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Pathology Flashcards

1
Q

What chemicals are present in cigarettes that are known carcinogens?

A 
Polycyclic hydrocarbons 
Aromatic amines
Phenols
Nickel
Cyanates 
20% of smokers will die of lung cancer but they can also suffer from laryngeal, cervical, bladder, mouth, oesophageal and colon cancer
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2
Q

What are other risk factors for lung cancer?

A 
Asbestos 
Nickel
Chromates 
Radiation 
Atmospheric pollution 
Genetics
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3
Q

What are some of the local effects of lung cancer?

A

Obstruction of the airway (pneumonia)
Invasion of the chest wall (pain)
Ulceration (haemoptysis)

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4
Q

Where can lung cancer metastasize to?

A

Nodes
Bones
Liver
Brain

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5
Q

What are some systemic effects of lung cancer?

A

Weight loss
Ectopic hormone production - PTH (parathyroid hormone) which maintains calcium levels in the blood in squamous cancer
ACTH (adrenocorticotropic hormone) regulates levels of cortisol in the blood

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6
Q

How are lung cancers classified?

A 
Adenocarcinoma 
Squamous carcinoma 
Small cell carcinoma 
Large cell carcinoma
Neuroendocrine tumours 
Bronchial gland tumours
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7
Q

How are cancers diagnosed histologically?

A

Bronchoscopy and biopsy of the tumour if seen
Biopsy or needle aspiration of metastases (especially mediastinal or supraclavicular lymph nodes)
Endobronchial ultrasound guided specimens (EBUS)

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8
Q

What is special histologically about a squamous carcinoma?

A

It keratinises

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9
Q

Why is small cell called small cell?

A

There are lots of cells tightly packed together and they are small because they don’t have much of a cytoplasm

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10
Q

Why are large cells called large cells?

A

They have a large cytoplasm that makes the cells look further apart

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11
Q

What is the point in classifying cells?

A

Prognosis
Treatment
Pathogenesis/biology
Epidemiology

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12
Q

What are the links between prognosis and histology?

A

Small cell has the worst prognosis

Large cells is worse than squamous or adenocarcinoma

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13
Q

How can small cell tumours be treated?

A

They are known to be chemosensitive but with rapidly emerging resistance. New targeted treatments based on pathologically identified abnormal DNA or other markers in tumours

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14
Q

What are the immunohistochemistry in NSCLC - non-small-cell-lung-carcinoma?

A

Adernocarcinoma expresses TTF ( thyroid transcription factor) 1
SSC expresses nuclear antigen p63 and high molecular w.t. cytokeratins

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15
Q

How is the immune response targeted in lung cancer?

A

If the lung cancer expresses the PD-L1 it binds to the PD receptor on T lymphocytes inactivating the cytotoxic immune response. Targeted therapy can inhibit this effect and enhance immune killing of tumour

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16
Q

What are the epithelium like of the pulmonary tissues?

A

Bronchial - ciliated, mucous, neuroendocrine, reserve

Bronchioles/alveoli - club cells, type 1 and 2 alveolar lining cells

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17
Q

What are the types of bronchial tumours?

A

Squamous metaplasia
Dysplasia
Carcinoma in situ
Invasive malignancy

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18
Q

What is a peripheral adenocarcnoma?

A

An atypical adenomatous hyperplasia that is spread of neoplastic cells along the alveolar walls (bronchiolalveolar carcinoma)
This is a true invasive adenocarcinnoma and the pattern is becoming commoner

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19
Q

What is the name for a pleural neoplasia?

A

Primary malignant neoplasm - mesothelioma

Very common site of invasion by lung carcinomas and metastatic cancers

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20
Q

What is pneumonia?

A

An infection involving the distal airspaces usually with inflammation exudation (localised oedema). Fluid filled spaces lead to consolidation

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21
Q

How is pneumonia classed?

