Lung Review Flashcards
Diffuse alveolar damage patterns?
What is Acute Fibrinous and Organizing Pneumonia?
Acute: >1 wk; Hyaline membranes and type 2 cell hyperplasia with fibrin thrombi
Organizing: >1 wk. Fibrosis in septa and remains of membranes
DAD variant without Hyaline membranes: Fibrin and organization present
Organizing pneumonia/BOOP has what on H and E?
Masson Bodies/Fibroblastic plugs and associated alveolar thickening
See in many things including other diseases and even abscesses and cancers
Obliterative Bronchiolitis H and E?
Seen in?
AKA: Constrictive bronchiolitis obliterans
Submucosal scaring in bronchioles
Associated with: Lung transplants, GVHD, Adenovirus
Actinomyces staining pattern?
Associated with?
Nocardia pattern?
Associated with?
Long branching rods, Gram +, Silver +, AFB -
Poor dentition
Nocardia: Long branching rods, Gram +, SIlver +, Weakly AFB +
Immunocompromised
Hot tub lung and ddx?
Which fungi are vascular invasive and infarction?
From MAC; Well Formed Non-nec granulomas; hypersensitivity pneumonitis (poorly formed)
Aspergillous and Mucor; Candia causes inflammation
What is seen in allergic bronchopulmonary aspergillosis?
AIDS patient with intra-alveolar froth or patient with DAD rule out?
Hypersensitivity reaction, Path: Mucoid impaction (layered) in bronchi, eosinophils, broncogenic granulomas
PJP pneumonia!
HIsto H and E?
Location?
Coccidio H and E?
Location?
Small yeasts 2-5 um; Ohio Valley
Larger spheres 20-60 um w/ endospores
SW US
Cryptococcus H and E?
Locaiton?
Blasto H and E?
Locaiton?
Dirofilaria H and E?
Wide capsular halo (Mucecarmine +); narrow budding
Assoc w/ Pigeons
Yeasts 25 um, Broad based budding; Mucicarmine -
Central and SE USA
Complex with Cuticle
Silica quartz vs amorphous which is worse?
Nodular silicosis H and E?
Acute silicosis casues?
Quartz!
Well circumscribed noduled with rim of histeocytes and eventual progressive massive fibrosis
Alveolar proteinosis
MIxed dust fibrosis differs from silicosis by?
Some things asbestos can cause?
Mixed dust: Stellate “medusa head fibrosis” vs well circumscribed nodules
Asbestosis, rounded atelectasis, carcinoma
Pluera: Plaques, effusions, mesothelioma
Asbestosis dx requirements?
Berrilliosis H and E?
Pulmonary fibrosis and 2 or more asbestos bodies in 1 cm2 of a 5 um thick lung; high counts of fibers in lung digest
Fe Stain Helps
See Sarcoid like granulomas: Need history
Hard metal pnemonocosis (2 metals) and H and E finding?
Tungsten and Cobalt; Giant cell interstital pneumonia
UIP Pattern?
Associated with?
Varigated apperance: “old and young fibrosis”, Honeycomb fibrosis, Fibroplastic plugging and normal lung
IFP, Connective tissues disease and chronic hypersensitivity pneumona
Nonspecific interstital pneumonia H and E?
Associated with?
Uniform pattern: Mild-moderate chronic inflammation, interstital fibrosis +/- inflammation
Idiopathic NSIP, Connective tissue disease, hypersensitivity, drug tox, infection
Respiratory bronchiolitis H and E?
Which population is this normal in?
Desquamative Interstital Pneumonia H and E?
Bronchiolocentric intra-alveolar macrophages
SMOKERS
Like worse RB; Uniform with diffuse intraalveolar macrophages and possible fibrosis
Also seen in smokers!
Lymphoid interstital pneumona main R/O?
Associated conditions?
LYMPHOMA
Immunodeficiency (HIV kids) and connective tissue disease
Pleuroparenchemal fibroroelastosis H and E?
Associated conditions?
Needs imaging to distinguish from?
Visceral pleura fibrosis, Subpleural fibroelastosis, Sparing of parenchyma far from pleura with abrupt transitions
Associated wtih: Idiopathic PPFE and Lung allograft rejection
Apical cap
Sarcoid H and E?
Hypersensitivity pneumonitis H and E?
Well formed granulomas with some possible coalescence
HP: Bronochiolocentric intersitial pneumonia, cellular bronchiolitis, vague fromed granulomas, orangizing pneumonia
Lymphangioleiomyomatosis (LAM) population?
Associated with?
H and E?
IHC?
Low grade neoplasm of PEComa; F childbearing age
Tuberous sclerosis (TSC1 and 2 even in sporatic cases)
See holes: Beta-Catenin +, HMB-45, Melan A
Pulmonary Lagerhans Histiocytosis population?
H and E?
Stains?
PLH vs Chronic eosinophilic pneumonia?
Smokers!
Stellate nodules interstital fibrosis nodules around bronchioles with Langerhans cells at periphery; some eosinophils
S-100+, CD1a+, Langerin +
CEP: Macrophages and eosinophils in alveolar spaces
Pulmonary vasculitis is treated with what?
c-ANCA is seen in what lung vasculitis?
p-ANCA is seen in what lung vasculitis?
Steroids
Granulomatosis with polyangitis; PR3+ in ELISA
Eosinophilic granulomatosis with polyangitis and microscopic polyangitis. MPO+
Granulomatous with polyangitis (Wegner’s) other body locations
H and E and ANCA?
Upper respiratory tract, lung, kidneys; c-ANCA/PR3+
Large parenchymal necrosis; neudtrophilic microabscesses and mixed inflammation with giant cells, Vasculitis
Eosinophilic Granulomatosis with Polyangitis (Churg Strauss) ANCA?
Criteria/H and E?
p-ANCA+/MPO
Asthma, >10% eos’s, Mono/poly neuropathy, Pulmonary opascities, paransal sinus abnormaltiies, biopsy shows increased esos
Asthmatic bronchitis, eosinophilic pneumonia, “Allergic granulomas”, Vasculitis
Microscopic polyangitis (Hypersensitivity vasculitis, leukocytoclastic vasculitis, Systemic necrotizing vasculitis); ANCA?
H and E?
p-ANCA/MPO
Alveolar hemorrhage, hemosiderin laden macrophages, Neutrophilic capilleritis (in speta and not alveolar spaces)