Pulmonary Pathology II

Question 1

What are the histologic findings of diffuse alveolar hemorrhage? (DAH)

Answer 1

1. Blood & iron-containing macrophafes in arispaces
2. Alveolar septa thickened by inflammation and fibroblasts

Question 2

What are the histologic findings c/w Pulmonary Alveolar Proeinosis (PAP)?

Answer 2

• Airspaces filled by pink fluid and macrophages

Question 3

What are the histologic findings of Usual Interstitial Pneumonia (UIP)?

Answer 3

• Patchy heterogenous fibrosis by collagen
• Fibroblastic foci
• Honeycomb cyctic changes (worse in the lower lobes)

Question 4

Describe what is meant by honey comb changes in UIP?

Answer 4

• Honeycomb change with mucus filled cysts lined by airway-type epithelium and surrounded by fibrosis

Question 5

What are the histologic findings of NonSpecific Interstitial Pneumonia (NSIP)?

Answer 5

• Uniform inflammation in septa (cellular)
• Uniform fibrosis of septa (fibrotic)
  
  • or both
• Little if any honeycomb change

Question 6

What are the histologic findings of Hypersensitivity Pneumonia?

Answer 6

• Airway-centered chronic inflammation
• Nonnecrotizing granlulomas
• Focal Organizing Pneumonia
• Variable fibrosis

HP is in response to foreign antigens such as: birds, mold, hot-tub mycobacteria)

Question 7

What is the chariceristic histology finding of Thromboembolic disease?

Answer 7

• Organizing fibrin clots in pulmonary arteries

Question 8

What is the histologic finding of a Talc embolism?

Answer 8

• Polarized crystals around vessels
  
  • meaning can be well visualized under polarized light
• May include foreign body multinucleated giant cells
• Usually from IV drug use

Question 9

What are the histologic findings of Pulmonary HTN?

Answer 9

• Muscular hypertrophy of pulmonary arteries
• Muscularization of arterioles (they should not normally have muscle)

Question 10

What are the histologic findings of Vasculitis?

Answer 10

• Inflammation in the vessel wall
• Often with alveolar hemorrhage
• May be autoimmune or infxn

Question 11

T/F: Nodules of sarcoid and chronic beryllium etiology have the same appearance?

Answer 11

True

Question 12

What is the histologic characteristics of a sarcoid/chronic berrylium disease nodule?

Answer 12

• Well formed nonnecrotizing granulomas (there will be live cells in the center)
• Concentric collagen deposition
• Lymphatic distribution (near vessels, airways, and pleura)

Question 13

What is the histologic finding of Pulmonary Langerhan’s Cell Histiocytosis (PLCH)/Eosinophilic Granuloma (EG)?

Answer 13

Two Phases

• Cellular Phase
  
  • Langerhan’s histocytes (CD1a/S100 positive)
  • Variable inflammation including eosinophils
• Fibrotic phase
  
  • Stellate scare around airway

Question 14

What are the histology findings of Carcinoid nodules?

Answer 14

• Nests and ribbons of neuroendocrine cells with powdery salt-and-pepper chromatin
• Stain positive for neuroendocrine markers
  
  • Chromogranin, synaptophysin, CD56

Question 15

What are the histology findings of Small Cell Carcinoma?

Answer 15

• Small blue easily-crushed cells with scant cytoplasm
• Stain positive for neuroendocrine markers
• High mitotic rate and abundant necrosis

Question 16

What are the histologic findings of Squamous Cell Carcinoma?

Answer 16

• Large polygonal cells with hyperchromatic (dark) nuclei and abundant cytoplasm
• Rarely have prominent nucleoli
• May be keratinizing and for “keratin pearls”

Question 17

What are the histologic findings of Adenocarcinoma?

Answer 17

• Cells with large nuceli, large nucleoli and variable amounts of cytoplasm
• Form gland-like structures

Question 18

What are the histologic findings of Large Cell Carcinoma?

Answer 18

• Large, sometime bizarre-appearing malignant cells that lack the typical features of either adenocarcinoma or squamos cell carcinoma