Flashcards in Lung Histopath Deck (69):
What is the pathology of chronic bronchitis?
Dilatation of bronchi & excess mucus production
Aetiology of chronic bronchitis (2)
Clinical features of chronic bronchitis
Productive cough for 3 months over 2 years
Histological features chronic bronchitis (3)
Goblet cell hyperplasia
Hypertrophy of mucous glands
Complications of chronic bronchitis (3)
Pathology of bronchiectasis
Airway dilatation & scarring
Clinical features of bronchiectasis (3)
Histological features of bronchiectasis
Permanent dilatation of bronchi
Complications of bronchiectasis (4)
Pathology of asthma
SM cell hyperplasia
Aetiology of asthma
Immunogenic: allergens, drugs, cold air, exercise
Clinical features of asthma (3)
Histological features of asthma (2)
Curschmann spirals - whorls of shed epithelium
Charcot Leyden crystals - eosinophils degraded in mucous plugs
Complications of asthma (2)
Death, chronic asthma
Pathology of emphysema
Affects acinus (distal to terminal bronchioles), wall destruction, airspace enlargement
Aetiology of emphysema (2)
Clinical features of emphysema (2)
Histological feature of emphysema
Loss of alveolar parenchyma (distal to terminal bronchiole)
Complications of emphysema (3)
Causes of bronchiectasis (6)
Abnormal host defence - hypogammaglobulinaemia
Ciliary dyskinesia (primary = Kartagener's)
Secondary to bronchiolar disease
What is the characteristics of all interstitial lung diseases?
Inflammation & fibrosis of the pulmonary connective tissue (particulary the interstitium of the alveolar wall)
End stage all have HONEYCOMB LUNG
Interstitial lung disease shows features of RESTRICTIVE lung disease on spirometry, name 3:
Decreased CO diffusion capacity
reduced lung compliance
reduced lung volume
Interstitial lung disease presents with: (3)
cyanosis, pulmonary HTN & corpulmonale
Causes of fibrosing interstitial lung disease: (6)
Radiation induced pneumonitis
Cryptogenic organizing pneumonia
associated with connective tissue disease
Causes of granulomatous interstitial lung disease (3)
Associated with vasculitides e.g. Wegener's, Churg-Strauss, microscopic polyangitis
2 other categories of interstitial lung disease
Is IPF more common in males or females?
Histology of IPF (3)
Pattern of fibrosis = USUAL INTERSTITIAL PNEUMONIA - progressive patchy interstitial fibrosis
Hyperplasia of type 2 pneumocytes, causing HONEYCOMB FIBROSIS (beginning at peripery of lobule)
Clinical presentation of IPF (4)
Hypoxaemia - whcih causes pulmonary HTN +/- Cor pulmonale
Treatment of IPF (3) & impact on survival
little impact on survival
What is pneumoconiosis?
An occupational lung disease, whereby inhalation of mineral dusts/ inorganic particles leads to a non-neoplastic lung rxn
In pneumoconiosis which lobe of lung is most commonly affected?
Upper lobe e.g. Coal workers, Silicosis
In Asbestosis which lobe is affected?
Usually lower lobe, and it can cause malignant as well as benign lesions e.g. adenocarcinoma, mesothelioma
What is a granuloma?
A collection of histiocytes + macrophages +/- multi-nucleate giant cells (cells of macrophage lineages fused together)
EAA/ Hypersensitvity pneumonitis/ Cryptogenic organising pneumonia/ Bronchiolitis obliterans organising pneumonia (BOOP). What are these conditions?
Group of IMMUNE MEDIATED lung disorders, caused by prolonged exposure to inhaled ORGANIC ags, which results in widespread ALVEOLAR INFLAMMATION (contrast with asthma - bronchi)
EAA is typically an occupational health disease
What is seen in histology of EAA etc? (2)
GRANULOMA formation and organising pneumonia - polypoid plugs of loose connective tissue within alveoli/ bronchioles
What is the acute presentation of EAA & how doews it present? (5)
Inhalation of antigenic dust in sensitized individual
Systemic sympoms - fevers, chills, cough, SOB, chest pain (within hours of exposure) Settles by next day
Presentation of chronic EAA? (4)
Persistent PRODUCTIVE cough
severe weight loss
Pigeon fancier's lung
Cheese washer's lung
proteins in excreta/ feathers
Heated water reservoirs
Germinating barley - aspergillus clavatus/fumigatus
Mouldy cheese - aspergillus clavatus/ penicillium casei
Early recognition > removal of ag > prevents progression to fibrosis
Patchy bronchial distribution
low virulence organisms
Lobar pneumonia, 4 stages
2) Red hepatisation (neutrophilia)
3) Grey hepatisation (fibrosis)
No alveolar inflammation
Risk factors for SCC (3)
Highest rate of p53/ c-myc mutations
Histology of SCC (2)
intercellular pricks (desmosomes)
Cytology of SCC (1)
Progression of SCC (6)
Epithelium > hyperplasia > metaplasia > dysplasia > angiosquamous dysplasia > carcinoma in situ > invasive carcinoma
In which group is adenocarcinoma of lungs most common?
Women & non-smokers
(a malignant epithelial tumour with glandular differentiation or mucin production) usually occurs peripherally
Histology of adenocarcinoma of lungs (1)
Glandular differentiation (and mucin production)
Cytology of adenocarcinoma of lungs (1)
Cells containing mucin vacuoles
What molecular mutation is sometimes seen in adenocarcinoma of lungs
EGFR mutations (treated with TK inhibitors)
Small cell carcinoma common location? Arises from which cells?
Centrally from proximal bronchi
Small cell carcinoma is associated with: (3)
Small cell carcinoma has strong relationship to smoking, what mutations are common? (2)
p53 & RB1
Large cell carcinoma - what is it?
poorly differentiated epithelial tumour - large cells, large & prominent nuclei (poor prognosis)
Histology of large cell carcinoma?
no evidence of glandular or squamous differentiation
Paraneoplastic syndromes occur due to large cell carcinoma, give 5 examples:
ERCC1 mutation associated with which cancer?
NSCLC - pooer response to cisplatin
EGFR mutation associated with which cancer?
Adeno - treat with anti-EGFR (TK inhibitors)
Kras mutations associated with which cancer?
Adeno/squamous, poor prognosis (does not respond to TKI)
EML4-ALK mutation associated with which cancer?
Adeno usually - no benefit from TKI
Clinical presentation of mesothelioma (3)
Pleural effusion (extensive)
Risk factors for PE (4) & Virchows triad
Virchow's = blood stasis + damage to endothelium + increased coagulation
Complications of large PE (3)
Acute cor pulmonale
Complications of small PE (2)
Can be silent
can cause peripheral wedge infarctions
What is defined as pulmonary HTN?
pressure > 25 mmHg at rest
Causes of secondary pulmonary HTN? Pre-cap (2), cap (1), post-cap (1)
Pre-capillary: Hypoxia/ embolus
Capillary: Pulmonary fibrosis
Post capillary: Left heart disease
Pulmonary HTN is most common in which group?
Complications of pulmonary HTN (3)
RHF > venous congestion of organs, nutmeg liver, peripheral oedema