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Pulm by Minnie > SM 167a - Lung Pathologies (Restrictive, Obstructive, Infectious, Tumors) > Flashcards

SM 167a - Lung Pathologies (Restrictive, Obstructive, Infectious, Tumors) Flashcards

1
Q

Which lung tumors have the best prognosis?

A

Carcinoid tumors

  • Frequently indolent
  • Usually do not metastasize
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2
Q

Describe the histopathology of small cell carcinoma

A
  • Neuroendocrine differentiation
    • May look like the adrenal medulla, pancreatic islets, or c-cells in the thyroid
  • Nuclear moulding
  • Dark uniform nuclei w/o nucleoli
  • High nucleus:cytoplasm ratio (not very much cytoplasm)
  • High-grade tumors
    • Lots of mitotic activity and necrosis
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3
Q

Which part of the lugn is affected by emphysema?

A

Alveolated lung parenchyma

(other obstructive lung diseases affect the larger airways)

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4
Q

Sarcoidosis or hypersensitivity pneumonitis characteristic?

“Loose granulomas”

A

Hypersensitivity pneumonitis

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5
Q

Name the only obstructive lung disease that affects the alveolated lung parenchyma

A

Emphysema

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6
Q

Obstructive or restrictive:

“COPD, Asthma”

A

Obstructive

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7
Q

What exposure is associated wtih malignant mesothelioma?

A

Asbestos

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8
Q

Describe the gross pathology of bacterially-infected lung tissue

A

Firm, congested, heavier than normal (consolidated)

Parenchyma may be heaptized

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9
Q

Most obstructive diseases involve the ____________, while restrictive lung diseases involve the _____________.

A

Most* obstructive diseases involve the large airways**, while restrictive lung diseases involve the **alveolated lung parenchyma.

*excpetion: emphysema is an obstructive disease that involves the alveolated lung parenchyma

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10
Q

What causes bronchiectasis?

A

Anything that can predispose a person to obstruction of the airways

  • Cystic fibrosis
  • Karatagener’s syndrome
  • Repeated infection
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11
Q

The end stage of which lung diseases is honeycomb lung?

A

Restrictive lung diseases

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12
Q

Describe the pathogenesis of acute lung injury

A
  • Damage to pneumocytes and or endothelial cells of teh aveolar septae
  • -> Inflammatory response
  • -> Cytokine release
  • -> Recruitment of inflammatory cells
  • -> Endothelial activation
    • Capillaries become leaky
    • Plasma proteins accumulate in alveolar spaces
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13
Q

Is there a pathology present in this picture?

If so, what is it?

A

Sarcoidosis: well-formed granulomas

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14
Q

What is the prognosis of small cell carcinoma?

A

Bad :(

The 5-year survival rate is <5%

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15
Q

Obstructive or restrictive:

“Sarcoidosis”

A

Restrictive

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16
Q

What are the 3 major classifications of lung tumors?

A

Non-small cell

Small cell

Carcinoid

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17
Q

Is this lung sample normal or abnormal?

If abnormal, what pathology can you identify?

A

The sample is normal

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18
Q

UIP or NSIP characteristic:

“No granulomas”

A

Both

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19
Q

Adenocarcinoma or squamous cell carcinoma characteristic?

Keratinization

A

Squamous cell carcinoma

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20
Q

Describe the histopathology of adenocarcinoma

A
  • Rounded gland formation
  • Single layer of columnar cells
  • Mucin production
  • TTF1 positive
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21
Q

What causes emphysema?

A

Too many proteases and not enough antiproteases

  • Proteases destroy alveolar septae in the lung parenchyma
  • Conditions that result in protease/antiprotease imbalance:
    • Smoking
    • A1T1 deficiency
    • Pre-existing lung scarring
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22
Q

Characteristic of which lung tumor?

High grade: lots of mitotic activity and necrosis

A

Small cell carcinoma

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23
Q

If acute lung injury does not resolve, what could it progress to?

A

Interstitial fibrosis with a restrictive pattern

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24
Q

What are the 3 categories of non-small cell lung carcinoma?

