Path Flashcards
1
Q
atelectasis
A
collapse of previously inflated lung resulting in relatively airless pulmonary parenchyma
2
Q
ARDS/DAD
A
HYALINE MEMBRANE
EDEMA
3
Q
emphysema
A
loss of elastic recoil of lung: abnormal PERMANENT enlargement of airspaces by destruction of their walls
4
Q
centriacinar emphysema
A
HEAVY SMOKING
UPPER lobes
5
Q
panacinar emphysema
A
alpha1-antitrypsin deficiency
LOWER lobes
6
Q
paraseptal emphysema
A
underlies SPONTANEOUS PNEUMOTHORAX
7
Q
chronic bronchitis
A
persistant cough with sputum at least 3 months in at least 2 consecutive years
increased REID index
large airway: submucosal gland hypertrophy
small airway: increase goblet cells
peribronchial fibrosis
8
Q
asthma
A
chronic inflammatory disorder of airways: increased responsiveness to stimuli
inflammation damages and perpetuates bronchoconstriction
overinflation, mucous plugs
EOSINOPHILS
CURSCHMANN SPIRAL
CARCOT LYDEN crystals
9
Q
bronchiectasis
A
permanent airway dilation with smooth muscle and elastic tissue destruction
repeated airway obstruction and inflammation lead to fibrosis
10
Q
obstructive lung disease
A
lung does not empty
11
Q
list of obstructive lung diseases (4)
A
emphysema
chronic bronchitis
asthma
bronchiectasis
12
Q
Two functions of type II pneumocyte
A
surfactant
repair
13
Q
resorption atelectasis
A
airway obstruction by mucous plugs, tumor
resorption of trapped O2 in dependent alveoli
mediastinum shifts TOWARD affected lung
14
Q
compression atelectasis
A
filling of pleural cavity by tumor, blood, air
compression of pulmonary tissue
mediastinum shifts AWAY from affected lung
15
Q
contraction atelectasis
A
fibrotic lung or pleura
prevention of full expansion
NOT reversible
16
Q
COPD
A
combination of emphysema and chronic bronchitis
17
Q
alpha1- antitrypsin deficiency
A
PANACINAR emphysema
LIVER CIRRHOSIS: PAS positive hyaline globules (misfolded protein accumulates in ER of hepatocytes)
18
Q
alpha 1 antitrypsin
A
neutralize proteases (elastase) released by inflammatory cells
19
Q
PiZZ
A
A1AT deficiency homozygote at risk for panacean emphysema and liver cirrhosis
20
Q
PiMZ
A
A1AT deficiency heterozygote: low levels of A1AT; ok unless smoke
21
Q
bullae
A
markedly enlarged subpleural airspaces
prone to rupture: results in pneumothorax
22
Q
What is the role of smoking in chronic bronchitis?
A
chronic irritation from inhalation results in mucous hyper secretion
23
Q
Reid index
A
ratio of thickness of the mucous gland layer to the thickness of the wall between the epithelial basement membrane and cartilage
normal: 0.4
increased in: chronic bronchitis
24
Q
extrinsic asthma
A
type I hypersensitivity reaction to inhaled allergen
IgE
MAST cells
25
intrinsic asthma
non-immunologic reaction: precipitated by respiratory infection, stress, exercise, cold, drugs, etc.
