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PATHOLOGY > Rosai Chapter 10 - Lung > Flashcards

Rosai Chapter 10 - Lung Flashcards

1
Q

Main proliferating component after alveolar injury

A

cuboidal type II (granular) pneumocytes

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2
Q

Main types of bronchial and bronchiolar epithelial cells (6)

A
  • Basal cells
  • Neuroendocrine cells
  • Ciliated cells
  • Serous cells
  • Clara cells
  • Goblet cells
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3
Q

Which of the main types of bronchial and bronchiolar epithelial cells decrease in number as one approaches the terminal bronchioles? (2)

A
  • Ciliated cells

- Goblet cells

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4
Q

Which of the main types of bronchial and bronchiolar epithelial cells increases proportionally in number as one approaches the terminal bronchioles?

A

-Clara cells

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5
Q

Represent the main progenitor cells after bronchiolar injury and has a secretory function

A

-Clara cells

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6
Q

Submucosal glands in larger bronchi is composed of:

A

-both Serous and Mucous cells

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7
Q

Structures sometimes seen in alveolar spaces that are of no diagnostic significance (4)

A

“CARB”

  • Corpora amylacea (common in elderly)
  • Alveolar macrophages (pigmented in smokers)
  • fresh RBCs
  • Blue bodies (Calcium carbonate)
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8
Q

Pulmonary ARTERY or VEIN:

Has internal and external elastic membrane

A

Pulmonary Artery

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9
Q

Pulmonary ARTERY or VEIN:

Has single (outer) elastic layer

A

Pulmonary Vein

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10
Q

Basic facts needed to know before diagnosing lung biopsy (6)

A
  • patient Age
  • whether or not the patient is immunocompromised
  • onset and tempo of disease progression (Acute or Chronic)
  • localized vs. diffuse radiological distribution of abnormalities
  • presence and degree of functional impairment
  • occupational or travel history
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11
Q

The type of lung biopsy that has the highest sensitivity, specificity, and accuracy for all non-neoplastic lung diseases

A

Wedge biopsy

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12
Q

Histologic findings that complicate interpretation of transbronchial biopsy (3)

A
  • “Holes” or “Bubbles” artifact that mimics the appearance of exogenous lipid pneumonia
  • procedure-related hemorrhage which is common
  • mesothelial cells when the biopsy unintentionally captures pleural tissue
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13
Q

Most common types of congenital cystic disease encountered in surgical pathology (4)

A
  • Congenital Lobar Overinflation (Congenital Lobar Emphysema)
  • CCAM / CPAM
  • Bronchogenic cyst
  • Pulmonary sequestration
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14
Q

Characterized by the presence of variously sized intercommunicating cysts lined by cuboidal-to-ciliated pseudostratified columnar (“adenomatoid”) epithelium

A

-CCAM / CPAM

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15
Q

Stocker types of CCAM / CPAM is based on __ and __

A
  • Size

- Number of cysts

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16
Q

Stocker type:

-Large cyst (>2 cm)

A

Stocker type 1

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17
Q

Stocker type:

-Small cyst (<2 cm)

A

Stocker type 2

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18
Q

Most common form of acquired cystic disease

A

-Emphysema

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19
Q

Defined as an increase in size of airspaces distal to the terminal bronchiole associated with destruction of their walls

A

Emphysema

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20
Q

Most important morphologic substrate of COPD

A

Emphysema

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21
Q

Large (>/= 1 cm) cystic spaces covered by a thin, stretched pleura

A

Bullae

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22
Q

Formed by the rupture of an alveolus directly beneath the pleura and the escape of air into the areolar layer of the pleura which results in interstitial pneumonia

A

Blebs

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23
Q

Size of Blebs

A

< 1 cm in diameter

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24
Q

Characterized by:

  • Severe emphysema
  • Bronchiectasis
  • Bronchiolitis obliterans
A

Swyer-James (McLeod) syndrome

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25
Q

Severe emphysema in Swyer-James (McLeod) syndrome is occasionally accompanied by:

A

Placental transmogrification

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26
Q

Rare genodermatosis associated with an increased risk of renal and colonic neoplasia

A

Birt-Hogg-Dube syndrome

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27
Q

Pulmonary component of Birt-Hogg-Dube syndrome is composed of:

A

Pleuropulmonary blebs and cysts (usually basilar)

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28
Q

Rare form of localized cystic lung malformation in which connective tissue septa contain cartilaginous islands

A

Chondroid cystic malformation

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29
Q

Chondroid cystic malformation is due to:

A

trisomy 8 mosaicism

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30
Q

Characterized by partial or complete separation of a portion of a lobe of the lung with a systemic arterial supply often affiliated with no connection to the functional components of the tracheobronchial tree (bronchial atresia)

A

Bronchopulmonary sequestration

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31
Q

Key to diagnosis of intralobar variety of Bronchopulmonary sequestration

A

surgeon’s identification of a large elastic artery representing systemic vascular connection

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32
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

aberrantly located pulmonary mesenchyme as an extrapulmonary island of lung tissue enveloped by its own pleural covering

A

Extralobar

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33
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

any level from the thoracic inlet to the diagphragm or even within the abdominal cavity

A

Extralobar

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34
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Left side

A

BOTH

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35
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Associated with:

  • diaphragmatic hernias
  • polyhydramnios
  • edema
A

Extralobar

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36
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

more heterogeneous

A

Intralobar

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37
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Bronchial atresia with systemic vascular connection

A

Intralobar

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38
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Symptomatic

A

Intralobar

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39
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

within the Lower lobe

A

Intralobar

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40
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Single cyst, multicystic area, or solid mass

A

Intralobar

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41
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Artery has an elastic pulmonary type

A

Intralobar

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42
Q

EXTRALOBAR / INTRALOBAR
Bronchopulmonary sequestration:

Microscopically - Nonspecific, Chronic inflammation, and Fibrosis

A

Intralobar

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43
Q

a condition characterized by fixed radiological abnormalities limited to the right middle lobe and/or lingula

A

Middle lobe syndrome

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44
Q

A syndrome characterized by:

  • Chronic sinonasal infection
  • Frequent bronchiectasis
  • complete sinus inversus
  • infertility
A

Kartagener or Immotile cilia syndrome (primary ciliary dyskinesia)

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45
Q

A syndrome characterized by:

  • Chronic sinonasal infection
  • Frequent bronchiectasis
  • Infertility caused by azoospermia but lacking ultrastructural ciliary abnormalities
A

Young syndrome

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46
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

partial or total obliteration of the bronchial lumen by a neoplasm, foreign body, localized inflammatory process, inspissated mucus, or external compression

A

Localize

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47
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

Any area of Lung

A

Localize

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48
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

If source of compression is relieved at an early stage, there is regression

A

Localize

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49
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

Irreversible if microscopically has secondary inflammation and fibrotic changes

A

Localize

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50
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

associated with Middle lobe syndrome

A

Localize

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51
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

consequence of inflammation and post-inflammatory destruction of airway walls that is usually the result of repeated episodes of infection

A

Diffuse

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52
Q

LOCALIZE / DIFFUSE
Bronchiectasis:

Associated with

  • Cystic fibrosis
  • Kartagener syndrome
  • Young syndrome
A

Diffuse

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53
Q

Most common locations of lung abscesses in surgical series (3)

A
  • Right lower lobe
  • Right upper lobe (particularly SUBAPICAL segment)
  • Left lower lobe

*in decreasing order

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54
Q

Most common causes of lung abscesses in children (3)

A
  • Staphylococcus aureus
  • Streptococcus sp.
  • Klebsiella pneumoniae
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55
Q

Second only to HIV as a cause for fatal infection in the developing world and remains a major global public health challenge

A

Tuberculosis

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56
Q

Solitary lung nodules seen in adults due to reinfection by tuberculosis

A

Tuberculomas

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57
Q

Infection due to MAC in an elderly woman that may resemble the middle lobe syndrome

A

Lady Windermere syndrome

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58
Q

A syndrome resembling hypersensitivity pneumonia resulting from exposure to hot tubs contaminated with nontuberculous mycobacteria

A

Hot tub lung

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59
Q

Presentations of Sarcoidosis in the thoracic cavity (5)

