Path Pics Flashcards
Name cells that white arrows point to.
Type II pneumocyte
Name cells at black arrows.
club cells or clara cells
What type of cell is this?
What do the arrows point to?
type II pneumocyte
lamellar bodies
Name the cell.
macrophage
Name the cell.
alveolar macrophage
Name the cell.
Why does this cell look this way?
alveolar macrophage: crack cocaine user
resorption atelectasis:
tumor obstructing right bronchus, markedly reduced right lung volume and right mediastinal shift
compression atelectasis:
left pneumothorax from chest wall trauma, left lung collapse and right mediastinal shift
What is at the arrow in this liver?
What disease does it indicate?
What lung disease will this person have?
pink PAS positive hyaline globules
alpha 1 antitrypsin deficiency
panacinar emphysema
What type of emphysema effects this part of the acinus?
centriacinar
emphysema: hyperinflation
hyperinflation of lungs: emphysema
What is at the arrow?
What disease is this?
centriacinar emphysema: enlarged airspaces with tissue destruction at APEX
What is at the arrows?
What disease is this?
central part of acinus has abnormally large airspace with club-shaped alveolar septa that appear to be free floating
centriacinar emphysema
What type of emphysema effects this part of the acinus?
panacinar emphysema: whole acinus is affected
destruction with airspace dilation is most severe in lower lobe
Panacinar emphysema
relatively uniform dilation of all parts of acini
panacinar emphysema
What type of emphysema effects this part of the acinus?
paraseptal emphysema: distal acini adjacent to interlobular septa and pleura affected
paraseptal emphysema
bullae: markedly enlarged subpleural airspaces
paraseptal emphysema: distal airspaces immediatley beneath the pleural space have marked dilation
chronic bronchitis: submucosal gland hypertrophy
chronic bronchitis: lymphocytes (arrow) surround the bronchial epithelium
chronic bronchitis: goblet cells (arrows) increased
mucous plug
asthma
asthma: thick BM with eosinophilic inflammation
Asthma: Charcot-Leyden (disintegrated eosinophils) and eosinophils
asthma: Curschmann spirals (mucous tight coils)
bronchiectasis: dilated airways exted almost to pleura
bronchiectasis: saccular dilation of airways with surrounding fibrosis
bronchiectasis: airway dilation accompanied by surrounding fibrosis and luminal pus
allergic rhinitis: type I hypersensitivity
arrow: Charcot-Leyden crystals
star: inflammation
nasal polyp with stromal edema and eosinophils
angiofibroma: large blood vessels and fibrous tissue
subpleural “net-like” reticulations (arrow)
idiopathic pulmonary fibrosis
patchy interstitial fibrosis (white arrow) that is most severe subpleurally with interveneing normal tissure
idiopathic pulmonary fibrosis
usual interstitial pneumonia (UIP): patchy interstitial fibrosis most severe subpleurally
indicitive of IPF or collagen vascular associated lung disease
usual interstitial pneumonia (UIP): localized areas of fibroblastic proliferation (arrows: fibroblast foci)
lymphocytes
usual interstitial pneumonia (UIP)
arrows: densely collagenized fibrosis
asterik: honeycomb cysts lined with metaplastic bronchiolar epithelium
usual interstitial pneumonia (UIP)
seen in IPF and collagen vascular disease associated lung disease
cryptogenic organizing pneumonia (COP)
intra-alveolar plugs of loose fibroconnective tissue (arrows)
organizing pneumonia following adult respiratory distress syndrome: alveolar duct plugged by loose fibroconnective tissue (arrows)
similar to COP: need clinical information to differentiate
simple coal workers pneumoconiosis
arrow: coal dust macule with dilated adjacent airspaces (localized emphysema)
complicated coal workers pneumoconiosis
BLACK LUNG
silicosis: dense collagenized nodule with surrounding lymphocytes
silicosis: birefringent silica particles under polarized light
asbestos
right: straight stiff: more pathogenic
left: curly flexible
pleural plaques (dense collagen): arise on parietal pleura and diaphragmatic domes
seen in asbestos inhalation
ASBESTOS bodies: iron coated asbestos
ASBESTOS bodies: iron coated on Prussian blue
asbestosis: diffuse interstitial fibrosis (looks like UIP) with asbestos bodies
Drug-induced pneumonitis: mild interstitial fibrosis with lymphocytes and type II pneumocyte hyperplasia (arrows)
sarcoidosis
gramuloma (arrow) alond bronchovascular bundles and interlobular septa
sarcoidosis
granuloma surrounding bronchiole
sarcoidosis: non-caseating granulomas with giant cells
asteroid bodies
sarcoidosis and other granulomatous diseases
Schaumann bodies (calcification)
sarcoidosis and other granulomatous diseases
hypersensitivity pneumonitis: lymphocytic interstitial inflammation and fibrosis is centered on bronchiole (arrow)
hypersensitivity pneumonitis
granuloma with giant cells surrouned by lymphocytes
hypersensitivity pneumonitis
plug of organizing pneumonia with lymphocytes
end stage hypersensitivity pneumonitis
HONEYCOMB LUNG: end stage of many interstitial fibrosisng lung diseases
desquamative interstitial pneumonia or respiratory bronchioloiti: filling of small airways with macrphages with yellow-brown pigment, widening of alveolar walls, mild fibrosis, type II cell hyperplasia
pulmonary langerhans cell histiocytosis
positive for: langerin, S-100, CD1a
pulmonary alveolar proteinosis: alveoli are filled with dense, amorphous, protein-lipid granular precipitate (alveolar walls are normal)
