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Pulm > SM_167a: Lung Pathology & Restrictive Lung Disease > Flashcards

SM_167a: Lung Pathology & Restrictive Lung Disease Flashcards

1
Q

What are features of normal lungs on gross anatomy?

A
  • Pleura that are smooth or glistening
  • Red color (but not overly red)
  • Consistency of a wet, firm sponge
  • Airways enlarged and patent
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2
Q

What are features of diseased lungs on gross anatomy?

A
  • Rough or dull pleura
  • Gray color (fibrosis, consolidation) or overly red splotchy color
  • Too firm (fibrosis, consolidation) or too soft (emphysema)
  • Lots of enlarged air spaces (emphysema)
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3
Q

_______ and ________ indicates this a bronchus

A

Cartilaginous ring and submucosal gland indicate this is a bronchus

(Ciliated columnar epithelium lining airway, submucosa sparsely populated with collagenous tissue and smooth muscles)

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4
Q

How can you tell that this bronchus is normal?

A
  • Ciliated columnar epithelium lining airway, then loose connective tissue, then cartilage
  • Submucosa sparsely populated with collagenous tissue and smooth muscles
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5
Q

How can you tell this alveolus is normal?

A
  • Nothing in the alveolar spaces
  • Alveolar septae (single layer of epithelium on both sides with capillary between them) are thin and delicate
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6
Q

What are the characteristics of obstructive lung disease?

A
  • Most involve airway
  • Increased resistance to airflow
  • Do not generally progress to honeycomb lung
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7
Q

What are the characteristics of restrictive lung disease?

A
  • Most involve lung parenchyma
  • Decreased lung capacity
  • Reduced expansion of lung parenchyma
  • May progress to end stage honeycomb lung
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8
Q

Most obstructive lung diseases involve the ______, while most restrictive lung diseases involve the ______

A

Most obstructive lung diseases involve the airway, while most restrictive lung diseases involve the lung parenchyma

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9
Q

Obstructive lung diseases involve increased ______, while restrictive lung diseases involve decreased ______

A

Obstructive lung diseases involve increased resistance to flow, while restrictive lung diseases involve decreased lung capacity and reduced expansion of lung parenchyma

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10
Q

Obstructive lung diseases ____ progress to honeycomb lung, while restrictive lung diseases ____ progress to end-stage honeycomb lung

A

Obstructive lung diseases do not generally progress to honeycomb lung, while restrictive lung diseases may progress to end-stage honeycomb lung

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11
Q

What are examples of obstructive lung disease?

A

Obstructive lung disease

  • COPD (emphysema, chronic bronchitis)
  • Asthma
  • Bronchiectasis
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12
Q

What are examples of restrictive lung disease?

A

Restrictive lung disease

  • Usual interstitial pneumonia
  • Nonspecific interstitial pneumonia
  • Hypersensitivity pneumonitis
  • Sarcoidosis
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13
Q

Restrictive lung disease patterns include ______ and ______

A

Restrictive lung disease patterns include usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP)

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14
Q

Specific disease entities causing restrictive lung disease include ______ and ______

A

Specific disease entities causing restrictive lung disease include sarcoidosis and hypersensitivity pneumonitis

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15
Q

What are common causes of usual interstitial pneumonia?

A
  • Idiopathic pulmonary fibrosis
  • Connective tissue diseases
  • Asbestosis
  • Chronic hypersensitivity pneumonia
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16
Q

Pathology of usual interstitial pneumonia involves ________ and _______ heterogeneity

A

Pathology of usual interstitial pneumonia involves temporal and geographic heterogeneity

  • Geographic heterogenity: normal areas immediately adjacent to areas of fibrosis
  • Temporal heterogeneity: areas of young fibrosis (fibroblastic foci) adjacent to areas of old (eosinophilic, hypocellar foci)
  • More severe in subpleural regions
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17
Q

Geographic heterogeneity in usual interstitial pneumonia is _______

A

Geographic heterogeneity in usual interstitial pneumonia is normal areas immediately adjacent to areas of fibrosis

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18
Q

Temporal heterogeneity in usual interstitial pneumonia is _______

A

Temporal heterogeneity in usual interstitial pneumonia is areas of young fibrosis (fibroblastic foci) adjacent to areas of old (eosinophilic, hypocellular) fibrosis

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19
Q

Geographic and temporal heterogeneity in usual interstitial pneumonia are more severe in _______ regions

A

Geographic and temporal heterogeneity in usual interstitial pneumonia are more severe in subpleural regions

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20
Q

What are common causes of nonspecific interstitial pneumonia?