26
histological aspects of asthma
1. thickened BM
2. submucosal gland hypertrophy
3. bronchial wall smooth muscle hypertrophy
4. eosinophils
27
causes of bronchiectasis
1. cystic fibrosis
2. Kartagener
3. necrotizing pneumonia
4. bronchial obstruction
28
cystic fibrosis
chloride transport defect results in thick obstructive secretions
29
Kartagener
immotile cilia syndromes: interferes with bacterial clearance
30
tracheoesophageal (T-E) Fistula
failure of fetal respiratory tract to separate from GI tract
| FOREGUT
31
alveolar stages
1. glandular: thick walls, lots of CT, cuboidal
2. saccular: transition to flat, type I and type 2 alveolar cells
3. alveolar stage: reduction of interstitial tissue and increase capillaries
NOT histologically mature until: age 8
32
rhinitis
inflammation of nasal mucosa
rhinovirus: common cold or allergic (type I)
repeated: NASAL POLYPS
33
nasal polyps
edematous, inflamed nasal mucosa
| causes: repeated rhinitis, CF, aspirin intolerant asthma
34
aspirin intolerant asthma
asthma
aspirin induced bronchospasm
nasal polyps
35
angiofibroma
benign tumor of the nasal mucosa composed of large blood vessels and fibrous tissue
Sx: profuse epitaxis
36
chronic interstitial/restrictive lung disease
heterogenous group
dyspnea and reduced lung capacity
results in diffuse scarring
37
honeycomb on CT
END STAGE of restrictive diseases
38
idiopathic pulmonary fibrosis (IPF)
patchy INTERSTITIAL fibrosis, lower lobe sub pleural distribution
Masson bodies, collagenized areas, mild lymphocytic inflammation
Sx: dyspnea on exertion, dry cough
Tx: NONE
must rule out secondary cause
TGF-B from injured pneumocytes: fibrosis
usual interstitial pneumonia (UIP): histologically
39
pneumoconioses
non-neoplastic lung rxn to inhaled dusts (coal, silica, asbestos, berylliosis, etc.)
40
hypersensitivity pneumonitis
prolonged exposure to inhaled dusts
type IV sensitivity: T cells (NO eosinophils)
GRANULOMA
to prevent fibrosis: remove environmental irritant
ex: farmer's lung, bird fancier's lung, etc.
interstitial fibrosis
41
Masson body
fibroblast foci
| believed to be sites of recent injury
42
collagen vascular disease-associated lung disease
RA, scleroderma, mixed connective tissue disease
| UIP histologically
43
cryptogenic organizing pneumonia (COP)
INTRA-ALVEOLAR: CT in bronchioles, alveolar ducts, and alveoli (all SAME AGE)
Tx: steroids
44
simple coal workers pneumoconiosis (CWP)
UPPER lobe
little or no pulm. dysfunction
coal dust macules (dust accumulation adjacent to respiratory bronchioles with/out dilated adjacent alveoli (emphysema)) and nodules (carbon-laden macrophages with collagen)
45
complicated coal workers pneumoconiosis (CWP)/ progressive massive fibrosis
lung function compromised
develops in those with simple CWP
black scars composed of pigment and dense collagen
associated with: RA
46
anthracosis
CWP
| carbonaceous pigment in macrophages that accumulates in CT along lymphatics and in lymph tissue
47
silicosis
SANDBLASTERS, MINE WORKERS, STONE cutters
progressive nodular fibrosis
UPPER lobes and hilar nodes
macrophages: ingest silica and release fibrogenic mediators
collagenous nodules, birefringent silica particles
increased susceptibility to TB
48
beryllium
SPACE industry, MINERS
non-caseating GRANULOMA: lung, hilar lymph nodes, organs
increased chance of lung CA
49
non-neoplastic asbestos-related diseases
1. diffuse pleural fibrosis
2. benign pleural effusions
3. plerual plaques
4. parenchymal interstitial fibrosis (Asbestosis)
MORE COMMON than cancer
50
parenchymal interstitial fibrosis (asbestosis)
Sx: slowly progressive dyspnea
heavy ASBESTOS exposure: 20 yr latency
initial injury: respiratory bronchioles and alveolar ducts: results in fibrosis of adjacent alveoli
51
drug/radiation pneumonitis
chemo (busulfan) or radiation to chest
52
sarcoidosis
```
AA female south
non-caseating GRANULOMA (hilar lymph nodes, lung, skin)
Sx: dyspnea, cough, non specific
Tx: steroids
CD4:CD8 ratio greater than 2.5
disease of EXCLUSION
```
53
desquamative interstitial pneumonia (DIP)
SMOKING
peribronchiolar
Tx: stop smoking, steroids
54
respiratory bronchiolitis
SMOKING