A

Adenocarcinoma

Squamous cell carcinoma

Larce cell carcinoma

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25
What are the most common causes of infectious granuloma?
* Mycobacterial organisms * TB, NTM * Dimorphic fungi * Blastomycosis, histoplasmosis, coccidiomycosis
26
Is there a pathology present in this picture? If so, what is it?
Sarcoidosis Shows confluent "naked" granulomas
27
What does the Reid index measure?
The ratio of: Thickness of submucosal glands/ Distance between bronchial cartilage and the epithelial surface Reid index \>0.4 is consistent with chronic bronchitis
28
What are the most common causes of viral pneumonia in the community setting?
Influenza A and B RSV Adenovirus hMPV
29
What are the two major categories of obstructive lung disease?
* COPD * Emphysema * Chronic bronchitis * Asthma
30
What has a better prognosis: Idiopathic UIP or idiopathic NSIP?
Idiopathic NSIP Idiopathic UIP = IPF, median survival is 3 years
31
How does smoking lead to emphysema?
Smoking causes an **increase in protease secretion by inflammatory cells** and **inactivation of antiproteases due to tobacco smoke** Too many proteases = destruction of alveolar septae -\> enlargement of lung spaces -\> emphysema
32
What is TTF1? How can it aid the diagnosis of lung cancer?
TTF1 is a protein produced by adenocarcinomas It is specific for adenocarcinomas of the lung
33
What are the most common causes of bacterial pneumonia in healthy patients in the community setting?
* Streptococcus pneumoniae* * Haemophilus​ influenzae* * Moraxella catarrhalis* * Staphylococcus aureus*
34
Long-term, chronic hypersensitivity pneumonitis shows a _________ pattern on HRCT.
Long-term, chronic hypersensitivity pneumonitis shows a **_UIP_** pattern on HRCT.
35
Atopic or non-atopic asthma characteristic? "Trigger = airway irritation due to exercise, cold air, inhaled irritants, or viral infection"
Non-atopic asthma
36
Obstructive or restrictive characteristic: "Increased lung capacity"
Obstructive
37
Obstructive or restrictive characteristic: "Rapid expiration of air"
Restrictive
38
Sarcoidosis or hypersensitivity pneumonitis characteristic? "Lymphoplasmacystic inflammation"
Hypersensitivity pneumonitis
39
Chronic Bronchitis or Asthma characteristic? "Medial therapy can restore normal physiology"
Asthma
40
UIP or NSIP characteristic: "Sub-pleural, basilar predominance"
UIP
41
What is the most common form of lung cancer?
Adeonocarcinoma (a type of non-small cell lung carcinoma)
42
Atopic or non-atopic asthma characteristic? "Type 1 IgE hypersensitivity reaction"
Atopic
43
Characteristic of which lung tumor? ## Footnote **Low nucleus:cytoplasm ratio**
Carcinoid tumor
44
What is the prognosis for malignant mestothelioma?
\<2 year median survival :(
45
Describe the key features of sarcoidosis
* **Non-necrotizing granulomatous inflammation** * Well-formed * No lymphocytic inflammation * Upper-lobe predominant * Idiopathic, systemic granulomatous disease * Must rule out infectious etiology to diagnose sarcoidosis
46
What pathologic changes are seen in chronic bronchitis?
* Mucus glad hypertrophy * More mucus cells in the bronchial epithelium * Increased thickness of the bronchial mucus glands * Chronic inflammatory infiltrate * Lots of lymphocytes and macrophages
47
Sarcoidosis or hypersensitivity pneumonitis characteristic? "Associated with infectious etiology"
Neither Sarcoidosis = idiopathic Hypersensitivity pneumonitis = exposure to organic antigens
48
UIP or NSIP characteristic: "Temporally and geographically heterogeneous fibrosis"
UIP
49
Describe the histology of squamous cell carcinoma
* Keratinization * Abundant dense, pink cytoplasm * Intracellular bridges (desmosomes) between squamous cells * TTF1 negative
50
Describe the pathologic findings of viral pneumonia
* Increased **lymphocytes** and plasma cells in alveolar septae and interstitium * Hyaline membrane and neutrophils may be present if very severe
