Pathology slide set 4 Flashcards
What are the two types of malignant mesothelioma
epithelioid type and sarcomatoid type
What cancers are more often at peripheral lung
adenocarcinoma
location of carcinoid
either central or peripheral
This is related to heavy asbestos exposure and much more frequent in males
peritoneal mesothelioma
IV drugs users and S. aureus
endocarditis
complications of lung transplantation
- accelerated pulmonary arteriosclerosis
- EBV-associated B cell lymphoma
immunostains for chromogranin, synaptophysin, and CD57+
Small cell carcinoma
Postpneumonic abscesses are usually associated with what organisms?
- S. aureus
- K. pneumonia
- Type 3 pneumoncocci
IHC shows serotonin, neuron-specific enolase, bombesin, calcitonin,
Carcinoid tumor
TSC2 mutation for tuberin and negative regulator of mTOR
lymphangioleiomyomatosis
majority express thyroid transcription factor-1
adenocarcinoma
gender and age for inflammatory myofibroblastic tumor
M=F
more common in children
erythema nodosum and erythemia multiforme (the San Joaquin Valley fever complex
Cocci
What broad category of organism is more common in Aspiration pneumonia
Aerobes
HIV <50
- CMV
- fungal
- mcyobacterium avium
hemaglutinin attaches the virus to its cellular target via what residues
sialic acid
What mutation is especially grim
KRAS in adenocarcinoma
5 year survival for Atypical carcinoids?
70%
what organ does lung cancer spread to most often?
adrenal glands
single, round well defined usually peripheral mass with cacium deposits. grayish white. spindle shaped fibroblasts and myofibroblasts, lymphocytes, plasma cells and peripheral fibrosis
inflammatory myofibroblastic tumor
morphology of chronic infection
bronchiolitis obliterans
EGFR, ALK, ROS, MET, RET
adenocarcinoma
Loss of RB
Small cell carcinoma
Most lung cancers spread early throughout the body EXCEPT this one which spreads outside the thorax late
Squamous cell carcinoma
4 cancers arising from bronchial neuroendocrine cells
- Carcinoids
- tumorlets
- Small cell carcinoma
- large cell carcinoma
whwhat is the diagnostic method for MPV
PCR for viral RNA and direct immunoflurescence
describe the reaction to inhales Cocci
delayed type hypersensitivity
What bacteria often secondarily infects with influenza viral pneumonia and can be life threatening?
S. aureus
which carcinoid is more likely to invade lymphatic vessels?
atypical
polymorphisms in this increases capacity to active procarcinogens leading to greater risk for lung cancer
P-450
Activating rearrangement in ALK gene on chromosome 2
inflammatory myofibroblastic tumor
What is the only definite treatment available for lymphangioleiomyomatosis
transplant
important cause of SECONDARY bacterial pneumonia in children and healthy adults following a viral respiratory illness (measles in children and influenza in both children and adults)
S. Aures
“salt and pepper pattern”
Small cell carcinoma
What do macrophages secrete in response to histo
TNF
shared genetic features of small cell carcinoma and squamous cell carcinoma
-loss of function mutations of TP53, RB, and deletion of 3p
Southwestern U.S.
cocci
Tree bark appearance
resolution of HISTO infection
Cause of bacterial pneumonia especially in ELDERLY and also second most common cause of bacterial exacerbation of COPD
Moraxella catarrhalis
multiple discrete nodules (CANNONBALL LESIONS) scattered throughout all lobes but more at PERIPHERY
metastasis
What is used for rapid diagnosis of legionella infection
Legionella antigens in urine
or positive fluorescent antibody test on sputum
if no cause can be found for an abscess what is it called
primary cryptogenic lung abscess
What predisposes someone with a viral pneumonia to getting a superimposed bacterial infection
impairment of mucociliary clearance
What tumors predominantly produce hypercalcemia
Squamous cell carcinoma
P63 and p40
squamous cell carcinoma
2 types of carcinoid tumor
Typical and Atypical (more agressive)
is the risk for malignant mesothelioma compounded by smoking?
NO
What biomarkers can be used to distinguish a bacterial from a viral pneumonia?