peribronchiolar
Tx: stop smoking, steroids
55
pulmonary langerhans cell histiocytosis
```
YOUNG SMOKERS
rare
Tx: quit
BRAF mutation
leads to alveolar damage and airway destruction
Langerin, S-100, CD1a
NO CD68
```
56
pulmonary alveolar proteinosis
rare
defect in GM-CSF or macrophages: accumulation of surfactant
can be autoimmune, secondary (malignancy or immunodeficiency), or hereditary (infants)
57
pneumocystis jirovecii
yeast fungus
| IMMUNOCOMPROMISED: HIV
58
pulmonary embolism
most from deep leg vein thrombi
immobilization, hypercoaguable states
adequate CV function: bronchial arterial supply sufficient to sustain distal lung tissue
inadequate pulmonary circulation (cardiac or pulmonary disease): infarction (10%)
59
secondary pulmonary hypertension causes
cardiopulmonary conditions that increase pulmonary blood flow/pressure/vascular resistance or left heart resistance to flow
1. chronic obstructive or interstitial lung disease
2. cardiac disease
3. recurrent thromboemboli
60
primary pulmonary hypertension
female, 20s-40s
Sx: dyspnea, fatigue
inactivating BMPR2 mutation: proliferation of vascular sm. muscle
61
How does chronic obstructive or interstitial lung disease lead to pulmonary HTN?
hypoxia and fewer alveolar capillaries from parenchymal destruction leads to increase pulmonary arterial resistance and pressure
62
How does cardiac disease lead to pulmonary HTN?
mitral stenosis causes elevated left atrial pressure that increases pulmonary venous and arterial pressure
63
How do recurrent pulmonary thromboemboli lead to pulmonary HTN?
decrease in functional area of pulmonary vascular bed leads to increased vascular resistance
64
good pasture
male, teens, smokers
autoimmune disorder with Ab to alpha-3 chain of collagen IV
destruction of BM in kidney glomeruli and lung alveoli
Sx: pulmonary hemorrhage
65
idiopathic pulmonary hemosiderosis
pulmonary hemorrhage disease
66
lupus erythematosus
vasculitis with pulmonary hemorrhage
67
wegener granulomatosis (polyangiitis with granulomatosis)
med. to small vessel vasculitis
| Sx: necrotizing granulomas of respiratory tract, glomerulonephritis, pulmonary hemorrhage
68
hemodynamic pulmonary edema causes
1. increased hydrostatic pressure: left heart failure
| 2. decreased oncotic pressure: liver disease
69
causes of pulmonary edema due to microvascular injury
1. infection
2. inhaled smoke and other gases
3. shock
70
acute lung injury/ ARDS (acute respiratory distress syndrome)
rapid onset of severe life-threatening respiratory insufficiency and hypoxia
caused by diffuse alveolar capillary damage
DECREASE COMPLIANCE
HIGH GRADE INFLAMMATION
high MORTALITY
HYALINE MEMBRANES, WHITE OUT CXR, non cardiogenic EDEMA
Sx: hypoxemia, cyanosis
Tx: underlying cause, PEEP, PRONE ventilation, diuresis as needed, NO (improves oxygenation, does NOT improve mortality)
SHUNT: does not respond to O2
complication: interstitial fibrosis (reduced DLCO), pneumothorax
death is due to: MULTI ORGAN FAILURE
71
diffuse alveolar damage (DAD)
histological manifestation of ARDS and neonatal RDS
72
neonatal RDS
preterm infants with deficient surfactant (28 weeks production, 34 weeks sufficient surfactant)
L:S ratio greater than 2: have enough surfactant
cause: premature, C-section, DM in mom
Sx: hypoxemia, cyanosis, tachypnea, increased respiratory effort, GROUND GLASS CXR
complications: patent ductus arteriosus, necrotizing enterocolitis
complications of supplemental O2: blindness, bronchopulmonary dysplasia
73
Direct lung injury causes of ARDS
DIRECT injury:
1. infection (pneumonia/ aspiration)
2. injury: trauma, near drowning, burns
3. inhaled irritants: O2 toxicity, smoke
4. fat emboli
74
pathophysiology of acute lung injury
1. INFLAMMATORY MEDIATORS: macrophages release: IL-8, IL-1 and TNF
2. NEUTROPHILS move from vasculature into alveolar space
3. INCREASED PERMEABILITY: neutrophils release leukotrienes, oxidants, proteases, PAF that cause endothelial and epithelial injury
4. PROTEIN RICH EDEMA in airspace, SURFACTANT INACTIVATION, hyaline membrane formation
5. macrophage TGF-B and PDGF stimulate fibroblasts
75
What happens in acute stage of acute lung injury?