A
  • moderate to marked perihilar lymph node involvement without pulmonary disease
  • diffuse pulmonary disease without radiographic evidence of node involvement
  • a combination of lymph node enlargement and diffuse pulmonary disease
  • Pulmonary interstitial fibrosis
  • Localized bronchostenosis with distal bronchiectasis and atelectasis
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60
Q

Hallmark of Sarcoidosis

A

compact non-caseating granuloma composed of:

  • Epithelioid cells
  • Langhans giant cells
  • Lymphocytes
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61
Q

Pulmonary disease characterized by extensive vascular granulomas that infiltrate and occlude pulmonary artery and vein and are accompanied by widespread necrosis of lung tissue

A

Necrotizing sarcoid granulomatosis

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62
Q

Main characteristics of Granulomatosis with Polyangiitis (GPA) / Wegener granulomatosis (4)

A
  • necrotizing granulomatous inflammation
  • necrotizing vasculitis
  • c-ANCA
  • small-to-medium size vessels
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63
Q

Main morphologic change in the lungs of patients with GPA

A

necrotizing granulomatous inflammation grossly resembling other localized necrotizing processes

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64
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

Triad of:

  • necrotizing angiitis
  • Aseptic necrosis (involving both URT and the lungs)
  • focal glomerulitis
A

Classic

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65
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

other vessels may be involved

A

Classic

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66
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

responsive to cytotoxic drugs (i.e. Cyclophosphamide)

A

Classic

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67
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

confined to the Lungs

A

Limited (Localized)

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68
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

No renal involvement

A

Limited (Localized)

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69
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

more protracted clinical course

A

Limited (Localized)

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70
Q

CLASSIC / LIMITED (LOCALIZED)
GPA:

Steroids and Cytotoxic drugs are both highly effective

A

Limited (Localized)

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71
Q

Main characteristics of Eosinophilic Granulomatosis with Polyangiitis (EGPA) / Churg-Strauss (3)

A
  • combination of necrotizing granulomatous inflammation, eosinophilia, and necrotizing vasculitis
  • small-to-medium size vessels
  • associated with p-ANCA and MPO
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72
Q

A disease occurring almost exclusively in asthmatics and patients with cystic fibrosis in whom the bronchocentric granulomatosis is usually accompanied by eosinophilic pneumonia and mucoid impaction of bronchi

A

Allergic bronchopulmonary aspergillosis

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73
Q

This is a complex group of non-neoplastic pulmonary diseases that often require correlation of morphologic, clinical, and radiological findings

A

Diffuse Interstitial Lung disease

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74
Q

Comprise the largest category of DILD and account for over 80% of patients with idiopathic interstitial pneumonia who undergo surgical lung biopsy

A

Chronic Fibrosing Interstitial Pneumonias

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75
Q

Most common of the idiopathic interstitial pneumonias, accounting for nearly 2/3 of patients who undergo biopsy for diffuse lung disease of unknown cause

A

Usual Interstitial Pneumonia (UIP)

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76
Q

a syndrome that classically has an insidious onset characterized by a combination of breathlessness and cough with a relentlessly progressive evolution, many of the patients dying of respiratory failure after 3-4 years

A

Idiopathic Pulmonary Fibrosis (IPF)

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77
Q

Common final pathway in patients with underlying UIP and is characterized by sudden worsening of symptoms and more rapid progression of respiratory failure

A

Acute exacerbation

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78
Q

Single most important feature that distinguishes UIP from the other interstitial pneumonias

A

Marked regional variation in the nature and degree of the fibrosis with a distinct patchwork distribution and evidence of architectural derangement as evidenced by:

  • scarring
  • Honeycomb change (in distal collapsed fibrotic lung)
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79
Q

Characteristic of UIP but are not specific

A

Fibroblast foci

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80
Q

2nd most common finding in patients with interstitial pneumonia of unknown cause

A

Non-specific Interstitial Pneumonia (NSIP)

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81
Q

Main morphologic difference of UIP vs. NSIP

A

Based on pattern of lung involvement:

  • UIP (heterogeneous)
  • NSIP (lacks heterogeneity)
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82
Q

FIBROTIC / CELLULAR
NSIP:

Alveolar septa in NSIP is expanded by an inflammatory infiltrate WITH collagen fibrosis

A

Fibrotic NSIP

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83
Q

FIBROTIC / CELLULAR
NSIP:

Alveolar septa in NSIP in expanded by an inflammatory infiltrate WITHOUT collagen fibrosis

A

Cellular NSIP

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84
Q

Characterized by an accumulation of lightly pigmented alveolar macrophages within respiratory bronchioles spilling into neighboring alveoli

A

Respiratory bronchiolitis

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85
Q

Symptomatic RB

A

Respiratory bronchiolitis-interstitial lung disease (RBILD)

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86
Q

RB/RBILD vs. Desquamative interstitial pneumonia (DIP):

Histiocytic accumulation is Diffuse

A

RB/RBILD

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87
Q

RB/RBILD vs. Desquamative interstitial pneumonia (DIP):

with an associated interstitial pneumonia

A

RB/RBILD

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88
Q

RB/RBILD vs. Desquamative interstitial pneumonia (DIP):

Histiocytic accumulation is Centriacinar

A

DIP

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89
Q

RB/RBILD vs. Desquamative interstitial pneumonia (DIP):

lacks an associated interstitial pneumonia

A

DIP

90
Q

RBILD accompanied by mild, paucicellular fibrosis in the form of lamellar eosinophilic collagenous thickening of alveolar septa in a patchy mainly subpleural distribution

A

Smoking-related interstitial fibrosis (SRIF)

91
Q

Earliest stages of Diffuse Alveolar Damage consists of (3):

A
  • edema
  • intra-alveolar hemorrhage
  • Fibrin deposition
92
Q

Hyaline membrane formation in DAD is most prominent to days after the injury

A

3 to 7 days

93
Q

a rapidly progressive form idiopathic interstitial pneumonia

A

Acute interstitial pneumonia (AIP)

94
Q

AIP is synonymous with - syndrome and there is no initiating event

A

Hamman-Rich syndrome

95
Q

Microscopic appearance equivalent of AIP

A

organizing phase of DAD

96
Q

Most striking feature microscopically of AIP

A

interstitial expansion and distortion by organizing fibroblasts and myofibroblasts

97
Q

Another term for organizing pneumonia

A

Bronchiolitis obliterans-organizing pneumonia (BOOP)

98
Q

Organizing pneumonia occasionally occurring as a form of diffuse lung disease of unknown (“idiopathic”) cause

A

Cryptogenic pneumonia

99
Q

Morphologic hallmark of organizing pneumonia in any clinical context

A

Fibroblastic plugs (“Masson bodies”) filling air spaces

100
Q

Characterized by a lymphocytic infiltrate with associated lymphoid follicles, often admixed with histiocytes and plasma cells, that expands alveolar septa and peribronchiolar interstitium

A

Lymphoid (lymphocytic) interstitial pneumonia (LIP)

101
Q

LIP is a lymphoproliferative disorder analogous to reactive lymphoid hyperplasia that overlaps clinically, radiologically, and histologically with:

A

Follicular bronchiolitis

102
Q

a localized form of fibroelastosis unique to the lung apices and superior segments of the lower lobes

A

Apical cap

103
Q

Generic term given to an acute, subacute, or chronic inflammatory process representing a tissue reaction to an inhaled allergen

A

Hypersensitivity Pneumonia (Extrinsic allergic alveolitis)

104
Q

Most common offending antigens of HP/EAA (3)

A

“MAT”

  • Molds
  • Avian proteins
  • Thermophilic bacteria
105
Q

Classic HP is microscopically characterized by (3)

A
  • Combination of a cellular interstitial pneumonia that tends to be accentuated around airways (Bronchiolocentric)
  • Equally cellular chronic bronchiolitis
  • a distinctive pattern of Granulomatous inflammation
106
Q

a form of acute lung injury secondary to nitrogen dioxide inhalation

A

Silo-filler’s disease (SFD)

107
Q

SFD is characterized by the presence of:

A

-DAD without granulomatous inflammation

108
Q

Essential element for the diagnosis of LCH

A

Langerhans cells

109
Q

Non-neoplastic reaction of the lungs to inhaled mineral or organic dust, exclusive of asthma, bronchitis, and emphysema

A

Pneumoconiosis

110
Q

Silicon nodules in patients with rheumatoid arthritis

A

Caplan syndrome

111
Q

Key feature in separating asbestos bodies from other types of non-asbestos ferruginous bodies

