Respiratory System Pathology 1- Galbraith lecture Flashcards
Infectious Rhinitis
usually viral, self limiting:
Adenovirus
Rhinovirus
Echovirus
Nasal mucosa edematous and hyperemic
-catarrhal secretion
May get bacterial superinfection –> mucopurulent secretion
Allergic rhinitis
Hypersensitivity reaction - IgE
Nasal mucosa edematous and hyperemic
-catarrhal secretion
Nasal polyps
Edematous protrusions of nasal mucosa
prominent eosinophils, lymphocytes, plasma cells, neutrophils
can be secondary to repeated episodes of rhinitis
no link to atopy
can cause obstruction (3-4 cm)
Sinusitis
Allergic or oral cavity microbial infection
Impaired drainage - mucosal edema of rhinitis or physical blockage
Severe chronic sinusitis - caused or complicated by fungi, seen in DM its or immunocompromised
- Mucormycosis
- Aspergillus
Discomfort, malaise
Can spread to bone, orbit, cranial vault
Pharyngitis and tonsilitis
most commonly viral:
- Adenovirus
- echovirus
- rhinovirus
Bacterial causes primary or superinfection
- usually beta-hemolytic streptococci
- occasionally S. aureus
- associated with whitish exudative material overlying reddened, swollen tonsils
Causes of necrotizing ulceration of upper respiratory tract
acute fungal infection
Granulomatosis with polyangiitis
Extra nodal EK/T cell lymphoma- nasal type
- associated with EBV
- male, 40-50s, Asian and Latin American
- Aggressive
Nasopharyngeal angiofibroma
Vascular tumor
Adolescent males - red-haired, fair-skinned
Arises in posterolateral roof of the nasal cavity
- benign
- Locally aggressive
- extend intracranially
Sinonasal (Schneiderian) papilloma
respiratory mucosa “benign” tumor
-nasal cavity and paranasal sinuses
M>F
30-60
Subtypes:
- Exophytic (fungating)
- Inverted (endophytic)
- Cylindrical
Exophytic and inverted associated with HPV 6 and 11
Epithelium respiratory or squamous
Inverted sinonasal papilloma
papillomatous growth of squamous cell-lined fronds downward from mucosal surface into underlying stromal tissue
May recur if not completely excised
May extend into orbit or cranial vault
10% malignant transformation
Olfactory neuroblastoma
esthesioneuroblastoma
neuroectoderm in superior nasal cavity
Small, round blue cell tumor
peaks at ages 15 and 50
Nasopharyngeal carcinoma
EBV related
African children, Chinese adults
May take form of:
- Keratinizing squamous cell carcinoma
- Nonkeratinizing squamous cell carcinoma
- undifferentiated basaloid carcinoma with numerous tumor-associated lymphocytes
Tx: radiation
- Keratinized carcinoma least radiosensitive
- Undifferentiated carcinoma most radiosensitive
Laryngitis
Secondary to infection, allergy, or environmental exposure (e.g. smoke)
may compromise airway in small children
Causes:
- RSV
- H. influenzae
- Beta-hemolytic streptococci
Reactive nodules
Smooth round small protrusion on true vocal cords
repeated vocal cord strain (singer’s nodules) or heavy smokers
lead to hoarseness
Benign
Squamous papillomas
Squamous-lined fronds with fibrovascular cores
Single or multiple
Children or adults
HPV 6 and 11
Benign, may recur
Laryngeal carcinoma
squamous cell carcinoma
men, 50s, smoker
Squamous hyperplasia –> dysplasia –> carcinoma
Bulky, fungating mass protruding from laryngeal surface, often with ulceration
Pulmonary hypoplasia
congenital
decreased weight, volume and acini for age/body weight
compression of lung(s) in utero - diaphragmatic hernia
If severe - fatal shortly after birth
Foregut cyst
Congenital
bronchogenic, esophageal, or enteric
Pulmonary sequestration
congenital
Segment of lung tissue without connection to airway
with systemic circulatory supply (not pulmonary)
Resorption atelectasis
complete obstruction of an airway (FB, secretions, tumor, anything that can physically block the airway)
air within dependent lung is resorbed –> collapse
Mediastinum shifts TOWARD the affected lung
Compression atelectasis
Fluid, tumor, or air accumulate within the pleural space
-prevents expansion
Mediastinum shifts AWAY from affected lung
Contraction atelectasis
pulmonary or pleural fibrosis preventing normal expansion
not reversible
Mediastinum shifts TOWARD the affected lung
Hemodynamic pulmonary edema
Intra-alveolar fluid accumulation
-increased hydrostatic pressure in pulmonary circulation
Basally at first
Alveolar capillaries congested
Intra-alveolar transudate seen - pink and granular
Hemosiderin-laden macrophages within alveoli (“heart failure cells”) with chronic pulmonary edema
-lungs become brown and indurated
Decreased oxygenation
Increased chance of infection
Pulmonary edema secondary to microvascular (alveolar) injury
Injury to and inflammation of alveolar vascular endothelium and/or respiratory epithelium
infectious or toxic insults
localized or diffuse
Acute lung injury - general
Inflammation induced vascular permeability
–> diffuse pulmonary edema and rapid onset of hypoxemia
Severe form - acute respiratory distress syndrome (ARDS)
Predisposing: infectious agents physical injury toxic substances Hemodynamic disturbances
sepsis, diffuse pulmonary infection, gastric aspiration, head trauma account for >50% of cases
