Respiratory Pathology - 5 (neoplasms/PE)

Question 1

What does a metastatic malignancy in the lungs look like if it is from testicular cancer?

Answer 1

Cannonball mets on CXR

Question 2

What are 3 Miscellaneous Pulmonary Neoplasms?

Answer 2

• Hamartoma
• LAM
• Inflammatory Myofibroblastic tumor

Question 3

With a Hamartoma in the lungs, what does a CT scan show?

Answer 3

Coin lesion

Question 4

With a Hamartoma, what does low power histology show?

Answer 4

Firm marble with smooth edges

Question 5

Firm marble with smooth edges

Answer 5

Low power histology of a Hamartoma in the lungs

Question 6

With a Hamartoma, what does high power histology show?

Answer 6

Fibrous tissue + benign glandular epithelium + hyaline cartilage

Question 7

Fibrous tissue + benign glandular epithelium + hyaline cartilage in the lungs

Answer 7

Hamartoma with high power histology

Question 8

LAM stands for?

Answer 8

Lymphangioleiomyomatosis

Question 9

In what patients do LAMS usually occur?

Answer 9

Young women

Question 10

What loss of function mutation is present with LAMs?

Answer 10

Loss of function of tumor suppressor gene, TSC2

Question 11

What is a LAM?

Answer 11

Proliferation of cells that creates cystic spaces

Question 12

With LAMs, how do they usually present and why?

Answer 12

Pneumothorax!

- Proliferation of cells creates cystic spaces

Question 13

With LAMs, what cells usually proliferate?

Answer 13

Perivascular epithelioid cells that are modified smooth muscle cells

Question 14

Perivascular epithelioid cells that are (+) HMB-45

Answer 14

LAM

- Lymphangioleiomyomatosis

Question 15

What marker can be (+) for LAM that is usually seen with ____?

Answer 15

(+) HMB - 45

– usually seen with Melanoma

Question 16

In what patient population are Inflammatory Myofibroblastic tumors usually found?

Answer 16

Children

Question 17

What rearrangements occur in Inflammatory Myofibroblastic Tumors?

Answer 17

Rearrangements of ALK receptor tyrosine kinase gene

Question 18

What does an Inflammatory Myofibroblastic Tumor look like and what shape are the cells?

Answer 18

Grayish round mass

- Spindle shaped cells

Question 19

Describe the normal set up of the pleura on the lung

Answer 19

• Lung
• Visceral pleura
• Pleural space
• Parietal pleura

Question 20

What is pleural effusion?

Answer 20

Fluid in the pleural space between the visceral and parietal pleura of the lung

Question 21

Transudate fluid

Answer 21

LOW protein and low cells

Question 22

How will transudate fluid look?

Answer 22

Serous

Question 23

What is a cause of a transudate pleural effusion and its mechanism?

Answer 23

Heart failure - increased hydrostatic pressure

Question 24

Heart failure pleural effusion type?

Answer 24

Transudative - serous fluid

Question 25

Exudative fluid

Answer 25

HIGH protein and some cells

Question 26

What are 2 inflammatory causes of a pleural effusion and the resulting fluid type?

Answer 26

- Infection - Malignancy = Exudative fluid

Question 27

Inflammatory pleural effusions will NOT be serous fluid. What will they likely look like?

Answer 27

Milky or bloody

Question 28

Empyema

Answer 28

Bacterial infection that causes an inflammatory exudate with accumulation of pus in the pleural space

Question 29

What is characteristic of Empysemas?

Answer 29

Loculations = web like traps for fluid

Question 30

Inflammatory exudate with accumulation of pus in pleural space with loculations

Answer 30

Empyema

Question 31

How does the fluid look and what cells are present with Empyemas?

Answer 31

Thick and yellow fluid | - Neutrophils and bacteria present

Question 32

What is a Pneumothorax?

Answer 32

Air in the pleural space

Question 33

Spontaneous Idiopathic pneumothorax

Answer 33

Rupture of subpleural blebs in children

Question 34

What are some possible secondary causes for a pneumothorax?

Answer 34

Cystic infections/tumors | Trauma, positive pressure ventilation

Question 35

Describe the pleural cavity pressure to atmospheric pressure relationship with a primary pneumothorax?

Answer 35

Atmospheric pressure >> Pleural cavity pressure

Question 36

What is a tension pneumothorax?

Answer 36

1 way valve allowing air IN but not out!!

Question 37

With a tension pneumothorax, air is pulled in from wherever it is easiest -- usually injury site. What happens to the organs?

Answer 37

Pushed to opposite side

Question 38

Describe the pleural cavity pressure to the atmospheric pressure with a tension pneumothorax

Answer 38

Pleural cavity pressure >> atmospheric pressure

Question 39

1 way valve allowing air in but not out of the pleural cavity

Answer 39

Tension Pneumothorax

Question 40

What is a common benign pleural tumor?

Answer 40

Solitary Fibrous Tumor

Question 41

With a benign Solitary Fibrous Tumor, describe how it looks and what marker is (+)

Answer 41

(+) CD34 | = well circumscribed, pedunculated mass that is attached to lung by a stalk

Question 42

What is a common malignant pleural tumor?

Answer 42

Mesothelioma

Question 43

What is Mesothelioma associated with and what are its 3 variants?

Answer 43

Associated with Asbestos exposure and can occur even decades after exposure - Epithelioid - Sarcomatoid - Mixed

Question 44

What marker is (+) and what will be seen on histology with a malignant pleural tumor (mesothelioma)?

Answer 44

(+) calretinin | - Ferruginous bodies

Question 45

Outlook for Mesothelioma?

Answer 45

Difficult to treat | -- survival less than 2 years