A

core is Translucent

112
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Rarely seen

A

Exogenous

113
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Mineral oil from nasal sprays, laxatives, or other sources reaches the lung through the tracheobronchial tree

A

Exogenous

114
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Gross - Well-circumscribed and firm

A

Exogenous

115
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Microscopic - Coarse lipid vacuoles

A

Exogenous

116
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Much more common

A

Endogenous

117
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Consequence of bronchial obstruction by carcinoma or some other process

A

Endogenous

118
Q

EXOGENOUS / ENDOGENOUS
Lipoid Pneumonia:

Microscopic - finely vacuolated lipid-laden macrophages in distal airspaces with frequent involvement of the peribronchiolar interstitium

A

Endogenous

119
Q

An acute self-limited form of simple eosinophilic pneumonia characterized by fleeting pulmonary infiltrates accompanied by eosinophilia and lasting no more than a month

A

Loeffler syndrome

120
Q

a rare disorder characterized by a paucicellular granular air space exudate composed of a combination of surfactant lipids and proteins

A

Pulmonary Alveolar Proteinosis (PAP) / Alveolar proteinosis

121
Q

Microscopic hallmark is an accumulation of an amorphous eosinophilic (but sometimes basophilic) PAS-positive material of predominantly phospholipid nature in the alveolar lumina, associated with a minimal infiltrate of lymphocytes, macrophages, and desquamated pneumocytes

A

PAP

122
Q

Leading cause of cancer-related deaths

A

Lung carcinoma

123
Q

Carcinomas located in the superior pulmonary sulcus

A

Pancoast syndrome

124
Q

Pain in Pancoast syndrome is in the distribution of __ nerve

A

Ulnar nerve

125
Q

Pancoast syndrome if with secondary involvement of the sympathetic chain may be accompanied by:

A

Horner syndrome

126
Q

Most common incident lung carcinoma

A

Adenocarcinoma

127
Q

IHC present in all types of lung carcinomas

A

Keratins

128
Q

TTF-1 is consistently expressed in (2)

A
  • Normal type 2 pneumocytes

- Clara cells

129
Q

a criterion for classifying otherwise poorly differentiated non-small cell carcinoma as Adenocarcinoma

A

-positivity in TTF-1 (or Napsin A)

130
Q

as aspartic proteinase involved in the maturation of surfactant protein B

A

Napsin A

131
Q

Napsin A is detected in the cytoplasm of (2)

A
  • type 2 pneumocytes

- alveolar macrophages

132
Q

a nontransactivated isoform (deltaNp63) with greater specificity for squamous/basal-type epithelium

A

p40

133
Q

a criterion for classifying TTF-1 negative poorly differentiated non-small carcinoma as Squamous cell carcinoma

A

diffuse staining for p63 or p40

134
Q

The 2 morphologic signs of glandular differentiation that define adenocarcinoma, often found together:

A
  • formation of tubules or papillae

- secretion of mucin

135
Q

Adenocarcinoma with excellent prognosis (4):

A
  • small (=3 cm) node-negative tumors
  • Noninvasive (in situ)
  • Minimally invasive (=0.5 cm of invasive carcinoma)
  • Lepidic predominant (previously known as Bronchioloalveolar carcinoma)
136
Q

Three lung adenocarcinomas with intermediate prognosis:

A
  • Conventional Acinar
  • Papillary
  • Invasive mucinous
137
Q

Two lung adenocarcinomas with poor prognosis:

A
  • Micropapillary

- Solid

138
Q

Commonly used antibody to TTF-1 that is less sensitive but more specific

A

8G7G3/1 (Dako)

139
Q

Commonly used antibody to TTF-1 that is more likely to show unanticipated TTF-1 staining in tumors from other sites

A

SPT24 (Leica/Novocastra)

140
Q

Blood group antigens consistently expressed in lung adenocarcinoma

A

Lewis X and Y

141
Q

The IHC DC-LAMP is positive in (3)

A
  • normal mature dendritic cells
  • endometrial adenocarcinoma
  • Adenocarcinoma with Clara cell differentiation
142
Q

a putative adenocarcinoma defined as a small (< 0.5 cm) localized proliferation of mildly to moderately atypical nonmucinous columnar cells without significant associated inflammation and/or fibrosis

