Respiratory Path Pots Flashcards
Describe the specimen
Specimen of left lung
Lung parenchyma shows honeycomb appearance, with large cyst-like spaces, particularly in upper lobe.
The lower lobe appears fibrotic
Usual Interstitial Pneumonia
UIP Aetiology
Largely Unknown.
Repeat cycles of Alveolitis caused by unidentified agent.
Associated with a Th2 response. Eosinophils, mast cells, IL-3, & IL-4 often found in lesions.
TGF-B1 released from injured Type I Alveolar cells favours production of collagen scar tissue in the lung
Cycles of injury and collagen scar wound healing lead to patchy interstitial fibrosis, and fibroblastic foci.
UIP tends to show early and late lesions, due to variable stages of inflammation and fibrosis.
Lower lobes predominantly show fibrosis.
Clinical aspects of UIP?
Complications of UIP?
Patients present will increasing SOB, dry cough
Insidious onset with variable progression, usually <3 years. Rapid deterioration may occur.
Typically present at 40-70 years old
<20% of cases respond to steroids.
Lung Transplant required.
Complications: Secondary pulmonary HTN, V/Q Mismatch, Respiratory Failure, Hypercapnia, etc.
UIP Micro?
Patchy Interstitial Fibrosis
Patchiness results from presence of early and late lesions: some showing inflammation, others showing collagen scar healing
Overall effect = destruction of lung parenchyma
Enlarged air-spaces with fibrous remodelling of airspace walls
Honeycomb lung formation - enlarged air spaces
Describe the specimen
Potted specimen shows the lower portion of the trachea where it bifurcates.
An undifferentiated carcinoma fills the bronchus, deforming the normal structure as it invades surrounding tissues.
Appears to be spreading into the oesophagus, posteriorly.
Describe the pot
Specimen is a slice of lung
Carcinoma mostly occluding the main bronchus, and is infiltrating surrounding lung parenchyma.
Lymph nodes appear largely replaced by carcinoma growth
The lung appears collapsed
There is bronchial thickening and dilation, indicative of bronchiectasis
Describe the specimen
Specimen is a section through the Right Lung and a section of 2 ribs
There is carcinoma growth about 7cm in diameter which appears to be arising from the upper lobe bronchus
Centre of the tumour appears friable and necrotic.
Peripherally, the tumour appears to have invaded the pleura and is adherent to the two ribs, also included in the pot
Describe the Specimen
The specimen shows the bifurcation of the trachea, and portions of the left and right lungs.
Bilateral carcinoma growth arising from the main bronchus of both lungs. Infiltration into adjacent lung parenchyma.
Tumour growth has replaced the hilar and (possibly inferior tracheobronchial) lymph nodes.
Tumour growth has distorted normal form of bronchi
Describe the specimen
Specimen shows a section through the R lower lobe.
There is carcinoma growth arising from the bronchus.
Tumour cells have infiltrated two hilar lymph nodes.
Tumour growth is also infiltrating surrounding lung parenchyma.
The remainder of the lung parenchyma shows consolidation - confluent broncho-pneumonia
Describe the Specimen
Specimen shows a slice of lung
There is carcinoma growth of 6x8cm that appears to be arising from the upper bronchus.
The tumour has infiltrated the lumen, resulting in a 1cm large mass protruding into the lumen.
The remainder of the lung shows patchy areas of pneumonia (consolidation) and emphysema.
There is carbon staining throughout the lung.
The pleura show fibrous adhesions
Describe the Specimen
The specimen shows a slice through the left lung, showing both upper and lower lobes.
The lung shows inflation classical of asthma
The bronchi appear prominent, with thickened walls and mucous plugging
Describe the specimen
The specimen shows a longitudinal section of lung.
The inflation is classic of asthma.
bronchi The cut surface shows prominent bronchi with thickened walls and mucous plugging.
The surrounding tissue also appears oedematous. Haemorrhage might also be present?
Describe the specimen
Normal Lung
The amount of anthracosis is normal for an adult
The pulmonary lobules are easily seen
Describe
Specimen is a mounted Right Lung
Distorted by multiple emphysematous Bullae
These are most developed on the apical and anterior margins of the lung
Considerable carbon deposition in the pleural lymphatics
Describe the specimen
Section of R lung
On medial surface shows multiple cyctic blobs
A few of which have combined to coalesce into a large bullae
Interiorly, there may be emphysematous parenchymal changes
Lung also appears over-inflated
Describe
Specimen shows section of lung
Obvious overinflation
There is obvious pneumonia evidenced by consolidation
There are also widespread emphysemaous changes.