A
  • Idiopathic
  • Autoimmune disease
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21
Q

Pathology of nonspecific interstitial pneumonia involves ______ and ______ _____ fibrosis

A

Pathology of nonspecific interstitial pneumonia involves temporally and geographically uniform fibrosis

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22
Q
  • What is sarcoidosis?
A

Granulomatous disease of unknown etiology

  • More common in adults <40, females, and African Americans
  • Extrapulmonary involvement (eyes, skin, spleen) common
  • Most cases regress with or without treatment but some progress to pulmonary fibrosis
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23
Q

Pathology of sarcoidosis involves _______ typically along _______

A

Pathology of sarcoidosis involves well formed granulomas without lymphoid inflammation or necrosis (naked granulomas) typically along bronchovascular structures

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24
Q

What must you rule out when considering a diagnosis of sarcoidosis?

A

Infectious etiology

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25
Q

A naked granuloma is a granuloma _______

A

A naked granuloma is a granuloma without inflammation or necrosis

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26
Q

What is hypersensitivity pneumonia?

A

Hypersensitivity pneumonia

  • Caused by prolonged exposure to inhaled organic antigens (animal proteins, bacteria, or plants)
  • Symptoms may be acute (fever, cough, dyspnea) or chronic (progressive respiratoru failure) depending on exposure
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27
Q

Pathology of hypersensitivity pneumonia involves ________

A

Pathology of hypersensitivity pneumonia involves poorly formed non-necrotizing granulomas accompanied by lymphocytes and plasma cells, typically around airways

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28
Q

Chronic hypersensitivity pneumonia demonstrates a ______ pattern of injury

A

Chronic hypersensitivity pneumonitis demonstrates a usual interstitial pneumonia pattern of injury

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29
Q

What is honeycomb lung?

A

Honeycomb lung

  • End stage form of fibrosis associated with restrictive lung disease (most commonly associated with usual interstitial pneumonia)
  • Can be identified in CT scans and pathologic specimens
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30
Q

Pathology of honeycomb lung involves ______ on gross examination and ______ on pathological examination

A

Pathology of honeycomb lung involves fibrosis and cystic dilated spaces on gross examination and dense fibrosis with loss of normal lung architecture and cystic spaces lined by columnar bronchial epithelial cells on pathological examination

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31
Q

Describe the characteristics of obstructive lung disease

A

Obstructive lung diseases

  • Produce decreased flow in large and small airways
  • Generally increase lung volumes due to air trapping and overexpansion
  • Generally decreased elastic recoil
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32
Q

_______, _______, and _______ are examples of obstructive lung disease

A

COPD (emphysema, chronic bronchitis), asthma, and bronchiectasis are examples of obstructive lung disease

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33
Q

COPD includes ______ and ______

A

COPD includes emphysema and chronic bronchitis

(irreversible, related to long term damage from smoking)

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34
Q

Emphysema is a disease of the ______, with ______ airway involvement

A

Emphysema is a disease of the lung parenchyma, with minimal airway involvement

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35
Q

Describe emphysema

A

Emphysema

  • Enlargement of alveolar spaces due to parenchymal destruction
  • Loss of elastic connective tissue around airways results in airway collapse during expiration (obstruction)
  • Protease-antiprotease imbalance
  • Smoking is most common etiology
36
Q

Pathology of emphysema involves _______ and _______

A

The pathology of emphysema involves large overinflated lungs and enlarged alveolar spaces w/ floating spaces

37
Q

A lung affected by emphysema shows ______ on gross inspection

A

A lung affected by emphysema shows enlarged alveolar spaces on gross inspection

(large and overinflated)

38
Q

A lung affected by emphysema shows _______ on pathology

A

A lung affected by emphysema shows enlarged alveolar spaces w/ floating septae on pathology

39
Q

Describe the variants of emphysema

A
  • Centriacinar: most common, smoking related
  • Distal acinar: involves areas of scarring
  • Panacinar: usually related to A1AT deficiency
40
Q

Describe chronic bronchitis

A

Chronic bronchitis

  • Disease of larger airways
  • Smoking related
  • Clinical diagnosis: productive cough for msot days in 3 consecutive months for 2 consecutive years
  • Predisposes to infection
41
Q

Pathology of chronic bronchitis involves _______ and _______

A

The pathology of chronic bronchitis involves chronic airway inflammation and mucus gland hypertrophy

42
Q

Reid index is defined as _______

A

Reid index is defined as ratio of mucus gland size to distance from epithelium to cartilage

( > 0.4 for chronic bronchitis)