A 
By clinical setting (CAP) 
By organism (mycoplasma, pneumococcal) 
By morphology (lobar pneumonia, bronchopneumonia)
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22
Q

What classes of organisms can cause pneumonia

A

Viruses - infleunza, parainfluenza, measles, varicella-zoster, respiratory syncytial virus (RSV)
Bacteria
Chlamydia, mycoplasma
Fungi

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23
Q

What is lobar pneumonia?

A

Confluent condolidation involving a complete lung lobe
Most often due to streptococcus pneumoniae (pneumococcus)
Can be seen with other organisms (Klebsiella, legionella)
Usually community acquired and classically in otherwise healthy young adults

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24
Q

What is the pathology of lobar pneumonia?

A

Classical acute inflammatory response:
Exudation of fibrin-rich fluid, neutrophil infiltration, macrophage infiltration, resolution
Immune system plays a part - antibodies lead to opsonisation, phagocytosis of bacteria

25
Q

What are some complications of lobar pneumonia?

A

Organisation (fibrous scarring)
Abscess
Bronchiectasis
Empyema

26
Q

What is bronchopneumonia?

A

An infection starting in the airways and spreading to adjacent alveolar lung
Most often seen in the context of pre-existing disease

27
Q

What is the clinical context of bronchopneumonia?

A

COPD
Cardiac failure (elderly)
Complication of viral infection (influenza)
Aspiration of gastric contents

28
Q

What organisms cause bronchopneumonia?

A

More varied than lobar - Strep. Pneumoniae, haemophilus influenza, staphylococcus, anaerobes, coliforms
Clinical context may helo - staph, anaerobes and coliforms are seen in aspiration

29
Q

What are some complications of bronchopneumonia?

A

Organisation
Abscess
Bronchiectasis
Empyema

30
Q

What is a lung abscess?

A

A localised collection of pus that is tumour like
Causes chronic malaise and fever
Clinical context - aspiration

31
Q

What is bronchiectasis?

A

The abnormal fixed dilation of the bronchi. Usually seen due to fibrous scarring following infection (pneumonia, TB, cystic fibrosis)
Also seen with chronic obstruction (tumour)
Dilated airways accumulate purulent secretions

32
Q

What is TB?

A

A mycobacterial infection
It can be described in many body sites such as the lung, gut, kidneys, lymph nodes and the skin
The pathology is characterised by delayed (type 4) hypersensitivity (granulomas with necrosis)

33
Q

What are the main organisms involved in TB?

A

M. Tuberculosis/ M. Bovis are the main pathogens
Others cause atypical infection especially in immunocompromised hosts.
Pathogenicity due to ability:
To avoid phagocytosis
To stimulate a host T-cell response

34
Q

How do immunity and hypersensitivity link?

A

T-cell responses to organisms enhances the macrophages ability to kill mycobacteria which constitutes immunity
T-cell response causes granulomatous inflammation, tissue necrosis and scarring - this is hypersensitivity (type 4)

35
Q

What is the pathology of primary TB?

A

Primary TB (1st exposure and up to 5 years afterwards) = inhaled organism phacogytosed and carried to hilar lymph nodes. Immune activation leads to a granulomatous response in nodes and lung usually with the killing of the organism. In a few cases the infection is overwhelming and it spreads

36
Q

What is the pathology of secondary TB?

A

Reinfection or reactivation of disease in a person with some immunity. The disease tends initially to remain localised, often in the apexes of the lung but it can progress to spread by airways and/or bloodstream

37
Q

What are the tissue changes in primary TB?

A 
Small focus (ghon focus) in periphery of mid zone lung 
Large hilar nodes (granulomatous)
38
Q

What are the tissue changes in secondary TB?

A

Fibrosing and cavitating apical lesions (cancer an important differential diagnosis)

39
Q

Why does disease reactivate?

A 
Decreased T-cell function due to: 
Age
Coincident disease (HIV) 
Immunosupressive therapy (steroids, cancer chemo) 
Reinfection at high dose or with more virulent organism
40
Q

What can occur in an immunocompromised host?