endothelial: vasculature leakage
epithelial: cell sloughing
edema, hyaline membrane, atelectasis
76
What happens in the organizing stage of acute lung injury?
type II cell proliferation
| interstitial inflammation: recovery, interstitial fibrosis, death
77
congestion stage of pneumonia
vascular engorgement and edema
few PMN
numerous bacteria
78
red hepatization stage of pneumonia
massive congestion
| abundant PMNs and fibrin
79
gray hepatization stage of pneumonia
disintegration of RBC, macrophages
| fibrinopurulent exudate
80
resolution stage of pneumonia
enzymatic digestion
| resorption by macrophages
81
aspiration pneumonia
risk: alcoholic, comatose, drugs
anaerobic from oropharynx
RIGHT LOWER lobe abscess
82
bronchogenic cysts
arise from abnormal detachments of primitive foregut and usually present with compression of nearby structures or are found incidentally
83
pulmonary sequestration
discrete area of lung tissue that lacks connection to the airway system and has an abnormal blood supply arising from the aorta
84
hamartoma
benign nodules of overgrowth mature connective tissue (in normal location)
karyotype: 6p21 or 12q14-15
85
causes of primary lung carcinoma
1. smoking (number 1)
2. industrial: radiation, uranium
3. asbestos: synergistic with smoking
4. air pollution
5. radon (number 2)
86
small cell carcinoma
presents at advanced stage
| Tx: chemo, radiaiton
87
Non-small cell carcinoma
more resistant to chemo
Tx: surgery with/out chemo, radiation
operate on I, II, IIIA (not past lung, involves structures that can be removed)
IIIb, IV (out of chest): not operable
88
lung adenocarcimona
```
most common: female, non-smoker
PERIPHERAL
GLANDS, MUCIN
sometimes pneumonia like consolidation
lepidic pattern
horner syndrome sometimes
stain: TTF-1 positive, CK-7 positive
```
89
squamous cell carcinoma
```
males, SMOKERS
CENTRAL
central necrosis/CAVITATION
KERATIN PEARLS, INTRACELLULAR BRIDGES
PTHrP: HYPERCALCEMIA
Stain: p40
```
90
large cell lung carcinoma
PERIPHERAL
large nuclei with prominent nucleoli and vesicular chromatin
POOR PROGNOSIS
91
small cell lung carcinoma
SMOKING
high grade NEUROENDOCRINE
CENTRAL: with mediastinal lymphadenopathy
AGGRESSIVE, RAPID growth with widespread metastases
more chemo/radiosensitive: good response, but comes back (high mortality)
abundant mitoses, small blue cells with scant cytoplasm and granular (SALT and PEPPER) chromatin
ADH: hyponatremia
ATCH: cushings
Lambert-Eaton syndrome: muscle weakness
stain: CHROMOGRANIN, SYNAPTOPHYSIN
MEDICAL disease, limited vs extensive
92
carcinoid tumor
```
50-70, often incidental finding
low grade NEUROENDOCRINE carcinoma
central or peripheral
bland cells with granular chromatin, dense core granules
CHROMOGRANIN
```
93
what does prognosis of lung carcinoma depend on?
stage (TMN)
T: size (invasion of pleura, bronchus, etc., distance from carina)
N: nodes
M: metastases
94
K-ras mutation
25% of ADENOCARCINOMA in SMOKERS
95
EGFR mutations
10-25% of ADENOCARCINOMAS
| non-smoker, FEMALE, ASIAN
96
ALK mutations
ADENOCARCINOMA
| mucin stain?
