Pathology Of The Respiratory System PART 2 - Dr. Singh Flashcards
1
Q
Age most high prevalence of pneumonia needing hospitalization
A
18-64yo
= can cause sepsis and shock
Leading cause of death in children under 5yo
2
Q
Bronchopneumonia vs lobar pneumonia
A
Bronchopneumonia: spread through airway and effect areas that airway goes to
Lobar pneumonia: effects the lobe
3
Q
4 stages of lobar pneumonia
A
- Congestion : due to Blood buildup and
- Red Hepatization : inflammatory cells and RBCs going into alveolar space (filling with blood) ——> looks like a red liver
- Grey Hepatization : inflammation and debri is left , Blood leaves side no more inflammatory cells needed) ——> looks like a grey liver
- Resolution : M clean and some fibrosis
4
Q
3 complications of Lobar pneumonia
A
- Abscess (c shaped or circular wall white , inside is white on bottom with air-fluid line on CXR)
- Empyema (bacteria invading into pleural space)
- Baceremia (bacteria invade into BVs)
5
Q
What are the community acquired bacterial pneumonia MOST common and some others
A
- Streptococcus Pneumonia
- H. Influenzae
- S. Aureus
- K. Pneumoniae
- P. Aeruginosa
6
Q
Streptococcus Pneumonia looks like Ab
A
Gram + diploccoi (pairs in chains) looks like a spear head
= most common community acquired pneumonia
= vaccines are given in > 65yo
7
Q
Haemophilus influenzae Pneumonia
A
Bacteria with high virulence in children
Vaccine in children under 5yo
8
Q
Steph Aureus
A
Abscess formation in lung
IV drug users
9
Q
Klebsiella Pneumonia
A
Alcoholics ——> aspirations
Current Jelly Sputum (hemorrhage + mucous = coughed up)
10
Q
Viral influenza in children
A
Cause bacterial haemophilus influenza to come and is what actually causes fatal SXs
11
Q
Pseudomonas Aeruginosa who, and associated with
A
Another CAP
= CF are prone to it usually by age 10yo
= green rusty looking, grape like smell
12
Q
Typical pneumonia
A
= fast onset
= resp sx
= consolidation on a lobe seen on CXR
= children and older adults
13
Q
Atypical Pneumonia
A
= slow onset
= systemic SXs
= patchy infiltrates on CXR
= young adults, teens, older children
14
Q
Typical pneumonia microorganisms
A
- Strep Pneumonia
- H. Influenza
- S. Aureus
- K. Pneumonia
- P. Aeruginosa
15
Q
Atypical Pneumonia microorganisms
A
- Mycoplasma Pneumonia
- Legionella Pneumophilia
- Chlamydia pneumonia
- Chlamydia Psittaci
16
Q
Mycoplasma Pneumonia looks like and what it does
A
Small tiny no cell wall organisms that can travel down far in the airway
= walking pneumonia
= no gram charge
17
Q
Legionella Pneumophilia type of organism and where it is found
A
Gram - bacillus growing in WARM FRESH WATERS = air conditions = Misters = Hot Tubs (Airborne)
18
Q
Community - Acquired Viral pneumonia 4 of them
A
- H1N1 Influenza
- SARS
- COVID-19
- Respiratory Syncytial Virus
19
Q
Viral pneumonia doesn’t what usually on CXR
A
Diffuse and all over usually not lobar and in one space
20
Q
Bacterial pneumonia does what to lung tissue
A
Destruction of lung parenchyma and infiltration on N and many RBCs into alveolar space
21
Q
Viral Pneumonia does what to lung tissues
A
Lymphocytes and plasmacytosis into interstitial spaces all around the alveoli
22
Q
2 proteins of the Influenza
A
- Hemagglutinin = attachment to cells
- Neuraminidase= release of virus from cell and replication
= these are the variants between the strains
23
Q
Tamiflu is what
A
Oseltamivir
= BLOCKS Neuraminidase (cutting virus off the cell to go one a bind and replicate on other cells)
= the Haemagglutinin is stuck on the cell
24
Q
Influenza SX
A
Body aches, chills, headache, fever, fast onset = which is not seen as much in colds
25
Antigenic SHIFT vs Antigenic DRIFT in influenza
SHIFT : EPIDEMIC , minor changes in neuramidase and haemugglutin proteins
= you still have some immunity
DRIFT : PANDEMICS , huge genomic alterations in H and N proteins and creates a virus that is completely new to body