51
Describe the histopathology of bacterial pneumonia
* Many **neutrophils** in alveolar spaces * Other inflammatory cells may be present too * Congestion of capillaries of aleolar septae * Hyaline membranes possible
52
Obstructive or restrictive characteristic: "Difficulty expiring air"
Obstructive
53
Adenocarcinoma or squamous cell carcinoma characteristic? ## Footnote **TTF1 negative**
Squamous cell carcinoma
54
Chronic Bronchitis or Asthma characteristic? "Eosinophilic infiltrate"
Asthma
55
Describe the characterisitics of chronic asthma
Basement membrane thickening Smooth muscle hypertrophy and hyperplasia Goblet cell (mucus gland) hyperplasia
56
Which non-small cell lung carcinoma is most strongly associated with a history of smoking?
Squamous cell carcinoma
57
Atopic or non-atopic asthma characteristic? "Trigger = environmental allergen"
Atopic asthma
58
Obstructive or restrictive characteristic: "End stage = honeycomb lung"
Restrictive
59
Characteristic of which lung tumor? ## Footnote **Keratinization**
Squamous cell carcinoma (non-small cell)
60
What is the underlying pathology of asthma?
Chronic inflammation * Surrounds the larger and smaller airways * Inflammatory infiltrate contains **eosinophils**, Th2 lymphocytes, leukotrienes
61
What is status asthmaticus?
Severe acute asthma Attacks wtihout return to normal - can be fatal
62
Sarcoidosis or hypersensitivity pneumonitis characteristic? "Presents with fever and cough"
Hypersensitivity penumonitis
63
Obstructive or restrictive characteristic: "Increased elastic recoil of the lung parenchyma"
Restrictive
64
UIP or NSIP characteristic: "Microcscopic honeycombing may be present"
UIP
65
Which lung cancers occur most commonly in smokers?
Squamous cell carcinoma (non-small cell) Small cell carcinoma
66
What are the pathologic findings of acute lung injury?
Diffuse alvolar damage * Intra-alveolar **dense, pink hyaline membrane** * Made up of necrotic cells + fibers + plsama protiens * High numbers of inflammatory cells
67
What etiologies are associated with an NSIP pattern?
* Autoimmune * Connective tissue disease * Idiopathic
68
What is bronchiectasis?
Irreversible dilation of the airways * Airways are bigger than the accompanying blood vessel * Walls are repeatedly destroyed and hollowed out * Bronchi become plugged wtih mucus containing acute and chronic inflammatory cells * Not a disease, but a process that can complicate other diseases * Ex: Cystic Fibrosis
69
What defines chronic bronchitis?
A productive cough on most days in **3 consecutive months** of **2 consecutive years**
70
Adenocarcinoma or squamous cell carcinoma characteristic? ## Footnote **TTF1 positive**
Adenocarcinoma
71
Describe the viscious cycle of bronchiectasis
Obstruction due to inflammation -\> Infection -\> Bronchial wall destruction -\> Rinse and repeate
72
Where are mesothelial cells located?
They line the pleural and peritoneal cavites
73
Characteristic of which lung tumor? **Mitotic figures and necrosis are rare**
Carcinoid tumors
74
Obstructive or restrictive characteristic: "Fibrosis, diffuse inflammatory infiltrate"
Restrictive
75
What cells are common in the infiltrate of a person with infectious granulomas?
Lymphocytic infiltrate
76
UIP or NSIP characteristic: "Temporally and geographically uniform fibrosis"
NSIP
77
Is there a pathology present in this picture? If so, what is it?
UIP Shows geographic and temporal heterogeneity
78
Describe the key features of acute or subacute hypersensitivity pneumonitis
* Loose/poorly-formed **granulomas** * **Lymphoplasmacystic infiltrate** * Associated with exposure to organic antigens * Animals, plants, bacteria * Special stains and cultures required for diagnosis
79
Describe the key features of chronic hypersensitivity pneumonitis
UIP pattern * Honeycombing * Geographically and temporally heterogeneous fibrosis
80