43
Q

Contrast emphysema and chronic bronchitis

A

Emphysema: disease lung parenchyma, does not require lots of inflammation, protease/antiprotease imbalance

Chronic bronchitis: larger airways, usually has more significant inflammatory component, airway irritation results in inflammation and mucus hypersecretion

44
Q

Describe bronchiectasis

A

Bronchiectasis

  • Irreversible dilatation of the airways
  • Vicious cycle of obstruction, infection, and bronchial wall destruction - caused by cystic fibrosis (thick secretions), Kartagener’s syndrome (ciliary dysmotility), repeated infections
  • Can cause chronic productive cough w/ foul-smelling sputum
45
Q

The pathology of bronchiectasis involves ______ and ______

A

The pathology of bronchiectasis involves dilated bronchi and plugging of bronchi with mucus containing acute and chronic inflammatory cells

46
Q

Asthma involves _____, _____, and _____

A

Asthma involves reversible episodic obstruction, airway hyperreactivity, and chronic inflammation

  • Reversible episodic obstruction: smooth muscle contraction, mucosal edema, mucus secretion
  • Airway hyperreactivity
  • Chronic inflammation: cytokine secreting TH2 lymphocytes, eosinophils (MBP), and leukotrienes are center
47
Q

Asthma has an ______ and ______ phase

A

Asthma has an early and late phase

48
Q

Early phase of asthma is mediated by ______

A

Early phase of asthma is mediated by soluble factors

  • Airway constriction, vascular permeability, edema
  • Mediated by leukotrienes, prostaglandins, histamine, etc
49
Q

Late phase of asthma is mediated by ______

A

Late phase of asthma is mediated by inflammatory cells

  • Recruitment of inflammatory cells: eosinophils, lymphocytes, etc
50
Q

Atopic asthma is a ______, while non-atopic can occur from _____

A

Atopic asthma is a Type I hypersensitivity, while non-atopic asthma may occur due to something like cold weather

51
Q

Acute pathology of asthma involves ______, ______, and ______

A

Acute pathology of asthma involves eosinophils (Charcot-Leyden crystals), mucus plugging, Churchman spiral

52
Q

Chronic pathology of asthma involves ______ and ______

A

Chronic pathology of asthma involves basement membrane thickening and smooth muscle hypertrophy and airway fibrosis

53
Q

_______ in asthma involves smooth muscle hyperplasia, mucus gland hyperplasia, and epithelial damage

A

Airway remodeling in asthma involves smooth muscle hyperplasia, mucus gland hyperplasia, and epithelial damage

54
Q

What is this?

What condition is this seen in?

A

Basement membrane thickening in asthma

55
Q

What is this?

What condition is this seen in?

A

Charcot-Leyden crystals in asthma

56
Q

What is this?

What condition is this seen in?

A

Mucus plugging in asthma

57
Q

What is this?

What condition is this seen in?

A

Churchman’s spirals in asthma

58
Q

Describe acute lung injury

A

Acute lung injury

  • Abrupt onset of hypoxemia and bilateral pulmonary infiltrates
  • Set of clinical symptoms, not a disease, caused by infection, physical injury, inhaled irritants, chemical injury
  • Pathogenesis related to pneumocyte/endothelial injury which triggers endothelial activation and inflammation
59
Q

Common etiologies of bacterial pneumonia are ______, ______, ______, and ______

A

Common etiologies of bacterial pneumonia are

  • S. pneumoniae
  • H. influenza
  • M. catarrhalis
  • S. aureus

(may be community or hospital acquired)

60
Q

Pathology of acute lung injury involves _____, characterized by _____ and _____

A

Pathology of acute lung injury involves diffuse alveolar damage, characterized by intra-alveolar dense pink hyaline membranes and increased inflammatory cells

61
Q

Common etiologies of viral pneumonia include

  • Immunocompetent:
  • Immunocompromised:
A

Common etiologies of viral pneumonia include

  • Immunocompetent: influenza A and B, RSV, adenovirus
  • Immunocompromised: CMV, herpes
62
Q

Pathology of bacterial pneumonia involves ______, ______, and ______

A

Pathology of bacterial pneumonia involves

  • May be patchy (bronchopneumonia) or diffuse (lobar pneumonia)
  • Parenchyma that are firm, congested and consolidated (hepatization)
  • Numerous neutrophils and hyaline membranes within alveolar spaces
63
Q

Pathology of viral pneumonia involves ______ and ______

A

Pathology of viral pneumonia involves lymphoid infiltrate within alveolar septae and interstitium and viral inclusions (CMV) or glassy chromatin (herpes)

64
Q

Pneumonia caused by CMV is characterized by ______

A

Pneumonia caused by CMV is characterized by viral inclusions

65
Q

Pneumonia caused by herpes is characterized by ______

A

Pneumonia caused by herpes is characterized by glassy chromatin

(cytopathic effect)

66
Q

Chronic granulomatous infection common etiologies are _____ and _____

A

Chronic granulomatous infection common etiologies are mycobacterial and fungal (histoplasmosis, blastomycoses, coccidiodomycosis)

(asymptomatic or subacute in healthy individuals)

67
Q

Pathology of chronic granulomatous infections involves ______

Which stains are used?