= usually from animals
26
H1N1 influenza caused what
Antigenic drift causing the Spanish Flu ( from bird)
H2N2 = Asian flu
H3N2 = Hong Kong flu
27
Fastest replicating virus is what type of route and which dies ease is it linked to
ssRNA +
| = SARS and COVID -19 (SARS-Co-2)
28
COVID-19 enters body how and what happens
Binds to ACE2 Receptors in gut and lungs
1. Cytokines storm
2. Damage and pulmonary edema (ALSO IN ARDS)
3. DVT prone pts —> PE
29
COVID lung histology
Hyaline membrane from fibrin and edema and inflammation
= alveoli fill up with cells and blood (like in bacterial pneumonia——> it came from COVID) as seen in viral influenza in children
30
Coagulation in lungs for COVID
Microthrombi in lungs = deadly
Megakaryocytes (not supposed to be in circulation however cause platelets microcoagulation in COVID) ——> microthrombi in heart and lungs and other vessels in the body
31
Neonatal most common pneumonia
Bacterial (Group B Streptpcoccal, gram - bacilli, Listeria)
| = from mother
32
Children over 1mo most common pneumonia
VIRAL : Respiratory Syncytial Virus, Parainfluenza influenza A + B, Adenovirus, Rhinovirus
BACTERIAL : Strep Pneumonia, H. Influenzae, M. Catarrhalis, S. Aureus
33
Older children and adolescents most common type of pneumonia
M. Pneumonia , C. Pneumonia (Walking pneumonia)
| = not as much RSV
34
Groups of Strep for diseases
Group A Streptococcus Pharyngitis : Rheumatic Fever
Group A B-Hemolytic Streptococcus : Lymphangitis
Group B Streptococcus : Neonatal Pneumonia
35
RSV type of virus and looks like
Paramyxovirus
| = multinucleated (inclusion bodies inside)
36
RSV SX
```
Babies come in with
= cough, runny nose
= wheezing, dyspnea
= Tachy
= cyanosis
```
37
RSV what happens in the lung
Thickening of walls of bronchus and mucous buildup
| = damaging respiratory epithelium
38
What can also look like the multinucleated syncytial bodies in RSV
Human Metapneumovirus
Parainfluenza
Measles
39
Presentations of BACTERIAL PNEUMONIA 5
1. Fast onset, not airborne unless (Legionella or Pertussis), not easily spread as much
2. HIGH FEVER
3. Crackles in lung
4. Lobar Consolidations seen
5. Can go into pleura
40
Presentations of VIRAL PNEUMONIA 6
1. Slow onset
2. Commonly spread easily (airborne)
3. Low fever
4. Wheezes in lung
5. Diffuse infiltration in CXR
6. Not usually in pleural cavity
41
Which microorganisms can cause lung abscess
1. S. Aureus
2. K. Pneumonia
3. Anaerobic bacteria (since they like to get walled off)
(Also in chronic alcoholism —> aspirations)
42
lung abscess most common location
Right middle or lower lobes (after carina the slope of RIGTH bronchus is more steep)
(CLASSIC ASPIRATION PNEUMONIA)
43
TB infection Primary lesion is called what
Ghon complex = 1st caseating complex (in the periphery and hilum that it’s connected to) of the lung
44
Miliary TB
As TB gets access to the Blood stream they disseminate and go the liver and spleen
45
Ceseating granuloma has what special cells around the granuloma and how do you stain for this and what do you seen in the stain
Giant multinucleated cells
Acid Fast : blue background and red/purple lines
46
4 causes of granulomas in the lung
1. TB
2. Sarcoidosis
3. Hypersensitivity pneumonia
4. Vasculitis (GPA)
47
Chronic Pneumonia most common fungal causes
Histoplasma
Blastomycosis
Coccidiomycosis
48
Histoplasma where and what does it do
Midwest and Caribbean (ohio, Mississippi River valley)
= in lungs granulomas form ——> calcifications and coin lesions in cxr, however no real sx
= can be aggressive in immunocompromized (chronic pneumonia)
49
Histoplasma looks like what on histology
Pumpkin seeds
50
Blastomyces dermatitides location and what does it do
Central and SE US (Ohio, Mississippi River valley)
= granulomas in lung
= can infect skin
= immunocompromized can get chronic pneumonia
51
Blastomyces dermatitides looks like what on histology
