Rosai Chapter 10 - Lung Flashcards by Jonathan Emmanuel Cancio

Main proliferating component after alveolar injury

cuboidal type II (granular) pneumocytes

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Main types of bronchial and bronchiolar epithelial cells (6)

Basal cells
Neuroendocrine cells
Ciliated cells
Serous cells
Clara cells
Goblet cells

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

Ciliated cells

- Goblet cells

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

-Clara cells

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

-Clara cells

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Submucosal glands in larger bronchi is composed of:

-both Serous and Mucous cells

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

“CARB”

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

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Pulmonary ARTERY or VEIN:

Has internal and external elastic membrane

Pulmonary Artery

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Pulmonary ARTERY or VEIN:

Has single (outer) elastic layer

Pulmonary Vein

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

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

Wedge biopsy

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Histologic findings that complicate interpretation of transbronchial biopsy (3)

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

Congenital Lobar Overinflation (Congenital Lobar Emphysema)
CCAM / CPAM
Bronchogenic cyst
Pulmonary sequestration

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

-CCAM / CPAM

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

Size

- Number of cysts

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Stocker type:

-Large cyst (>2 cm)

Stocker type 1

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Stocker type:

-Small cyst (<2 cm)

Stocker type 2

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Most common form of acquired cystic disease

-Emphysema

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

Emphysema

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Most important morphologic substrate of COPD

Emphysema

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

Bullae

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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

Blebs

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Size of Blebs

< 1 cm in diameter

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Characterized by:

Severe emphysema
Bronchiectasis
Bronchiolitis obliterans

Swyer-James (McLeod) syndrome

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

Placental transmogrification

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

Birt-Hogg-Dube syndrome

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

Pleuropulmonary blebs and cysts (usually basilar)

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

Chondroid cystic malformation

Chondroid cystic malformation is due to:

trisomy 8 mosaicism

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)

Bronchopulmonary sequestration

Key to diagnosis of intralobar variety of Bronchopulmonary sequestration

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

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: aberrantly located pulmonary mesenchyme as an extrapulmonary island of lung tissue enveloped by its own pleural covering

Extralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: any level from the thoracic inlet to the diagphragm or even within the abdominal cavity

Extralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Left side

BOTH

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Associated with: - diaphragmatic hernias - polyhydramnios - edema

Extralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: more heterogeneous

Intralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Bronchial atresia with systemic vascular connection

Intralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Symptomatic

Intralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: within the Lower lobe

Intralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Single cyst, multicystic area, or solid mass

Intralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Artery has an elastic pulmonary type

Intralobar

EXTRALOBAR / INTRALOBAR Bronchopulmonary sequestration: Microscopically - Nonspecific, Chronic inflammation, and Fibrosis

Intralobar

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

Middle lobe syndrome

A syndrome characterized by: - Chronic sinonasal infection - Frequent bronchiectasis - complete sinus inversus - infertility

Kartagener or Immotile cilia syndrome (primary ciliary dyskinesia)

A syndrome characterized by: - Chronic sinonasal infection - Frequent bronchiectasis - Infertility caused by azoospermia but lacking ultrastructural ciliary abnormalities

Young syndrome

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

Localize

LOCALIZE / DIFFUSE Bronchiectasis: Any area of Lung

Localize

LOCALIZE / DIFFUSE Bronchiectasis: If source of compression is relieved at an early stage, there is regression

Localize

LOCALIZE / DIFFUSE Bronchiectasis: Irreversible if microscopically has secondary inflammation and fibrotic changes

Localize

LOCALIZE / DIFFUSE Bronchiectasis: associated with Middle lobe syndrome

Localize

LOCALIZE / DIFFUSE Bronchiectasis: consequence of inflammation and post-inflammatory destruction of airway walls that is usually the result of repeated episodes of infection

Diffuse

LOCALIZE / DIFFUSE Bronchiectasis: Associated with - Cystic fibrosis - Kartagener syndrome - Young syndrome

Diffuse

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

- Right lower lobe - Right upper lobe (particularly SUBAPICAL segment) - Left lower lobe *in decreasing order

Most common causes of lung abscesses in children (3)

- Staphylococcus aureus - Streptococcus sp. - Klebsiella pneumoniae

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

Tuberculosis

Solitary lung nodules seen in adults due to reinfection by tuberculosis

Tuberculomas

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

Lady Windermere syndrome

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

Hot tub lung

Presentations of Sarcoidosis in the thoracic cavity (5)

