PAT Patho Pharma Flashcards
1
Q
complication of acute tonsilitis
A
- Spread of infection:
a. Direct: Peritonsillar abscess (Quinzy) - otitis media – pharyngitis- laryngitis.
b. Lymphatic spread: Cervical lymph nodes (lymphadenitis).
c. Blood spread: Bacteremia- septicemia- toxemia- pyemia. - Hypersensitivity :
to streptococcal sore throat or URT infections may result in
© Rheumatic Fever Or
© Post Streptococcal Glomerulonephritis. - Chronicity: Chronic tonsillitis.
2
Q
complications of otitis media
A
- include mastoiditis, meningitis, and brain abscess.
- Inflammation may persist and become chronic with hear loss.
3
Q
Definition of Diphtheria
A
Diphtheria is a life-threatening disease characterized by a pseudo-membranous inflammation of throat and tonsils of young children.
4
Q
Gross of pseudomembranous inflammation
A
Multiple small yellowish foci of necrosis gradually enlarge, fuse together and form a continuous membrane.
The membrane:
is slightly raised and adherent, but if removed by force it leaves bleeding ulcerating surface and reforms again
5
Q
causes of pyemic abscess of lung
A
septic empoli from septic thrombophlebitis of systemic veins
infective endocarditis of the right side of the heart
6
Q
Gross of the pyemic abscess
A
multiple , very small and always next to a blood vessel, yellow spots surrounded by a zone of congestion
7
Q
It is the type of emphysema that occurs with alpha 1 antitrypsin deficiency
A
Panacinar
(panlobular)
8
Q
Distention of all air spaces distal to the terminal bronchiole i,e. the whole lobular unit
A
Panacinar
(panlobular)
9
Q
emphysema occurs more commonly in the lower lung zones
A
Panacinar
(panlobular)
10
Q
what is Centriacinar
(bronchiolar
emphysema)
A
§ Distention of the central part of the acinus formed by the respiratory bronchioles while distal alveoli are spared.
§ The lesions are more common and severe in the upper lobes, particularly the upper segments.
§ This type is common in cigarette smokers & coal workers’
Pneumoconiosis
11
Q
Definition of Emphysema
A
Permanent over distention of air spaces distal to the terminal
bronchioles, with destruction of their walls
12
Q
location of centriacinar emphysema
A
distention of respiratory bronchioles more common in the upper lobes, particularly the upper segments
13
Q
cause of the panacina emphysema
A
alpha 1 antitrypsin defeciency
14
Q
what is panacinar emphysema
A
Distention of all air spaces distal to the terminal bronchiole i,e. the whole lobular unit
15
Q
other names of the centri, pan, disatalacinar emphysema
A
bronchiolar
panlobular
paraseptal
16
Q
location of the panacinar emphysema
A
lower lung zones
17
Q
emphysema occurs adjacent to areas of pulmonary scarring, or atelectasis
A
Distal acinar (paraseptal)
18
Q
location of the paraseptal emphysema
A
usually in the upper half of the lung
19
Q
Pathogenesis of the emphysema
A
- Alveolar wall destruction in emphysema likely results from imbalances between pulmonary proteases and their inhibitors
- Tobacco smoke and air pollutants:
ü recruit neutrophils and macrophages.
ü Smoking enhance elastase release from macrophages and neutrophils
ü at the same time inhibit alpha 1 antitrypsisn.
increase the elastases over the antitrypsin degrades the extracellular matric and the elastic tissue of the alveoli thus preventing the alveoli from returning to normal size after their inflation with air during inspiration
20
Q
the microscopic picture of the emphysema
A
enlargment and dilation of the air spaces of thinning and destruction of the alveolar wall
and number of alveolar capillaries are diminshed
21
Q
the gross of emphysema
A
panacinar: pale, dry, and voluminous lungs that obscure the heart
centriacinar: less pale and less voluminous and upper two thirds of the lung are more severely affected
22
Q
Clinical picture of emphysema
A
1) Dyspnea
2) Iassociated with chronic bronchitis there is coughing and wheezing.
