Pulmo Pathology

Question 1

Answer 1

Centriacinar emphysema

Increased size lung fields

Hypertranslucency (vascular destruction

Long thin heart - emphysema

No infiltrates

Question 2

Answer 2

Centriacinar emphysema

extensive involvement of upper lung field

Question 3

Answer 3

Centriacinar emphysema

Question 4

Answer 4

Destroyed respiratory bronchioles and alveolar ducts distal to the terminal bronchiole

Note that the alveoli (i.e.,
peripheral portion of the lung acinus) are comparatively intact.

Question 5

Answer 5

Bronchiole in the centre (no cartilage)

Dilated + mucostasis

Peribronchial chronic inflammation composed of mature lymphocytes (small airways disease)

Question 6

Answer 6

Hyperinflated lung fields w/o infiltrates

Patchy areas of atelectasis (right lower zone on PA film)

Question 7

Answer 7

Hyperinflated lungs (don’t collapse even after removed)

Question 8

Answer 8

Mucous plug

Question 9

Answer 9

Membranous bronchiole and accompanying pulmonary artery

Mucou secretions within airway lumen

airway inflammation/thickening

Question 10

Answer 10

Mucu within airway lumen

Apparent thickening of the subepithelial basement membrane

Inflammatory infiltrates (PMNs + eosinophils)

Subepithelial and adventitial fibrosis

Question 11

Answer 11

Extensive bronchiectasis

Question 12

Answer 12

Bronchiectasis

pneumonia + abscess formation

Question 13

Answer 13

Bronchiectasis

Question 14

Answer 14

Mucous secretions within airway lumen

Chronic airway inflammation

Some goblet cell metaplasia of the epithelium

Question 15

Answer 15

Dilated submucosal glands

Inspissated secretions within their lumens (typical of CF)

Question 16

Answer 16

Consolidation of R. middle lobe

Question 17

Answer 17

Consolidation of whole R middle lobe (uniform)

Grayish brown dry surface

Lobar pneumonia

Question 18

Answer 18

Suppurative, neutrophil-rich exudate filling alveolar air spaces

Question 19

Answer 19

+ Hx (foul purulent sputum, chills, fever)

Lung abscess

Cavitatory lesion with irregular walls

Necrosis of lung tissue

Question 20

Answer 20

Lung abscess

Well-circumsized 3-4 cm lesion with necrotic material in the centre

The cavity contains necrotic sloughed lung tissue and
degenerated purulent excudate in varied proportions

The cavity is surrounded by granulation tissue which in long-standing
cases, will become a well-developed fibrous capsule

Question 21

Answer 21

Lung abscess

suppurative
destruction of the lung parenchyma within the central area of cavitation

The cavity contains necrotic sloughed lung tissue and
degenerated purulent excudate in varied proportions

The cavity is surrounded by granulation tissue which in long-standing
cases, will become a well-developed fibrous capsule (which is seen in the photograph).

Question 22

Answer 22

ARDS, severe pneumonia

Question 23

Answer 23

early exudative phase of ARDS with edema, cellular debris and early hyaline membrane formation

Question 24

Answer 24

proliferative phase of ARDS

well defined hyaline membranes

increased cellularity in the interstitium with occasional
fibroblast-like cells seen (spindled cells)

arrow = hyaline membranes

Question 25

Answer 25

Ground glass centrilobular nodes Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Question 26

Answer 26

Irregular chronic interstitial inflammatory infiltrate Poorly formed granulomas and chronic interstitial inflammation at arrows, no true fibrosis Extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Question 27

Answer 27

Granulomas are present in lung and mediastinal node; node is enlarged because it is completely replaced by granulomas. Dx = sarcoid

Question 28

Answer 28

Granulomas are present in lung and mediastinal node; node is enlarged because it is completely replaced by granulomas. Dx = sarcoid.

Question 29

Answer 29

Granulomas are present in lung and mediastinal node; node is enlarged because it is completely replaced by granulomas. Dx = sarcoid

Question 30

Answer 30

Patchy patterns of fibrosis Fibroblast focus at arrow Usual interstitial pneumonia (idiopathic pulmonary fibrosis)

Question 31

Answer 31

R. lower lobe collapse Atelectasis due to obstruction or compression

Question 32

Bronchial biopsy

Answer 32

Moderately well-differentiated squamous cell carcinoma Upper 10% of photograph = bronchial mucosa immediately below: chronic inflammatory cells, including many plasma cells

Question 33

Answer 33

Squamous cell carcinoma single cell keratinization

Question 34

Answer 34

Squamous cell carcinoma keratin pearl formation

Question 35

Answer 35

Squamous cell carcinoma intercellular bridges

Question 36

Answer 36

Adenocarcinoma gland formation

Question 37

Answer 37

Adenocarcinoma mucus production

Question 38

Answer 38

Cavitary Pancoast tumour cavity inside lesion = carcinoma, TB, lung abscess

Question 39

Sputum cytology and fine needle aspiration of supraclavicular mass

Answer 39

Small cell carcinoma In sputum the tumor appears as small dark cells in non-cohesive clusters; nuclei are hyperchromatic, nucleoli are absent, cytoplasm is scant, nuclei mold around one another and crush artefact may be present. Well preserved small cell carcinoma cells in fine needle aspirates are two to three times the size of a lymphocyte, have "salt and pepper" chromatin with hyperchromatic, variably sized and shaped nuclei, no (or inconspicuous) nucleoli and tend to mold around one another. ``` Crush artifact (strands of DNA) is usually present. The tumor cells tend to be clustered together but are not usually cohesive ```

Question 40

Answer 40

Cardiac muscle showing small cell carcinoma infiltration (uncommon)