A 
A virulent infection with a common organism or an opportunistic pathogen: 
Virus (cytomegalovirus CMV)
Bacteria
Fungi
Protozoa
41
Q

How is TB diagonsed?

A

High index of suspicion
Teamwork (physician, microbiologist, pathologist)
Broncho-alveolar lavage
Biopsy

42
Q

What constitutes the pulmonary interstitium?

A

Alveolar lining cells (types 1 and 2)

Thin elastin-rich connective component containing capillary blood vessels

43
Q

What characterises early stage and late stage interstitial lung disease?

A

Early stage is alveolitis (injury with inflammatory cell infiltration)
Late stage is characterised by fibrosis

44
Q

What can cause interstitial lung disease?

A

Environmental (minerals, drugs, radiation)
Hypersensitivity (mouldy hay, avian proteins)
Unknown (idiopathic) - connective tissue diseases - rheumatoid or lupus, idiopathic pulmonary fibrosis (IPF)

45
Q

How can a biopsy be taken in interstitial lung disease?

A

Transbronchial biopsy - special forceps used at bronchoscopy
Thoracoscopic biopsy - more invasive but more reliable and generates far more tissue
Most people however do not need a biopsy because the diagnosis can be confirmed from clinical signs and radiology

46
Q

What are types of chronic interstitial lung disease?

A 
Idiopathic pulmonary fibrosis (IPF)
Sarcoidosis 
Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
Pneumoconiosis
Connective tissue diseases
47
Q

What is idiopathic pulmonary fibrosis?

A

Progressive interstitial fibrosis of unknown cause, variable associated with inflammation and shows finger clubbing

48
Q

What is the pathology of idiopathic pulmonary fibrosis?

A

Subpleural and basal fibrosis
Inflammatory component variable
Terminally lung structure replaced by dilated spaces surrounded by fibrous walls
Peripheral and bases of the lungs are usually affected
The walls of the alvoelar cells becomes thickened making the distance for gas exchange too large

49
Q

What is extrinsic allergic alveolitis (hypersensitivity pneumonitis)?

A 
Chronic inflammatory disease (small airways, interstitium, occasional granulomas)
Allergic origin (type 3 hypersensitivity - antibody mediated and type 4 hypersensitivity - T cell mediated and leads to granuloma formation) 
An abnormal immune response to an external agent
50
Q

What can cause EAA?

A

Thermophilic bacteria - farmers lung
Avian proteins - bird fanciers lung
Fungi - malt workers lung
Precipitins (antibodies) usually detectable in serum

51
Q

What is sarcoidosis?

A

A multisystem granulomatous disorder of unknown cause (defined by histological means)
Pulmonary involvement is common
Most cases are mild and self-limiting

52
Q

What are some symptoms of sarcoidosis?

A

Uveitis (inflammation of iris)
Erythema nodosum
Lymphadenopathy
Hypercalcaemia - abnormal calcium metabolism leading to increased alcium in serum

53
Q

What lobes of the lung are usually involved in sarcoidosis?

A

The apexes - which distinguishes it from IPF as the apexes are not inlolved in IPF

54
Q

What can be pulmonary involved in connective tissues diseases?

A

Interstitial fibrosis (milder than IPF)
Pleural effusions
Rheumatoid nodules

55
Q

What is pneumoconiosis?

A

Lung disease caused by mineral dust exposure - asbestosis, coal workers lung, silicosis

56
Q

What does the disease in the lu`ngs depend on?

A

The particle size (1-5 micrometers) - too large and the particles will stick in the nose and too small and they will just blow out of the lungs
Reactivity of particle - if it is non-reactive nothing will happen
Clearance of particle
Host response

57
Q

What is asbestos and what are the 2 different types?

A

A silicate
Serpentine (curved) asbestos fibres are relatively safe
Straight (amphibole) asbestos are highly dangerous

58
Q

What can asbestos cause?

A

Parietal pleural plaques
Interstitial fibrosis (asbestosis)
Bronchial carcrinoma
Mesothelioma

Respiratory (24 decks)

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