- 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

Hallmark of Sarcoidosis

compact non-caseating granuloma composed of: - Epithelioid cells - Langhans giant cells - Lymphocytes

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

Necrotizing sarcoid granulomatosis

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

- necrotizing granulomatous inflammation - necrotizing vasculitis - c-ANCA - small-to-medium size vessels

Main morphologic change in the lungs of patients with GPA

necrotizing granulomatous inflammation grossly resembling other localized necrotizing processes

CLASSIC / LIMITED (LOCALIZED) GPA: Triad of: - necrotizing angiitis - Aseptic necrosis (involving both URT and the lungs) - focal glomerulitis

Classic

CLASSIC / LIMITED (LOCALIZED) GPA: other vessels may be involved

Classic

CLASSIC / LIMITED (LOCALIZED) GPA: responsive to cytotoxic drugs (i.e. Cyclophosphamide)

Classic

CLASSIC / LIMITED (LOCALIZED) GPA: confined to the Lungs

Limited (Localized)

CLASSIC / LIMITED (LOCALIZED) GPA: No renal involvement

Limited (Localized)

CLASSIC / LIMITED (LOCALIZED) GPA: more protracted clinical course

Limited (Localized)

CLASSIC / LIMITED (LOCALIZED) GPA: Steroids and Cytotoxic drugs are both highly effective

Limited (Localized)

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

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

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

Allergic bronchopulmonary aspergillosis

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

Diffuse Interstitial Lung disease

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

Chronic Fibrosing Interstitial Pneumonias

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

Usual Interstitial Pneumonia (UIP)

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

Idiopathic Pulmonary Fibrosis (IPF)

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

Acute exacerbation

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

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)

Characteristic of UIP but are not specific

Fibroblast foci

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

Non-specific Interstitial Pneumonia (NSIP)

Main morphologic difference of UIP vs. NSIP

Based on pattern of lung involvement: - UIP (heterogeneous) - NSIP (lacks heterogeneity)

FIBROTIC / CELLULAR NSIP: Alveolar septa in NSIP is expanded by an inflammatory infiltrate WITH collagen fibrosis

Fibrotic NSIP

FIBROTIC / CELLULAR NSIP: Alveolar septa in NSIP in expanded by an inflammatory infiltrate WITHOUT collagen fibrosis

Cellular NSIP

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

Respiratory bronchiolitis

Symptomatic RB

Respiratory bronchiolitis-interstitial lung disease (RBILD)

RB/RBILD vs. Desquamative interstitial pneumonia (DIP): Histiocytic accumulation is Diffuse

RB/RBILD

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

RB/RBILD

RB/RBILD vs. Desquamative interstitial pneumonia (DIP): Histiocytic accumulation is Centriacinar

DIP

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

DIP

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

Smoking-related interstitial fibrosis (SRIF)

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

- edema - intra-alveolar hemorrhage - Fibrin deposition

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

3 to 7 days

a rapidly progressive form idiopathic interstitial pneumonia

Acute interstitial pneumonia (AIP)

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

Hamman-Rich syndrome

Microscopic appearance equivalent of AIP

organizing phase of DAD

Most striking feature microscopically of AIP

interstitial expansion and distortion by organizing fibroblasts and myofibroblasts

Another term for organizing pneumonia

Bronchiolitis obliterans-organizing pneumonia (BOOP)

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

Cryptogenic pneumonia

Morphologic hallmark of organizing pneumonia in any clinical context

Fibroblastic plugs ("Masson bodies") filling air spaces

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

Lymphoid (lymphocytic) interstitial pneumonia (LIP)

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

Follicular bronchiolitis

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

Apical cap

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

Hypersensitivity Pneumonia (Extrinsic allergic alveolitis)

Most common offending antigens of HP/EAA (3)

"MAT" - Molds - Avian proteins - Thermophilic bacteria

Classic HP is microscopically characterized by (3)

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

a form of acute lung injury secondary to nitrogen dioxide inhalation

Silo-filler's disease (SFD)

SFD is characterized by the presence of:

-DAD without granulomatous inflammation

Essential element for the diagnosis of LCH

Langerhans cells

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

Pneumoconiosis

Silicon nodules in patients with rheumatoid arthritis

Caplan syndrome

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

core is Translucent

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Rarely seen

Exogenous

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Mineral oil from nasal sprays, laxatives, or other sources reaches the lung through the tracheobronchial tree