Broad Based Budding (2 circles that look like they are budding that are tightly attached to each other)
52
Coccidiodes immitis location and what does it do
SW US and Mexico
= lung granulomas + high Eosinophils
= self -limited pneumonia
= can become disseminated infection esp immunocompromized
53
Coccidiodes immitis looks like what
Perfect round circle with a bunch of smaller circles inside it (plasmocytes)
54
Most common pneumonia causes in HIV patients
```
Pneumocystis Jiroveci (carinii)
CMV
```
55
Pneumocystis Jiroveci is what and what happens
Fungal infection
= AIDS get pneumonia
= very elderly and immunocompromized pts can also
56
Pneumocystis Jiroveci looks like what on histology
Cup shaped yeast
57
Cytomegalovirus is what and does what and what it looks like on histology
1. Viral infection = Bid Cell Virus
2. Pneumonia in immunocompromized
3. Cowdry image (like an eyeball, one of the owl eyes, you see virus in nucleus + cytoplasm)
58
Mycobacterium Adium Complex (MAC) is what and stain for it
Immuocompromized and pneumonia
| = mycobacterium in acid fast stain
59
After transplantation of lungs how can you see if they are rejecting the lungs or infection of lungs
REJECTION = mononuclear infiltrates of lymphocytes = give steroids
INFECTION fungal or viral = you see the organism = treat that and lower steroids
60
Lung cancer is associated with what
```
= tobacco smoking
= Radiation
= uranium
= asbestos
= radon
```
61
Gene protecting from lung cancer
Polymorphism in P450 (DNA repair genes)
62
SCC effects what cells in the lung and what genes are associated with it
Basal cell——> ciliated cells (Bronchous most proximal)
| SOX2, NOTCH, CDKN2A
63
Small Cell carcinoma effects what cells in the lung and what genes are associated with it
Neuroendocrine cells (thought out the respiratory epithelium)
= TP53
=RB1
64
Adenocarcinoma effects what cells in the lung and what genes are associated with it
Type 2 alveolar cells
= EGRF-RAS pathway (K-RAS, B-catenin)
= sometimes p53 also
65
Smoking usually cause what lung cancers
SCC
| Small Cell Carcinoma
66
Most common lung cancer
Adenocarcinoma
67
Adenocarcinoma first stage and what is the characteristics of this stage
Atypical Adenomatous Hyperplasia (AAH)
= <5mm, dysplastic pneumocytes present in alveoli
= some interstitial fibrosis
68
Adenocarcinoma second stage and what is the characteristics of this stage
Adenocarcinoma in situ (AIS)
= <3cm bronchioalveolar carcinoma
= dysplastic pneumocytes growing along alveoli (making a wall)
69
Adenocarcinoma 3rd stage and what is the characteristics of this stage
Pulmonary Adenocarcinoma
= metastatic glands
= most common type of lung cancer in smokers and non-smokers
= IDENTIFY THIS since it has a treatment
70
Pulmonary Adenocarcinoma dx
Stain with + TTF-1
71
Mutinous Adenocarcinoma what is it and it looks like what
Grow along the wall of the alveoli however longer then in AIS
= can look exactly like pneumonia on CXR
= deadly pneumonia
72
SCC stages and each stage looks like after cilia have been destroyed
1. Squamous Metaplasia : basal layer is abnormal only then the flat cells on top are normal
2. Squamous Carcinoma in Situ : all cells are round and abnormal more vertical looking
3. Squamous invasive
73
How to identify SCC on histology
Keratin pearls (pink pearl with swollen big cells inside and around it)
74
SCC on cytology
Orange cytoplasm = keratin
| = Big cells
75
SCC prevalence and location
Men, smokers,
| = centrally locations more from the airways
76
TNM
```
T = tumorsize
N = LNs involved
M = metastasis to how many distant locations
```
77
Most common SX of lung tumor
1. cough
2. Hemoptysis
3. Chest pain
4. Pneumonia = (tumor invading airway) look at CT scan if smoker
5. Hoarseness = recurrent laryngeal nerve invasion
78
Small cell neuroendocrine carcinoma prevalence and what it does
= heavy smokers and older pts
= very deadly (5% 5 year survival)
