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OS 213 Respiratory Exam 2 > Pathology of Mediastinal Disease > Flashcards

Pathology of Mediastinal Disease Flashcards

1
Q

Portion of the thoracic cavity located between pleural cavities

A

Mediastinum

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2
Q

traumatic perforation of the esophagus

A

Acute Mediastinitis

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3
Q

Ruptured esophagus due to sudden increase in intraesophageal pressure and negative intrathoracic pressure caused by retching; common in alcoholics

A

Boerhaave’s syndrome

  • Descent of infection from within the neck
  • Spread from chest wall or after heart surgery
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4
Q

Chronic mediastinitis

A

Anterior Mediastinum
Can produce compression SVC
Common causes; granuloma, fibrosis or both
May be mycotic or tuberculosis in etiology

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5
Q

Tumors, masses, and non neoplastic diseases in the SUPERIOR MEDIASTINUM

A

Lymphoma - thymus contains lymph nodes
Thymoma - Thymus located in this area as a baby
Thyroid Lesions -thyroid sometimes fails to migrate upward, leading to a low-lying/ectopic thyroid -.plunging thyroid
Metastatic carcinoma
Parathyroid tumors

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6
Q

Tumors, masses, and non neoplastic diseases in the ANTERIOR MEDIASTINUM

A 
Thymoma
Teratoma - usually in the midline
Lymphoma
Thyroid Lesions
Parathyroid lesions
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7
Q

Tumors, masses, and non neoplastic diseases in the POSTERIOR MEDIASTINUM

A

Neurogenic tumors (schwannoma, neurofibroma -benign)
Lymphoma
gastroenteric hernia - esophagus is in this area

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8
Q

Tumors, masses, and non neoplastic diseases in the MIDDLE MEDIASTINUM

A

Bronchogenic cysts
Pericardial cyst - lined by mesothelium
Lymphoma

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9
Q

Usually at the right cardiophrenic angle
Due to failure of lacunar cavities to merge
Soft and unilocular, contain clear fluid unless infected
Inner surface: flat or cuboidal single layer of mesothelium

A

Pericardial (Coelomic cysts)

-surgical resection is curative

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10
Q

Small bud or diverticulum carried to the mediastinum by the downward growth of lungs

A

Foregut cysts

Bronchial - pseudostratified columnar
Esophageal - squamous
gastric and enteric cysts
pancreatic cysts and pseudocysts

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11
Q

Can present as superior mediastinal masses, Arise from cervical thyroid that has been pulled down by enlargement

A

THYROID LESIONS

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12
Q

Usually found on the anterosuperior compartment

A

Parathyroid lesions and tumors

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13
Q

small soze, primitive-appearing epithelium without segregation into cortical and medullary regions, presence of tubules and rosettes, absence of Hassal’s corpuscle, almost total absence of lymphocytes

A

Thymic dysplasia

  • Thymus is converted to a multicystic structure
  • Thymus shows immature histology
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14
Q

Unilocular thymic cysts

A

Cyst only has one cavity

Development origin - remants of the 3rd branchial pouch-derived thymopharyngeal duct

Epitheial lining is flattened, cuboidal, columnar or squamous

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15
Q

Acquired process of a reactive nature
Accompanied by inflammation and fibrosis
Lining may be flat, cuboidal, ciliated columnar or squamous; single or stratiied

A

Multilocular cyst

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16
Q

NON neoplastic diseases

A

Ectopic thymus
Ectopic parathyroid glands
Acute thymic involution - HIV infection
True thymic hyperplasia - epithelial component of thymus proliferates
Thymic follicular hyperplasia - lymphoid follicles in thymus proliferate

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17
Q

Tumors of thymic epithelial cells

A

Thymomas

18
Q

WHO classification of Thymomas

A

cytologically benign and noninvasive
cytologically benign but invasive or metastatic
cytologically malignant

