9/23- Pathology Review Flashcards Preview

MS2 Respiratory > 9/23- Pathology Review > Flashcards

Flashcards in 9/23- Pathology Review Deck (47):
1

What are the stage of intrauterine lung develompent? Timeline?

- Embryonic (26d- 5 wks)

- Pseudoglandular (6 - 16 wks)

- Canaliculur (17-28 wks)

- Saccular (29 wks - birth)

- Alveolar (35 wks - ?)

2

Histo characteristics of canalicular phase?

Immature acinar structures surrounded by supporting framework

- Can see red cells in some small capillaries 

3

Histology of trachea and bronchi?

- Cartilage

  • C-shaped in trachea
  • Plates in bronchi

- Submucosal glands

- Smooth muscle

- Lamina propria

- Epithelium

4

What is key to distinguishing membranous from respiratory bronchiole?

Membranous has smooth muscle (more pink surrounding it)

5

What type of cells are type I pneumocytes?

Squamous epithelial cells

6

When does surfactant production by type II pneumocytes begin?

Saccular phase (29 wks - birth)

7

What are Pores of Kohn and Canals of Lambert?

Provide collateral ventilation by connecting adjacent alveoli and bronchioles

8

What comprises the pulmonary acinus? Function?

Functional unit of gas transfer (because all lined by alveoli; gas transfer can happen anywhere)

- Respiratory bronchiole

- Alveolar ducts

- Alveoli

9

What is the epithelium in each lung structure/stage?

- Bronchus: ciliated columnar (pseudostratified?)

- Bronchioles: simple epithelial, columnar or cuboidal

  • No more goblet cells, submucosal glands, or cartilage (Lose smooth muscle going from Memb -> Resp bronchiole)

10

What are the three forms of atelectasis?

- Resorption (obstructive), e.g. mucus plugs

- Compressive, e.g. pleural effusion

- Contraction, e.g. tumor (mesothelioma)

11

What is DAD?

Diffuse alveolar damage

- Form of acute injury

- Histologic counterpart to the clinical process of ARDS

12

What are the two types/forms of DAD?

1. Exudative (under 1 wk from injury/inciting event)

- Hyaline membranes = histologic landmark! (begin 2d, peak 4-5 d); precipitated plasma protein and debris from sloughed epithelial cells

2. Proliferative (Organizing) (> 1 wk)

- Proliferation of type 2 pneumocytes

- Formation of granulation tissue - Fibrosis

13

What is seen here? 

Exudative phase of DAD/ARDS

14

What are types of obstructive lung disease? Provide histologic features of each

Asthma

- Goblet cell metaplasia

- Mucus plugs

- Muscle wall hypertrophy

Chronic bronchitis

- Goblet cell metaplasia

- Mucus plugs

- Submucosal gland hypertrophy/hyperplasia

Bronchiectasis

- Permanent dilatation of airways

- Lower lobes

- Destruction of muscle/elastic tissue by inflammation and fibrosis

- Occurs in cystic fibrosis as well as others

Emphysema

- Permanent enlargement of airspaces distal to terminal bronchiole

- Centriacinar in smokers or panacinar in alpha 1 antitrypsin deficiency

15

What are the histological components of asthma?

Asthma

- Goblet cell metaplasia

- Mucus plugs

- Muscle wall hypertrophy

16

What are the histological components of chronic bronchitis?

Chronic bronchitis

- Goblet cell metaplasia

- Mucus plugs

- Submucosal gland hypertrophy/hyperplasia

17

What parts of the acinus does centriacinar emphysema involve? Panacinar?

Centriacinar

- Respiratory bronchiole

Panacinar

- Alveolar duct

- Alveoli

- Begins distally, but may progress to involve respiratory bronchiole

18

Is centriacinar emphysema upper or lower lobe dominant? Associations? Panacinar?

Centriacinar

- Upper lobe

- Associated with smoking

Panacinar

- Lower lobe

- Alpha 1 antitrypsin deficiency

19

What are the macroscopic patterns of pneumonia?

- Bronchopneumonia: inflammation centered in the airways and possibly alveolar tissue just around those tissues (very patchy)

- Lobar

Bronchopneumonia can transition to lobar pneumonia if not treated (although some very virulent organisms may start out lobar)

20

T/F: A single organism can cause either bronchopneumonia and lobar pneumonia?

True

21

What are the microscopic patterns of pneumonia?

For lobar pneumonia:

1. Congestion

2. Red hepatization

3. Gray hepatization

4. Resolution

22

What are some complications of pneumonia?

- Lung abscess

- Empyema

- Septicemia -> multiorgan abscess

23

What is seen here? 

Bronchopneumonia

- Patchy; around airways

24

What is seen here? 

Lobar pneumonia

25

What are complications of lung transplants?

- Infections (bacterial, viral, fungal)

- Acute rejection (wks - mos)

  • International Working Formulation (A0-A4) grades rejection based on location and predominant cell type (lymphocytes early, neutrophils later?)

