pulmonary pathology Flashcards
Structure Of The Lung
bronchioles/lobe number for R/L lung, anlge?
importance?
3 for R and 2 for L
R bronchus is also more vertical: means that inspried object more liley to go right
compoents of trachea/ brocnhus
cartilage
and glands
bronchiole components
lack
cartilage and glands,
has smooth muscle for bronchoconstriction/dialtion
components of the alveolar wall
type 1 and 2 pneumocytes and pores of kohn
- Type I pneumocyte –
flattened alveolar
lining cell
- Type II pneumocyte – functions
surfactant, repair
pores of kohn allow?
passage of exudate between alveoli
IS cell found in alveoli?
alveolar macrophage
Surfactant
Surface active agent –reduces surface
tension
type 2 pneumo development, without this
- Type II pneumocytes by 27-28th weeks of gestation
- without this Hyaline membrane disease can occur and be fatal
Pleura
- Visceral pleura (inner)
- Parietal pleura (outer)
- Mesothelial lining created by this
- Pleural space –a potential space
implication?
pain receptors at lung/pleura
- Pleura –pain receptors
- Lung –few pain receptors
- Pain is not a part of lung disease until the pleura is involved
lymphatics at lung
very rich, metatsis likely
forms?
Atelectasis
Collapsed Lung
* Resorption– Obstruction prevents air from reaching distal airway
* Compression– Fluid within pleural cavity
* Contraction– Local or generalized fibrotic changes
Scoliosis and Kyphosis pul effects
can add P onto lungs and reduce function
COPD
combination of two diseases: chronic bronchitis and emphysema
chronic inflamm where? resistance to?
- Chronic bronchitis –
chronic inflammation of bronchi
–increases resistance to the outflow of air
Emphysema
destruction of elastic tissue, loss of surface area
–reduces the elastic recoil of the lung
and surface area
common in? rare in?
Chronic Obstructive
Pulmonary Disease
- Common in cigarette smokers
- Rare in non-smokers
portion of airway affected by chronic bronchitis?
proximal?
portion of airway affected by emphysema
distal
Pure Chronic Bronchitis vs
Pure Chronic Emphysema
clinical def of chronic bronchitis
persistent productive cough for 3 consecutive months in 2 consecutive years
forms of chronic brochitis
simple
asthmatic
obstructive
Simple chronic bronchitis
–airflow not obstructed
Chronic asthmatic bronchitis
–hyperreactive airways with bronchospasm and wheezing
Chronic obstructive bronchitis
chronic outflow obstruction
histo effects of chronic bronchitis
squamous metaplasia and thickening of the mucus layer
Chronic Bronchitis
* Inspiration vs Expiration
- Inspiration –easy
- Expiration - difficult
Emphysema
- Abnormal permanent enlargement of the air spaces
- Destruction of alveolar walls without fibrosis
- Reduction in surface area for gas exchange
forms of emphysema
centrilobular and panacinar
centrilobular emphysema
affects res bronchiole
* Typically seen in
cigarette smokers
centrilobular emphysema
affects res bronchiole
* Typically seen in
cigarette smokers
panacinar emphysema
affect alveolus
* Most commonly seen in Alpha-1 Anti-trypsin Deficiency
* Seen in people without risk factors (smoking)
Alpha-1 Antitrypsin Deficiency
- Causes a rare form of emphysema –panacinar emphysema
- Protease-antiprotease imbalance
- Oxidant-antioxidant imbalance
- A1AT is anti-protease synthesized in the liver
- A1AT scavenges proteases released by inflammatory cells (polys and macrophages)
COPD –“Pink Puffer” due to
Predominance of Emphysema
COPD –“Blue Bloater” due to
Predominance of Chronic Bronchitis
Bronchiectasis
- A secondary disease; not a primary disease
- Permanent dilation of bronchi and bronchioles caused by destruction of muscle and supporting tissue resulting from chronic necrotizing infections
- Cough and expectoration of copious amounts of purulent sputum
seen with CF
Brochial Asthma
symptoms?
diff with?
bronchi?
time frame?
tx?
Status asthmaticus?
