Pathology slide set 4 Flashcards
1
Q
What are the two types of malignant mesothelioma
A
epithelioid type and sarcomatoid type
2
Q
What cancers are more often at peripheral lung
A
adenocarcinoma
3
Q
location of carcinoid
A
either central or peripheral
4
Q
This is related to heavy asbestos exposure and much more frequent in males
A
peritoneal mesothelioma
5
Q
IV drugs users and S. aureus
A
endocarditis
6
Q
complications of lung transplantation
A
- accelerated pulmonary arteriosclerosis
- EBV-associated B cell lymphoma
7
Q
immunostains for chromogranin, synaptophysin, and CD57+
A
Small cell carcinoma
8
Q
Postpneumonic abscesses are usually associated with what organisms?
A
- S. aureus
- K. pneumonia
- Type 3 pneumoncocci
9
Q
IHC shows serotonin, neuron-specific enolase, bombesin, calcitonin,
A
Carcinoid tumor
10
Q
TSC2 mutation for tuberin and negative regulator of mTOR
A
lymphangioleiomyomatosis
11
Q
majority express thyroid transcription factor-1
A
adenocarcinoma
12
Q
gender and age for inflammatory myofibroblastic tumor
A
M=F
more common in children
13
Q
erythema nodosum and erythemia multiforme (the San Joaquin Valley fever complex
A
Cocci
14
Q
What broad category of organism is more common in Aspiration pneumonia
A
Aerobes
15
Q
HIV <50
A
- CMV
- fungal
- mcyobacterium avium
16
Q
hemaglutinin attaches the virus to its cellular target via what residues
A
sialic acid
17
Q
What mutation is especially grim
A
KRAS in adenocarcinoma
18
Q
5 year survival for Atypical carcinoids?
A
70%
19
Q
what organ does lung cancer spread to most often?
A
adrenal glands
20
Q
single, round well defined usually peripheral mass with cacium deposits. grayish white. spindle shaped fibroblasts and myofibroblasts, lymphocytes, plasma cells and peripheral fibrosis
A
inflammatory myofibroblastic tumor
21
Q
morphology of chronic infection
A
bronchiolitis obliterans
22
Q
EGFR, ALK, ROS, MET, RET
A
adenocarcinoma
23
Q
Loss of RB
A
Small cell carcinoma
24
Q
Most lung cancers spread early throughout the body EXCEPT this one which spreads outside the thorax late
A
Squamous cell carcinoma
25
4 cancers arising from bronchial neuroendocrine cells
- Carcinoids
- tumorlets
- Small cell carcinoma
- large cell carcinoma
26
whwhat is the diagnostic method for MPV
PCR for viral RNA and direct immunoflurescence
27
describe the reaction to inhales Cocci
delayed type hypersensitivity
28
What bacteria often secondarily infects with influenza viral pneumonia and can be life threatening?
S. aureus
29
which carcinoid is more likely to invade lymphatic vessels?
atypical
30
polymorphisms in this increases capacity to active procarcinogens leading to greater risk for lung cancer
P-450
31
Activating rearrangement in ALK gene on chromosome 2
inflammatory myofibroblastic tumor
32
What is the only definite treatment available for lymphangioleiomyomatosis
transplant
33
important cause of SECONDARY bacterial pneumonia in children and healthy adults following a viral respiratory illness (measles in children and influenza in both children and adults)
S. Aures
34
"salt and pepper pattern"
Small cell carcinoma
35
What do macrophages secrete in response to histo
TNF
36
shared genetic features of small cell carcinoma and squamous cell carcinoma
-loss of function mutations of TP53, RB, and deletion of 3p
37
Southwestern U.S.
cocci
38
Tree bark appearance
resolution of HISTO infection
39
Cause of bacterial pneumonia especially in ELDERLY and also second most common cause of bacterial exacerbation of COPD
Moraxella catarrhalis
40
multiple discrete nodules (CANNONBALL LESIONS) scattered throughout all lobes but more at PERIPHERY
metastasis
41
What is used for rapid diagnosis of legionella infection
Legionella antigens in urine
or positive fluorescent antibody test on sputum
42
if no cause can be found for an abscess what is it called
primary cryptogenic lung abscess
43
What predisposes someone with a viral pneumonia to getting a superimposed bacterial infection
impairment of mucociliary clearance
44
What tumors predominantly produce hypercalcemia
Squamous cell carcinoma
45
P63 and p40
squamous cell carcinoma
46
2 types of carcinoid tumor
Typical and Atypical (more agressive)
47
is the risk for malignant mesothelioma compounded by smoking?
NO
48
What biomarkers can be used to distinguish a bacterial from a viral pneumonia?
