Topic 38-42: Pulmonary infections, Neoplasia Flashcards
Pneumonia is defined as what? what are the classifications?
Pneumonia is any infection in the lung
classified based on: who, what, when, where, how, specifics
- acute or chronic (when)
- Histology: exudates, cell infiltration, granulomas and cavitations (specifics)
- pattern: lobar or bronco (where)
- clinical features: atypical, hypostatic (where)
- type of infection: community, nosocomial, opportunistic (how)
- bacterial, viral or fungal (what)
- host: immunocompromised or normal (who)
What are the types of pneumonia:
- community acquired pneumonia
- community acquired atypical
- legionella pneumonia
- nosocomial pneumonia
- aspiration
- lung abscess
- chronic pneumonia
- opportunistic pneumonia
Community acquired pneumonia originated how? what is the most common infectious agent?
Typically it’s bacterial in origin that follows a viral infection.
-Most common agent is S. pneumoniae (90%) and mostly infects immunocompromised, asplenic and people with chronic disease (diabetes, COPD)
-it can be broncho or lobar
lobar pneumonia has 4 stages:
- congestion - red, congested
- red hepatization - alveoli are filled with RBC, neutrophils, fibrin (hemo fibropurulent exudate)
- grey hepatization- fibrinosuppurative exudate in alveoli, lysed RBCs
- resolution - exudate in enzymatically digested and eventually coughed up or phagocytosed by macrophages.
pleural reaction may accompany a lobar pneumonia and may resolve or undergo organization, leaving fibrous adhesions
Bronchopneumonia is described morphologically as what?
patchy inflammation, undergoing the stages of lobar hepatization but at different speeds. alveoli, bronchioles, and bronchi are also filled with exudate
what are complications that can occur with pneumonia?
- abscess
- empyema
- scar
- dissemination (becomes meningitis, infective endocarditis, etc)
community acquired atypical pneumonia are caused by which agent? what are symptoms that differentiate it from a regular pneumonia?
a pneumonia that is caused by a non-traditional pathogen such as M pneumoniae, chlamydia, or a virus.
- Absence of pulmonary consolidation
- moderate elevation of WBC (vs high in normal)
- Lack of alveolar exudate (because it’s in the interstitium!)
what is the morphology of an atypical pneumonia?
inflammation is confined to the walls of the alveoli!!!
-wide septa, alveoli is free of cellular debris
aspiration pneumonia is most frequently in which side? what are the infectious agents?
laying down, standing, or laying on your right side will always cause aspirations or foreign bodies to go to the right lung.
left sides laying –> lingula
mixed anaerobic, aerobic bacteria from the gut or oral cavity
abscesses will occur with or progress from which type of pneumonia?
- necrotizing pneumonia
- aspiration
–complicated pneumonias
chronic pneumonias are caused by which agents and associated with which morphological symptom?
nocardia, actinomyces, TB
granulomas
Opportunistic pneumonias are caused by which agents?
fungi, candida and aspergillus,
also pneumocystis jiroveci, cytomegalovirus
pleural lesions are what? name the primary and secondary causes of pleural lesions
any pathologic involvement in the pleura
primary:
- intrapleural bacterial infections
- mesothelioma
secondary:
- pleural effusion and pleuritis
- pneumothorax
- hemothorax
- chylothorax
- mesothelioma
what are the types of pleural effusion?
-transudate –> hydrothorax from ultrafiltrate of the blood
- exudate
- -microbial invasion (from pneumonia or sepsis)
- -cancer (usually hemorrhagic)
- -pulmonary infarction
- -viral pleuritis
pneumothorax can be:
- spontaneous - rupture of emphysematous bulla, abscess, etc
- secondary - due to a disorder such as emphysema, fractured rib
- traumatic - stab wound, car accident
what are complications of pneumothorax?
- tension pneumothorax - one way valve leak may leak air into pleural space causing a tension pneumothorax and shift mediastinum away from collapsed lung because the pressure is positive in the pleural cavity
- infection
- empyema
hemothorax is typically from:
intrathoracic anyurism
chylothorax is typically from:
obstruction of major lymph duct
mesothelioma is typically due to what? it takes how long to occur? how common is it? what does it look like morphologically?
Most of the time it is due to cigarette smoke and asbestos.
it takes about 35 years to develope (so primary lung cancer is more commonly seen)
mesothelioma is very rare! primary is even rarer. mesothelioma from asbestos exposure is still rare.
looks like a pleural plaque or fibrosis that spreads widely over time to multiple areas
Nasopharyngeal carcinoma is associated with what causative agent and what are the three histological subtypes:
-EBV - replicated in B cells in the tonsils that can eventually lead to transformation of the epithelium
- well differentiated keratinizing squamous carcinoma
- moderately diff. non-keratinizing squamous carcinoma
- undifferentiated (most strongly associated with EBV)
laryngeal tumors can be divided in malignant and nonmalignant. what are the types of each
non-malignant:
- vocal cord polyps
- laryngeal papilloma
malignant
-laryngeal carcinoma
ALL frequently arise on the true vocal cords!
laryngeal carcinomas are common in what type of person? what type of cell does it normally originate from?
mostly in men, smokers
from squamous cell epithelium, only 10% adenocarcinoma
benign tumors of the lung and maybe a word or two about each
- hamartoma - most common, overgrowth of normal cells such as fat, cartilage, or epithelium.
- adenoma - 2nd most common, normally in the bronchi
- solitary fibrous tumor - rare, in pleura
- desmoid tumor - soft tissue, looks like tendon,appears infiltrative but well differentiated
- carcinoid - come from kichitsky cells (neuroendocrine)
- sclerosing hemangioma
- salivary gland-like tumor
metastatic tumors of lung (cancers that send metastases to the lung) are which?
- breast
- colorectal
- renal cell carcinoma
- uterine leiomyomas
- head and neck squamous cell carcinoma