3) Barrel chest (increased antero-posterior diameter) due to lung
overinflation.
4) Finger clubbing due to hypoxia.
23
Q
Complications of emphysema
A
1) pulmonary hypertension and right sided heart failure (cor pulmonale)
2) Respiratory failure from defective ventilation, perfusion & diffusion ofgases with increased C02 in blood, respiratory acidosis & death.
3) Rupture bullae containing air into pleura producing pneumothorax (air in pleural cavity)
heart and respiratory failure and pneumothorax
24
Q
what is compensatory emphysema
A
compensatory dilatation of alveoli in response to loss of the lung substance due to fibrosis or atelectasis
25
Definition of the chronic bronchitis
Chronic bronchitis is defined clinically as persistent productive cough for at least 3 consecutive months, for 2 consecutive years.
26
what is bullous emphysema?
It is a localized accentuation of any form of emphysema which there are large cystic spaces (bullae) greater than 1 cm
27
What is Interstitial
emphysema?
§ air collects out of the air spaces in the connective tissue
septa of the lung and track into the connective tissue of the
mediastinum and the neck.
§ It may occur spontaneously with sudden increase in **intraalveolar pressure** (as violent coughing in **children** with
whooping cough), or from perforating injuries of the lung.
§ There is marked swelling of the neck with **crepitus** under the
skin.
§ Air is absorbed spontaneously
| air from connective tissue of lung to C.T of the mediastinum and neck
28
What is senile or atrophic emphysema
Occurs as a result of senile loss of elasticity of tissues
accompanying the atrophic changes of aging.
29
Etiology of the chronic bronchitis
The most important causative factor is cigarette smoking
30
pathology of chronic bronchitis
hypersecretion of mucus in trachea and large bronchi
due to
hypertrophy of submucosal mucous glands
31
Definition of Chronic Interstitial Lung Diseases
Chronic interstitial lung diseases are a heterogeneous group of
disorders characterized by bilateral, patchy, chronic Involvement of the interstitium of the lung.
32
the main clinical manifestation of Chronic Interstitial Lung Diseases
Chronic interstitial lung diseases are a heterogeneous group of
disorders characterized by bilateral, patchy, chronic Involvement of the interstitium of the lung
33
# [](http://)
Pathogenesis of Chronic Interstitial Lung Diseases
reduced compliance
More pressure is required to expand the lungs because they are stiff
dypnea
affection of ventilation and perfusion causes hypoxia
ground glass shadows
honey-comb lung appearance
respiratory failure often with pulmonary
hypertension and cor pulmonale
34
Types of Chronic Interstitial Lung Diseases
1) Idiopathic pulmonary fibrosis.
2) Non- specific chronic interstitial pneumonia
3) Cryptogenic organizing pneumonia
4) Pulmonary involvement in collagen
diseases as rheumatoid arthritis and
systemic lupus erythematosus).
5) Sarcoidosis.
6) Pneumoconiosis
35
Definition of Pneumoconiosis
Lung disease caused by inhaled dust. Dust may be inorganic (mineral) or organic.
36
stages of Coal worker's pneumoconiosis
Simple anthracosis: presence of coal dust pigments which are taken by alveolar macrophages.
Macules and nodules
1) of dust-laden macrophages with delicate collagen fibers.
2) Can lead to centilobular emphysema.
Complicated stage Progressive massive fibrosis with black pigment.
37
the most prevalent occupational disease
Silicosis
38
increase the susceptibility to tuberculous infection
silicosis
39
increase risk of mesothelioma
asbestosis
40
definition of atelectasis and collapse
Atelectasis is failure of expansion of the lung or collapse of previously
inflated lung, affecting part or all of one lung
41
types of atelectasis
* Resorption atelectasis
* Compression atelectasis
42
the 5 % non carcinoma tumors of the lung
carcinoid tumor,
fibrosarcoma,
leiomyosarcoma
lymphoma
43
the most common benign tumor of the lung is
hamartoma
44
what is hamartoma?
benign tumor of the lung which spherical coin like-shadow on X ray
It consists mainly of mature cartilage admixed with fat, fibrous tissue and blood vessels
45
Gross of the squamous cell carcinoma
Centrally located mass:
85% of tumors arise in major bronchi and present as;
* An endobronchial growth
* An infiltrative tumor that invade the bronchial wall and surrounding lung tissue.
