resp pathology Flashcards
what are the microscopic and macroscopic histopathological features of:
pulmonary oedema
and how do they correlate to clinical features?
Heavy watery lungs, intra-alveolar fluid on histology
fluid in alveolar spaces
causes Poor gas exchange therefore hypoxia and respiratory failure.
what are the microscopic and macroscopic histopathological features of:
Acute lung injury
and how do they correlate to clinical features?
presents as ARDS in adults & Hyaline disease in newborn.
pathology is same: Diffuse alveolar damage
causes: death, infection, scarring, or resolves
what are the microscopic and macroscopic histopathological features of:
Asthma
○ There are a lot of eosinophils and mast cells
○ You will also see goblet cell hyperplasia
○ Mucus plugs can be seen within the airway
○ The bronchial smooth muscle becomes thick and the blood vessels become dilated
- curshman spiral; mucus plugs
- charco leyden crystal: esinophils
what are the microscopic and macroscopic histopathological features of:
COPD - chronic bronchitis
and how do they correlate to clinical features?
Dilated airways
Mucus gland hyperplasia
Goblet cell hyperplasia
Mild inflammation
correlate to clinical features:
that’s why they have chronic cough productive of sputum
what are the microscopic and macroscopic histopathological features of:
COPD - emphysema
and how do they correlate to clinical features?
Histology:
loss of the alveolar parenchyma
distal to the terminal bronchiole
smoking: Loss centred on bronchiole - CENTRILOBULAR
a1 antitryp deficiency : Diffuse loss of alveolae - PANACINAR
clinical:
hence chronic SOB
- resulting large airspace/bullae = pneumothorax risk
what are the microscopic and macroscopic histopathological features of:
Bronchiectasis
and how do they correlate to clinical features?
Permanent abnormal dilatation of bronchi
Inflamed, scarred/fibrosed lungs with dilated airways
can cause mucus plugs
clinically:
chronic cough with mucus production
what are the microscopic and macroscopic histopathological features of:
cystic fibrosis
and how do they correlate to clinical features?
histopath:
exocrine glands produce abnormally thick mucus secretion
clinical:
recurring chest infections
wheezing, coughing, shortness of breath and damage to the airways (bronchiectasis)
what are the microscopic and macroscopic histopathological features of:
pulmonary infections
and how do they correlate to clinical features?
Bronchopneumonia Histopath:
- Acute inflammation, with Patchy bronchial and peribronchial distribution, and within alveoli often lower lobes
Lobar pneumonia histopath:
- Congestion: Hyperaemia, Intra-alveolar fluid
- Red hepatization: Intra-alveolar neutrophils
- Grey hepatization: Intra-alveolar connective tissue
- Resolution: Restoration normal architecture.
clinical:
Shortness of breath, cough, fever, purulent sputum - as these are responses to infections processes
most common cause of lobar pneumonia?
90-95% pneumococci (S. pneumoniae)
A Collection of histiocytes/macrophages +/- multinucleate giant cells, Necrotising or non necrotising is indicative of?
Tuberculosis
this is describing a grnauloma
○ Interstitial inflammation (pneumonitis) without accumulation of intra-alveolar inflammatory cells
○ Chronic inflammatory cells within alveolar septa with oedema with or without viral inclusions
are indicative of ?
atypical pneumonia
Haemorrhagic infarct in the lung parenchyma are indicative of?
pulmonary emboli
list the malignant lung cancers, in their groups
NON-small cell carcinoma
Squamous cell carcinoma - SCC (30%)
Adenocarcinoma (30%)
Large cell carcinoma (20%)
SMALL cell carcinoma
Small cell carcinoma - SCC (20%)
smoking is most closely associated with which lung cancers?
squamous cell carcinoma - SCC
small cell carcinoma - SCC
what is the multistep pathway to the Development of Carcinoma?
metaplasia, dysplasia, carcinoma-in-situ to invasive carcinoma
these are the histopath features seen on Invasive Squamous Cell Carcinoma
what are the behaviour of:
Invasive Squamous Cell Carcinoma
Traditionally centrally located, but can be otherwise
Local spread, metastasise late.
which cancers are more common in females and non smokers?
Invasive Adenocarcinoma
what are the microscopic and macroscopic histopathological features of:
Invasive Adenocarcinoma
Histology shows evidence of glandular differentiation:
Gland formation, Papillae formation, Mucin!!
Precursor lesion: Atypical adenomatous hyperplasia
Proliferation of atypical cells lining the alveolar walls.
progresses to non-mucinous bronchoalveolar carcinoma
beofre mixed pattern adenoCa
put the following in order of how far malignancy can spread and what timeframe
- Invasive Squamous Cell Carcinoma - ISCC
- local spread, late mets
Invasive Adenocarcinoma
- extra thoracic mets early and common
the following is pathogmonic of?
Poorly differentiated tumours composed of large cells
No histological evidence of glandular or squamous differentiation
large cell carcinoma
what mutations are common in small cell carcinoma?
tumour suppressor genes:
p53 and RB1 - retinoblastoma
in adenocarcinoma which mutations are associated with smokers and which with non-smokers?
smokers - p53, kras, dna methylation
non-smokers - EGFR mutation/amplification
others: Alk translocation, Ros1 translocation
what are the microscopic and macroscopic histopathological features of:
small cell cancer
rx?
complete loss of cilia
rx: chemoradiotherapy
rx for non small cell caners?
NOT chemosensitive!
immunotherapies on the rise
when would the following be used:
Biopsy at bronchoscopy -
Percutaneous CT guided biopsy -
Mediastinoscopy and lymph node biopsy -
frozen section
Biopsy at bronchoscopy - central tumours
Percutaneous CT guided biopsy - peripheral tumours
Mediastinoscopy and lymph node biopsy - for staging
frozen section - Open biopsy at time of surgery if lesion not accessible otherwise
how does threapy change from curative to palliative?
no surgery for palliative care, rest is fine.
what kinds of moleuculae testing can be done on histology samples?
immunohistochemistry
FISH
EGFR - epidermal growth factor receptor is part of which family of receptors?
is often considered the “prototypical” receptor tyrosine kinase
which lung cancer has teh following:
Epithelioid type, Sarcomatoid type
mesothelioma
