Lung Review

Question 1

Diffuse alveolar damage patterns?

What is Acute Fibrinous and Organizing Pneumonia?

Answer 1

Acute: >1 wk; Hyaline membranes and type 2 cell hyperplasia with fibrin thrombi

Organizing: >1 wk. Fibrosis in septa and remains of membranes

DAD variant without Hyaline membranes: Fibrin and organization present

Question 2

Organizing pneumonia/BOOP has what on H and E?

Answer 2

Masson Bodies/Fibroblastic plugs and associated alveolar thickening

See in many things including other diseases and even abscesses and cancers

Question 3

Obliterative Bronchiolitis H and E?

Seen in?

Answer 3

AKA: Constrictive bronchiolitis obliterans
Submucosal scaring in bronchioles

Associated with: Lung transplants, GVHD, Adenovirus

Question 4

Actinomyces staining pattern?

Associated with?

Nocardia pattern?
Associated with?

Answer 4

Long branching rods, Gram +, Silver +, AFB -

Poor dentition

Nocardia: Long branching rods, Gram +, SIlver +, Weakly AFB +

Immunocompromised

Question 5

Hot tub lung and ddx?

Which fungi are vascular invasive and infarction?

Answer 5

From MAC; Well Formed Non-nec granulomas; hypersensitivity pneumonitis (poorly formed)

Aspergillous and Mucor; Candia causes inflammation

Question 6

What is seen in allergic bronchopulmonary aspergillosis?

AIDS patient with intra-alveolar froth or patient with DAD rule out?

Answer 6

Hypersensitivity reaction, Path: Mucoid impaction (layered) in bronchi, eosinophils, broncogenic granulomas

PJP pneumonia!

Question 7

HIsto H and E?

Location?

Coccidio H and E?
Location?

Answer 7

Small yeasts 2-5 um; Ohio Valley

Larger spheres 20-60 um w/ endospores

SW US

Question 8

Cryptococcus H and E?

Locaiton?

Blasto H and E?

Locaiton?

Dirofilaria H and E?

Answer 8

Wide capsular halo (Mucecarmine +); narrow budding
Assoc w/ Pigeons

Yeasts 25 um, Broad based budding; Mucicarmine -

Central and SE USA

Complex with Cuticle

Question 9

Silica quartz vs amorphous which is worse?

Nodular silicosis H and E?

Acute silicosis casues?

Answer 9

Quartz!

Well circumscribed noduled with rim of histeocytes and eventual progressive massive fibrosis

Alveolar proteinosis

Question 10

MIxed dust fibrosis differs from silicosis by?

Some things asbestos can cause?

Answer 10

Mixed dust: Stellate “medusa head fibrosis” vs well circumscribed nodules

Asbestosis, rounded atelectasis, carcinoma
Pluera: Plaques, effusions, mesothelioma

Question 11

Asbestosis dx requirements?

Berrilliosis H and E?

Answer 11

Pulmonary fibrosis and 2 or more asbestos bodies in 1 cm2 of a 5 um thick lung; high counts of fibers in lung digest

Fe Stain Helps

See Sarcoid like granulomas: Need history

Question 12

Hard metal pnemonocosis (2 metals) and H and E finding?

Answer 12

Tungsten and Cobalt; Giant cell interstital pneumonia

Question 13

UIP Pattern?

Associated with?

Answer 13

Varigated apperance: “old and young fibrosis”, Honeycomb fibrosis, Fibroplastic plugging and normal lung

IFP, Connective tissues disease and chronic hypersensitivity pneumona

Question 14

Nonspecific interstital pneumonia H and E?

Associated with?

Answer 14

Uniform pattern: Mild-moderate chronic inflammation, interstital fibrosis +/- inflammation

Idiopathic NSIP, Connective tissue disease, hypersensitivity, drug tox, infection

Question 15

Respiratory bronchiolitis H and E?

Which population is this normal in?

Desquamative Interstital Pneumonia H and E?

Answer 15

Bronchiolocentric intra-alveolar macrophages

SMOKERS

Like worse RB; Uniform with diffuse intraalveolar macrophages and possible fibrosis

Also seen in smokers!

Question 16

Lymphoid interstital pneumona main R/O?

Associated conditions?

Answer 16

LYMPHOMA

Immunodeficiency (HIV kids) and connective tissue disease

Question 17

Pleuroparenchemal fibroroelastosis H and E?

Associated conditions?

