PATH LAB 1

Question 1

What x-ray features may be present in cor pulmonale?

Answer 1

In chronic cor pulmonale, right ventricular dilation and hypertrophy, as well as increased vascular markings at the hilum, are seen in a chest x-ray.

Question 2

Why is emphysema considered to be an obstructive airway disease? Is there any mechanical obstruction?

Answer 2

Because emphysema affects the peripheral airways, it is not, anatomically speaking, an obstructive disease, and there is no mechanical obstruction. However, it is functionally an obstructive disease, because destruction of the septal walls prevents the elastic recoil that is necessary to push air out of the lungs. Thus, in effect, there is limitation of airflow, just as there would be if there were mechanical obstruction.

Question 3

Why are heavy smokers at risk for the development of multiple tumors of the upper aerodigestive tract?

Answer 3

These lesions result from the so-called field effect, ie, the entire upper aerodigestive tract has been damaged by exposure to tobacco-related carcinogens, develops multiple preneoplastic lesions, and is at increased risk for the development of one or more cancers.

Question 4

Tumors that show lepidic growth exclusively are known as ____________.

Answer 4

bronchioloalveolar carcinomas

Question 5

Whay pulmonary malignancy is associated with clubbing?

Answer 5

Adenocarcinoma

Question 6

What is the meaning of the term asthmatic bronchitis?

Answer 6

Some patients with clinically manifest chronic bronchitis (persistent productive cough for at least three consecutive months in at least two consecutive years) have hyperresponsive airways and intermittent episodes of bronchospasm. This condition is called asthmatic bronchitis.

Question 7

What role do eosinophils play in causing tissue damage?

Answer 7

Major basic protein of eosinophils causes epithelial damage and shedding.

Question 8

What is the most common cause of cardiogenic edema?

Answer 8

Increased hydrostatic pressure from left-sided heart failure.

Question 9

What parts of the lung are likely to be more severely involved by congestion and edema?

Answer 9

Basal regions of the lower lobes, since hydrostatic pressure is greater in these sites.

Question 10

What are the components of an asbestos body?

Answer 10

Asbestos bodies appear as golden brown fusiform or beaded rods with a translucent center; they are asbestos fibers coated with an iron-containing proteinaceous material.

Question 11

What are the usual causes of pulmonary infarction?

Answer 11

Infarcts are caused by thromboembolism, the source of emboli being deep vein thrombosis in the leg. However, infarcts tend to occur only when pre-existing lung or heart disease compromises the oxygenation of the lung.

Question 12

Are the bony metastases in SCLC osteoblastic or osteolytic?

Answer 12

They may be of either type. While many tumors cause osteolytic metastases, the most common sources of osteoblastic metastases are small cell lung cancer and carcinomas of the prostate gland and breast.

Question 13

What would the histologic finding be in edema due to microvascular injury?

Answer 13

Hyaline membrane formation.

Question 14

What anatomical features distinguish bronchi from bronchioles?

Answer 14

Bronchi have larger lumina, a continuous muscular layer, mucosal glands, and cartilage.

Question 15

In severe, long-standing pulmonary hypertension, the pulmonary artery develops ____________.

Answer 15

accelerated atherosclerosis

Question 16

Does smoking increase the chances of developing the malignancies associated with asbestos?

Answer 16

Smoking increases the risk of lung carcinoma, but not of mesothelioma. Asbestos workers who smoke have ten times the risk of lung cancer compared to asbestos workers who aren’t smokers.

Question 17

While brain metastases are common with lung cancers, especially SCLC and adenocarcinoma, ___________ is characteristic of SCLC.

Answer 17

diffuse leptomeningeal spread

Question 18

What are the major causes of cavitary lesions in the lung?

Answer 18

Pulmonary tuberculosis is the most common cause. A cavitating tumor, especially squamous cell carcinoma, is the next most common. Other causes are relatively uncommon and include lung abscesses and Hodgkin lymphoma.