= can metastasize to brain and neural involvement
79
Small cell carcinoma histology looks like what
nuclear molding = crowding of cells into like a subway look (looks like nuclei combining and making a rocket ship)
= a lot of necrosis
= many blue nuclei crowing
80
Small cell carcinoma TX
Surgical excision only if not reached LN
| Chemo and radiation = high response only high recurrence rate
81
Small cell carcinoma DX
1. Nuclear molding + necrosis
2. Neural involvement if that sage has happened
3. CD56 for all neurocarcinomas
82
Adenocarcinoma TX (dont need to know specific pathways and drugs)
Molecular Testing
1. EGFR (HER1 receptor) BLOCKER of receptor for this pathway (ERLOTINIB)
2. ALK-EML4 BLOCKER of the gene fusion (Crizotinib)
3. PDL-1 (block tumor from evading immune system with CTLA4 or PD1) (PEMBROLIZUMAB)
83
What to look for when TX Adenocarcinoma
1. EGFR unregulated pathway expression yes or no
2. ALK rearrangement yes or no
3. PD-1 expression (getting away from immune system)
4. CTLA-4 expression (getting away from immune system)
84
SCC and agents for tx
Don’t use VEGF inhibitors = They can bleed due to their location so close to BVs
85
SSC Paraneoplastic syndrome it is associated with
PTH release causing HYPERCALCEMIA = mental changes and EKG changes
86
Small cell carcinoma paraneoplastic syndromes it is associated with
1. ADH secretion = SIADH (weakness, confusion, hyponatremia)
| 2. ACTH secretion = Atypical Cushing Syndrome (non obese, striae since it’s so fat onset), edema, HTN, hyperglycemia)
87
Horners Syndrome is what
Apex of lung tumor that invades into sympathetic trunk = oculosympathetic palsy
88
Horners Syndrome sx
1. Enophthalmos = sunken eyeball
2. Ptosis = drooping eyelid
3. Miosis = constricted pupil
4. Anhydrosis = no sweating on that side of the face
5. Arm parasthesia = pain, wasting in arm due to brachial plexus constriction
89
4 Neuroendocrine tumors
1. Small cell carcinoma
2. Carcinoid tumor
3. Atypical Carcinoid tumor
4. Precursor Lesion : DIPNECH (Diffuse Interstitial Pulmonary Neuroendocrine Cell Hyperplasia)
90
DIPNECH is what and how to see this
= high resolution CT needed
= very small nodules < 5mm (hyperplasia)
= NOT risk factor
91
Carcinoid tumor is what
```
5mm < *
Can metastasize (in lung and SI), Grade 1
```
92
Carcinoid Tumor histology
Larger tumor with Neuroendocrine cells (round with purple cytoplasm)
93
Atypical Carcinoid tumor
Grade 2*
1. grow fast (the Neuroendocrine purple round cells)
2. Necrosis (pink spots)
= higher change to metastasize
94
Grade 3 Neuroendocrine carcinoma
Small cell carcinoma
95
Carcinoid syndrome
Any grade Neuroendocrine carcinoma can give you this (also seen in GI)
- flushing
- D
- Cyanosis
96
5 year survival grade 1,2,3
Carcinoid tumor = 95%
Atypical carcinoid tumor = 70%
Small Cell carcinoma = 5%
97
Multiple huge tumors all over lungs seen on CT scan what do you suspect
Not primary tumor
| = metastatic from other place (testicular, melanoma) even in young pts
98
Pulmonary hamartoma what Is it and risk + CT Scan
Benign
= ball of hyaline cartilage and mixed cells
= coin lesion on CT
99
Lymphangioleiomyomatosis (LAM) what is this
= perivascular epithelioid cell growth (PEC-oma)
| = crest cystic spaces
100
Lymphangioleiomyomatosis (LAM) associated with what
Tuberous sclerosis
101
Lymphangioleiomyomatosis (LAM) DX + gene
Stain with melanoma markers = HMB-45
| = loss of function of TSC2 gene
102
Lymphangioleiomyomatosis (LAM) prevalence
Young women
103
Lymphangioleiomyomatosis (LAM) risks
The cystic spaces that are made grow and expand so much they can cause pneumothorax
104
pleural effusion of CT
You see fluid on the posterior side since they are laying down
105
Transudate pleural effusion what and exs
```
FLUID ONLY
= higher hydrostatic p
1. HF
2. Nephrotic syndrome
3. Cirrhosis
```
106
Exudative Pleural effusion what and exs
PROTEIN FLUID CELLS (inflammation)
1. PE
2. Lung infection
