Pulmonary Pathology I

Question 1

Basic composition of airways

Answer 1

mucus glands, smooth muscle and ciliated columnar respiratory epithelium

Question 2

Bronchi (general definition) + pathologies that can affect bronchi

Answer 2

• bronchi = large airways w/cartilage
• Acute bronchitis
• Chronic bronchitis
• Bronchiectasis
• Asthma

Question 3

Pathologic (histologic) changes in Acute Bronchitis

Answer 3

• Neutrophils in the airway lumen and infiltrating the wall of the airway
• Usually infectious

Question 4

Pathologic (histologic) changes in Chronic Bronchitis

Answer 4

Chronic inflammation (mostly lymphocytes) in the airway wall

Squamous metaplasia of the epithelium (transformation of the ciliated columnar type cells to flattened polygonal squamous cells)

Mucus gland hypertrophy (too many glands making too much mucus)

Question 5

Pathologic (histologic) changes in Bronchiectasis

Answer 5

• Dilation of the airway compared to the neighboring vessel (should be roughly the same size)
• Often the result of long-standing infection/inflammation

Question 6

Pathologic (histologic) changes in Asthma

Answer 6

• Thickened subbasal lamina
• Eosinophilic inflammation
• Mucus hypersecretion

Question 7

Bronchioles (general definition) + pathology affecting bronchioles

Answer 7

• broncioles = small airways w/out cartilage
• chronic bronciolitis
• follicular bronchiolitis
• constrictive/obliterative bronchiolitis
• granulomatous bronchiolitis

Question 8

Structures indicated by arrows (A - D)

Answer 8

A. Mucus glands

B. Smooth muscle

C. Cartilage

D. Epithelium

Question 9

Process occuring + likely dx

Answer 9

• squamous metaplasia
• chronic bronchitis

Question 10

Process occuring + likely dx

Answer 10

• mucus gland hyperplasia
• dx: chronic bronchitis

Question 11

Pathologic (histologic) changes in chronic bronchiolitis

Answer 11

• Inflammation in the wall of small airways that do not contain cartilage.
• Most common type of inflammation is chronic inflammation (lymphocyte predominate)

Question 12

Pathologic (histologic) changes in follicular bronchiolitis

Answer 12

lymphoid aggregates with germinal centers

Question 13

Pathologic (histologic) changes in constrictive/obliterative bronchiolitis

Answer 13

• Fibrosis squeezing the airway lumen shut
• ​May cause severe airtrapping in the downstream lung

Question 14

Pathologic (histologic) changes in granulomatous bronchiolitis

Answer 14

• Granulomas composed of clustered histiocytes and multinucleated giant cells
• May be centrally necrotizing or nonnecrotizing
• Necrotizing cases are usually infectious
• Nonnecrotizing cases may be infection, sarcoid or chronic beryllium disease

Question 15

Probable dx

Answer 15

constrictive bronciolitis

Question 16

Probable dx

Answer 16

• airway lume = completely obliterated by fibrosis ==>
• obliterative bronchiolitis

Question 17

Airspaces (general definition) + pathology affecting airspaces

Answer 17

• Pneumonia: acute, aspiration, eosinophillic, organizing
• Diffuse Alveolar Damage (DAD
• Emphysema
• Other smoking-related lung diseases:
  
  • Respiratory Bronchiolitis (RB)
  • Desquamative Interstitial Pneumonia (DIP)
• Diffuse Alveolar Hemorrhage (DAH
• Pulmonary Alveolar Proteinosis (PAP)

Question 18

Pathologic (histologic) changes in Acute Pneumonia

Answer 18

Neutrophils, macrophages and fibrin within airspaces

Usually infectious

Question 19

Pathologic (histologic) changes in Aspiration Pneumonia

Answer 19

Airspace foreign material (food)

Multinucleated giant cells

Question 20

Pathologic (histologic) changes in Organizing Pneumonia

Answer 20

• Plugs of loose myxoid fibroblastic tissue plugs in airspaces and small airways
• Usually patchy and may have densely consolidated areas
• May have a small amount of intermixed pink fibrin
• A relatively non-specific finding consistent with an element of sub-acute lung injury
• Also known as Bronchiolitis Obliterans Organizing Pneumonia (BOOP) or Cryptogenic Organizing Pneumonia (COP)

Question 21

Pathologic (histologic) changes in Eosinophillic Pneumonia

Answer 21

Eosinophils, macrophages and fibrin within airspaces

Question 22

Pathologic (histologic) changes in Diffuse Alveolar Damage (DAD)

Answer 22

• Hyaline membranes (fibrin ribbons in the airspaces lining the alveolar septa)
• Alveolar septa may be expanded by inflammation and fibroblastic tissue
• The histologic pattern that corresponds to ARDS

Question 23

Probable Dx

Answer 23

• Diffuse Alveolar Damage ==> ARDS

Question 24

Pathologic (histologic) changes in Emphysema

Answer 24

• Enlarged airspaces
• Broken alveolar septa (irreversible damage)
• Subpleural blebs – may become very large and cause a pneumothorax if ruptured

Question 25

Smoking emphysema vs. Alpha-1-antitrypsin pathologic features

Answer 25

* 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 26

Pathologic (histologic) changes in Respiratory Bronchiolitis

Answer 26

Brown pigmented macrophages in small bronchioles and surrounding airspaces

Question 27

Pathologic (histologic) changes in Desquamative Interstitial Pneumonia (DIP)

Answer 27

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

Question 28

Probable Dx

Answer 28

Severe emphysema

Question 29

Probable Dx

Answer 29

* Nonnecrotizing granuloma * Dx: granulomatous bronchiolitis * infection, sarcoid, beryllium

Question 30

Pathologic (histologic) changes in diffuse alveolar hemorrhage

Answer 30

* Blood and iron-containing macrophages within airspaces * Alveolar septa may be mildly thickened by inflammation and fibroblastic tissue * May be associated with capillaritis (neutrophils attacking the capillaries of the alveolar septa)

Question 31

Pathologic (histologic) changes in pulmonary alveolar proteinosis

Answer 31

Airspaces filled with pink fluid and macrophages