Pleural+Mediastinal Path

Question 1

Empyema (pyothorax)

Answer 1

purulent pleural effusion from complciating lung infection

organziation produces adheasions and loculation circbumscribing the pus and limiting lung expansion

Question 1

morphology and demographics congenital cysts

Answer 1

5-15 years

usually unilocular

simple cuboidal epitehlium possibly filled with serous fluid

Question 1

thymic hyperplasia associated with

Answer 1

myathenia gravis

other autoimmune

Question 2

symptoms thymoma

Answer 2

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)

Question 3

thymoma hiso

Answer 3

type A (spindle cells)

type b (round cells

type AB

Question 4

clinical presentation pleural effusion

Answer 4

dyspnea

pleuritic pain

cough

dullness on percussion, decreased breath sounds

compression > atelectasis > resp distress

Question 5

non-inflammatory pleural effusions

Answer 5

hydrothorax

hemothorax

chylothorax

Question 6

inflammatory pleural effusions

Answer 6

serofibrinous

suppurative

hemorrhagic

Question 7

systemic causes of pleural effusion

Answer 7

CHF

cirrhosis

nephrotic syndrome

collagen vascular diseases

Question 8

thymoma =

Answer 8

neoplastic proliferation of thymic epithelial cells

(cotains T cells. but not part of tumor)

Question 8

histology thymic carcinoma

Answer 8

dx of exclusion

no differing features allow diagnosis

Question 9

granulomatous mediastinitis = chronic disorder secondary to

Answer 9

fungal or myobacterial infection

Question 10

lines pleural surface, pericardial sac, peritoneum

Answer 10

mesothelium

Question 11

sources of metatases to pleura

Answer 11

lung

breast

ovarian

pancreas

kidney

(via blood or direct extensions)

Question 12

morphology solitary fibrous tumor

Answer 12

polyploid, well-circumsribed, pedeunculated

composed of fibrolast with collagenized stroma

cured by simple excision

Question 13

course mesothelioma

Answer 13

Latency 20-40 years

slow growing

recurrent pleural effusion

chest pain and dypsnea in advanced

20% develop pulmonary fibrosis (asbestiosis)

fatal maligancy (18mo survival)

Question 14

acute mediastinintis = complciation of

Answer 14

nearby organ pathology (esophageal perforation, lung abscess etc.)

Question 15

associations and presentation, solitary fibrous tumor

Answer 15

hypoglycemia

clubbing

typically asymptomatic

Question 16

thymoma morphology, corse

Answer 16

spindle cells or round epitheliod cells

slow growing, metatasis rare

Question 18

Hemmoragic pleuritis pathologies

Answer 18

coagulopathis

rickettsial disease

malignancies

Question 20

demographic and etiology, mesotheliom

Answer 20

adults >50

Asbestos

radiation

chronic inflammation

viral infxn (SV40 simian virus in old polio vaccines)

idopathic in 50%

Question 21

neoplastic proliferation of mesotheilal cells lining serosal surfaces

Answer 21

mesothelioma

Question 22

clinical behavior thymoma

Answer 22

depdends on capsule status:

encapsulated easily excised

invasive tumors eventually metastasize

my progress to thymic carcinoma

Question 24

histology and tumor spread malignant mesothelioma

Answer 24

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

Question 25

microscopy absestos-related mesothelioma

Answer 25

asbestos fibers engulfed by macrophages and covered with ferritin

=ferritinous bodies

Question 26

granulomatous mediastinitis due to

Answer 26

histoplasmosis

tuberculosis

crytococcosis

atypical myobacteria

aspergillosis

(His Tub Cleaned atypical Assholes)

Question 27

gross morphology empyema (pyothorax)

Answer 27

pleural surface coated by shaggy thick fibrin later

greenish purulent exudate