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Pathology II (Kiva) > Topic 38-42: Pulmonary infections, Neoplasia > Flashcards

Topic 38-42: Pulmonary infections, Neoplasia Flashcards

1
Q

Pneumonia is defined as what? what are the classifications?

A

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)
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2
Q

What are the types of pneumonia:

A
  • community acquired pneumonia
  • community acquired atypical
  • legionella pneumonia
  • nosocomial pneumonia
  • aspiration
  • lung abscess
  • chronic pneumonia
  • opportunistic pneumonia
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3
Q

Community acquired pneumonia originated how? what is the most common infectious agent?

A

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

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4
Q

lobar pneumonia has 4 stages:

A
  1. congestion - red, congested
  2. red hepatization - alveoli are filled with RBC, neutrophils, fibrin (hemo fibropurulent exudate)
  3. grey hepatization- fibrinosuppurative exudate in alveoli, lysed RBCs
  4. 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

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5
Q

Bronchopneumonia is described morphologically as what?

A

patchy inflammation, undergoing the stages of lobar hepatization but at different speeds. alveoli, bronchioles, and bronchi are also filled with exudate

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6
Q

what are complications that can occur with pneumonia?

A
  • abscess
  • empyema
  • scar
  • dissemination (becomes meningitis, infective endocarditis, etc)
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7
Q

community acquired atypical pneumonia are caused by which agent? what are symptoms that differentiate it from a regular pneumonia?

A

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!)
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8
Q

what is the morphology of an atypical pneumonia?

A

inflammation is confined to the walls of the alveoli!!!

-wide septa, alveoli is free of cellular debris

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9
Q

aspiration pneumonia is most frequently in which side? what are the infectious agents?

A

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

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10
Q

abscesses will occur with or progress from which type of pneumonia?

A
  • necrotizing pneumonia
  • aspiration

–complicated pneumonias

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11
Q

chronic pneumonias are caused by which agents and associated with which morphological symptom?

A

nocardia, actinomyces, TB

granulomas

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12
Q

Opportunistic pneumonias are caused by which agents?

A

fungi, candida and aspergillus,

also pneumocystis jiroveci, cytomegalovirus

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13
Q

pleural lesions are what? name the primary and secondary causes of pleural lesions

A

any pathologic involvement in the pleura

primary:
- intrapleural bacterial infections
- mesothelioma

secondary:

  • pleural effusion and pleuritis
  • pneumothorax
  • hemothorax
  • chylothorax
  • mesothelioma
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14
Q

what are the types of pleural effusion?

A

-transudate –> hydrothorax from ultrafiltrate of the blood

  • exudate
  • -microbial invasion (from pneumonia or sepsis)
  • -cancer (usually hemorrhagic)
  • -pulmonary infarction
  • -viral pleuritis
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15
Q

pneumothorax can be:

A
  • spontaneous - rupture of emphysematous bulla, abscess, etc
  • secondary - due to a disorder such as emphysema, fractured rib
  • traumatic - stab wound, car accident
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16
Q

what are complications of pneumothorax?

A
  • 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
17
Q

hemothorax is typically from:

A

intrathoracic anyurism

18
Q

chylothorax is typically from:

A

obstruction of major lymph duct

19
Q

mesothelioma is typically due to what? it takes how long to occur? how common is it? what does it look like morphologically?

A

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

20
Q

Nasopharyngeal carcinoma is associated with what causative agent and what are the three histological subtypes:

A

-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)
21
Q

laryngeal tumors can be divided in malignant and nonmalignant. what are the types of each

A

non-malignant:

  • vocal cord polyps
  • laryngeal papilloma

malignant
-laryngeal carcinoma

ALL frequently arise on the true vocal cords!

22
Q

laryngeal carcinomas are common in what type of person? what type of cell does it normally originate from?

A

mostly in men, smokers

from squamous cell epithelium, only 10% adenocarcinoma

23
Q

benign tumors of the lung and maybe a word or two about each

A
  • 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
24
Q

metastatic tumors of lung (cancers that send metastases to the lung) are which?

A
  • breast
  • colorectal
  • renal cell carcinoma
  • uterine leiomyomas
  • head and neck squamous cell carcinoma
25
Q

malignant lung cancer typically arises from which epithelium? what are the two main types?

A

95% comes from bronchial epithelium –> thus carcinoma is used

Small cell lung cancer
Non-Small cell lung cancer

26
Q

What are the two cell types that cause small cell lung cancer?

A
  • neuroendocrine

- anaplastic

27
Q

What are the cell types that cause non-small cell lung cancer?

A
  • squamous epithelial cells
  • adenocarcinoma
  • large cell carcinoma
28
Q

What is the most common primary lung cancer? where is it found and what is the morphology? what is a precursor lesion?

A

adenocarcinoma

  • typically found in the periphery (but can be central too!)
  • they can be acinar, papillary or solid lesions with various degrees of atypia

-often is preceded by atypical adenomatous hyperplasia

29
Q

squamous cell carcinoma is more common in who?where is it found and what is the morphology? what is a precursor lesion?

A
  • It’s more common in men, will arise centrally near the bronchi (where there is squamous epithelium!)
  • preceding squamous metaplasia or dysplasia is common
  • ranges in differentiation, sometimes with keratin pearls
30
Q

small cell carcinoma: where is it found and what is the morphology? what is a precursor lesion?

A

-normally found centrally located with extensions into the parenchyma. hilum and lymph nodes are involved early

  • small cells with little cytoplasm
  • precursor cells are neuroendocrine cell (kulschitzky cells) that cause paraneoplastic syndrome
31
Q

large cell carcinoma: where is it found and what is the morphology? what is a precursor lesion?

A

these cells are so undifferentiated that they could have originated from squamous or glandular tissue.

-cells have large nuclei and moderate cytoplasm

32
Q

pathogenisis of lung cancer typically progresses in what way?

A
  • starts with inactivation of a tumor suppressor gene on chrom 3p
  • late stage has p53 inactivation or KRAS activation

these early changes can be found in the epithelium of pts without lung cancer, suggesting the mucosa is “fertile soil” for more mutations and eventual cancer development

33
Q

general morphology of lung cancer?

A

start as small lesion that grows and begins to push the parenchyma, invade bronchial mucosa, or form bulky masses

eventually the tumors can extend to the pleura, invade the chest wall and then thoracic structures

lymph and hematogenous spread to distal regions

34
Q

what causes horners syndrome? what are the symptoms?

A

pancoast tumors in the pulmonary apex will compress the cervical symp ganglion

  • ptosis- droopy eyes
  • miosis - constriction of pupils (remember myDriasis is Dilation) can be one-sided
  • enophthalmos - sinking in eyes
35
Q

carcinoid tumors cells contain what? what are the two classifications of carcinoid tumors?

A

carcinoid tumor cells contain neurosecretory granules

  • typical low grade- slow growing cells, similar to GI carcinoid tumors, no p53 mutations
  • atypical high grade - high mitotic rate, metastases, and p53 mutations in about 30%

Pathology II (Kiva) (23 decks)

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