Exogenous

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Gross - Well-circumscribed and firm

Exogenous

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Microscopic - Coarse lipid vacuoles

Exogenous

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Much more common

Endogenous

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Consequence of bronchial obstruction by carcinoma or some other process

Endogenous

EXOGENOUS / ENDOGENOUS Lipoid Pneumonia: Microscopic - finely vacuolated lipid-laden macrophages in distal airspaces with frequent involvement of the peribronchiolar interstitium

Endogenous

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

Loeffler syndrome

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

Pulmonary Alveolar Proteinosis (PAP) / Alveolar proteinosis

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

PAP

Leading cause of cancer-related deaths

Lung carcinoma

Carcinomas located in the superior pulmonary sulcus

Pancoast syndrome

Pain in Pancoast syndrome is in the distribution of __ nerve

Ulnar nerve

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

Horner syndrome

Most common incident lung carcinoma

Adenocarcinoma

IHC present in all types of lung carcinomas

Keratins

TTF-1 is consistently expressed in (2)

- Normal type 2 pneumocytes | - Clara cells

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

-positivity in TTF-1 (or Napsin A)

as aspartic proteinase involved in the maturation of surfactant protein B

Napsin A

Napsin A is detected in the cytoplasm of (2)

- type 2 pneumocytes | - alveolar macrophages

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

p40

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

diffuse staining for p63 or p40

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

- formation of tubules or papillae | - secretion of mucin

Adenocarcinoma with excellent prognosis (4):

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

Three lung adenocarcinomas with intermediate prognosis:

- Conventional Acinar - Papillary - Invasive mucinous

Two lung adenocarcinomas with poor prognosis:

- Micropapillary | - Solid

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

8G7G3/1 (Dako)

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

SPT24 (Leica/Novocastra)

Blood group antigens consistently expressed in lung adenocarcinoma

Lewis X and Y

The IHC DC-LAMP is positive in (3)

- normal mature dendritic cells - endometrial adenocarcinoma - Adenocarcinoma with Clara cell differentiation

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

Atypical adenomatous hyperplasia

Atypical adenomatous hyperplasia has _ and _ mutations

- KRAS | - EGFR

Characteristics of Adenocarcinomas with EGFR mutations (4):

- exclusive of KRAS mutations - East asians > Non-Asians - Women > Men - Never-smokers > Ever-smokers

Characteristics of ALK-translocated pulmonary adenocarcinoma (3):

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

Second most common form of lung carcinoma

Squamous cell carcinoma

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

increased mitochondrial density

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

basaloid SCCA

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

CK5/6

High-grade variants of Neuroendocrine tumors (2)

- Small cell carcinoma | - Large cell neuroendocrine carcinoma

Intermediate variant of NE tumors

Atypical carcinoid tumors

Low-grade variant of NE tumors

Typical carcinoid tumors

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

Azzopardi effect

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

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

Chromatin in Small cell carcinomas

Finely dispersed without prominent clumps

Nucleoli in Small cell carcinomas

inconspicuous or absent

LMW Keratins in SmCC vs. Lymphoma

- SmCC - positive | - Lymphoma - negative

HMW Keratins in SmCC vs. Basaloid SCCA

- SmCC - neg/focally pos | - Basaloid SCCA - positive

p63 in SmCC vs. Basaloid SCCA

- SmCC - neg/focally pos | - Basaloid SCCA - positive

p40 in SmCC vs. Basaloid SCCA

- SmCC - neg/focally pos | - Basaloid SCCA - positive

TTF-1 in SmCC vs. Basaloid SCCA

- SmCC - positive (80-90%) | - Basaloid SCCA - negative

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

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

Microscopic characteristics of Large cell Neuroendocrine carcinoma (5)

- 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

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

Neuroendocrine architecture (LCNEC)

How do you distinguish LCNEC vs Atypical carcinoid?

Mitotic rate - >10 mitoses per 2 mm (LCNEC) - 2-10 mitoses (Atypical carcinoid)

How do you distinguish LCNEC vs SmCCa?