- Severe dyspnea with wheezing
- Difficulty with expiration
- Bronchi constricted and filled with mucin and debris
- Attacks last from one to several hours
- Subside spontaneously or with therapy –usually bronchodilators and corticosteroids
- Status asthmaticus –a severe paroxysm that does not respond to therapy and persists
what occurs in the airway with brochial asthma
- Mucus accumulation
- Goblet cell hyperplasia
- Hypertrophy of submucosalmucous glands
- Chronic inflammation
- Basement membrane thickening
- Smooth muscle cell hypertrophy and hyperplasia
Allergic Asthma
type od dx?
obstruction?
inflamm/cells involved?
smooth mm?
- Allergic disease - repeated immediate hypersensitivity and late phase reactions
- Intermittent and reversible airway obstruction
- Chronic bronchial inflammation with eosinophils
- Bronchial smooth muscle hypertrophy and hyper-reactivity
Drug-Induced Asthma
what drug?
seen in?
- Aspirin sensitivity –aspirin induces asthma attack
- seen in pts with History of recurrent rhinitis, nasal polyps, urticaria and bronchospasm
Metastatic Disease at lungs
* frequent site?
* The most common lung tumor?
* Lung metastases are present in about ______of all cancer deaths
Metastatic Disease
* The lungs are a frequent site of metastatic disease
* The most common lung tumor is metastatic
* Lung metastases are present in about 1/3 of all cancer deaths
why are metasises so common at lung
Metastases to the lungs are more common even than primary lung neoplasms simply because so many other primary tumors can metastasize to the lungs
carcinoma/sarcoma routes to lung
- Carcinomas usually metastasize via the lymphatics
- Sarcomas frequently metastasize via the hematogenous route
Therapeutic Classification of
Bronchogenic Carcinoma
- Small cell carcinoma (NE cells)
- Non-small cell carcinoma (epi cells)
both classes respond to dif tx
Pathologic Classification of
Bronchogenic Carcinoma
- Squamous cell carcinoma
- Adenocarcinoma
- Small cell carcinoma (oat cell carcinoma)
- Large cell undifferentiated carcinoma
Squamous Cell Carcinoma
* Most often seen in?
* Arises from where in lung?
* precursor lesion?
* Prognosis depends on?
- Most often seen in cigarette smokers
- Arises centrally from main bronchi close to the bifurcation
- Squamous metaplasia precursor lesion
- Prognosis depends on the stage
Squamous Metaplasia of Columnar,
Ciliated Respiratory Epithelium
- Smoking causes squamous metaplasia of respiratory epithelium
- Creates “dead spots” in mucociliary escalator
- Creates “fertile soil” for development of epithelial dysplasia leading to squamous cell carcinoma (most common type of bronchogenic carcinoma in smokers)
Precursor Lesions of Bronchogenic
Squamous Cell Carcinoma
what pigment can be seen with SCC
anthrcotic in the lesion due to smoke
Small Cell Carcinoma
(Oat Cell Carcinoma)
* Arise where in lung?
* Aggressive?
* tx?
* origin?
* Frequent association with?
- Arise centrally
- Aggressive –metastasize early and widely, poor prognosis
- Chemotherapy
- Neuroendocrine origin
- Frequent association with smoking
pigmentation of oat cell carcinoma
can still see antrascotic pigment of lesion
small cell carcinoma can cause ulceration where?
can see neutropenic ulceration in the oral cavity
Adenocarcinomas arise where in lung
Arises peripherally in lung
Large Cell Carcinoma
- Undifferentiated epithelial tumors that lack the cytologic features of small cell carcinoma and glandular or squamous differentiation
- poorly differentiated large cells= diagnosis of exclusion
- can arise centrally of peripherally
Bronchial Carcinoid
* origin?
* tx?
- Neuroendocrine cell origin
- Often resectable and curable
Mass Effects of Lung Cancer
- Obstruction (atelectasis)
- Superior vena cava syndrome
- Pancoast syndrome
- Horner syndrome
Superior Vena Cava Syndrome
* Obstruction of?
* Impaired?