3. Lung malignancy
4. CT problem (SLE, RA)
5. Pancreatitis
107
Bloody effusion from pleural effusion
Metastatic cancer
108
Transparent effusion from pleural effusion
Left HF
109
Milky white effusion from pleural effusion
Bronchogenic carcinoma obstructing the thoracic duct or any other cause of thoracic duct obstruction
110
Empyema
Can happen from inflammation BACTERIAL = thick and pussy exudate (Webs of trapped fluid = LOCULATIONS)
111
Empyema tx
Surgery to clear the loculations so fluid can be cleared and tx works
112
Spontaneous pneumothorax cause and prevalence
Usually younger pts
| = rupture of subpleural blebs ——> introducing air into pleural space
113
Secondary Pneumothorax what are causes 4
1. Cystic infection (PCP = pneumocystis pneumonia)
2. Cystic tumor
3. Positive Pressure ventilation
4. Trauma
114
Tension Pneumothorax
Injury to chest wall causing in air to flow into pleural space every time you inspire only it cant get out (since you expand your chest when you inhale) = more and more air comes in to pleural space ——> pushes all other organs aside
115
Tension pneumothorax tx
Stick a needle in (needle decompression) and the air flows out
116
Solitary Fibrous Tumor what is it and histology
TUMOR IN PLEURAL CAVITY
Fibroblast tumor = benign (small and pendunculated)
= staghorn looking
117
Solitary fibrous tumor risks
Can get really large and behave like sarcomas
118
Solitary Fibrous Tumor tx and stain
CD34
| Remove them since they are benign
119
Mesothelioma associated with what and who
```
TUMOR IN PLEURAL CAVITY, can invade into lung
Asbestos exposure
= shipworker, steam pipes
= construction worker, insulation’s
Can happen decades after exposure
```
120
Types of Mesothelioma and stain
Epithelioid, sarcomatoid, mixed , STAIN CALRETININ
| In TTF-1 —> adenocarcinoma
121
Mesothelioma histology you can see
Looks like Adenocarcinoma with glands and cells
| + you can see ferruginous bodies (asbestos bodies)
122
Mesothelioma TX
Most pts don’t survive 2years, not responsive to chemo or radiation as much, can’t be removed surgically
123
Inflammatory Sinonasal Polyps are what
Edema (infectious) OR Eosinophilis (allergic) in polyp of the stroma
= histology is light color
124
2 ways to obstruct the nasals cavity
1. Empyema : mucous and bacterial secretions accumulate obstructing
2. Mucocele : mucous secreting glands forms and secrete purulent material in the cavity made
125
Bacterial sinusitis of maxillary sinus can happen how
From oral flora from dental procedures
126
Ethmoid sinusitis can cause what
Periorbital cellulitis
127
Frontal sinusitis can cause what
1. Meningitis
| 2. Epidural abscess, brain abscess, subdural abscess
128
Allergic Fungal sinusitis
Aspergillus that causes allergic type reaction when it enters nasal cavities
Eosinophils come and try to get rid of them —> Chacoidlinar crystals form
129
Aspergillosis can cause what
Mycetoma = fungal ball (you see acute angle sepae
130
Acute invasive sinusitis who and from what
Zygomycosis (Murcor)
DM or immunocompromized
= EMERGENCY IV TX
131
Acute Invasive sinusitis can cause what and to and what does it look like on histology*
Spread to brain or sepsis
= IV Anti-fungals
= deadly
= non-septal hyphae****
132
GPA (granulomatosis with Polyangiitis (Wagner’s) sx subtle
1. Nasal ulceration or necrosis or perforations
| 2. Can effect kidneys and lungs
133
GPA histology
Necrobiotic necrosis : blue (blast of inflammation killing all vascular cells)
134
Nasopharyngeal Angiofibroma what is it and histology
Polyploid mass growing in nasal tissue
| HIST : penile tissue resembling, fibrous + vascular polyp
135
Nasopharyngeal Angiofibroma what can happen and associated with
bleeding + recur however is benign
| = Familial Adenomatous Polyposis* (Adenomatous polyps in colon —> carcinoma by middle age, APC gene), IN YOUNG PTS
136
Nasopharyngeal Angiofibroma prevalence