Prominent nucleoli and more abundant cytoplasm (LCNEC)

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

- Necrosis | - Mitotic rate

Most common of the neuroendocrine lung tumors

Typical carcinoid tumor (previously known as Bronchial adenoma)

Most common primary malignant lung neoplasm in children

Typical carcinoid tumor

Atypical features in Atypical Carcinoid tumors (2)

- High mitotic activity (2-10 mitoses per 2 mm) | - foci of necrosis

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

- Female - Large tumor size - Nodal involvement - Higher mitotic rates - Marked invasion into adjacent lung parenchyma - Lymph vessel invasion

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

Tumorlet (carcinoid tumorlet)

Classification of idiopathic interstitial pneumonias (4)

- Chronic fibrosing interstitial pneumonias - Smoking-related interstitial pneumonias - Acute/subacute interstitial pneumonias - Rare interstitial pneumonias

Chronic fibrosing interstitial pneumonias (2)

- UIP | - NSIP

Smoking-related interstitial pneumonias (2)

- RBILD | - SRIF

Acute/subacute interstitial pneumonias (2)

- Diffuse alveolar damage | - Organizing penumonia

Rare interstitial pneumonias (3)

- LIP - Pleuroparenchymal fibroelastosis - Unclassifiable interstitial pneumonia

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

Reactive eosinophilic pleuritis

Characteristics of Chronic Eosinophilic Pneumonia (4)

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

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

Acute eosinophilic pneumonia

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

Idiopathic pulmonary hemosiderosis

Most commonly used method for diagnosing pneumocystis pneumonia

Bronchoalveolar lavage

Most reliable stain for detecting Pneumocystis jirovecii

GMS

Most prevalent opportunistic infection in AIDS patients

Pneumocystis

Microscopic cause of this infectious pneumonia: -Foamy or honeycombed intra-alveolar exudate accompanied by a lymphoplasmacytic interstitial infiltrate

Pneumocystis jirovecii

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

Pneumocystis jirovecii

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

Pneumocystis jirovecii pneumonia

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

Cytomegalovirus pneumonia

Microscopic cause of this infectious pneumonia: -patchy mixed inflammatory infiltrate seen in conjunction with an air space exudate and hyperplasia of the alveolar epithelium

Cytomegalovirus

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

Herpes simplex pneumonia

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

- Nucleus | - Cytoplasm

Microscopic cause of this infectious pneumonia: Necrotizing tracheobronchitis and bronchopneumonia that is frequently accompanied by DAD

Herpes simplex pneumonia

Viral inclusions in Herpes simplex

Intranuclear

Microscopic cause of this infectious pneumonia: Smudged nuclei and bricklike intranuclear inclusions in epithelial cells

Adenovirus

Microscopic cause of this infectious pneumonia: - mild acute and organizing pneumonia - no characteristic viral cytopathic changes - diagnosis requires confirmatory cultures or serological studies

Influenza

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

SARS

Microscopic cause of this infectious pneumonia: -Pulmonary edema and/or DAD with focal hyaline membranes

Hantavirus

Microscopic cause of this infectious pneumonia: - intra-alveolar accumulation of neutrophils, macrophages, and fibrin - leukocytoclastic neutrophilic infiltrate, small vessel vasculitis, and necrosis

Legionnaires' disease

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

Dieterle silver impregnation stain

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

Nocardiosis

Microscopic cause of this infectious pneumonia: -severe acute and chronic bronchiolitis with an acute inflammatory exudate in the lumens of small airways

Mycoplasma pneumoniae pneumonia (Atypical pneumonia)

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

10%

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

Pleuropulmonary blastoma (PPB)

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

Pulmonary blastoma

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

Hamartoma

Carney triad

- Pulmonary chondromas (usually multiple) - Gastric epithelioid Leiomyosarcomas (GISTs) - functioning extra-adrenal Paragangliomas

other name for Pulmonary Paraganglioma

Chemodectoma

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

Pleuropulmonary Blastoma

Predominantly cystic PPB

type I

Entirely solid PPB

type III

Hypercalcemia is most commonly related to what lung tumor type?

Squamous cell carcinoma

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

Parathyroid hormone-related protein (PTHRP)

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

- Gynecomastia | - Cortical cerebellar degeneration

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

hCG

Carcinoid tumor can have this systemic effects (2):

- Cushing syndrome | - Carcinoid syndrome

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

ACTH

Hyponatremia of SmCC is due to release of what hormone?

ADH

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

Myopathic-myasthenia syndrome

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

- Clubbing of Fingers | - Hypertrophic pulmonary osteoarthropathy

This lung tumor type has the most systemic effects

Small cell carcinoma