- Chronic rejection (3-5 yrs post-op)

  • Problem in half of transplants
  • Bronchiolitis obliterans = hallmark!; granulation tissue at level of membranous bronchioles: fibrosis +/- inflammation

26

What are some organisms that frequently cause opportunistic infection (in lung transplants)?

- Aspergillus: 45' septated branches

- Crytpococcus: budding yeast with clear halo of polysaccharide capsule

- Pneumocystis

- Herpes

- CMV: can have nuclear or even cytoplasmic inclusions

- Histoplasma

27

What condition/disease involves bronchiolitis obliterans?

- Acute rejection of lung transplant

- Others?

28

What are the microscopic and gross findings of UIP?

Microscopic:

- Temporal heterogeneity (mature and immature fibrous tissue adjacent)

- Honeycombing; cystic spaces filled with mucin and lined by metaplastic bronchial cells

- Patchy fibrosis

- Subpleural distribution

Grossly:

- Cobblestoning of pleural surface over involved lung

29

What can cause honeycombing?

- UIP and other interstitial diseases

- Infection

- Radiation

30

What are the microscopic findings of NSIP?

Microscopic:

- Lymphoplasmacytic interstitial infiltrate

- Architecture preserved!

- Type II pneumocyte hyperplasia

- Temporally uniform fibrosis (in contrast to UIP); no fibroblastic foci

31

What are the microscopic and gross findings of asbestosis?

Microscopic:

- Patchy interstitial and subpleural fibrosis (fibers stimulate release of mediators leading ot repeated cycles of inflammation/fibrosis)

- Starts around resp bronchioles and alveolar ducts; proceeds distally

- Fibrosis similar to UIP, but should see asbestos bodies! (asbestos fiber + iron-protein coat; look like dumbbell beaded bodies)

- Honeycombing

Grossly:

- Visceral pleural thickening

- Most commonly affects lower lobes

32

Where do pleural plaques commonly form?

- Parietal pleura

- Domes of diaphragm

33

What are pleural plaques made of?

Typically acellular; don't commonly have asbestos bodies

34

What are the microscopic and gross findings of silicosis?

- Early: dust-filled macrophages, lymphatic/bronchovascular distribution

- Later: silicotic nodules (lamellar fiborsis with birefringent silica particles)

- Uniform fibrosis begins around bronchioles

- Can get honeycombing

Grossly: upper lobes

35

What are the microscopic and gross findings of HP?

Acute:

- Neutrophils in alveoli and respiratory bronchioles

- Lasts 1-2 days

Subacute/chronic (3 characteristics you need to know!)

1. Interstitial lymphoplasmacytic infiltrate (beings around bronchioles (~100%)

2. Ill-defined, random, non-caseating granulomas (~67%)- these are more diffuse/less discrete than the granulomas of sarcoidosis

3. Patchy organizing pneumonia (60%)

36

What are the microscopic findings of sarcoidosis?

Microscopic

- Mutliple nodules: pleura, interlobular septa, bronchovascular structures

- Well-formed/defined granulomas:

  • Epithelioid histioctyes
  • Multinucleated giant cells
  • Chronic inflammatory cells

- Usually no necrosis!! (noncaseating)

- Lung architecture preserved

- Must rule out infectious organisms (TB, fungus) before starting to treat sarcoidosis with steroids

37

What are the microscopic findings of COP?

Microscopic:

- Intraluminal plugs of granulation tissue (Masson bodies) in distal airways (bronchioles, alveolar ducts, alveoli)

- Patchy distribution; temporally homogeneous

- Lung architecture preserved

- Inflammation

38

What are the microscopic findings of RB?

- Finely pigmented (dusty brown) macrophages in respiratory bronchioles and adjacent alveolar ducts and alveoli

- Lung architecture preserved

- More?

39

What are the microscopic findings of DIP?

- Diffuse involvement of lung parenchyma

- Large accumulation of alveolar macrophages

- Uniform fibrotic thickening of alveolar septa (mild-moderate)

- Chronic inflammation; overall lung architecture preserved

- No honeycombing

40

What are the ILDs associated with smoking?

- RB: Respiratory Bronchiolitis

- DIP: Desquamative Interstitial Pneumonitis

41

How are lung cancers divided?

How does the treatment vary with each?

- Small cell: chemo and radiation

- Non-small cell: start with surgery if resectable

42

Histological characteristics of squamous cell carcinomas?

- Have stratified squamous organization

- Commonly necrotic; can form ---

- Keratin

43

Histological characteristics of adenocarcinoma?

- Presence of glands

- Mucin production (if no glands seen, may have to stain for mucin)

44

What are the 2 types of AIS?

Adenocarcinoma in situ

1. Mucinous

2. Non-mucinous

(Can only say AIS if entire resection and no vascular or septal invasion.. otherwise adenocarcinoma "with lepidic growth pattern")

45

Histological characteristics of small cell carcinoma?

- Hyperchromatic cells

- Indistinct nucleoli

- Nuclear indentation/hugging

- Necrosis (?)

46

Histological characteristics of typical carcinoid tumor?

- Bland looking cells

- Rich vascular tissue

- Chromogranin stain shows NE

47

Stain for large cell NE tumor?

CD56+