CRP and procalcitonin
4 stages of lobar pneumonia
- congestion
- red hepatization
- grey hepatization
- resolution
pulmonary disorder that primarily affects young woman of childbearing age characterized by proliferation of perivascular epithelioid cells taht express markers of both melanocytes and smooth muscle cells
Lymphangioleiomyomatosis
TTF-1 and napsin A
Adenocarcinoma
which cancer has strongest association with smoking
small cell carcinoma
HIV < 200
Pneumocystis pneumonia
intermittent attacks of diarrhea, flushing, and cyanosis
carcinoid syndrome
NAB2 and STAT6
solitary fibrous tumor
These tend to spread aerogenously, forming satellite tumors
mucinous adenocarcinoma
Gender preference for smoking carcinogens
females
What stain is used for fungi?
silver stain
What is the most common complication of a transplant in the first few weeks after
bacterial infection
Who is at high risk for disseminated Cocci disease
- Filipinos
- African American
- immunosuppressed
The change that occurs in lymphangioleiomyomatosis is similar to what pulmonary disease
emphysema
secretion of parathormone related protein, a cause of paraneoplastic hypercalcemia
Small cell carcinoma
Collar-Button lesion
Carcinoid tumor
This type of pneumonia is often necrotizing, pursues a fulminant clinical course and is a frequent cause of death?
Aspiration pneumonia
whorls of reticulin and collagen fibers interspersed with spindle cells
solitary fibrous tumor
deletion of CDKN2A/INK4a
malignant mesothelioma
Most often a localized lesion in immunocompetent patient. Typically granulomatous and caused by M. tuberculosis or fungi (histoplasma capsulatum)
chronic pneumonia
The innate immune system induces release of what in response to influenza viral infection
alpha and beta interferon
What are the most commonly isolated organisms that cause lung Abscess
- Aerobic and anaerobic strep
- Staph. aureus
- host of gram negatives
soft-tissue tumor attached to pleural surface by a pedicle
solitary fibrous tumors
1 year survival for malignant mesothelioma
approximately 50%. most die within 2 years
precursor to the development of multiple tumorlets and typical or atypical carcinoids
diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
What do helper T cell secrete in response to Histo
IFN-gamma
IHC showed high levels of anti-apoptotic protein BCL2
Small cell carcinoma
This viral protein binds to respiratory epithelial cells, allowing cellular infection
Hemagglutinin
This viral protein allows release of newly-created virions
Neuraminidase
Giant cells containing large sperules with endospores
Cocci
KRAS
adenocarcinoma
where do central carcinoid tumors protrude
into bronchial lumen
Germline mutations in what gene that is an adaptor for TLRs and important for activation of NFkappaB are associated with destructive bacterial pneumococcal pneumonias
MyD88
Most common Gram negative bacterial pneumonia
Klebsiella
What 3 things does influenza virus infectiong the respiratory epithelium cause?
- intraalveolar fluid accumulation
- cell death
- inflammation
small, poorly formed nonnecrotizing granulomas with multinucleated foreign body giant cell reaction that iss inconsequential and especially in those with gastroesophageal reflux
microaspiration
likely gender and cancer for NON smoker
women
adenocarcinoma
important cause of PEDIATRIC bacterial pneumonia, and otitis media
H. influenzae (nonencapsulated)
cryptic inversion of chromosome 12
solitary fibrous tumor
CDKN2A and TP53 mutations
Squamous cell carcinoma
What stage of lobar pnuemonia: robust exudate with neutrophils, erythrocytes, fibrin fill alveolar space
Red, firm, airless
red hepatization
amplification of MYC
Small cell carcinoma
What lobes are most frequently affected with blasto
upper
relation of asbestos exposure with a solitary fibrous tumor
NONE
Marked by gain of function mutations involving growth factor receptor pathways
adenocarcinoma
- little cytoplasm
- closely arranged nuclei with “molding”
- clusters
- may have marked necrosis
small cell carcinoma
Cough, fever, and copious amounts of foul-smelling purulent or sanguinous sputum. Fever, chest pain, and weight loss. clubbing of finger and toes may appear with a few weeks
lung abscess
Factors that favor extension of a viral infection from upper respiratory tract to lower causing pneumonia?
- extremes of age
- malnutrition
- alcoholism
- underlying debilitating illnesses
can be patchy or may involve whole lobe and bilateral or unilateral and the affected area is RED-BLUE and congested
Viral pnuemonia
Abrupt onset of high fever, shaking chills, and cough producing mucopurulent (rust colored) sputum. occasional hemoptysis
community acquired pneumonia
how does a Blast infection resolve
spontanously
characterized by presence of keratinization and/or intercellular bridges.