penumocystis jirovecii
Gomori methenamine silver stain
saddle pulmonary embolism: lodges at bifurcatio nof pulmonary arteries
sudden death due to acute cor pulmonale
arrows: pulmonary embolism
line: wedge shaped hemorrhagic infarct
pulmonary embolism with early infarction with alveolar hemorrhage (arrow) and coagulative necrosis of the alveolar septa (asterik)
resolving pulmonary infarct: after 48 hours
becomes paler red-brown (arrows) due to conversion of hemorrhage into hemosiderin by macrophages (will eventually scar)
non-thrombotic pulmonary embolism
foreign material (IV drug use)
pulmonary vascular thickening contricts lumen
pulmonary HTN
plexogenic lesion: network of capillary formations span lumen of pulmonary arteries
severe primary pulmonary HTN and congenital heart disease with L to R shunt
diffuse pulmonary hemorrhage: lungs are heavy and show diffuse dark red consolidation
goodpasture, idiopathic pulmonary hemosiderosis, lupus, wegener granulomatosis
necrotizing hemorrhagic interstitial pneumonitis due to autoimmune alveolar BM destruction: arrow necrosis of alveolar walls with intra-alveolar hemorrhage
goodpasture syndrome
pulmonary edema
long standing pulmonary edema with alveolar microhemorrhages and hemosiderin-laden macrophages (arrow= heart failure cells)
protein rich fluid and necrotic epithlial cells: hyaline membranes
Diffuse alveloar damage: acute stage
diffuse alveolar damage: organizing stage
hyaline membranes have been resorbed and replaced with plugs of intra-alveolar organizing fibroconnective tissue (arrow)
right: trichrome stain
bronchopneumonia: patchy pale areas of consolication in upper lobe
lobar pneumonia: lower lobe is consolidated
red hepatization: pneumonia
gray hepatization: pneumonia
S. pneumoniae
right: alveoli with neutrophils and proteinaceous exudate
left: gram positive lancet shaped diplocci in neutrophil rich exudate
pulmonary abscess: necrotizing pneumonia
pulmonary abscess: lots of neutrophils, alveolar destruction
atypical pneumonia: lymphocytic inflammation of the interstitium (red arrows) and pneumocyte hyperplasia (yellow arrows)
Ghon complex (black arrow) and caseous hilar nodes (red arrow)
primary TB
TB granulomas with central necrosis
granulomatous inflammation with central necrosis (caseation) rimmed by macrophages
TB
TB: red rods on acid fast stain
confluent areas of caseous necrosis and cavitation (arrow) on upper lobe (highest O2)
secondary TB
miliary TB: lymphohematogenous dissemination
multiple foci of granulomatous inflammation
granulomatous inflammation, necrotizing
histoplasmosis
histoplasmosis: macrophages with tiny yeast
blastomycosis
BROAD BASED BUD: snowman
right: H and E: lighlty basophilic budding yeast surrounded by a clear space (capsule)
left: stain that highlights capsule
Cryptococcus neoformans
thick walled non-budding SPHERULES filled with ENDOSPORES
Coccidiomycosis
CMV pneumonia
infected cell: enlarged with cytoplasmic and intranuclear viral inclusions (owl eyes)
pneumocystis pneumonia
right: central umbilications on SILVER STAIN
left: organism in granular alveloar exudate
aspergillosis
right: ACUTE ANGLE branching, SEPTATE HYPHAE
left: angioinvasion allows aspergillus to cause hemorrhagic destrction that crosses fissure
Murcormycosis
angioinvasive
BROAD WIDE ANGLE BRANCHING, NON-SEPTATE HYPHAE
bronchogenic cysts
pulmonaory sequestration
meconium aspiration syndrome
arrows: amniotic fluid/squamous debris and meconium (red)
infant
hyaline membrane disease: neonatal RDS
circumscribed coin lesion; peripheral solitary
hamartoma
grey-white glistening nodule
hamartoma
lobules of mature cartilage entrapped in benign respiratory epithelium
pulmonary hamartoma
peripheral spiculated mass
adneocarcinoma
peripheral tumor
adenocarcinoma
cancer
pneumonia like consolidation of entire lobe
adenocarcinoma
lung adenocarcinoma
mucin produing glands
lepidic pattern shows growth along alveloar septa (arrows)
lung adenocarcinoma
large centrally located mass
squamous cell lung carcinoma
large tumor that obliterates entire central portion of lung and shows cavitation
squamous cell lung carcinoma
keratin pearl
squamous cell lung carcinoma
large cells with prominent nucleoli
large cell lung carcinoma
central tumor (arrows) with infiltrative growth into surrounding lung
small cell lung carcinoma
small cells with scant cytoplasm and crush artifact (arrow), mitoses
small cell lung carcinoma
endobronchial circumscribed tumor
carcinoid tumor
nests of bland cells with granular chromatin
carcionoid tumor
dense core granules on EM are evidence of neuroendocrine differentiation
carcinoid tumor
pancoast tumor
metastatic lung cancer: cannonball appearance
circumscribed nodule of metastatic colon adenocarcinoma with normal surrounding parenchyma
diffusely thickened pleura with rind like encasement of lung
Malignant pleural meosthelioma
mesothelioma type?
epithelioid type of mesothelioma
tubules: arrow that mimic adenocarcinoma
CALRETININ: positive brown stain
mesothelioma
mesothelioma or adenocarcinoma?
long, slender microvilli
mesothelioma
mesothelioma or adenocarcinoma?
adenocarcinoma
stubby microvillous rootlets
nasopharyngeal carcinoma
poorly differentiated squamoous cell carcinoma in background of lymphocytes
laryngeal papilloma
laryngeal carcinoma
squamous cell carcinoma of vocal cord
