Pulmonary Path 3/4 Flashcards
Atypical adenomatous hyperplasia (AAH)
<5 mm
dysplastic pneumocytes present along alveoli with some interstitial fibrosis
Adenocarcinoma in situ (AIS)
< 3 cm
dysplastic pneumocytes confluently growing along alveoli
DIPNECH characteristics
precursor lesion
neuroendocrine tumor
very small, less than 5 mm (“tumorlets”)
carcinoid tumor characteristics
5mm or larger
can metastasize
neuroendocrine carcinoma grade 1
Neuroendocrine tumor grade 2
Atypical carcinoid tumor
- necrosis
- increased mitotic activity (increased rates of metastasis)
- disordered growth
Neuroendocrine tumor grade 3
small cell carcinoma
empyema
exudate with accumulation of pus in the pleural space (typically from a bacterial infection)
What is empyema notorious for?
creating loculations or web like traps for fluid
what does empyema look like?
fluid will be thick, yellow; smears show neutrophils and bacteria
viral infectious rhinitis/sinusitis causes and appearance
- Rhinovirus, coronavirus, adenovirus, echovirus
- clear rhinorrhea
bacterial rhinitis/sinusitis causes and appearance
- superimposed infection (strep pneumoniae, haemophilius influenzae)
- thick purulent nasal secretions
allergic rhinitis/sinusitis cause/appearance
- can be from a variety of inhaled allergens (type 1 hypersensitivity)
- edema, rhinorrhea
inflammatory sinonasal polyps clinical presentation/histo
presentation: large ball of mucus in sinuses
histo: edema in stroma with eosinophilic infiltrates
What can cause obstructions with sinusitis?
- empyema
- mucocele
Pathway of infection with sinusitis?
- enters maxillary sinus by tracking along periapical tissues (oral flora)
- advanced sinusitis can secondarily spread infection
Where can ethmoidal sinusitis spread to?
pre-septum, orbit
Where can frontal sinusitis spread to?
brain, meninges
mycetoma
fungal ball seen with fungal sinusitis
who gets acute invasive sinusitis?
diabetics, immunocompromised people
What causes fungal sinusitis?
Zygomycosis species (mucor)
Treatment of fungal sinusitis
emergent situation requiring IV antifungal therapy to prevent extension into the brain or sepsis
clinical presentation Granulomatosis with polyangiitis
- middle aged adults
- nasal passages and sinuses have ulceration, necrosis and perforation of the septum
histology Granulomatosis with polyangiitis
granulomatous inflammation/vasculitis
classic necrobiotic blue
What agents are responsible for otitis media?
Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae
What agent is responsible for chronic otitis media in diabetics?
Pseudomonas aeruginosa
what is a cholesteatoma?
- cystic lesion that arises in chronic otitis media
- lined by benign squamous epithelium with trapped keratin debris
- Not neoplasm, can enlarge and erode adjacent bone
otosclerosis
abnormal bony deposition, typically at the stapedial foot plate
what does otosclerosis cause?
conductive hearing loss
what is the inheritance of otosclerosis?
Autosomal dominant
embryological origin of carotid body tumors
neural crest cells (from autonomic paraganglia)
clinical presentation of carotid body tumors
May arise sporadically or be associated with MEN2
radiographic features of carotid body tumors
lyre sign (bowing of vessels)
Histologic findings for Dx of carotid body tumors
Nests of cells (“zellenballen”) that are demonstrated with S-100 stain
what radiological finding is ARDS associated with and why?
Diffuse whiteout due to permeative pulmonary edema
What type of lesion is a hamartoma on radiology?
popcorn calcification or “coin”
What causes resorption atelectatsis and what does it look like?
Airway blockage causes and it looks like a wedge shape
Possible Blockages
- tumor
- foreign body
- mucus
pneumothorax on radiology
expiratory chest film shows shift of mediastinum