A

Atypical adenomatous hyperplasia

143
Q

Atypical adenomatous hyperplasia has _ and _ mutations

A
  • KRAS

- EGFR

144
Q

Characteristics of Adenocarcinomas with EGFR mutations (4):

A
  • exclusive of KRAS mutations
  • East asians > Non-Asians
  • Women > Men
  • Never-smokers > Ever-smokers
145
Q

Characteristics of ALK-translocated pulmonary adenocarcinoma (3):

A
  • in never-smokers or light smokers
  • younger age
  • lack of mutations in EGFR, KRAS, and TP53
146
Q

Second most common form of lung carcinoma

A

Squamous cell carcinoma

147
Q

Oncocytoid appearance of the tumor cells in SCCA is due to:

A

increased mitochondrial density

148
Q

a poorly differentiated carcinoma with a characteristically lobulated growth pattern and peripheral palisading of neoplastic cells

A

basaloid SCCA

149
Q

antibody of choice directed against HMW keratins for distinguishing SCCA from Adenocarcinoma in the lung

A

CK5/6

150
Q

High-grade variants of Neuroendocrine tumors (2)

A
  • Small cell carcinoma

- Large cell neuroendocrine carcinoma

151
Q

Intermediate variant of NE tumors

A

Atypical carcinoid tumors

152
Q

Low-grade variant of NE tumors

A

Typical carcinoid tumors

153
Q

Artifact seen in small cell carcinoma that has chromatin diffusion and encrustation of blood vessel walls which appear strongly hematoxyphilic

A

Azzopardi effect

154
Q

Key factor in determining whether a lung tumor belongs to the small cell category or not, in either a pure or combined form:

A

Chromatin and Nucleolar patterns as determined by light microscopic examination of routinely stained material

155
Q

Chromatin in Small cell carcinomas

A

Finely dispersed without prominent clumps

156
Q

Nucleoli in Small cell carcinomas

A

inconspicuous or absent

157
Q

LMW Keratins in SmCC vs. Lymphoma

A
  • SmCC - positive

- Lymphoma - negative

158
Q

HMW Keratins in SmCC vs. Basaloid SCCA

A
  • SmCC - neg/focally pos

- Basaloid SCCA - positive

159
Q

p63 in SmCC vs. Basaloid SCCA

A
  • SmCC - neg/focally pos

- Basaloid SCCA - positive

160
Q

p40 in SmCC vs. Basaloid SCCA

A
  • SmCC - neg/focally pos

- Basaloid SCCA - positive

161
Q

TTF-1 in SmCC vs. Basaloid SCCA

A
  • SmCC - positive (80-90%)

- Basaloid SCCA - negative

162
Q

Key finding in the differential diagnosis of SmCCA vs. Carcinoid and Atypical carcinoid

A

-SmCC has a 100% proliferation rate on Ki-67 (MIB-1)

163
Q

Microscopic characteristics of Large cell Neuroendocrine carcinoma (5)

A
  • NE architecture under microscope (organoid, trabecular, peripheral palisading, and rosette-like structures)
  • relatively large cells with prominent nucleoli and variably abundant cytoplasm
  • high mitotic rate (>10 mitoses per 2 mm)
  • Necrosis
  • IHC evidence of NE differentiation
164
Q

How do you distinguish LCNEC vs other High-grade NSCC with NE differentiation?

A

Neuroendocrine architecture (LCNEC)

165
Q

How do you distinguish LCNEC vs Atypical carcinoid?

A

Mitotic rate

  • > 10 mitoses per 2 mm (LCNEC)
  • 2-10 mitoses (Atypical carcinoid)
166
Q

How do you distinguish LCNEC vs SmCCa?

