Pulmonary Path (Ivanovic)

Question 1

What histologic findings would you expect in the “red hepatization” stage of bacterial lobar pneumonia?

a) granular, semifluid debris and macrophages
b) fibrin, red blood cells and numerous neutrophils
c) fibrosis and granulation tissue within the alveolar spaces
d) hyaline membranes without alveolar infiltrates

Answer 1

b. This mass of cells and fibrin would be filling the aveolar spaces in this stage of bacterial lobar pneumonia, and the gross findings would show firm, red, airless, liver-like lungs.

Question 2

Microscopic findings in this stage of bacterial lobar pneumonia would include enzymatic digestion of the alveolar exudate to produce granular, semifluid debris that gets resorbed, ingested by macrophages, expectorated or organized by fibroblasts growing into it

Answer 2

resolution

Question 3

Microscopic findings in this stage of bacterial lobar pneumonia would include disintegration of red blood cells and persistence of fibropurulent exudate

Answer 3

gray hepatization

Question 4

type of pneumonia characterized by acute febrile respiratory disease with patchy inflammatory changes in the lungs (mostly involving alveolar septa)

Answer 4

atypical (viral) pneumonia

Question 5

what are the main difference in findings between atypical and bacterial pneumonia?

Answer 5

Atypical: moderate amounts of sputum with no consolidation, no alveolar exudate, inflammation is in the interstitum with mainly lymphocytes

Bacterial: exudate filling alveolar space, vascular engorgement, and lots of neutrophils

Question 6

gross finding that is an obvious characteristic of idiopathic pulmonary fibrosis (AKA usual interstitial pneumonia)

Answer 6

“honeycombing” of the lung. honeycombing is an irreversible finding in interstitial lung disease and associated with a poor prognosis.

Question 7

A 53 year old woman presents with symptoms of progressive dyspnea over the past year. High resolution CT scan showing findings consistent with interstitial lung disease. She had recurring episodes of fever, dyspnea and cough in past several years since she acquired her pet bird. What is a likely diagnosis?

Answer 7

hypersensitivity pneumonitis (aka, extrinsic allergic alveolitis)

Question 8

Histologic findings shown on the picture below are consistent with:

a) atypical (viral) pneumonia
b) interstitial lung disease
c) sarcoidosis
d) emphysema
e) bacterial pneumonia

Answer 8

e

Question 9

Type of disease as shown in the histological image below:

Answer 9

hypersensitivity pneumonitis; poorly formed noncaseating granulomas, inflammation of the interstitium and honeycombing (late stage)

Question 10

The gross findings shown below are consistent with what disease?

Answer 10

sarcoidosis (these are noncaseating granulomas)

Question 11

a star-shaped eosinophilic structure seen in 2-9% of patients with sarcoidosis (not specific for sarcoidosis).

Answer 11

asteroid body

Question 12

a concentric laminated calcification seen in 70% of patients with sarcoidosis.

Answer 12

Schaumann body

Question 13

interstitial lung diseases are often idiopathic, though some may be a chronic manifestation of systemic collagen vascular diseases like these

Answer 13

lupus and sjogren syndrome

Question 14

Which of the following regarding lung cancers is FALSE?

A. Both adneocarinoma and small cell carcinoma are more common in females than males

B. Non-small cell carcinoma is more fatal, with only a 6.5% survival rate at 5 years

C. Metastatic carcinoma to the lung is more common than primary lung cancer

D. Metastatic carcinoma most commonly presents as multiple bilateral nodules

E. Primary lung cancer usually presents as a solitary
lesion

Answer 14

B. Small cell carcinoma has higher mortality, with a 6.5% survival rate at 5 years, compared to non-small cell carcinoma which has a 21.4% survival rate at 5 years.

Question 15

What type of carcinoma shows, keratinization with keratin pearls, eosinophilic dense cytoplasm, and intercellular bridging and is highly associated with smoking?

Answer 15

squamous cell carcinoma

Question 16

What carcinoma of the lung has very high association with smoking, originates from neuroendocrine cells, and shows cells with “salt and pepper” like chromatin, as depicted below?

Answer 16

small cell carcinoma

Question 17

what are the prognostic and histological differences between small cell carcinoma and carcinoid (shown below)?

Answer 17

prognosis: carcinoid is less aggressive and has better survival rate than small cell
histology: carcinoid has trabecular pattern with round nuclei and more abundant cytoplasm than small cell

Question 18

Which type of lung cancer is the one most often found in never-smokers that presents with gland formation and “pleural puckering”? With what mutation is it commonly associated?

Answer 18

adenocarcinoma; associated with EGFR mutation

Question 19

a rare tumor of the pleura (NOT lung parenchyma ) associated with asbestos exposure and very poor outcome

Answer 19

mesothelioma

Question 20

type of tumor that often clinically mimics pneumonia and is characterized by a “spongy” appearance on gross section, due to a loss of desmplasia (no invasion, grows along intact alveolar walls)

Answer 20

bronchioloalveolar carcinoma, aka, non-invasive adenocarcinoma; may either be mucinous (shown below) or non-mucinous

Question 21

What type of tumor may show the below histological finding?

Answer 21

mesothelioma; indicative of asbestos exposure, characterized by iron protein-coated “ferruginous bodies”

Question 22

Is a primary or metastatic lung cancer?

Answer 22

Metastatic. This photo demonstrates an entire lobe of lung riddled by multiple white-tan tumor nodules. This appearance is more in keeping with a metastatic process than a primary process. When these types of nodules are seen on an imaging study, they are often referred to as ‘cannon balls’