Needs imaging to distinguish from?

Answer 17

Visceral pleura fibrosis, Subpleural fibroelastosis, Sparing of parenchyma far from pleura with abrupt transitions

Associated wtih: Idiopathic PPFE and Lung allograft rejection

Apical cap

Question 18

Sarcoid H and E?

Hypersensitivity pneumonitis H and E?

Answer 18

Well formed granulomas with some possible coalescence

HP: Bronochiolocentric intersitial pneumonia, cellular bronchiolitis, vague fromed granulomas, orangizing pneumonia

Question 19

Lymphangioleiomyomatosis (LAM) population?
Associated with?

H and E?

IHC?

Answer 19

Low grade neoplasm of PEComa; F childbearing age

Tuberous sclerosis (TSC1 and 2 even in sporatic cases)

See holes: Beta-Catenin +, HMB-45, Melan A

Question 20

Pulmonary Lagerhans Histiocytosis population?
H and E?
Stains?

PLH vs Chronic eosinophilic pneumonia?

Answer 20

Smokers!

Stellate nodules interstital fibrosis nodules around bronchioles with Langerhans cells at periphery; some eosinophils

S-100+, CD1a+, Langerin +

CEP: Macrophages and eosinophils in alveolar spaces

Question 21

Pulmonary vasculitis is treated with what?

c-ANCA is seen in what lung vasculitis?

p-ANCA is seen in what lung vasculitis?

Answer 21

Steroids

Granulomatosis with polyangitis; PR3+ in ELISA

Eosinophilic granulomatosis with polyangitis and microscopic polyangitis. MPO+

Question 22

Granulomatous with polyangitis (Wegner’s) other body locations

H and E and ANCA?

Answer 22

Upper respiratory tract, lung, kidneys; c-ANCA/PR3+

Large parenchymal necrosis; neudtrophilic microabscesses and mixed inflammation with giant cells, Vasculitis

Question 23

Eosinophilic Granulomatosis with Polyangitis (Churg Strauss) ANCA?

Criteria/H and E?

Answer 23

p-ANCA+/MPO

Asthma, >10% eos’s, Mono/poly neuropathy, Pulmonary opascities, paransal sinus abnormaltiies, biopsy shows increased esos

Asthmatic bronchitis, eosinophilic pneumonia, “Allergic granulomas”, Vasculitis

Question 24

Microscopic polyangitis (Hypersensitivity vasculitis, leukocytoclastic vasculitis, Systemic necrotizing vasculitis); ANCA?

H and E?

Answer 24

p-ANCA/MPO

Alveolar hemorrhage, hemosiderin laden macrophages, Neutrophilic capilleritis (in speta and not alveolar spaces)

Question 25

Anti-GBM disease (Goodpasture) patient population?

IF Pattern?

Dx criteria?

Answer 25

Young male smoker

Linear
Alvolar hemorrage, Glomerulonephritis, Serum Anti-GBM Ab

Linear IF

Question 26

Atypical adenomatous hyperplasia cell type/size?

Adenocarcinoma in situ size cut off/growth pattern?

Minimally invasise size/invasion cut off?

What to think of outside of these criteria?

Answer 26

Atypical Type 2 proliferation, <0.5cm

<3.0 cm; lepidic; Non invasive

<3.0 in size and <0.5 cm invasion

If >3 cm or 0.5 cm invasive or multiple nodules or not circumscribed=Invasive mucinous adenocarcinoma

Question 28

Adenocarcinoma must be tested for?

NGS adds?

What to test if EGFR treatment is resistant?

Answer 28

EGFR (treatment), ALK, ROS1

AKL/ROS are FISH or IHC

NGS adds: ERBB2, MET, BRAF, KRAS

EGFR T700M

Question 29

Carcinoid criteria?

Atypical?

Large cell?

Diffuse idiopathic neuroendocrine cell hyperplasia (just know it is a thing)

Answer 29

Less than 2 mits/ 10 HPF; No necrosis

Atypical: 2-10 mites/10 HPF with some necrosis

>10 mites/10 HPF, necrosis (large); cyto features of non small carcinoma; NE by IHC

DIPNAC: Generalized proliferation of lung NE cells

Question 30

Patternless pattern, hyper and hypocellular areas, and Ropey Collagen?

Best predictor of prognosis?

Answer 30

Think SFT! Stat6+, and CD34+

Most: >4 mites/2mm2
Less reliable: Size, atypia, necrosis