A

Prominent nucleoli and more abundant cytoplasm (LCNEC)

167
Q

Pulmonary carcinoid tumors are separated into typical and atypical based on: (2)

A
  • Necrosis

- Mitotic rate

168
Q

Most common of the neuroendocrine lung tumors

A

Typical carcinoid tumor (previously known as Bronchial adenoma)

169
Q

Most common primary malignant lung neoplasm in children

A

Typical carcinoid tumor

170
Q

Atypical features in Atypical Carcinoid tumors (2)

A
  • High mitotic activity (2-10 mitoses per 2 mm)

- foci of necrosis

171
Q

Features of adverse prognosis in Atypical Carcinoid Tumors (6):

A
  • Female
  • Large tumor size
  • Nodal involvement
  • Higher mitotic rates
  • Marked invasion into adjacent lung parenchyma
  • Lymph vessel invasion
172
Q

The term given to a nodular proliferation of small spindle cells seen in relation to bronchioles, often in association with bronchiectasis and other conditions associated with scarring including intralobular sequestration

A

Tumorlet (carcinoid tumorlet)

173
Q

Classification of idiopathic interstitial pneumonias (4)

A
  • Chronic fibrosing interstitial pneumonias
  • Smoking-related interstitial pneumonias
  • Acute/subacute interstitial pneumonias
  • Rare interstitial pneumonias
174
Q

Chronic fibrosing interstitial pneumonias (2)

A
  • UIP

- NSIP

175
Q

Smoking-related interstitial pneumonias (2)

A
  • RBILD

- SRIF

176
Q

Acute/subacute interstitial pneumonias (2)

A
  • Diffuse alveolar damage

- Organizing penumonia

177
Q

Rare interstitial pneumonias (3)

A
  • LIP
  • Pleuroparenchymal fibroelastosis
  • Unclassifiable interstitial pneumonia
178
Q

a nonspecific response to pleural injury that may closely simulate LCH because of the mixture of eosinophils, mesothelial cells, and histiocytes

A

Reactive eosinophilic pleuritis

179
Q

Characteristics of Chronic Eosinophilic Pneumonia (4)

A
  • Women > Men
  • between 30-50 yo
  • history of Asthma (half)
  • peripheral Eosinophilia
180
Q

This form of eosinophilic pneumonia presents as acute respiratory failure, often with profound hypoxemia requiring intubation and mechanical ventilation but respond quickly and dramatically to corticosteroid

A

Acute eosinophilic pneumonia

181
Q

a rare condition of pulmonary hemorrhage that classically presents in children and young adults with dyspnea, cough, hemoptysis, and refractory anemia

A

Idiopathic pulmonary hemosiderosis

182
Q

Most commonly used method for diagnosing pneumocystis pneumonia

A

Bronchoalveolar lavage

183
Q

Most reliable stain for detecting Pneumocystis jirovecii

A

GMS

184
Q

Most prevalent opportunistic infection in AIDS patients

A

Pneumocystis

185
Q

Microscopic cause of this infectious pneumonia:

-Foamy or honeycombed intra-alveolar exudate accompanied by a lymphoplasmacytic interstitial infiltrate

A

Pneumocystis jirovecii

186
Q

Microscopic cause of this infectious pneumonia:

-Epithelioid granulomas, focal multinucleated giant cells, marked interstitial fibrosis, vasculitis, a marked infiltrate of alveolar macrophages, calcifications, or DAD

A

Pneumocystis jirovecii

187
Q

Infectious pneumonia seen in individuals who are chronically debilitated and immunosuppressed, such as those receiving therapy for neoplastic disease or affected with AIDS

A

Pneumocystis jirovecii pneumonia

188
Q

Infectious pneumonia usually seen in immunocompromised patients, such as those with AIDS or lymphoid malignancies, transplant recipients, and those receiving cytotoxic drugs

A

Cytomegalovirus pneumonia

189
Q

Microscopic cause of this infectious pneumonia:

-patchy mixed inflammatory infiltrate seen in conjunction with an air space exudate and hyperplasia of the alveolar epithelium

A

Cytomegalovirus

190
Q

Infectious pneumonia which occurs in immunocompromised patients and immunocompetent patients requiring prolonged mechanical ventilation

A

Herpes simplex pneumonia

191
Q

Viral inclusion bodies in Cytomegalovirus are found in the _ and _ of alveolar macrophages, epithelial cells, and endothelial cells

A
  • Nucleus

- Cytoplasm

192
Q

Microscopic cause of this infectious pneumonia:

Necrotizing tracheobronchitis and bronchopneumonia that is frequently accompanied by DAD

A

Herpes simplex pneumonia

193
Q

Viral inclusions in Herpes simplex

A

Intranuclear

194
Q

Microscopic cause of this infectious pneumonia:

