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MD2 Pathology > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

What is bronchiectasis?

A

Chronic disorder characterised by permanent dilatation of the bronchi and inflammatory changes in their walls and in adjacent lung parenchyma

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2
Q

Describe the pathogenesis of bronchiectasis

A

Recurrent inflammation of the bronchial walls combined with fibrosis in the surrounding parenchyma leads to traction on weakened walls causing irreversible dilatation

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3
Q

List 4 post-inflammatory causes of bronchiectasis

A

Allergic bronchopulmonary aspergillosis Infection (pneumonia, measles, whooping cough) Congenital (congenital hypogammaglobulinaemia, CF, immotile cilia syndrome) Reactions to inhaled toxic fumes

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4
Q

List 5 post-obstructive causes of bronchiectasis

A

Neoplasm Foreign body Inspissated mucus (in asthma) External compression (by e.g. hilar LNs, aortic aneurysm) Rarely bronchial webs or atresia

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5
Q

What is the most common cause of lung abscess?

A

Aspiration

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6
Q

What disease process is most often associated with lung abscess?

A

Bacterial pneumonia

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7
Q

What 3 factors are associated with aspiration?

A

Altered consciousness (e.g. in alcoholics)

Poor dental hygiene

Immune suppression

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8
Q

What bacteria are commonly found in lung abscesses?

A

Anaerobic

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9
Q

List 5 other associations of lung abscess

A

Pulmonary infarcts

Malignancies

Penetrating trauma

Necrotising pneumonias

Bronchial obstruction

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10
Q

Why does lung abscess occur mostly in the right lung?

A

Because the right bronchus is more vertical

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11
Q

List 4 important risk factors for lung cancer

A

Smoking

Occupational hazards

Scarring

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12
Q

What level of smoking places you at 20x risk of lung cancer?

A

>40 cigarettes/day for several years

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13
Q

List 5 occupational hazards which may increase risk of lung cancer

A

Asbestos

Crystalline silica

Radon

Polycyclic aromatic hydrocarbons

Heavy metals

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14
Q

Correlate the clinical presentation of lung cancers with their anatomical location

A

Centrally located: cough, dyspnoea, weakness

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15
Q

Correlate the anatomical location of lung cancers with its probable type

A

Distal: more often adenoma

Proximal: more often squamous or small cell

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16
Q

How can tissue sampling be achieved for a centrally located tumor?

A

Sputum

Bronchial washings/brushings

EBUS-TBNA (endobronchial U/S transbronchial needle aspirate)

Bronchial biopsy

17
Q

How can tissue sampling be achieved for a peripherally located tumour?

A

FNA (CT-guided, ENB - electromagnetic navigation bronchoscopy-guided)

Pleural biopsy

18
Q

List the 5 types of non-small cell carcinoma

A

Squamous cell carcinoma

Adenocarcinoma

Adenosquamous carcinoma

Large cell carcinoma

Sarcomatoid carcinoma

19
Q

Does squamous cell carcinoma tend to be central or peripheral?

A

Central with frequent involvement of large airways

20
Q

What are the histological criteria for diagnosis of a squamous cell carcinoma?

A

Intercellular bridges

Keratinisation

If features not obvious due to poor differentiation, immunohistochemical staining may be required

21
Q

How does squamous cell carcinoma usually appear macroscopically?

A

Grey-white to yellow, often with a dry flaky appearance that reflects keratinisation

Necrosis and haemorrhage common, may be cavitation

22
Q

What is the most common type of non-small cell carcinoma?

A

Adenocarcinoma

23
Q

Describe the typical anatomical location of adenocarcinoma

A

Generally peripheral and well-circumscribed

Most unrelated to bronchi

May have pleural involvement

24
Q

Describe the macroscopic appearance of adenocarcinoma

A

Grey-white with necrosis and haemorrhage

Mucoid appearance in tumours with extensive mucin production

25
Q

Can adenocarcinoma be diagnosed on cytology? What is the advantage of this? What is the disadvantage?

A

Yes, usually

Cheap, low complications

However often histo is done as this gives more reliable tissue for molecular testing, which most adenocarcinomas undergo

26
Q

What histological features are characteristic of adenocarcinoma?

A

Well to moderately differentiated tumour with glandular and/or papillary structures

Cytoplasmic mucinous vacuoles or mucin extending into stroma

27
Q

What is adenocarcinoma-in-situ?

A

Adenocarcinoma showing growth of neoplastic cells along pre-existing alveolar structures (lepidic growth), with no evidence of stromal, vascular or pleural invasion

28
Q

What is the prognosis of adenocarcinoma-in-situ/bronchiolo-alveolar carcinoma (BAC)?

A

Solitary BAC

29
Q

Describe the typical anatomical presentation of adenocarcinoma-in-situ

A

Well-demarcated single or multiple nodules

“Pneumonic” pattern with involvement of whole lobe

30
Q

In what clinical scenario should adenocarcinoma-in-situ be considered?

A

Non-resolving consolidation/pneumonia

31
Q

What are the 3 histo subtypes of adenocarcinoma-in-situ, in order from most to least common?

A

Non-mucinous

Mucinous

Mixed mucinous and non-mucinous

32
Q

What line of differentiation does small cell carcinoma show?

A

Neuroendocrine

33
Q

List 8 complications of lung cancer

A

Lipid pneumonia distal to obstructing tumour (due to build-up of surfactant)

Atelectasis

Bronchitis

Bronchiectasis

Cavitation and abscess formation

Fistula formation

Pleuritis, pleural effusion

Vascular thrombosis

34
Q

What are the 4 most common sites of distal metastases for lung cancer (from most to least common)?

A

Adrenals

Liver

Brain

Bone

35
Q

What are the 4 most common types of cancer metastasising to the lungs?

A

Breast

Lower GIT

Melanoma

RCC

36
Q

Describe the typical anatomical presentation of small cell carcinoma

A

Rapidly growing mass often with local obstruction (e.g. major bronchi, SVC)

Often regional LN or distant metastases at initial presentation

37
Q
A

MD2 Pathology (28 decks)

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