* Edema and congestion?
* Upper extremity veins?
- Obstruction of superior vena cava
- Impaired venous return from the head and neck
- Edema and congestion of face, neck and upper chest
- Upper extremity veins fail to empty on elevation
Horner Syndrome
* eyes?
* eyelid?
* pupils
* sweating?
Compression of the sympathetic
nerves to head and neck causing:
* Enophthalmos –retraction of
globe
* Ptosis of the upper eyelid
* Miosis - Pupillary constriction
* Anhidrosis –lack of sweating
Pancoast Syndrome
- Compression of the lower cervical and upper thoracic nerves causing shoulder pain radiating down the arm
potnetial forms?
paraneoplasitc syndromes of lung cancer
Well Known for Causing Paraneoplastic Syndromes
* Small cell carcinoma –frequent ectopic hormone production
- Cushing syndrome - ectopic secretion of an ACTH-like hormone
– Patients present with Cushing syndrome - Hyperparathyroidism - ectopic secretion of a parathyroid-like hormone
– Patients present with symptoms of hyperparathyroidism –parathyroids normal
airway? metasis? paraneo? SVC? horner?
Effects of Bronchogenic Carcinoma
Summation
- Local mass effects by blockage of airway
- Metastasis
- Paraneoplastic syndromes
- Superior vena syndrome
- Horner syndrome
also increased risk of?
Mesothelioma
Mesothelioma
* Malignant neoplasm of pleura (pain occurs) associated with environmental asbestos exposure
* Asbestos also increases risk for squamous cell
carcinoma as well as mesothelioma
Pulmonary Hamartoma
hyperproduction of lung tissue, benign
Traditional Classification of
Pneumonia by Anatomic Distribution
- classified based on Pattern of lung involvement
- Bronchopneumonia –patchy involvement
- Lobar pneumonia –entire lobe involved
types of pneumonia?
lobular pneumonia
Classification of Pneumonia by
Etiologic Agent or Clinical Setting
- Specific etiologic agent –e.g. Streptococcus pneumoniae
- Clinical setting
– Community-acquired pneumonia
– Nosocomial pneumonia (in hospital)
– Aspiration pneumonia
– Chronic pneumonia
– Pneumonia in the immunocompromised host
Pneumonia in Immunocompromised
Individuals spp?
- Pneumocystis jiroveci(older name: Pneumocystis carinii)– Fungal organism of very low virulence in
immunocompetent individials - Mycobacterium avium intracellulare (MAI)
possible agents of pneumonia
- Bacterial
- Viral
- Other
bacterial agents of pneumonia
– Streptococcus pneumoniae
– Klebsiella pneumoniae
– Staphylococcus aureus
– Streptococcus pyogenes
– Legionella pneumophilia
other agents of pneumonia
– Mycoplasma
– Chlamydia psittaci (psittacosis –parrot fever)
viral agents of pneumonia
– Cytomegalovirus
– Roseola (measles)
– Varicella (chickenpox)
Pneumonia in AIDS
- AIDS patients are susceptible to all forms of pneumonia
- Pneumocystis carinii pneumonia (PCP)
– AIDS patients especially vulnerable to Pneumocystis carinii pneumonia (PCP)
– Reclassified from a protozoan to a fungus
– Name changed to Pneumocystis jiroveci
Tuberculosis
caused by?
AIDS?
transmission?
inital lesion where? name?
course of events?
- Caused by Mycobacterium tuberculosis hominis or bovis
- In AIDS patients, Mycobacterium avium-intracellulare is a common pathogen
- Transmitted from person-to-person by aerosolized droplets during coughing, sneezing and talking
- Initial lesion in lung (Gohn focus/complex)
- Following exposure the course of events is variable - may disseminate and cause systemic involvement
Primary Tuberculosis histology
- Granulomas form in the periphery of the lung
(Gohn focus) followed by Gohn complex - The classic lesion is a caseating granuloma –a
collection of activated macrophages (epitheliod
histiocytes), sensitized lymphocytes, multinucleated giant cells and a collar of fibroblasts
gohn complex of TB
what necrosis occurs with TB
caseous
Secondary Tuberculosis
* Lesions classically appear where? how?