Squamous cell carcinoma
Pneudomonas most commonly causes what type of infection
hospital acquired
What causes carcinoid syndrome?
tumor cells secreting vasoactive amines (serotonin)
Thick, mucoid, (often blood-tinged) sputum is characteristic of this infection
klebsiella
infection of what may follow a viral respiratory infection, and is a pediatric emergency and has high mortality rate
H. influenzae
Cancers in nonsmokers are more likely to have what mutations and almost never have what mutation
EGFR
KRAS
What are the most common organisms that cause health care associated pneumonia
- methicillin-resistant Staph. Aureus
- P. aeruginosa
muscle weakness caused by auto antibodies (possibly elicited by tumor ionic channels) directed to the neuronal calcium channel; peripheral sensory neuropathy; dermatologic abnormalities, including acanthosis nigricans; hematologic abnormalities such as leukemoid reactions; trousseau syndrome; and hypertrophic pulmonary osteoarthrophathy associated with clubbing of the fingers
Lambert-Eaton myasthenic syndrome
What cells does histo target
macrophages
losses in chromosome 3, 9, and 17
Squamous cell carcinoma
-Enophthalmos
-ptosis
-miosis
-anhidrosis on same side of lesion
and pain in ulnar nerve distribution
Pancoast tumor
Antigenic drift
EPIdemic . . spontaneous mutations
may occur in patients with multiple endocrine neoplasia type 1
carcinoids
What do bacterial infections often follow?
upper respiratory viral infection
What virus is most commonly seen in young children, elderly, and immunocompromised
Human metapneumovirus (MPV)
Peak incidence for lung carcinomas
50s-60s
Gram positive, slightly elongated diplococci
Strep Pneumo
deletion of 9p
malignant mesothelioma
This infection occurs in Cystic fibrosis patients and immunocompromised and in neutropenic patients. Also invades blood vessels (hematogenous spread)
pseudomonas
What stage of lobar pneumonia: organizing fibrosis admixed with macrophages
resolution
CD34+ and keratin-negative
solitary fibrous tumor
What stage of lobar pneumonia: vascular engorgement, cell-poor intra-alveolar fluid with numerous bacteria and few neutrophils
Heavy, boggy, red
congestion
describe malignancy of carcinoid tumor
low grade
progression of malignant mesothelioma
long latent period of 25-45 years
when bilateral chronic infection is present from cystic fibrosis or bronchiectasis what do you do with the transplant?
both lungs must be replaces
Most common cause of bacterial acute exacerbation of COPD?
Haemophilus influenzae
most common causes are hospital acquired
Gram + cocci (mainly S. aureus and S. pneumo)
Gram - rods (enterobacteriacea and Pseudomonas)+
p53 overexpression
Squamous cell carcinoma
In those who survive Aspiration Pneumonia, What is a common complication?
Lung abscess
Do granulomas occur in fulminant disseminated histoplasmosis which occurs in immunosuppressed
NO
Well developed lesion are slightly elevated, dry, granular, gray-red to yellow and poorly delimited at their margins,
Histologically: neutrophil-rich exudate that fills bronchi, bronchioles, and adjacent alveolar spaces
Bronchopneumonia
What indivivuals are at special risk for postpneumonic pneumonia?
immunosuppressed or post transplant
Strong positivity for keratin proteins, calretinin, WT-1, cytokeratin 5/6, and D2-40
malignant mesothelioma
how do you histologically differentiate Histo from TB, sarcoidosis, and Cocci
3-5 micrometer thin walled yeast forms
Morphology of acute rejection
inflammatory infiltrates either around small vessels, in submucosa of airways or both
What is the only chronic pneumonia causing fungi that gives headaches
Blasto
What conditions predispose to legionella infection?
- cardiac, renal, immunologic, or hematologic disease
- Organ transplant recipients are particularly susceptible
most common form of lung cancer in women
adenocarcinoma
Common viruses that cause community acquired pneumonia?
- influenza type A and B
- RSV
- human metapneumovirus
- adenovirus
- rhinovirus
- rubeola
- varicella
Where does legionella flourish
water tanks, pipes
What are the 3 complications of pneumonia?