What etiologies are associated wtih a UIP pattern of lung disease?
* Autoimmune * Asbestos exposure * Hypersensitivity * IPF _if all else is ruled out_
81
Adenocarcinoma or squamous cell carcinoma characteristic? ## Footnote **Mucin production**
Adenocarcinoma
82
Obstructive or restrictive characteristic: "Decreased lung capacity"
Restrictive
83
Charcot Leyden crystals are seen in which airway pathology?
Asthma Charcot leyden crystals are formed from the products of eosinophil degradation
84
Is there a pathology present in this picture? If so, what is it?
This is a normal lung!
85
Adenocarcinoma or squamous cell carcinoma characteristic? ## Footnote **Single layer of columnar cells**
Adenocarcinoma
86
Describe the histopathology of carcinoid tumors
* Neuroendocrine differentiation * Nested/cord-like growth pattern * Abundant cytoplasm * Nuclei are bland with granular "salt and pepper" chromatin * Mitotic figures and necrosis are rare
87
What is the most common cause of bacterial pneumonia in cystic fibrosis?
*Pseudomonas aeruginosa*
88
What are the characteristic findings of pneumonia caused by Herpes viruses?
* Pale glassy chromatin * Nuclear moulding * Multinucleation * Margination of chromatin
89
Chronic Bronchitis or Asthma characteristic? "Infiltrate contains lots of lymphocytes and macrophages"
Chronic bronchitis
90
Viral pneumonia caused by which viruses is usually only seen in immunocompromised patients?
CMV Herpes viruses
91
Describe the key features of a Usual Interstitial Pneumonia (UIP) pattern
* **Fibrosis:** Temporally and geographically **heterogeneous** * Fibrosis and normal lung may be adjacent * Mature and less mature fibrosis may be adjacent * **Sub-pleural predominance** * **Basilar predominance** * No granulomas
92
Obstructive or restrictive characteristic: "Decreased elastic recoil of the lung parenchyma"
Obstructive
93
Characteristic of which lung tumor? ## Footnote **Neuroendocrine differentiation**
Small cell carcinoma Carcinoid tumor
94
Describe the key features of a Nonspecific Interstitial Pneumonia (NSIP) pattern
* **Fibrosis:** Temporally and geographically **uniform** * No granulomas
95
Sarcoidosis or hypersensitivity pneumonitis characteristic? "Well-formed, tightly-packed granulomas"
Sarcoidosis
96
What are the most common causes of bacterial pneumonia in the hospital setting?
* Staphylococcus aureus* * Gram negative enteric bacteria*
97
What is the most common cause of bacterial pneumonia in alcoholics?
*Klebsiella pneumoniae*
98
How is large cell carcinoma diagnosed?
By excluding squamous cell carcinoma and adenocarcinoma Large cell carcinoma tumors are poorly differentiated, and they do not have features of adenocarcinoma, squamous cell carcinoma, or small cell carcinoma
99
Describe the presentation of bronchiectasis
Chronic productive cough with foul-smelling sputum
100
Describe the gross pathology of bronchiectasis
Large airspaces in the periphery of the lung (normally, you would only find large airspaces centrally)
101
What is the difference between bronchopneumonia and lobar penumonia?
* **Bronchopneumonia** has a **patchy** distribution * **Lobar** pneumonia has a confluent pattern, may infect the **entire lung**
102
Characteristic of which lung tumor? **High nucleus:cytoplasm ratio**
Small cell carcinoma
103
Describe the gross pathology of malignant mesothelioma
Thick, pale, fibrous rind around normal lung parenchyma
104
Is there a pathology present in this picture? If so, what is it?
NSIP Shows uniform fibrosis
105
What are the characteristic findings of pneumonia caused by CMV?
Intranuclear "owl eye" inclusions Usually only immunocompromised patients have pneumonia caused by CMV
106
Almost all cases of chronic bronchitis are related to \_\_\_\_\_\_\_
Almost all cases of chronic bronchitis are related to **_smoking_**

Pulm by Minnie (34 decks)

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