46
Microscopic picture of squamous cell carcinoma
Squamous cell carcinoma with various grades of differentiation and Keratin pearl formation.
47
# [](http://)
Most common type of lung cancer in women
Adenocarcinoma
48
Gross of Adenocarcinoma
* Most are peripherally located, and may be multiple.
* Can occur centrally in men.
* Seeding of the pleura occur early.
49
what is Large cell carcinoma
Large cell undifferentiated carcinoma that have no glandular or keratin formation
50
Keratin pearl formation related to
squamous cell carcinoma
51
Gross of the small cell carcinoma
a central mass which is rapidly growing and early metastasizing
52
Microscopic picture of small cell carcinoma
* Cells are twice the size of small lymphocytes with scant cytoplasm.
* Necrosis is always present and may be extensive.
* These tumors often secrete a variety of polypeptide hormones that may result in paraneoplastic syndromes
* The tumor cells can be stained by anti chromogranin which is a marker of neuroendocrine cells.
53
inflammatory ulcers of the tongue and oral cavity
Dental ulcer
Apthous ulcer
Herpitic ulcer
Tuberculous ulcer
Syphilitic ulcer (primary, secondary, Teritiary)
54
sharp teeth producing a single superficial ulcer (simple ulcer)
on the edges of the tongue.
Dental ulcer
55
idiopathic, possibly autoimmune. Occur as multiple, small,
shallow, recurrent painful ulcers
Apthous ulcer
56
herpes simplex vesicles which ulcerate
Herpitic ulcer
57
what is dental ulcer
inflammatory ulcer of the tongue which is sharp teeth producing
single superficial ulcer
on the edges of the tongue
58
location of tuberculous ulcer
tip of tongue
59
what is tuberculous ulcer of the tongue
o Ulcer occurs at tip of tongue from coughed sputum.
o The ulcer have undermined edge and caseous floor
60
what is syphilitic ulcer of the tongue
Primary syphilis ulcerated chancre (describe from general).
Secondary syphilis ulcerated mucous patches.
Tertiary syphilis ulcerated gumma (precancerous)
61
the neoplastic ulcer of the tongue
squamous cell carcinoma malignant ulcer on the anterior 2/3 of the tongue
62
what is leukoplakia
whitish mucosal patch which is squamous hyperplasia with hyperkeratosis
63
complication of leukoplakia
squamous cell carcinoma
64
Predisposing factors of squamous cell carcinoma of the tongue
1) leukoplakia
2) tobacco chewing
3) HPV 16&18
4) tertiary syphilitic (gumma ulcer)
65
Gross of squamous cell carcinoma of the tongue
anterior 2/3 of the tongue as a polypoid fungating mass or a malignant ulcer
Edge: raised everted
floor: necrotic
base: fibrotic
66
Microscopic picture of the squamous cell carcinoma of the tongue
cell nest of malignant cell
outer columnar
middle polyhydral cells
inner flat cells and keratin in center
67
complication of the squamous cell carcinoma of the tongue
Direct spread:
producing fixation of tongue, restriction of its mobility & improper speech.
Lymphatic: Cervical lymph nodes
Blood spread: to systemic circulation (early)
68
what is sialadenitis
Inflammation of the salivary glands (minor or major)
69
causes of sialadenitis
Viral: mumps and cytomegalovirus
Bacterial: Acute abscess and chronic sialadenitis
70
is the most common tumor of salivary glands tumor
pleomorphic adenoma
71
80% of salivary glands tumors occur in the
parotids
72
other name of the pleomorphic adenoma
Benign Mixed Salivary Gland Tumor
73
Gross Picture of Pleomorphic adenoma
Capsule: benign tumor with an incomplete capsule
outer surface: Lobulated outer surface
color: bluish white in color
consistency: Soft, Gelatinous Consistency
Cut section: Bulging With Rounded Borders & Cystic Areas.