- Abscess formation (type 3 pneumococci and klebsiella)
- spread of infection to pleural cavity (empyema)
- Bacteremic dessemination
what enzyme system converts chemicals into carcinogens
P-450 monooxygenase
epidemiology of squamous cell carcinoma
males
-strong association with smoking
- double wall
- visible nucleus
- 5-15micrometers
- Granulomas with NEUTROPHILS
- BROAD BASED BUDDING
Blasto
When are antibodies against histo formed
2-6 weeks after infection
p16 loss
Squamous cell carcinoma
What causes pontiac fever, a self-limited URI
Legionella
- Intracellular Fungi
- Midwest
- Bird/bat dropping
Histoplasmosis
hyperplasia of the lymphiod tissue within the Waldeyer ring frequently in children
virus-induced tonsillitis
at periphery there is often lepidic pattern of spread in which the tumor cells “crawl” along normal appearing alveolar septa
Adenocarcinoma
lobes for bronchopneumis?
bilateral?
lower lobes more often
bilateral
S. aureus is associated with a high incidence of complication such as what?
- Lung abscess
- empyema
Shortly after an influenza virus enter into pneumocytes, it inhibits what channel?
sodium channelss
central or southeaster U.S. SOIL dwelling
-Also Canada, mexico, middle east, Africa, and India
Blasto
most virulent form of H. influenza
encapsulated type b
predominant histologic pattern of viral pneumonia
interstitial inflammatory reaction involving the walls of the alveoli
What are predisposing factors to CAP bacterial
- Age: young or old
- chronic disease: COPD, diabetes, CHF
- Absent splenic function
ORGANOID nests, trabecular, pallisading, ribbon, or rosette-like arrangements of cells separated by a delicate fibrovascular stroma
carcinoid tumor
Where can histoplasmosis spread
liver, adrenals, mediastinum, meninges
What are the two influenza viral proteins?
Hemagglutinin and neuraminidase
What do apical lung cancers in the superior pulmonary sulcus tend to invade?
neural structure around the trachea
- Cervical sympathetic plexus
- Horner syndrome
- Sever pain in distribution of ulnar nerve
affected lung becomes ensheathed by thick layer of soft, gelatinous, grayish pink tumor tissue
malignant melothelioma
What happens do histoplasmosis in an immunocompromised patient
wide dissemination
edema to head and arm
superior vena cava syndrome
What does an absent spleen predispose infection of?
encapsulated bacterial like pneumococcus
commonly afflicts debilitate and malnourished people, particularly chronic alcoholics
klebsiella
What patients are at particularly high risk of getting hospital-acquired pneumonia
patients on mechanical ventilation
likely arise from neuroendocrine cells in the bronchial epithelium
small cell carcinoma
Chronic, progressive, secondary lung disease which is localized to the lung apices and causes cough, fever, and night sweats
Histoplasmosis
What is the most common cause of acute CAP?
Strep. Pneumo
describe the progression of lymphangioleiomyomatosis
slowly progressive over a period of several decades
complications of a lung abscess
- extension of infection into pleural cavity
- hemorrhage
- development of brain abscesses or meningitis from septic emboli
- Rarely secondary amyloidosis
What tumors predominantly produce ACTH and ADH
Small cell carcinomas
5 year survival for typical carcinoids?
95%
if abscess is discovered in an older individual, you must rule out underlying what?
carcinoma
What stage of lobar pneumonia: fibrinosuppurative material, erythrocyte disintegration, early organization
grey hepatization
alpha and beta interferon upregulate what gene in response to influenza viral pneumonia
MX1 gene
- Coin lesion
- nodules of connective tissue (CARTILAGE) intersected by epithelial clefts
hamartoma
CAP common among children and young adults.
local epidemics (schools, military camps, prisons)
Low level walking pneumo. persistent dry cough that won’t go away
Mycoplasma pneumo.
highly malignant and agressive
Small cell carcinoma
What anaerobic organisms that are normally found in the oral cavity can cause abscess
- Bacteroides
- Fusobacterium
- Peptococcus
3 most common causes of otitis media in children
- S. pneumoniae
- H. influenzae
- M. catarrhalis
worrisome epithelial changes with smoking
basal cell hyperplasia->squamous metaplasia –> squamous dysplasia –> carcinoma in situ
Distant spread of lung carcinoma occur through what?
both lymphatic and hematogenous spread
What is the only antiviral treatment available for human MPV
Ribavirin
location of squamous cell carcinoma
central lung/hilar region
Antigenic shift
PANdemic . . coinfection of different types of influenza virus
Gender and age for carcinoid tumor
M=F
less than 40
HIV >200
Tubercular infection
Self limited and often latent primary pulmonary involvment which may result in COIN LESIONS on chest radiography
Histoplasmosis