CRP and procalcitonin
49
4 stages of lobar pneumonia
- congestion
- red hepatization
- grey hepatization
- resolution
50
pulmonary disorder that primarily affects young woman of childbearing age characterized by proliferation of perivascular epithelioid cells taht express markers of both melanocytes and smooth muscle cells
Lymphangioleiomyomatosis
51
TTF-1 and napsin A
Adenocarcinoma
52
which cancer has strongest association with smoking
small cell carcinoma
53
HIV < 200
Pneumocystis pneumonia
54
intermittent attacks of diarrhea, flushing, and cyanosis
carcinoid syndrome
55
NAB2 and STAT6
solitary fibrous tumor
56
These tend to spread aerogenously, forming satellite tumors
mucinous adenocarcinoma
57
Gender preference for smoking carcinogens
females
58
What stain is used for fungi?
silver stain
59
What is the most common complication of a transplant in the first few weeks after
bacterial infection
60
Who is at high risk for disseminated Cocci disease
- Filipinos
- African American
- immunosuppressed
61
The change that occurs in lymphangioleiomyomatosis is similar to what pulmonary disease
emphysema
62
secretion of parathormone related protein, a cause of paraneoplastic hypercalcemia
Small cell carcinoma
63
Collar-Button lesion
Carcinoid tumor
64
This type of pneumonia is often necrotizing, pursues a fulminant clinical course and is a frequent cause of death?
Aspiration pneumonia
65
whorls of reticulin and collagen fibers interspersed with spindle cells
solitary fibrous tumor
66
deletion of CDKN2A/INK4a
malignant mesothelioma
67
Most often a localized lesion in immunocompetent patient. Typically granulomatous and caused by M. tuberculosis or fungi (histoplasma capsulatum)
chronic pneumonia
68
The innate immune system induces release of what in response to influenza viral infection
alpha and beta interferon
69
What are the most commonly isolated organisms that cause lung Abscess
- Aerobic and anaerobic strep
- Staph. aureus
- host of gram negatives
70
soft-tissue tumor attached to pleural surface by a pedicle
solitary fibrous tumors
71
1 year survival for malignant mesothelioma
approximately 50%. most die within 2 years
72
precursor to the development of multiple tumorlets and typical or atypical carcinoids
diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
73
What do helper T cell secrete in response to Histo
IFN-gamma
74
IHC showed high levels of anti-apoptotic protein BCL2
Small cell carcinoma
75
This viral protein binds to respiratory epithelial cells, allowing cellular infection
Hemagglutinin
76
This viral protein allows release of newly-created virions
Neuraminidase
77
Giant cells containing large sperules with endospores
Cocci
78
KRAS
adenocarcinoma
79
where do central carcinoid tumors protrude
into bronchial lumen
80
Germline mutations in what gene that is an adaptor for TLRs and important for activation of NFkappaB are associated with destructive bacterial pneumococcal pneumonias
MyD88
81
Most common Gram negative bacterial pneumonia
Klebsiella
82
What 3 things does influenza virus infectiong the respiratory epithelium cause?
- intraalveolar fluid accumulation
- cell death
- inflammation
83
small, poorly formed nonnecrotizing granulomas with multinucleated foreign body giant cell reaction that iss inconsequential and especially in those with gastroesophageal reflux
microaspiration
84
likely gender and cancer for NON smoker
women
| adenocarcinoma
85
important cause of PEDIATRIC bacterial pneumonia, and otitis media
H. influenzae (nonencapsulated)
86
cryptic inversion of chromosome 12
solitary fibrous tumor
87
CDKN2A and TP53 mutations
Squamous cell carcinoma
88
What stage of lobar pnuemonia: robust exudate with neutrophils, erythrocytes, fibrin fill alveolar space
Red, firm, airless
red hepatization
89
amplification of MYC
Small cell carcinoma
90
What lobes are most frequently affected with blasto
upper
91
relation of asbestos exposure with a solitary fibrous tumor
NONE
92
Marked by gain of function mutations involving growth factor receptor pathways
adenocarcinoma
93
- little cytoplasm
- closely arranged nuclei with "molding"
- clusters
- may have marked necrosis
small cell carcinoma
94
Cough, fever, and copious amounts of foul-smelling purulent or sanguinous sputum. Fever, chest pain, and weight loss. clubbing of finger and toes may appear with a few weeks
lung abscess
95
Factors that favor extension of a viral infection from upper respiratory tract to lower causing pneumonia?
- extremes of age
- malnutrition
- alcoholism
- underlying debilitating illnesses
96
can be patchy or may involve whole lobe and bilateral or unilateral and the affected area is RED-BLUE and congested
Viral pnuemonia
97
Abrupt onset of high fever, shaking chills, and cough producing mucopurulent (rust colored) sputum. occasional hemoptysis
community acquired pneumonia
98
how does a Blast infection resolve
spontanously
99
characterized by presence of keratinization and/or intercellular bridges.