97
local effects of lung cancer spread
1. tumor obstruction of airway: pneumonia, abscess, collapse
2. recurrent laryngeal nerve invasion: hoarse
3. superior vena cava compression: superior vena cava syndrome
4. sympathetic ganglion invasion: horner syndrome
98
horner syndrome
PANCOAST tumor: just above lung
sympathetic nerve ganglion invasion
Sx: one sided: mild ptosis (drooping), miosis, lack of sweating, red half of face
99
Lambert-Eaton syndrome
Ab to voltage gated Ca channels
| muscle weakness
100
common origins of metastatic lung cancer
MOST COMMON site of metastatic tumors
carcinoma (lymph): breast, colon, lung, melanoma
sarcomas: blood
101
common origins of metastatic pleural tumors
MORE common than primary
| lung, breast
102
malignant mesothelioma
```
parietal or visceral pleura
ASBESTOS
long latency:20 + years
SIMIAN virus 40 assoc.
Chromsome deletions: 1p, 3p, 6q, 9p, 22q common
Sx: chest pain, dyspnea, effusion
rapid course: 50% die in less than a year
Tx: surgery, chemo/radiation
```
103
histologic types of malignant mesothelioma
1. epithelioid (most common): can resemble metastatic adenocarcinoma
2. sarcomatoid: resembles sarcoma
3. biphasic: mix of both
104
how do you distinguish mesothelioma from adenocarcinoma?
1. histochemical stain
2. immunohistochemical stain
3. electron microscopy
```
mesothelioma
1. hyaluronic acid
2. calretinin
3. long slender microvilli
Adenocarcinoma
1. mucin
2. CEA (carcinoembryonic antigen)
3. stubby microvillus rootlets
```
105
nasopharyngeal carcinoma
malignant epithelial cancer
EBV association
cervical lymph nodes are often involved
106
laryngeal papilloma
benign: papillary lesion of vocal cord
HPV 6 and 11
single in adults
multiple in children
107
laryngeal carcinoma
squamous cell carcinoma arising from vocal cord
| risk: ALCOHOL, TOBACCO
108
Primary lung cancer vs. Secondary lung cancer
primary: one nodule
secondary: multiple nodules
lung adenocarcinoma: colonic adenocarcinoma metastasis: taller longer cells, dirty necrosis
109
CK20
stain
positive if origin of cancer is below the waist
ex: colonic that metastasize to lung
110
CK7
stain
positive if origin of cancer is above the waist
ex: originate from lung
111
p40
stain
| squamous cell lung carcinoma
112
CA19
stain
| pancreatic adenocarcinoma
113
CDX2
stain
| colonic adenocarcinoma
114
performance status
poor (status 3 or 4): can't tolerate surgery, chemo, or radio
respectability also depends on if patient can survive removal of whole lobe or the lung
0: perfect
1: less than 25% have to rest/nap during day
2: less than 50%
3: less than 75%
4: have to rest entire day
5: dead
115
Tx of NSCLC by stage of cancer
I: surgery
II: surgery (radiation if unable to under go surgery), then chemo (adjuvant)
III: radiation and chemo
IV: chemo, immune Rx, palliative radiation
116
adjuvant tx
surgery, then chemo
117
neoadjuvant tx
radiation to shrink, then surgery
118
Indirect lung injury causes of ARDS
INDIRECT injury:
1. SEPSIS
2. chemical injury: heroin overdose
3. shock (hypoperfusion)
4. hematologic: multiple transfusions: TRALI (transfusion related acute lung injury)
4. cardiopulmonary bypass
6. acute pancreatitis
119
Causes of ARDS in unknown category
1. hypersensitivity rxn
| 2. uremia
120
4 stages of ARDS and their time frames
1. exudative (acute): 0-4 days
2. proliferative: 4-8 days
3. fibrotic: greater than 8 days
4. recovery
121
factors that increase the risk of death in ARDS
1. chronic liver disease
2. non-pulmonary organ dysfunction
3. sepsis
4. old age
122
When is pneumothorax after ARDS most prevalent?
after 2 weeks of ARDS onset