Smudged nuclei and bricklike intranuclear inclusions in epithelial cells

A

Adenovirus

195
Q

Microscopic cause of this infectious pneumonia:

  • mild acute and organizing pneumonia
  • no characteristic viral cytopathic changes
  • diagnosis requires confirmatory cultures or serological studies
A

Influenza

196
Q

Microscopic cause of this infectious pneumonia:

  • predominant pattern is that of DAD
  • often associated with fibrinous air space exudate resembling acute fibrinous and organizing pneumonia
A

SARS

197
Q

Microscopic cause of this infectious pneumonia:

-Pulmonary edema and/or DAD with focal hyaline membranes

A

Hantavirus

198
Q

Microscopic cause of this infectious pneumonia:

  • intra-alveolar accumulation of neutrophils, macrophages, and fibrin
  • leukocytoclastic neutrophilic infiltrate, small vessel vasculitis, and necrosis
A

Legionnaires’ disease

199
Q

Most reliable for identifying the short gram-negative bacillus that is the etiologic agent of Legionnaires’ disease

A

Dieterle silver impregnation stain

200
Q

Microscopic cause of this infectious pneumonia:

  • focal necrotizing bronchopneumonia with microabscesses
  • peripheral inflammatory infiltrate that frequently includes palisaded histiocytes resulting in a vaguely granulomatous appearance
A

Nocardiosis

201
Q

Microscopic cause of this infectious pneumonia:

-severe acute and chronic bronchiolitis with an acute inflammatory exudate in the lumens of small airways

A

Mycoplasma pneumoniae pneumonia (Atypical pneumonia)

202
Q

The term Adenosquamous carcinoma is used for lung tumors in which distinct areas of squamous and glandular differentiation are found in the same neoplasm, each accounting for at least _% of the sampled tumor

A

10%

203
Q

a pediatric malignancy with a totally different presentation and morphologic appearance of pulmonary blastoma of adults

A

Pleuropulmonary blastoma (PPB)

204
Q

Microscopically characterized by the presence of well-differentiated adenocarcinomatous component in a cellular stroma composed of undifferentiated small (“blastematous”) spindle cells

A

Pulmonary blastoma

205
Q

Most common benign neoplasm encountered in surgical pathology and generally occurs in adults and is more common in male

A

Hamartoma

206
Q

Carney triad

A
  • Pulmonary chondromas (usually multiple)
  • Gastric epithelioid Leiomyosarcomas (GISTs)
  • functioning extra-adrenal Paragangliomas
207
Q

other name for Pulmonary Paraganglioma

A

Chemodectoma

208
Q

a dysontogenetic (embryonal, blastomatous) malignant pediatric neoplasm that is pulmonary and/or pleural based

A

Pleuropulmonary Blastoma

209
Q

Predominantly cystic PPB

A

type I

210
Q

Entirely solid PPB

A

type III

211
Q

Hypercalcemia is most commonly related to what lung tumor type?

A

Squamous cell carcinoma

212
Q

Hypercalcemia of Lung SCCa is due to release of what protein/hormone?

A

Parathyroid hormone-related protein (PTHRP)

213
Q

Which systemic effects (2) are most commonly related to all lung tumor types?

A
  • Gynecomastia

- Cortical cerebellar degeneration

214
Q

Gynecomastia of Lung Cancer is due to release of what protein/hormone?

A

hCG

215
Q

Carcinoid tumor can have this systemic effects (2):

A
  • Cushing syndrome

- Carcinoid syndrome

216
Q

Cushing syndrome of SmCC and/or Carcinoid tumor is due to release of what hormone?

A

ACTH

217
Q

Hyponatremia of SmCC is due to release of what hormone?

A

ADH

218
Q

Lambert-Eaton syndrome associated with SmCC is also known as:

A

Myopathic-myasthenia syndrome

219
Q

Systemic effects (2) unrelated to lung tumor type but is mainly dependent on proximity to pleural surface

A
  • Clubbing of Fingers

- Hypertrophic pulmonary osteoarthropathy

220
Q

This lung tumor type has the most systemic effects

A

Small cell carcinoma

PATHOLOGY (26 decks)

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