A

Pathology of chronic granulomatous infections involves granulomatous inflammation (typically necrotizing)

  • Silver stain to highlight fungal organisms
  • Acid fast bacillus stain to highlight mycobacteria
68
Q

_____ stain is used to highlight fungal organisms in chronic granulomatous infection

A

Silver stain is used to highlight fungal organisms in chronic granulomatous infection

69
Q

_____ stain is used to highlight mycobacteria in chronic granulomatous infection

A

Acif fast bacillus stain is used to highlight mycobacteria in chronic granulomatous infections

70
Q

Describe the categorization of tumors affecting the lung

A
  • Lung tumors
    • Non-small cell lung carcinoma: adenocarcinoma, squamous cell carcinoma, large cell carcinoma
    • Small cell carcinoma
    • Carcinoid
  • Pleural tumors: malignant mesothelioma
71
Q

Describe adenocarcinoma

A

Adenocarcinoma

  • Type of non-small cell carcinoma
  • Most common form of lung carcinoma and in non-smokers
  • Often peripheral tumors
  • Molecular testing for driver mutations used to guide therapy in unresectable cases
72
Q

Pathology of adenocarcinoma involves _____, _____, and _____

A

Pathology of adenocarcinoma involves gland formation, mucin production, and immunoreactive for TTF1

73
Q

What pathologic changes is occuring?

Which condition is this?

A

Gland formation in adenocarcinoma

74
Q

What pathologic changes is occuring?

Which condition is this?

A

Mucin production in adenocarcinoma

75
Q

What pathologic changes is occuring?

Which condition is this?

A

TTF1 immunoreactivity in adenocarcinoma

76
Q

Describe squamous cell carcinoma

A

Squamous cell carcinoma

  • Type of non-small cell carcinoma
  • Almost always occurs in smokers
  • Usually large centrally placed masses
  • Different set of driver mutation than adenocarcinoma, none of which have an associated drug
77
Q

Pathology of squamous cell carcinoma involves _____, _____, and _____

A

Pathology of squamous cell carcinoma involves keratinization, intracellular bridges, and TTF1 negative

78
Q

What pathologic changes is occuring?

Which condition is this?

A

Keratinization in squamous cell carcinoma

79
Q

What pathologic changes is occuring?

Which condition is this?

A

Intracellular bridges in squamous cell carcinoma

80
Q

Describe large cell carcinoma

A

Large cell carcinoma

  • Wastebasket category
  • Non-small cell carcinoma with no evidence of squamous or glandular differentiation
  • Tend to be poorly differentiated tumors
81
Q

Describe small cell carcinoma

A

Small cell carcinoma

  • Invariably associated with smoking
  • Vast majority of cases are unresectable bulky mediastinal disease
  • Distant metastases are common
  • Demonstrate neuroendocrine differnetiation (neurosecretory granules)
82
Q

Pathology of small cell carcinoma involves ______, ______, and ______

A

Pathology of small cell carcinoma involves high nuclear/cytoplasmic ratios, lots of mitotic figures, and dark granular chromatin w/o nucleoli

83
Q

Describe carcinoid tumors

A

Carcinoid tumors

  • Often not associated with smoking
  • Usually very indolent but metastasize occassionally
  • Usually centrally placed tumors - often endobronchial
  • Neuroendocrine differentiation (neurosecretory granules)
84
Q

Pathology of carcinoid tumors involves ______, ______, and ______

A

Pathology of carcinoid tumors involves low nuclear cytoplasmic ratios, nested growth, granular “salt and pepper” chromatin

85
Q

Describe malignant mesothelioma

A

Malignant mesothelioma

  • Arises from mesothelial cells lining pleural and peritoneal surfaces
  • Frequently associated with asbestos exposure
  • Bad prognosis
86
Q

Pathology of malignant mestholioma involves ______

A

Pathology of malignant mestholioma involves resembling adenocarcinoma or a malignant spindle cell tumor

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