Pulmonary pathology

Question 1

Histology of acute bronchitis

Answer 1

In bronchi: Neutrophils in the airway lumen and infiltrating wall

Question 2

Histology of chronic bronchitis

Answer 2

In bronchi: chronic inflammation(lymphocyte cell infiltrates in airway wall), squamous metaplasia (transformation of ciliated columnar cells of bronchi into flattened squamous cells which is reversible) and mucus gland hypertrophy

Question 3

What is bronchiectasis

Answer 3

dilated airways, usually from chronic infections

Question 4

Bronchiectasis histology

Answer 4

Bronchi shows dilated airways (compared to adjacent pulm artery) this is irreversible

Question 5

Asthma histology

Answer 5

bronchi show Thickened subbasal lamina (pink band under epithelium is thick), Eosinophilic inflammation, Mucus hypersecretion

Question 6

Histology of chronic bronchiolitis

Answer 6

Bronchioles show chronic inflammation in the walls (mostly lymphocytes). This is reversible

Question 7

Follicular bronchiolitis histology

Answer 7

lymphoid (mostly T cells) aggregates with germinal centers (mostly B cells) in the bronchioles

Question 8

Constructive and obliterative bronchiolitis histology

Answer 8

Fibrosis btw mucosa and smooth muscle squeezing the bronchiole airway lumen shut (obstructive) or completely obliterating the airway (obliterative), May cause severe airtrapping in the downstream lung. These are irreversible processes

Question 9

Granulomatous bronchiolitis histology

Answer 9

In bronchiole: Granulomas composed of clustered histiocytes (elongated nuclei and abundant cytoplasm) and multinucleated giant cells. May be centrally necrotizing or nonnecrotizing

Question 10

Causes of necrotizing vs nonnecrotizing granulomatous bronchiolitis

Answer 10

Necrotizing cases are usually infectious. Nonnecrotizing cases may be infection, sarcoid or chronic beryllium disease

Question 11

Acute pneumonia histology

Answer 11

Neutrophils, macrophages and fibrin in airspaces

Question 12

Aspiration pneumonia histology

Answer 12

Airspace foreign material (food), Multinucleated giant cells

Question 13

Eosinophilic pneumonia histology

Answer 13

Eosinophils, macrophages and fibrin within airspaces

Question 14

Organizing pneumonia histology

Answer 14

Fibroblast plugs in airways and airspaces. Patchy by may be densely consolidating. May also have small amounts of pink fibrin.

Question 15

Diffuse alveolar damage histology

Answer 15

Hyaline membranes (fibrin ribbons in the airspaces lining the alveolar septa). Alveolar septa may be expanded by inflammation and fibroblastic tissue

Question 16

Which histologic pattern corresponds to ARDS

Answer 16

diffuse alveolar damage

Question 17

emphysema histology

Answer 17

Enlarged airspaces, broken alveolar septa (irreversible damage), subpleural blebs (may become large enough to cause pneumothorax).

Question 18

Describe distribution of damage in smoking related emphysema and alpha-1 antitrypsin related emphysema

Answer 18

Smoking-related emphysema is worse in the upper lobes and around bronchioles (centrilobular emphysema). Alpha-1-antitrypin deficiency related emphysema is worse in the lower lobes and is NOT worse around the airways (panlobular emphysema)

Question 19

List three smoking related diseases

Answer 19

emphysema, respiratory bronchiolitis and desquamative interstitial pneumonia

Question 20

Respiratory bronchiolitis histology

Answer 20

Brown pigmented macrophages in small bronchioles and surrounding airspaces. Airspaces far from airway are usually spared

Question 21

Desquamative Interstitial Pneumonia (DIP) histology

Answer 21

Similar brown pigmented airspace macrophages as RB, but found diffusely in the airspaces, not just around small airways