74
Microscopic Picture of pleomorphic adenoma
mixed epithelial & mesenchymal differentiation
* Epithelial gland
* myoepithelial cells in solid groups
* Myxoid, hyaline, chondroid (pseudo-cartilage)
75
complication of pleomorphic adenoma
May undergo malignant transformation producing malignant mixed salivary gland tumor
76
It is a benign tumor formed of cystic spaces lined by eosinophilic cells and surrounded by dense lymphoid stroma
Warthin tumor
77
named adenolymphoma
Warthin tumor
78
is the most common primary malignant salivary gland tumor
Mucoepidermoid Carcinoma
79
A malignant tumor, more common in minor salivary glands
Adenoid cystic carcinoma
80
tumor of salivary gland has a tendency for perineural spread
Adenoid cystic carcinoma
81
microscopic picture of mucoepidermoid carcinoma
It consists of mucus-secreting cells, squamous cells and intermediate cells
82
microscopic picture of Adenoid cystic carcinoma
It is formed of small cells arranged in islands with microcystic changes
83
is a failure of embryological canalisation of the esophagus, & it is usually associated with an abnormal connection (fistula) between the patent proximal part of the esophagus and the trachea
Atresia
84
effect of atresia
The affected child cannot swallow and develops aspiration bronchopneumonia.
85
what is atresia
is a failure of emryological canalisation of the esophagus & it is usually associated with abnormal connection (fistula) between patent proximal ppart of the esophagus and the trachea
86
what is diverticulum
An outpouching of the wall of a hollow structure in the body, which can be saccular dilation of the full thickness or formed of herniation of mucosa and submucosa through defect in the muscle wall
87
types of diverticulum
traction (external forces pulling on the wall) or pulsion (forcible distension)
88
effect of diverticulum
difficulties in swallowing (dysphagia)
89
definition of the hiatus hernia
It is defined as the protrusion of the upper part of the stomach
into the thorax via the diaphragmatic orifice
90
Etiology of the hiatus hernia
increased intra-abdominal pressure and loss of diaphragmatic muscular tone with aging
predisposing factors: obesity, tear clothes, bending, lifting heavy weights, frequent coughing fits
91
Etiology of achalasia
o Patients usually present with
1) recurrent progressive dysphagia (difficulty in swallowing) and
2) vomiting of undigested food.
o Achalasia may be primary due to
1) neural degeneration
2) neurotropic infection with
- Trypanosoma cruzi (Chagas’ disease),
- varicella-zoster virus,
- measles and HSV1 .
o Achalasia also occurs in patients with autoimmune disease such as
- multiple sclerosis,
- Sjogren’s syndrome,
- patients with antibodies against myenteric neurons or
- other diseases impairing nerve function such as diabetes and alcoholism.
92
C/P of Achalasia
Achalasia results in slowing or retention of the food bolus with increasing obstruction and dilatation of the esophagus.
93
Treatment
94
Treatment of Achalasia
pneumatic dilatation or surgical myotomy of the lower sphincter
95
defintion of Esophageal varices
Dilated congested tortuous submucosal veins, in the lower end of the
esophagus, due to portal hypertension
96
etiology of esophageal varices
liver fibrosis or cirrhosis : the blood flow through the liver is
impaired leading to portal hypertension & opening of porto-systemic
anastomosis.
97
complications of Esophageal varices
Ulceration and Hematemesis
98
etiology of acute esophagitis
1. Infections :
- Herpes simplex type 1 virus, cytomegalovirus or Candida albicans
2. Ingestion of corrosive substances
99
pathogenesis of REFLUX ESOPHAGITIS, GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)
- Reflux of gastric juices is the major source of mucosal injury.