Squamous cell carcinoma
100
Pneudomonas most commonly causes what type of infection
hospital acquired
101
What causes carcinoid syndrome?
tumor cells secreting vasoactive amines (serotonin)
102
Thick, mucoid, (often blood-tinged) sputum is characteristic of this infection
klebsiella
103
infection of what may follow a viral respiratory infection, and is a pediatric emergency and has high mortality rate
H. influenzae
104
Cancers in nonsmokers are more likely to have what mutations and almost never have what mutation
EGFR
KRAS
105
What are the most common organisms that cause health care associated pneumonia
- methicillin-resistant Staph. Aureus
| - P. aeruginosa
106
muscle weakness caused by auto antibodies (possibly elicited by tumor ionic channels) directed to the neuronal calcium channel; peripheral sensory neuropathy; dermatologic abnormalities, including acanthosis nigricans; hematologic abnormalities such as leukemoid reactions; trousseau syndrome; and hypertrophic pulmonary osteoarthrophathy associated with clubbing of the fingers
Lambert-Eaton myasthenic syndrome
107
What cells does histo target
macrophages
108
losses in chromosome 3, 9, and 17
Squamous cell carcinoma
109
-Enophthalmos
-ptosis
-miosis
-anhidrosis on same side of lesion
and pain in ulnar nerve distribution
Pancoast tumor
110
Antigenic drift
EPIdemic . . spontaneous mutations
111
may occur in patients with multiple endocrine neoplasia type 1
carcinoids
112
What do bacterial infections often follow?
upper respiratory viral infection
113
What virus is most commonly seen in young children, elderly, and immunocompromised
Human metapneumovirus (MPV)
114
Peak incidence for lung carcinomas
50s-60s
115
Gram positive, slightly elongated diplococci
Strep Pneumo
116
deletion of 9p
malignant mesothelioma
117
This infection occurs in Cystic fibrosis patients and immunocompromised and in neutropenic patients. Also invades blood vessels (hematogenous spread)
pseudomonas
118
What stage of lobar pneumonia: organizing fibrosis admixed with macrophages
resolution
119
CD34+ and keratin-negative
solitary fibrous tumor
120
What stage of lobar pneumonia: vascular engorgement, cell-poor intra-alveolar fluid with numerous bacteria and few neutrophils
Heavy, boggy, red
congestion
121
describe malignancy of carcinoid tumor
low grade
122
progression of malignant mesothelioma
long latent period of 25-45 years
123
when bilateral chronic infection is present from cystic fibrosis or bronchiectasis what do you do with the transplant?
both lungs must be replaces
124
Most common cause of bacterial acute exacerbation of COPD?
Haemophilus influenzae
125
most common causes are hospital acquired
Gram + cocci (mainly S. aureus and S. pneumo)
| Gram - rods (enterobacteriacea and Pseudomonas)+
126
p53 overexpression
Squamous cell carcinoma
127
In those who survive Aspiration Pneumonia, What is a common complication?
Lung abscess
128
Do granulomas occur in fulminant disseminated histoplasmosis which occurs in immunosuppressed
NO
129
Well developed lesion are slightly elevated, dry, granular, gray-red to yellow and poorly delimited at their margins,
Histologically: neutrophil-rich exudate that fills bronchi, bronchioles, and adjacent alveolar spaces
Bronchopneumonia
130
What indivivuals are at special risk for postpneumonic pneumonia?
immunosuppressed or post transplant
131
Strong positivity for keratin proteins, calretinin, WT-1, cytokeratin 5/6, and D2-40
malignant mesothelioma
132
how do you histologically differentiate Histo from TB, sarcoidosis, and Cocci
3-5 micrometer thin walled yeast forms
133
Morphology of acute rejection
inflammatory infiltrates either around small vessels, in submucosa of airways or both
134
What is the only chronic pneumonia causing fungi that gives headaches
Blasto
135
What conditions predispose to legionella infection?
- cardiac, renal, immunologic, or hematologic disease
| - Organ transplant recipients are particularly susceptible
136
most common form of lung cancer in women
adenocarcinoma
137
Common viruses that cause community acquired pneumonia?
- influenza type A and B
- RSV
- human metapneumovirus
- adenovirus
- rhinovirus
- rubeola
- varicella
138
Where does legionella flourish
water tanks, pipes
139
What are the 3 complications of pneumonia?