* the result of?
* triggered by?
- Lesions classically appear at the apices of the lungs and are cavitary
- This form of tuberculosis usually is the result of reactivation of dormant organisms in old, silent lesions of primary tuberculosis
- Reactivation is usually triggered by immunosuppression
milliary tuberculosis of the spleen, can occur with dessimination thru lymphatics
Pneumoconioses
Lung scarring from inhaled particulate matter
forms of Pneumoconioses
- Silicosis –silica
- Asbestosis –asbestos
- Berylliosis –Beryllium
- Anthracosis –coal dust: Coal worker’s pneumoconiosis, Black lung disease
Silicosis increases risk of? what is seen in histo
- Increased risk for tuberculosis= Silico-tuberculosis
- silica crystal seen
from? risk for? will form?
Asbestosis
- Environmental hazard
- Risk for mesothelioma
forms a fibrous pleaural plaque
progressive? what pigments are seen?
Coal Worker’s Pneumoconiosis
- Black lung disease
- Progressive massive fibrosis
will see an anthracotic pigment
IV drug use Lung effect
Talc Crystals form in Lung
Nasopharyngeal Carcinoma
* Strong epidemiologic link?
* High frequency in?
* Three histologic variants?
* variant most common?
* Radiosensitive?
- Strong epidemiologic link to Epstein Barr
virus - High frequency in Chinese
- Three histologic variants:
– Keratinizing SCCa
– Non-keratinizing SCCa
– Undifferentiated carcinoma - Undifferentiated carcinoma variant most
common
– “Lymphoepithelioma” (a misnomer) due
to the influx of mature lymphocytes - Radiosensitive –50% 5-year survival rate
what dx are associated with HHV-4
- Infectious Mononucleosis
- Lymphomas –NHL and HL
e.g. Burkitt lymphoma (NHL) - Nasopharyngeal Carcinoma
- Oral Hairy Leukoplakia
Most common presenting symptom of laryngeal lesions is?
Most common presenting symptom of laryngeal lesions is hoarseness
hoarseness of larynx seen with
Vocal cord nodules (singer’s nodes, polyps) –chronic irritation
* Laryngeal papillomas –squamous papilloma - HPV
squamous? recurrent? inherited?
- Laryngeal papillomas
Squamous papilloma - HPV
– Solitary in adults
– Multiple in children
- Recurrent respiratory papillomatosis (RRP)
- HPV types 6 and 11 (vaccination) –vertical transmission from infected mother- Spontaneously regress at puberty
demo? associated with? most common sign?
Laryngeal Squamous Cell Carcinoma
- Adult males (7:1)
- Strong association with cigarette smoking
- Persistent hoarseness is most common symptom
forms of laryngeal SCC
glottic
supraglottic
subglottic
confined? when are symptoms? prognosis?
- Glottic tumors
- Glottic tumors (directly on vocal cords) most common
– Most confined to larynx at diagnosis
– Cause symptoms early in course of disease
– Best prognosis –sparse lymphatics
- Supraglottic tumors
- Supraglottic tumors (above the vocal cords)
– Rich in lymphatics –likely to metastasize to regional (cervical) lymph nodes
- Subglottic tumors
- Subglottic tumors (below the vocal cords) least common
– Remain subclinical and present with advanced disease
Toxic Pulmonary Effects of
Chemotherapy
Pulmonary Fibrosis will occur
* Pulmonary function tests (PFTs) normal at start of chemotherapy
* One year later PFTs, 19% of lung function remaining
* Continuous 100% oxygen therapy
* Confined to wheel chair
where can lung cancer metastisize too that we will see?
oral cavity, gingiva
what pul. fungal infection can be seen orally on occasion
histoplasmosis, diagnosed with biopsy, would see red dots in macrophages
radiographic app of metasises in oral
presents as a luceny
what sarcoma can be seen orally
karposi sarcoma
how can this be avoided?
what oral infection can occur with corticosteroid inhalers?
candidasis, do not touch inhaler to mouth and rinse with water after use
