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OS 213 Respiratory Exam 2 > Pathology of Mediastinal Disease > Flashcards

Pathology of Mediastinal Disease Flashcards

1
Q

Portion of the thoracic cavity located between pleural cavities

A

Mediastinum

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2
Q

traumatic perforation of the esophagus

A

Acute Mediastinitis

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3
Q

Ruptured esophagus due to sudden increase in intraesophageal pressure and negative intrathoracic pressure caused by retching; common in alcoholics

A

Boerhaave’s syndrome

  • Descent of infection from within the neck
  • Spread from chest wall or after heart surgery
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4
Q

Chronic mediastinitis

A

Anterior Mediastinum
Can produce compression SVC
Common causes; granuloma, fibrosis or both
May be mycotic or tuberculosis in etiology

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5
Q

Tumors, masses, and non neoplastic diseases in the SUPERIOR MEDIASTINUM

A

Lymphoma - thymus contains lymph nodes
Thymoma - Thymus located in this area as a baby
Thyroid Lesions -thyroid sometimes fails to migrate upward, leading to a low-lying/ectopic thyroid -.plunging thyroid
Metastatic carcinoma
Parathyroid tumors

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6
Q

Tumors, masses, and non neoplastic diseases in the ANTERIOR MEDIASTINUM

A 
Thymoma
Teratoma - usually in the midline
Lymphoma
Thyroid Lesions
Parathyroid lesions
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7
Q

Tumors, masses, and non neoplastic diseases in the POSTERIOR MEDIASTINUM

A

Neurogenic tumors (schwannoma, neurofibroma -benign)
Lymphoma
gastroenteric hernia - esophagus is in this area

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8
Q

Tumors, masses, and non neoplastic diseases in the MIDDLE MEDIASTINUM

A

Bronchogenic cysts
Pericardial cyst - lined by mesothelium
Lymphoma

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9
Q

Usually at the right cardiophrenic angle
Due to failure of lacunar cavities to merge
Soft and unilocular, contain clear fluid unless infected
Inner surface: flat or cuboidal single layer of mesothelium

A

Pericardial (Coelomic cysts)

-surgical resection is curative

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10
Q

Small bud or diverticulum carried to the mediastinum by the downward growth of lungs

A

Foregut cysts

Bronchial - pseudostratified columnar
Esophageal - squamous
gastric and enteric cysts
pancreatic cysts and pseudocysts

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11
Q

Can present as superior mediastinal masses, Arise from cervical thyroid that has been pulled down by enlargement

A

THYROID LESIONS

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12
Q

Usually found on the anterosuperior compartment

A

Parathyroid lesions and tumors

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13
Q

small soze, primitive-appearing epithelium without segregation into cortical and medullary regions, presence of tubules and rosettes, absence of Hassal’s corpuscle, almost total absence of lymphocytes

A

Thymic dysplasia

  • Thymus is converted to a multicystic structure
  • Thymus shows immature histology
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14
Q

Unilocular thymic cysts

A

Cyst only has one cavity

Development origin - remants of the 3rd branchial pouch-derived thymopharyngeal duct

Epitheial lining is flattened, cuboidal, columnar or squamous

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15
Q

Acquired process of a reactive nature
Accompanied by inflammation and fibrosis
Lining may be flat, cuboidal, ciliated columnar or squamous; single or stratiied

A

Multilocular cyst

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16
Q

NON neoplastic diseases

A

Ectopic thymus
Ectopic parathyroid glands
Acute thymic involution - HIV infection
True thymic hyperplasia - epithelial component of thymus proliferates
Thymic follicular hyperplasia - lymphoid follicles in thymus proliferate

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17
Q

Tumors of thymic epithelial cells

18
Q

WHO classification of Thymomas

A

cytologically benign and noninvasive
cytologically benign but invasive or metastatic
cytologically malignant

19
Q

Account for 20-30% of tumors in the anterosuperior mediastinum

20
Q

Morphology of thymomas

A

Lobulated, firm gray-white massess up to 15 to 20 cm
Areas of cystic necrosis and calcification’
Most are encapsulated
Noninvasive

Medullary type epithelial cells
Mixture of medullary and cortical type-epithelial cells
Sparse infiltrate of lymphocytes

21
Q

Cytologically benign but locally invasive

  • Much more likely to metastasize
  • Cortical Epithelial cells
  • Usually mixed with numerous thymocytes
  • Cytologic atypia
  • 20-25% of all thymomas
  • Penetrate through the capsule
A

Invasive thymomas

22
Q

5% of thymomas
Fleshy, obviously invasive
Metastasis
Most are SCCAs, next most common lymphoepithelioma-like carcinoma

A

Thymic carcinoma

23
Q

Clinical features of thymic carcinoma

A

impingement on mediastinal structures
MG for all types of thymic tumors
Hypogammaglobulinemia, PRC aplasia, grave’s, PA

24
Q

NEUROENDOCRINE TUMORS of the THYMUS

A

Carcinoid tumor - well differentiated
Small Cell Neuroendocrine carcinoma
Large cell neuroendocrine carcinoma

25
Approximately 20% f the mediastinal tumors and cysts
Germ Cell Tumors
26
histogenesis is controversial, primary origin from extragonal germ cell is favored
germ cell tumors
27
also known as germinoma, almost always within thymus, Similar to testicular counterpart; fibrous septa infiltrated by lymphocytes lymphocytes and plasma cella, numerous germinal centers, cells with large amounts of cytoplasmic glycogen
SEMINOMA
28
Immunolic marker for Seminoma
PLAP and CD 117
29
Most common type of mediastinal germ cell neoplasm. Can grow to a large size, has a distinct, sharply delineated wall that often becomes calcified, Cut surface is predominantly cystic
Mature cystic teratoma
30
Similar to mature teratoma but containing immature epithelial, mesenchymal or neural elements, but most imporantly, the neural element
Immature teratoma - more aggressive and tends to metastasize
31
Invasive, highly necrotic neoplasm, Poorly differentiated, Reactive for keratin, PLAP, CD30 and CD57
Embryonal Carcinoma
32
Admixed with other germ cell elements or as a pure neoplasm. MAy have prominent spindle cell features, contain a hepatoid coponent
Yolk sac tumor
33
Tumor forms rosette structure around a vessel
Schiller-Duval bodies
34
COmbination of embryonal carcinoma and teratoma
Teratocarcinoma
35
Elevated levels of HCG | Extremely poor prognosis
Choriocarcinoma
36
Malignant lymphoma
Anterior, superior or middle mediastinal mass Most common primary neoplasm of the middle pportion of the mediastinum Manifestation of a disseminated process or as a primary mediastinal disease
37
Hodgkin Lymphoma
``` Involve the thymus or lymph nodes Young adults, females Local pressure symptoms or found incidentally Nearly always of nodular sclerosis type Polymorphic ```
38
binucleate cells, "owl's eye" appearance
Reed-Sternberg
39
Particular predilection for the thymic region Males are commonly affected Solid, soft, unencapsulated Involves thymic parenchyma Lymphocytes with "blastic" appearance - atypical, fine chromatin pattern, nuclear convolutions, mitotic figures
Lymphoblastic Lymphoma
40
Mass in the thymus, with or without lymph node involvement Young adult with SVC syndrome Grossly firm with frequent foci of necrosis Wide bands of fibrosis, epithelial cells, germ cells, or neuroendocrine neoplasm
Large Cell Lymphoma

OS 213 Respiratory Exam 2 (15 decks)

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