Question 19

Hemosiderin. Acute or chronic passive congestion.

Answer 19

Chronic

Question 20

What is the difference between overinflation and emphysema?

Answer 20

Overinflation refers to expansion of all or part of a lung due to mechanical obstruction and consequent trapping of air in the lung. Obstruction may be caused by a tumor or foreign body, as well as by bronchoconstriction and mucus. In emphysema, there is no mechanical obstruction; instead, there is functional obstruction of airflow.

Question 21

What other tumors are associated with leptomeningeal spread?

Answer 21

In particular, the childhood leukemias.

Question 22

As this infarct heals, what morphologic evidence will remain?

Answer 22

Subpleural fibrosis and scar formation with puckering of the overlying pleura.

Question 23

Name some of the other causes of acute pulmonary congestion.

Answer 23

Mitral stenosis, fluid overload, pulmonary vein obstruction, liver failure, and renal failure.

Question 24

Are there extrapulmonary lesions in sarcoidosis? What organs are commonly involved?

Answer 24

While almost any organ may be involved, common sites include eye, salivary glands, skin, spleen and liver.

Question 25

Are all forms of asthma associated with type I hypersensitivity reactions?

Answer 25

No. Intrinsic asthma is not triggered by type I hypersensitivity. The precise causes of hyperreactive airways in intrinsic asthma are not known.

Question 26

What is the pathogenesis of hyaline membrane formation?

Answer 26

Alveolar hyaline membranes consist of fibrin-rich edema fluid mixed with the cytoplasmic and lipid remnants of necrotic epithelial cells.

Question 27

What are the typical symptoms and signs in a patient who suffers nonlethal pulmonary infarction?

Answer 27

Symptoms may resemble an acute myocardial infarct. Small emboli cause pleuritic pain and cough. Surprisingly, many emboli, even large ones, may be asymptomatic.

Question 28

What is responsible for the accumulation of eosinophils, in asthma?

Answer 28

Eosinophils are attracted by chemotactic factors released by mast cells and also by the chemokine eotaxin. The latter is produced by bronchial epithelial cells. Eosinophil accumulation is also favored by IL-5, a T-cell-derived cytokine.

Question 29

Name some of the other conditions in which abundant iron pigment is present in the lungs.

Answer 29

When there is a local or systemic excess of iron, ferritin forms hemosiderin granules. Any form of pulmonary hemorrhage, including thromboembolism, acute left-sided heart failure, Goodpasture syndrome, and idiopathic pulmonary hemosiderosis, may result in accumulation of iron in the lung.

Question 30

Normal molecules secreted by neuroendocrine cells of the lung

Answer 30

serotonin, calcitonin, and gastrin-releasing peptide

Question 31

How do these changes (seen in silicosis) compare with those found in asbestosis?

Answer 31

The pulmonary fibrosis of asbestosis is characterized by the presence of asbestos bodies and the absence of large nodules. Striking pleural changes are often present in asbestosis.

Question 32

What happens to the asbestos fiber after ingestion by the macrophage?

Answer 32

The macrophages coat the fibers with ferritin and other proteinaceous materials, because the macrophages cannot digest the fibers.

Question 33

Are other diseases associated with HPO?

Answer 33

Yes. A variety of chronic pulmonary diseases and some congenital heart diseases, especially those with increased pulmonary blood flow, may be associated with hypertrophic pulmonary osteoarthropathy.

Question 34

How can epithelioid mesotheliomas be distinguished from adenocarcinoma?

Answer 34

Evidence of mucin formation would be diagnostic of adenocarcinoma. Electron microscopic evidence of long, branching microvilli is characteristic of mesotheliomas. A large number of cell-surface and cytoplasmic antigens are considered to be of diagnostic usefulness, but none is totally specific.

Question 35

What caused the cavity in this tumor?

Answer 35

Necrosis of tumor cells that had inadequate blood supply.