Unit 3 Day 8 (Thur 4/30)

Question 1

Interstitial Lung Diseases

Answer 1

• UIP- usual interstitial pneumonia
• NSIP- non specific interstitial pneumonia
• HP- hypersensitivity pneumonitis

Question 2

Usual Interstitial Pneumonia

Answer 2

• patchy heterogeneous fibrosis by collagen fibroblastic foci
• honeycomb cystic changes worse in lower lobes
• affects alveolar septa (interstitium)

Question 3

Non Specific Interstitial Lung Disease

Answer 3

• uniform inflammation in septa (cellular), uniform fibrosis of septa (fibrotic), or both
• few if any fibroblastic foci
• little if any honeycomb change
• affects alveolar septa

Question 4

Hypersensitivity Pneumonitis

Answer 4

• airway centered chronic inflammation
• non-necrotizing granulomas
• focal organizing pneumonia
• variable fibrosis
• response to foreign antigens (birds, mold, hot tub mycobacteria)

Question 5

Thromboembolic Disease

Answer 5

• organizing fibrin clots in pulmonary arteries
• may be in situ (thrombus) or travel to the lung from elsewhere (embolism)
• affects vessels

Question 6

Talc Embolism

Answer 6

• polarized crystals around vessels
• may include foreign body multinucleated giant cells
• usually from IV drug use
• talc particles very visible under polarized light
• affects vessels

Question 7

Pulmonary Hypertension

Answer 7

• muscular hypertrohpy of pulmonary arteries
• muscularization of arterioles
• some forms may have plexiform lesions (artery lumen replaced by endothelial proliferation with numerous tangled slit-like lumens)
• affects vessels

Question 8

Vasculitis

Answer 8

• inflammation in the vessel wall
• often with alveolar hemorrhage
• may be autoimmune of infection
• affects vessels

Question 9

Sarcoid/Chronic Beryllium Disease

Answer 9

• both have same appearance
• well formed non-necrotizing granulomas
• concentric collagen deposition
• lymphatic distribution
• affects nodules

Question 10

Pulmonary Langerhans Cell Histiocytosis

Answer 10

• langerhans histiocytes (CD1a/S100 positive)
• variable inflammation including eosinophils
• fibrotic phase: stellate scar around airway
• usually smoking related if lung limited
• affects nodules

Question 11

Carcinoid

Answer 11

• nests and ribbons of neuroendocrine cells with powdery salt and pepper chromatin
• stain positive for neuroendocrine markers
• usually indolent but may act in a malignant fashion particularly if there is nuclear atypia, high mitotic rate, or necrosis
• affects nodules

Question 12

Small Cell Carcinoma

Answer 12

• Small, blue, easily crushed cells with scant cytoplasm
• stain positive for neuroendocrine markers
• high mitotic rate and abundant necrosis
• affects nodules

Question 13

Squamous Cell Carcinoma

Answer 13

• large polygonal cells with hyperchromatic (dark) nuclei and abundant cytoplasm
• rarely have prominent nucleoli
• may be keratinizing and form keratin pearls
• affects nodules

Question 14

Adenocarcinoma

Answer 14

• cells with large nuclei, large nucleoli, and variable amounts of cytoplasm
• form gland-like structure
• if cells only line septa and do not invade, considered in situ
• affects nodules

Question 15

Large Cell Carcinoma

Answer 15

-large, sometimes bizarre appearing malignant cells that lack the typical features of either adenocarcinomas or squamous cell carcinomas

Question 16

Airway Diseases of the Bronchi

Answer 16

-acute bronchitis
-chronic bronchitis
-bronchiectasis
asthma

Question 17

Airway Diseases of the Bronchioles

Answer 17

• chronic bronchiolitis
• follicular bronchiolitis
• constrictive and obliterative bronchiolitis
• granulomatous bronchiolitis

Question 18

Diseases of the Airspaces

Answer 18

• acute pneumonia
• aspiration pneumonia
• eosinophilic pneumonia
• organizing pneumonia
• diffuse alveolar damage
• emphysema
• respiratory bronchiolitis
• desquamative interstitial pneumonia

Question 19

Asthma

Answer 19

• pink, thickened submucosal lamina
• esoinophilic inflammation
• mucus hypertension
• smooth muscle hyperplasia
• mainly affects bronchi

Question 20

Acute Pneumonia

Answer 20

-neutrophils in airspaces

Question 21

Aspiration Pneumonia

Answer 21

• foreign material in airspaces

- may also have multinucleated giant cells

Question 22

Eosinophilic Pneumonia

Answer 22

-eosinophils, macrophages, and fibrin in airspaces

Question 23

Organizing Pneumonia

Answer 23

• fibroblast plugs in airways and airspaces
• patchy but may be densely consolidating
• may also include small amounts of fibrin
• also known as BOOP and COP

Question 24

Emphysema

Answer 24

• enlarged airspaces
• broken alveolar septa
• subpleural blebs
• smoking related emphysema is worse in the upper lobe
• alpha-1-antitrypsin deficiency associated emphysema is worse in the lower lobes