Young fair skin and light hair / red hair males
137
Sinonasal (SCHNEIDERIAN) Papilloma prevalence and associated with
Middle age men
| HPV
138
Sinonasal (SCHNEIDERIAN) Papilloma 3 types
1. Exophytic : grows outward
2. Endophytic : grows inward and can become a carcinoma *
3. Oncocytic : cells are different type
139
Olfactory neuroblastoma histology and prevalence
Small round blue tumor cells (Roset formation can happen kind of like a bulls eye looking thing with light pink in middle the white around then blue cells around)
Adolescence and middle age (2 age peaks)
140
Olfactory neuroblastoma is what
Neuroectoderm in superior nasal passage (Neuroendocrine tumor)
= malignant
141
Olfactory neuroblastoma on CT
Dumb-bell shaped ( first grows down, then penetrates cribriform plate and grows up towards brain)
142
Nasopharyngeal Carcinoma is what and sx
SCC from nasopharynx only no real sx
| NECK LN metastasis —> when sx form very enlarged LN
143
Nasopharyngeal Carcinoma risk factors and prevalence
1. EBV*
2. Chinese, Southeast Asian adults (smoked fish with nitrosamines)
3. African children
144
EBV is associated with what malignancies
Burkitts
Nasopharyngeal Carcinoma
Extranodal NK/T cell lymphoma
145
EBV stain
EBER-1
146
Vocal Cord Nodules are what
SINGERS NODULES
= edematous soft polyp on vocal cords
(Happens as a reactions, not true neoplasm) singers can get these
147
Laryngeal squamous Papilloma what is it and location
Benign squamous neoplasm with small papillary masses on VOCAL CORDS and can extend down the airway
(RARE malignant forming)
148
Laryngeal squamous Papilloma associated with what 2 things
1. HPV 6 and 11
| 2. Recurrent respiratory papillomatosis
149
Laryngeal squamous Papilloma can cause what
Cysts of air trapped in lungs
150
Laryngeal squamous Papilloma prevalence
BABIES TO Mother’s under 20yo , vaginal delivery, 1st born (get HPV 6,11)
Adolescents , children
151
Laryngeal carcinoma is what
SCC in larynx
152
Laryngeal carcinoma prevalence and associated with what risks
Men over 60yo
= alcohol
= smoking
= HPV
153
Laryngeal carcinoma looks like
Ulcerative lesion
154
Otitis Media caused by what 3 organism
1. Streptococcus pneumonia
2. Moraxella Catarrhalis
3. Haemophilus Influenza
155
Chronic Otitis Media is caused by what and who
Pseudomonas Aeruginosa in DM
156
Cholesteatoma happens how
Chronic otitis media causes cystic lesion that invaginate into the epithelium
= keratin gets trapped inside
= can enlarge and erode adjacent bone
= looks like a large zit in the ear
157
Otosclerosis is what
Bony deposits in the stapedial footplate
158
Otosclerosis sx and hesitance
Conductive hearing loss
| AD (familal deafness)
159
Otosclerosis tx
Remove the bone and replace it
160
Brachial Cyst is what
```
Stratified squamous (full of keratin) or respiratory epithelium cyst that forms from 2nd BRANCH ARCH during development
=fibrous + lymphoid tissue
```
161
Brachial Cyst location and prevalence
In front of sternocleidomastoid
| Young adults
162
Cystic lesion in adult and in children on the neck
ADULT : metastatic cystic carcinoma
CHILDREN : bronchial cyst on congenital
(Keratin debri inside is seen)
163
Thyroglossal Duct Cyst is what
Thyroid tissue remnants from when it migrated
| = changes into a cyst (nests)
164
Thyroglossal Duct Cyst location
Anyplace on midline on neck from back of tongue
165
Carotid Body Tumor what is this
NCC from autonomic paraganglia (Paravertebral paraganglia, phenochromocytoma (adrenal gland), vessels)
= involves the carotid body vessels and a tumor at the bifurcation of it****
166
Carotid Body Tumor location and CT scan and associated
Bifurcation of carotid A = looks like of like Poseidon’s stick
= MEN2 (multiple endocrine neoplasia 2)
167
Carotid Body Tumor histology and DX
Cobble stone looking = ZELLBALLEN (ball of cells)* = nests of cells
S-100 stain
168
Carotid Body Tumor prognosis
15%-40% malignant and histology cant tell
