Small Group 6 Pathology of Obstructive Disease

Question 1

Describe the key pathological findings in a patient with pan-acinar emphysema due to alpha-1 antitrypsin deficiency.

Answer 1

bullae due to parenchymal loss and airspace coalescence
prominent vessels on cut surface due to parenchymal loss
microscopic images with septal loss and enlarged airspaces

Question 2

Describe the key pathological findings in a patient with status asthmatics. (gross and microscopic)

Answer 2

gross: sever hyperinflation, cut surface shows mucus plug, bronchial smooth muscle hypertrophy and increased size of submucosal glands
microscopic: muscus plugging, smooth muscle hypertrophy and eosinophilia (red/pink), high power shooing Curschmann’s spiral (made of eosinophil membrane protein) and Charcot-Leyden crystals

Question 3

Describe the key pathological findings in a patient with chronic bronchitis.

Answer 3

lymphocytic chronic inflammation
mucus gland hyperplasia
right ventricular hypertrophy

Question 4

Describe the key pathological findings in a patient with cystic fibrosis.

Answer 4

bronchiectasis, fibrosis

Question 5

COPD with enlargement in the centriacinar emphysema is often more severe in which part of the lung due to smoking?

Answer 5

upper lobes

conversely panacinar enlargement tends to be more sever in the lower lungs

Question 6

How does smoking contribute to the development of emphysema?

Answer 6

proteases derived form neutrophils and macrophages that accumulate in the lungs of smokers, increased proteases like elastase (and decreased alpha-1 antitrypsin) cause destruction of parenchyma

Question 7

In asthma, what is responsible for accumulation of eosinophils and what role do eosinophils play in causing tissue damage?

Answer 7

eosinophils are attracted by chemotactic factors released by mast cells and chemokine eotaxin produced by bronchial epithelial cells, and IL-5 a T-cell derived cytokine

major basic protein of eosinophils causes epithelial damage and shedding

Question 8

What is the cause of airflow obstruction in cystic fibrosis?

Answer 8

multifactorial: dynamic compression of inflamed and overly compliant airways, airway obstruction form inspissated mucus, and state airway narrowing from airway inflammation

patchy centrilobar emphysema may play a minor role and in some individuals bronchospasms