19
Q

Account for 20-30% of tumors in the anterosuperior mediastinum

A

thymomas

20
Q

Morphology of thymomas

A

Lobulated, firm gray-white massess up to 15 to 20 cm
Areas of cystic necrosis and calcification’
Most are encapsulated
Noninvasive

Medullary type epithelial cells
Mixture of medullary and cortical type-epithelial cells
Sparse infiltrate of lymphocytes

21
Q

Cytologically benign but locally invasive

  • Much more likely to metastasize
  • Cortical Epithelial cells
  • Usually mixed with numerous thymocytes
  • Cytologic atypia
  • 20-25% of all thymomas
  • Penetrate through the capsule
A

Invasive thymomas

22
Q

5% of thymomas
Fleshy, obviously invasive
Metastasis
Most are SCCAs, next most common lymphoepithelioma-like carcinoma

A

Thymic carcinoma

23
Q

Clinical features of thymic carcinoma

A

impingement on mediastinal structures
MG for all types of thymic tumors
Hypogammaglobulinemia, PRC aplasia, grave’s, PA

24
Q

NEUROENDOCRINE TUMORS of the THYMUS

A

Carcinoid tumor - well differentiated
Small Cell Neuroendocrine carcinoma
Large cell neuroendocrine carcinoma

25
Q

Approximately 20% f the mediastinal tumors and cysts

A

Germ Cell Tumors

26
Q

histogenesis is controversial, primary origin from extragonal germ cell is favored

A

germ cell tumors

27
Q

also known as germinoma, almost always within thymus, Similar to testicular counterpart; fibrous septa infiltrated by lymphocytes lymphocytes and plasma cella, numerous germinal centers, cells with large amounts of cytoplasmic glycogen

A

SEMINOMA

28
Q

Immunolic marker for Seminoma

A

PLAP and CD 117

29
Q

Most common type of mediastinal germ cell neoplasm. Can grow to a large size, has a distinct, sharply delineated wall that often becomes calcified,

Cut surface is predominantly cystic

A

Mature cystic teratoma

30
Q

Similar to mature teratoma but containing immature epithelial, mesenchymal or neural elements, but most imporantly, the neural element

A

Immature teratoma

  • more aggressive and tends to metastasize
31
Q

Invasive, highly necrotic neoplasm, Poorly differentiated, Reactive for keratin, PLAP, CD30 and CD57

A

Embryonal Carcinoma

32
Q

Admixed with other germ cell elements or as a pure neoplasm. MAy have prominent spindle cell features, contain a hepatoid coponent

A

Yolk sac tumor

33
Q

Tumor forms rosette structure around a vessel

A

Schiller-Duval bodies

34
Q

COmbination of embryonal carcinoma and teratoma

A

Teratocarcinoma

35
Q

Elevated levels of HCG

Extremely poor prognosis

A

Choriocarcinoma

36
Q

Malignant lymphoma

A

Anterior, superior or middle mediastinal mass

Most common primary neoplasm of the middle pportion of the mediastinum

Manifestation of a disseminated process or as a primary mediastinal disease

37
Q

Hodgkin Lymphoma

A 
Involve the thymus or lymph nodes
Young adults, females
Local pressure symptoms or found incidentally
Nearly always of nodular sclerosis type
Polymorphic
38
Q

binucleate cells, “owl’s eye” appearance

A

Reed-Sternberg

39
Q

Particular predilection for the thymic region
Males are commonly affected
Solid, soft, unencapsulated
Involves thymic parenchyma
Lymphocytes with “blastic” appearance - atypical, fine chromatin pattern, nuclear convolutions, mitotic figures

A

Lymphoblastic Lymphoma

40
Q

Mass in the thymus, with or without lymph node involvement

Young adult with SVC syndrome

Grossly firm with frequent foci of necrosis

Wide bands of fibrosis, epithelial cells, germ cells, or neuroendocrine neoplasm

A

Large Cell Lymphoma

OS 213 Respiratory Exam 2 (15 decks)

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