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Flashcards in Pathology Deck (26):
1

Emphysema - centriacinar

Upper lobes, smokers, proximal/middle acini, menWill always see a rim of normal acini surrounding emphysematous portion

2

Emphysema - panacinar

Pan = all acini affected – from respiratory bronchiole through alveoliAlpha1 antitrypsin deficiency – lower lobe predominant due to higher perfusion

3

Emphysema - paracicatricial

Buzzword = pulmonary scars (i.e. s/p surgical removal of lung tumor)Little clinical significance

4

Emphysema - paraseptal

Affects acini in periphery of lungYoung ptsRupture = bleb formation = spontaneous pneumothorax (most often seen in young males)

5

Reticular Infiltrates

CXR or CTlooks hazy: opacitiesLattice likeRanges from fine expansion (thinner, earlier disease) to coarse expansion (thicker, esp in later disease since more fibrosis)*NSIP

6

Honeycombing

CXR or CTprogressive fibrosis or thickening of interstitiumCyst appearing areas*UIP

7

Ground Glass

CT onlyINFLAMMATORY PROCESS (reversible!)Hazy, patchy infiltratesNot fibrotic*RBILD, DIP, NSIP, COP

8

Sarcoidosis

Most common ILDYoung (

9

UIP

Insidious onset, progresses relentlessly – “disease of the walking dead”Buzzword: Velcro-like (coarse) cracklesLater in disease: digit clubbing, cyanosis, and cor pulmonaleHisto: PATCHY distribution of fibroblastic foci, chronic interstitial inflammationCXR: only ILD with honeycombing

10

UIP Key Histologic Features (6)

1 - patchy distribution2 - fibroblastic foci3 - temporal heterogeneity4 - honeycomb cysts5 - localized to basilar & peripheral/subpleural regions6 - chronic interstitial inflammation

11

NSIP

More favorable outcome than UIPPhysical exam: fine crackles at base of lungsHisto: HOMOGENOUS appearance of either inflammation (cellular pattern, thickening of interstitium due to inflammation) or fibrosis (fibrosing pattern, thickening due to collagen deposition)Reticular (CXR) or ground glass appearance (CT)Tx: very responsive to corticosteroids

12

AIP

Rapidly progressive, pts present with ARDS, >50% mortalityExam: Diffuse inspiratory cracklesHisto: infiltrates of BOTH alveoli and interstitium; diffuse alveolar damageThree phases: Exudative (cellular), proliferative (organizing), and fibrotic (chronic)* temporal uniformity - only one stage at a timeSx: like pneumonia-tachypnea, severe dyspnea, constitutional sx*Respiratory failureTreatment - supportive

13

RBILD

Buzzword: SMOKERSYoung patients: 30-40 y/oMild symptoms: cough, dyspneaCXR: Can be normal in 20-30%, CT can show ground glass, but very patchy*Histo* - Pigmented intralumenal macrophages located in 1st and 2nd order bronchiolesTx: smoking cessation

14

DIP

Very uncommon Young male smokersProminent accumation of intra-alveolar macrophagesRBILD – macs found in the bronchiolesPreservation of lung architecture (not seen in UIP)Tx: smoking cessation

15

COP

NOT idiopathicNon-specific onset – usually preceded by URI that did not resolve over a few monthsCommon in Non-smokersPersistent resp sx that progressPE: inspiratory cracklesCT: ground glass & consolidationBiopsy needed for dxTx: CS work, long course; frequent lapse

16

Three Phases of AIP

1 - Exudative (acute) - mostly inflammatory; hilar membranes lining the alveolar ducts; inflammatory exudate2 - Proliferative (organizing) - transition from inflammatory to fibrotic; volume is greater because more thickening of interstitium and alveolar walls; more organizaiton of interstitium3 - Fibrotic (chronic) - more fibrosis, disruption of basement membranes

17

Small Cell Lung Cancer

Very aggressive tumor, almost always seen in smokersCENTRALLY locatedparaneoplastic syndromesHistology: small cells with fine chromatin pattern very little cytoplasm w/ abundant mitotic figures and bizarre looking cells“Smudged cells” -> “Azzopardi effect”Stain synaptophysin and chromogranin positiveStaging:Limited (30-40%): everything is ipsilateralExtensive (60-70%): spread outside one lung

18

Adenocarcinoma

GLANDS -> mucin productionPERIPHERALLY locatedPreservation of alveolar architectureSpread through airwayCancer cells line airways so show up as dense hazinessGround glass-like

19

Squamous Cell Carcinoma

CENTRALLY locatedMay invade vasculature so no anti-angiogenic therapy Possible Paraneoplastic Syndrome: hypercalcemiaHistology: inter-cellular bridge and keratin pearls w/ swirling of nesting cells outside and around itCavitation on CXR and CT

20

Large Cell Carcinoma

Poorly differentiated, large cells with lots of cytoplasm Large nuclei with prominent nucleoliDx by exclusion

21

Staging of Non-Small Cell Lung Cancers

Stage I - single solitary nodule (small)Stage II - add hilar LNStage III - invasion into the great vessels, trachea, esophagus, heart, vertebrae, main carinaStage IIIB - contralateral diseaseStage IV - mets

22

Common Paraneoplastic Syndromes

Hypercalcemia - squamous cellSIADH - small cellretention of water, hyponatremiaCushing's - small cellproducing ACTHEaton-Lambert - small cellproduction of auto-antibodies against pre-synaptic Ca2+ channels causing muscle weakness

23

Benign Characteristics of Solitary Nodule

smooth & roundwell circumscribedcentral, densely calcified, laminated, "popcorn"

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Malignant Characteristics of Solitary Nodule

SpiculationsIrregular contourEccentric calcifications>3cm

25

Chronic bronchitis

Blue bloaterHypoxicCyanoticEdema - weight gainProductive coughLots of wheezing, sputum, tachypnea, prolonged expiratory timeCyanotic lipsNot working very hard - living on hypoxic driveChronic compensated respiratory acidosis*hist: thickening of bronchial wall & hypertrophy of submucosal glandsSquamous metaplasia

26

Emphysema (general)

Pink pufferThinPursed lip breathingAccessory muscle use - leaning forward (bucket handle position)Barrel chestedWheezingTachypnicGrossly, lungs have holesBulla ->blebs->pneumothoraxCXR - lungs dark and hyperinflatedAlpha1-anti-trypsin deficiency, destroyed elastinBreathing on steeper part of compliance curve (lungs are more elastic)