- Conditions which contribute to GERD are
1) smoking,
2) alcohol,
3) increased abdominal pressure,
4) pregnancy,
5) hiatal hernia
6) obesity.
100
gross of GERD
Hyperemia
101
microscopic picture of GERD
- Basal zone hyperplasia (exceeding 20% of the epithelium) & thinning of superficial epithelial layers.
- Neutrophil &/or eosinophil infiltration
102
symptoms of GERD
Dysphagia, heartburn, & regurgitation of gastric contents into the mouth
103
Complication of GERD
Ulceration, hematemesis, melena, stricture, or Barrett esophagus
104
what is Barrett esophagus
a complication of long standing GERD characterized by foci of
intestinal metaplasia (columnar epithelium with goblet cells) in the esophageal squamous mucosa
105
complication of barrett esophagus
develop esophageal adenocarcinoma
106
endoscopy of Barrett esophagus
appears as salmon-colored tongues replacing the pearly white
squamous epithelium of the esophagus
107
most frequently encountered benign esophageal tumors
smooth muscle
tumors (leiomyoma)
108
The only benign epithelial tumor of esophagus
squamous cell papilloma which may be linked to human papillomavirus (HPV) infection
109
risk factors of squamous cell carcinoma of esophagus
1. Tobacco
2. Alcohol
3. Nitrosamine in pickled food, or fungus contaminated food.
4. Vitamin deficiencies.
5. Repeated thermal injury due to hot beverages.
6. Human papillomavirus infection.
7. Squamous cancers develop from squamous epithelium and may be preceded by
dysplastic changes.
110
111
Gross of squamous cell carcinoma of esophagus
- Half of the tumors are in the middle third of esophagus.
- It starts as insitu carcinoma on top of dysplasia
and appears as grey white thickening.
- With invasion they present as
( polypoid mass - malignant ulcer or diffuse annular stricture )
112
spread of squamous cell carcinoma of esophagus
1. Local spread
- Spread to trachea and bronchi causing pneumonia.
- Spread to the mediastinum and pericardium.
- Spread to aorta causing severe hemorrhage.
2. Lymphatic spread:
- Tumors in upper third spread to cervical lymph nodes
- Tumors in middle third fspread to mediastinal, pretracheal and
tracheobronchial lymph nodes.
- Tumors in lower third spread to gastric and celiac lymph nodes.
113
complications of squamous cell carcinoma of esophagus
1. Dysphagia
2. Hematemesis
3. Tracheo-esophageal fistula
114
Risk factors of adenocarcinoma of esophagus
Gastro-esophageal reflux disease and Barrett's esophagus
115
Gross Picture of the adenocarcinoma
- Adenocarcinoma occurs in the distal third of esophagus.
- They present as exophytic mass, ulcer or diffuse annular stricture
116
Microscopic of adenocarcinoma of esophagus
- Tumors typically produce mucin & form glands.
- Barrett esophagus frequently is seen adjacent to the tumor
117
lining of the cardia
mucin secreting columnar cells
118
# li
lining of the antral
mucin secreting cells and G cells that secrete gastrin
119
lining of the fundus and body
parietal cells that secrete acids
120
lining of the fundus
parietal cells and chief cells that secrete pepsin
121
An abnormal hypertrophy of the circular muscle coat at the pylorus
Congenital Stenosis PYLORIC STENOSIS
122
clinical picture of the pyloric stenosis
projectile vomiting
123
pathogenesis of the acute gastritis
chemical agents 1) damage the epithelial cells
2) diminish secretion of mucus which protects against acid
3) inhibit prostaglandins synthesis by mucosal cells
124
causes the acute gastritis
1- Alcohol
2- Aspirin & non-steroidal anti-inflammatory agents (NSAIDs),
3- Cortisone & cytotoxic drugs.
4- stress
5- shock
6- sepsis
125
Gross Picture of the acute gastritis
- Edema & hyperemia.
- If injury is severe, erosions and hemorrhage occur (acute erosive hemorrhagic gastritis).
126
microscopic picture of acute gastritis
- Neutrophils invade the epithelium, with superficial epithelial erosion.
