- Inhaled carbon pigment engulfed by alveolar/interstitial macs
- Accumulate in connective tissue along lymphatics
Simple CWP: histology, location, complications
HISTOLOGY
- Coal macules: 1-2 mm and consist of carbon laden macs
- Coal nodules: larger and consist of carbon laden macs and delicate network of collagen fibres
LOCATION
- More commonly affects upper lobes and upper zones of lower lobes
- Adjacent to respiratory bronchioles
COMPLICATIONS
1. Centrilobular emphysema
Complicated CWP/ progressive massive fibrosis (PMF)
Gross, histo
Associated with lung dysfunction
Gross
- Blackened scars: 1-10cm
- Usually multiple
Histology
- Dense collagen and pigment
- Center of lesion is necrotic, because of ischemia
Clinical presentation of CWP
- PMF: pulmonary dysfunction, pulmonary hypertension, cor pulmonale
Silicosis definition
An occupational lung disease caused by inhalation of Proinflammatory crystalline silica
Crystalline silica examples
Quartz- most common
Cristobalite
Tridymite
More dangerous than amorphous because MORE FIBROGENIC
Acute silicosis histology
Accumulation of abundant lipoproteinaceous material in the alveoli
Inflammatory cytokines made be macs ie implicated in silicosis
IL 1 and IL 18
Silicosis Gross and microscopic morphology
Gross:
- Initially, in the hilar lymph nodes and upper parts of lung, tiny nodules
- The nodules later COALESCE to form Hard collagenous (fibrous) scars
- Nodules also might also undergo central cavitation secondary to TB or ischemia
- Fibrotic lesions in hilar LN or pleura
- Egg shell calcification
- Later, PMF
Micro:
- Hallmark lesion: central area of whorled collagen fibres and peripheral area of silica laden macs
- Birefringent silicates
Onset of silicosis
- Slow, insidious: 10-30 years (most common)
- Accelerated: within 10 years of exposure
- Rapid: weeks or months of exposure
Classify lung tumours
Add picturer page 714
Adenocarcinoma precursor lesions
- Atypical adenomatous hyperplasia
A. <5mm small lesion
B. Has dysplastic pneumocytes lining alveolar walls - Adenocarcinoma in situ
A. <3cm
B. Dysplastic cells growing along alveolar septae (lepidic pattern)
C. May or May not have mucin
Adenocarcinoma histology
- Malignant epithelial tumor with glandular differentiation or mucin production
- Patterns : PALMS (papillary, acinar, lepidic, micropapillary, solid)
Adenocarcinoma IHC
- TTF-1:thryroid trans factor needed for normal lung maturation
- Napsin A
