Pleural+Mediastinal Path Flashcards
Empyema (pyothorax)
purulent pleural effusion from complciating lung infection
organziation produces adheasions and loculation circbumscribing the pus and limiting lung expansion
morphology and demographics congenital cysts
5-15 years
usually unilocular
simple cuboidal epitehlium possibly filled with serous fluid
thymic hyperplasia associated with
myathenia gravis
other autoimmune
symptoms thymoma
asymptomatic in 30%
cough
dypsnea
chest pain
Paraneoplastic syndromes (myathenia gravis, pure red cell aplasia, hypogammaglobulinemia, agraunulocytosis, white blood cell aplsia, polymyositis, SLE, pehmphigus vulgaris, disseminated herpes)
thymoma hiso
type A (spindle cells)
type b (round cells
type AB
clinical presentation pleural effusion
dyspnea
pleuritic pain
cough
dullness on percussion, decreased breath sounds
compression > atelectasis > resp distress
non-inflammatory pleural effusions
hydrothorax
hemothorax
chylothorax
inflammatory pleural effusions
serofibrinous
suppurative
hemorrhagic
systemic causes of pleural effusion
CHF
cirrhosis
nephrotic syndrome
collagen vascular diseases
thymoma =
neoplastic proliferation of thymic epithelial cells
(cotains T cells. but not part of tumor)
histology thymic carcinoma
dx of exclusion
no differing features allow diagnosis
granulomatous mediastinitis = chronic disorder secondary to
fungal or myobacterial infection
lines pleural surface, pericardial sac, peritoneum
mesothelium
sources of metatases to pleura
lung
breast
ovarian
pancreas
kidney
(via blood or direct extensions)
morphology solitary fibrous tumor
polyploid, well-circumsribed, pedeunculated
composed of fibrolast with collagenized stroma
cured by simple excision
course mesothelioma
Latency 20-40 years
slow growing
recurrent pleural effusion
chest pain and dypsnea in advanced
20% develop pulmonary fibrosis (asbestiosis)
fatal maligancy (18mo survival)
acute mediastinintis = complciation of
nearby organ pathology (esophageal perforation, lung abscess etc.)
associations and presentation, solitary fibrous tumor
hypoglycemia
clubbing
typically asymptomatic
thymoma morphology, corse
spindle cells or round epitheliod cells
slow growing, metatasis rare
Hemmoragic pleuritis pathologies
coagulopathis
rickettsial disease
malignancies
demographic and etiology, mesotheliom
adults >50
Asbestos
radiation
chronic inflammation
viral infxn (SV40 simian virus in old polio vaccines)
idopathic in 50%
neoplastic proliferation of mesotheilal cells lining serosal surfaces
mesothelioma
clinical behavior thymoma
depdends on capsule status:
encapsulated easily excised
invasive tumors eventually metastasize
my progress to thymic carcinoma
histology and tumor spread malignant mesothelioma
spreads along mesothelial surfaces
bland cuboidal cells, well-differentiated
spindle cell type or epitheliod type
can involve other serosal surfaces (peritoneum, tunica vaginalis, pericardium)
spares parenchyma
microscopy absestos-related mesothelioma
asbestos fibers engulfed by macrophages and covered with ferritin
=ferritinous bodies
granulomatous mediastinitis due to
histoplasmosis
tuberculosis
crytococcosis
atypical myobacteria
aspergillosis
(His Tub Cleaned atypical Assholes)
gross morphology empyema (pyothorax)
pleural surface coated by shaggy thick fibrin later
greenish purulent exudate