- Fibrinous luminal exudate.
127
Clinical picture of acute gastritis
- Dyspepsia (epigastric discomfort).
- Epigastric pain.
- Hematemesis or melena.
- Nausea & vomiting.
128
fate of acute gastritis
Healing by regeneration
129
what is type A gastritis
Autoimmune associated gastritis
130
Pathogenesis of autoimmune associated gastritis
- Destruction of parietal cells is the major pathogenic mechanism by cell mediated autoimmunity.
- Autoantibodies to parietal cells & intrinsic factor are also present in the serum.
- Parietal cell destruction leads to defective gastric acid secretion (achlorhydria),
- Reduced intrinsic factor production impedes B12 absorption & causes pernicious anemia.
131
132
which type of gastrits causes prenicious anemia?
Autoimmune associated gastritis
133
which type of gastrits causes achlorhydria
Autoimmune associated gastritis
134
Gross Picture of autoimmune associated gasrtritis
- Fundus & body are affected (typically spares the antrum).
- Mucosa appears thin paper like with loss of rugae & pallor.
135
Tumors Of The Nasopharynx
Juvenile Angiofibroma
Nasopharyngeal Carcinoma
136
Micro of nasopharyngeal carcinoma
[It may take one of three histological variants]:
* Keratinizing squamous cell carcinoma.
* Non-keratinizing squamous cell carcinoma.
* Undifferentiated carcinoma with excess lymphocytes in the stroma
lymphoepitheliomal
137
Complications of diphteria
1) Asphyxia
2) 2) Acute toxaemi may cause toxic myocarditis and necrosis of supra renal cortex and temporary paralysis
138
Nasal Polyp gross and micro
¶ Gross:
Multiple, soft, pink polyps projecting from mucosa of nose & sinuses
¶ Microscopic: 2 C [ cover + core ]
Ø Cover:
* Pseudostratified columnar ciliated (respiratory) epithelial cover,
but with chronic irritation it may changes to squamous (metaplasia)
* Thickened, pink basement membrane
Ø Core:
* Thick, very wide edematous core with many eosinophils,
* lymphocytes and plasma cells.
* Increased number of mucous glands (hyperplasia).
139
complication of nasal polyps
Nasal obstruction leading to 2ry infection & spread of the infection, & epistaxis
139
def of adenoids
Adenoids denote hyperplastic lymphoid tissue at the posterior wall of the nasopharynx, due to chronic infection in infants and children
140
characteristic adenoid face
Opened mouth, short upper lip, protruding upper incisors,
narrow nasal openings, absent nasolabial folds
141
Rhinoscleroma micro and gross
Morphology:
Ä Gross:
* The lesions appear as small hard nodular mass or masses filling the nasal cavity.
Ä Microscopic:
* There is a chronic inflammatory infiltrate involving the submucosa ,
* The inflammatory cells comprise:
Þ Mickulicz cells:
o these are the predominant cells.
o They are macrophages with foamy cytoplasm.
o They are large with a small pyknotic nucleus.
Þ Plasma cells and Russell bodies:
( Plasma cells with hyaline change due to accumulated immunoglobulin)
* Later there is fibrosis
142
related to mickulicz cells
Rhinoscleroma
143
causative agent of Nasopharyngeal Carcinoma
EBV
144
Squamous Cell Papilloma Of Larynx caused by
HPV 6 & 11
145
Squamous Cell Papilloma Of Larynx G&M
¶ Gross: Fine finger-like surface protrusions.
¶ Microscopic: 2 C [cover + core ]
Ø Cover:
covered by hyperplastic stratified
squamous epithelium, showing hyperkerotosis,
parakeratosis and acanthosis.
Ø Core: Papillary thin fibrovascular core
146
Squamous Cell Carcinoma- Larynx G&M
Morphology:
Ø Gross: Ulcerating or fungating tumors.
Ø Microscopic: Squamous cell carcinoma. Glottic tumors are usually keratinizing and better differentiated than others.