Bronchi appear thickened with mucous plugging.
Thus, there is underlying COPD (chronic bronchitis and emphysema)
Describe
Mounted specimen shows an inflated left lung
There is widespread centrilobar emphysema
Apical Bullae (perhaps visible on the other side?)
And an apical scar
Bronchopneumonia also present
Evidenced by prominent, thickened bronchi with mucous plugging
Describe
Specimen is a left lung with emphysema
There are multiple, large, sub-pleural bullae of the upper lobe
Some of the smaller enlarged airspaces can be seen surrounding bronchi, indicating that this is centrilobar emphysema
Describe
Specimen of left lung
Upper lobe shows diffuse consolidation of the whole lobe, and sparing of only a small slither anteriorly/superiorly.
The upper lobe shows grey hepatisation stage pneumonia
The lower lobe also shows diffuse consolidation, but in the red hepatisation stage of pneumonia
Describe
The specimen is a slice through the Right Lung
Diffuse consolidation, suppuration and necrosis is seen throughout all three lobes, with some sparing of parenchyma towards the inferior aspect of the lower lobe
There are multiple creamy yellow, variably sized foci
the largest of which shows cavitation - abscess formation
This is evident of beonchopneumonia with an abscess
The parts of the lung unaffected by the bronchopneumonia appear emphysematous
There is an apical scar which may be from old TB
CAP common organisms?
Streptococcus pneumoniae
Hemophilus influenzae
Mycoplasma pneumoniae
Influenza
Nosocomial Pneumonia organisms?
Mainly gram negatives
E. coli
Proteus Mirabilus
PSeudomonas Aeruginosa
Immunosuppressed Pneumonia organisms?
Usually the same as CAP but can also be caused by numerous, less virulent organisms
Viruses: Herpex Simplex, Cytomegalovirus
Fungi: Aspergillus, Candida
Protozoa: Toxoplasmosis
Describe
Specimen is a slide of the left lung
Shows apical cavitation indicative of Post-Primary TB
There is diffuse consolidation throughout the remainder of lung, including the lower lobe, with caseous-looking foci
Lower lobe caseation is consistent with confluent tuberculosis bronchopneumonia
Describe
Specmen shows slice through R lung (TB)
Cavitation of apical region of upper lobe, and dissemination of the infective process into the lower lobe, marked by diffuse consolidations, centred around the bronchi.
This is suggestive of tuberculosis bronchopneumonia
There is sparing of the middle lobe
Describe
The specimen consists of a portion of the right lung.
The lung parenchyma is studded with multiple variably sized rounded nodules of grey-white tumour tissue showing focal areas of haemorrhage and early cystic change.
Many nodules also bulge from the visceral pleural surface. The lung parenchyma between the nodules is compressed and slightly congested.
Metastasies**
Describe
Specimen shows section through R lung
There is a sharply demarkated yellow/grey tumour about 1.8cm in diameter sitting centrally in the lower lobe
Does not appear to have any connection to bronchi
Metastatic tumour
Describe
Specimen shows medial half of the left lung
Numerous bullae are evident.
Thickened, fibrotic septae spread through the bullae.
Homeycomb lung formation is also present - fibrotic thickenings of airspace walls, and enlarged airspaces.
Central area of consolidation, and thickened bronchi
Emphysematous changes throughout
Consolidation suggestive of pneumonia
Also fibrotic adhesions of the pleura present
Describe
Specimen shows section through the lung.
There is pinky/creamy/whitish homogenous tunour tissue that appears to be extending in from the periphery of the lung.
The tumour has almost completely destroyed the lung tissue, which is compressed in the centre of the tumous growth.
The tumour growth measures up to 7 cm in diameter and encircles the small section of lung parenchyma left centrally.
Mesothelioma - arising from the mesothelial cells of the pleura
Mesothelioma: Aetiology, clinical features, prognosis
Mesotheliomas arise from the mesothelial surface of the pleura. Most commonly occur in the lungs, but can occur elsewhere.
Associated with heavy exposure to asbestos.
Note that people with asbestos exposure who also smoke are more likely to develop lung carcinoma, rather than mesothelioma*
Clinical Features: latent period of 25-45 years before development of asbestos-related mesothelioma
~7-10% lifetime risk in exposed individuals
Presents with chest pain, dyspnoea, recurrent pleural effusions
Lung is directly invaded and there is often metastatic spread to surrounding lymph nodes
Prognosis:
Poor. 50% die within 12 months. Few survive beyond 2 years. Aggressive surgery, chemo- and raiotherapy can help to improeve the prognosis somewhat