- Abscess formation (type 3 pneumococci and klebsiella)
- spread of infection to pleural cavity (empyema)
- Bacteremic dessemination
140
what enzyme system converts chemicals into carcinogens
P-450 monooxygenase
141
epidemiology of squamous cell carcinoma
males
| -strong association with smoking
142
- double wall
- visible nucleus
- 5-15micrometers
- Granulomas with NEUTROPHILS
- BROAD BASED BUDDING
Blasto
143
When are antibodies against histo formed
2-6 weeks after infection
144
p16 loss
Squamous cell carcinoma
145
What causes pontiac fever, a self-limited URI
Legionella
146
- Intracellular Fungi
- Midwest
- Bird/bat dropping
Histoplasmosis
147
hyperplasia of the lymphiod tissue within the Waldeyer ring frequently in children
virus-induced tonsillitis
148
at periphery there is often lepidic pattern of spread in which the tumor cells "crawl" along normal appearing alveolar septa
Adenocarcinoma
149
lobes for bronchopneumis?
bilateral?
lower lobes more often
bilateral
150
S. aureus is associated with a high incidence of complication such as what?
- Lung abscess
| - empyema
151
Shortly after an influenza virus enter into pneumocytes, it inhibits what channel?
sodium channelss
152
central or southeaster U.S. SOIL dwelling
-Also Canada, mexico, middle east, Africa, and India
Blasto
153
most virulent form of H. influenza
encapsulated type b
154
predominant histologic pattern of viral pneumonia
interstitial inflammatory reaction involving the walls of the alveoli
155
What are predisposing factors to CAP bacterial
- Age: young or old
- chronic disease: COPD, diabetes, CHF
- Absent splenic function
156
ORGANOID nests, trabecular, pallisading, ribbon, or rosette-like arrangements of cells separated by a delicate fibrovascular stroma
carcinoid tumor
157
Where can histoplasmosis spread
liver, adrenals, mediastinum, meninges
158
What are the two influenza viral proteins?
Hemagglutinin and neuraminidase
159
What do apical lung cancers in the superior pulmonary sulcus tend to invade?
neural structure around the trachea
- Cervical sympathetic plexus
- Horner syndrome
- Sever pain in distribution of ulnar nerve
160
affected lung becomes ensheathed by thick layer of soft, gelatinous, grayish pink tumor tissue
malignant melothelioma
161
What happens do histoplasmosis in an immunocompromised patient
wide dissemination
162
edema to head and arm
superior vena cava syndrome
163
What does an absent spleen predispose infection of?
encapsulated bacterial like pneumococcus
164
commonly afflicts debilitate and malnourished people, particularly chronic alcoholics
klebsiella
165
What patients are at particularly high risk of getting hospital-acquired pneumonia
patients on mechanical ventilation
166
likely arise from neuroendocrine cells in the bronchial epithelium
small cell carcinoma
167
Chronic, progressive, secondary lung disease which is localized to the lung apices and causes cough, fever, and night sweats
Histoplasmosis
168
What is the most common cause of acute CAP?
Strep. Pneumo
169
describe the progression of lymphangioleiomyomatosis
slowly progressive over a period of several decades
170
complications of a lung abscess
- extension of infection into pleural cavity
- hemorrhage
- development of brain abscesses or meningitis from septic emboli
- Rarely secondary amyloidosis
171
What tumors predominantly produce ACTH and ADH
Small cell carcinomas
172
5 year survival for typical carcinoids?
95%
173
if abscess is discovered in an older individual, you must rule out underlying what?
carcinoma
174
What stage of lobar pneumonia: fibrinosuppurative material, erythrocyte disintegration, early organization
grey hepatization
175
alpha and beta interferon upregulate what gene in response to influenza viral pneumonia
MX1 gene
176
- Coin lesion
| - nodules of connective tissue (CARTILAGE) intersected by epithelial clefts
hamartoma
177
CAP common among children and young adults.
local epidemics (schools, military camps, prisons)
Low level walking pneumo. persistent dry cough that won't go away
Mycoplasma pneumo.
178
highly malignant and agressive
Small cell carcinoma
179
What anaerobic organisms that are normally found in the oral cavity can cause abscess
- Bacteroides
- Fusobacterium
- Peptococcus
180
3 most common causes of otitis media in children
- S. pneumoniae
- H. influenzae
- M. catarrhalis
181
worrisome epithelial changes with smoking
basal cell hyperplasia->squamous metaplasia --> squamous dysplasia --> carcinoma in situ
182
Distant spread of lung carcinoma occur through what?
both lymphatic and hematogenous spread
183
What is the only antiviral treatment available for human MPV
Ribavirin
184
location of squamous cell carcinoma
central lung/hilar region
185
Antigenic shift
PANdemic . . coinfection of different types of influenza virus
186
Gender and age for carcinoid tumor
M=F
| less than 40
187
HIV >200
Tubercular infection
188
Self limited and often latent primary pulmonary involvment which may result in COIN LESIONS on chest radiography
Histoplasmosis