146
Squamous Cell Carcinoma- Larynx complications
Ø Spread:
- Direct to nearby structures (esophagus, trachea & pharynx)
- Lymphatic to cervical lymph nodes, especially supraglottic tumors because this area is rich in lymphatics.
146
Malignant Mesothelioma GM
Gross:
§ Mesothelioma is usually unilateral, starting as small nodules on the visceral pleura and extends to cover the whole lung and obliterate the pleural cavity.
§ The tumor is yellowish white.
Microscopic:
Epithelioid type Cuboidal cells forming papillae and acini (looks like adenocarcinoma)
Sarcomatoid type sheets of spindle malignant cells (looks like sarcoma)
Mixed type (biphasic): Epithelial + sarcomatous
146
Causes of hemoptysis
Causes:
1. Bronchitis, bronchiectasis, pneumonia, lung abscess
2. Chronic fibrocaseous tuberculosis
3. Carcinoid tumor, carcinoma of the lung and secondaries of the lung.
4. Chronic venous congestion of the lung
5. General causes as leukemia, hemophilia , purpura, vitamin C and K
deficiency.
146
Bronchopneumonia G&M
Gross: Usually bilateral lower lobe affection
* Bronchioles: contain pus
* Patchy areas of yellow consolidation (purulent exudate in alveoli), some areas may become confluent.
* Pleurisy.
* Enlarged hilar lymph nodes (lymphadenitis).
Microscopic:
- Suppurative (neutrophilic) exudation filling bronchi, bronchioles, and alveoli.
- Alveoli: The alveoli are full of pus (patchy areas of consolidation)
147
adult respiratory distress syndrome ARDS related to
Atypical pneumonia
147
causative agent of atypical pneumonia
Mycoplasma pneumoniae
147
bronchoectasis GM
Gross:
§ Site: is mostly bilateral, Most severe changes occur in peripheral lower lobes.
Medium sized bronchi & bronchioles:
ü Airways can be dilated up to four times the normal size.
ü The bronchi appear thickened, with suppuration of their lining.
ü The dilated bronchi could be seen from hilum till the pleura
Microscopic:
Bronchi
§ Lumen: filled with pus & blood.
§ Lining respiratory epithelium shows areas of ulceration.
§ Wall shows intense acute and chronic inflammatory cells and fibrosis.
Alveoli
§ Adjacent alveoli undergo fibrosis.
§ Patches of compensatory emphysema (to compensate for
nonfunctioning alveoli).
Pleura § Fibrosis and adhesions.
147
Bronchoecatasis complications
a. Hemoptysis with abundant foul smelling, yellowish red sputum (pus + blood).
b. Lung abscess- gangrene.
c. Spread of infection (see septic bronchopneumonia).
d. Bilateral lung fibrosis , pulmonary hypertension & right sided heart failure
(cor pulmonale).
e. Secondary amyloidosis (chronic destructive condition).
f. Squamous metaplasia
147
Pulmonary Hypertension causes
a. Chronic obstructive or interstitial lung disease.
b. Recurrent pulmonary emboli.
c. Mitral stenosis.
d. Congenital left to right shunt due to increased pulmonary blood flow
e. Idiopathic or primary pulmonary hypertension
147
lung cancer complication
Direct:
§ to the pericardium, medi
astinum and esophagus.
§ Pleural seeding especially in adenocarcinoma
Lymphatic:
§ To the hilar and mediastinal lymph node.
§ The supraclavicular node affection (Virchow’s node) may be the first
presentation.
Ä Blood spread: To the brain, bones, liver, adrenals or other lung.
B) Hemoptysis.
C) Obstruction leading to collapse, secondary infection, bronchiectasis or lung
abscess.
D) Paraneoplastic syndrome:
§ 3-10% of patients with lung cancer develop clinical paraneoplastic syndrome
due to secretion of polypeptide hormones.
§ It presents in one or more of the following forms:
ü Hypercalcemia.
ü Cushing syndrome.
ü Myasthenia gravis.
ü Excess ADH.
