Pulmonary Pathology

Question 1

Answer 1

PULMONARY EDEMA

HEMODYNAMIC PE, b/c alv-cap membrane is intact

Location: alveolus

Interstitium is thickened

Fluid in alveolar spaces

Question 2

Answer 2

ADENOCARCINOMA

Glandular proliferation w/abnormal cells

Lesion destroys normal lung architecture

Question 3

Answer 3

ASTHMA

Inflammatory cells (eosinophils) in an airway

Thickened basement membrane

Mucus plugging

Question 4

Answer 4

HEMOSIDERIN-LADEN MØ

Location: alveolar spaces

Causes: chronic passive congestion and outflow obstruction

Question 5

Answer 5

HEALED TB

Location: apex of the lung

Note: there is also an emphysematous area to the left of the TB scar

Question 6

Answer 6

CHRONIC INTERSTITIAL INFLAMMATION

Location: alveolus

DDx: infection, interstitial lung disease

Question 7

Answer 7

NORMAL AIRWAY

Pseudostratified Ciliated Columnar Epithelium

Question 8

Answer 8

ACUTE INFLAMMATION

Location: alveolar spaces

Cause: pneumonia

Question 9

Answer 9

CENTRAL MALIGNANCY:

Consistent with: Squamous cell carcinoma, small cell carcinoma, large cell carcinoma (50% are central)

Question 10

Answer 10

NON-NECROTIZING GRANULOMAS AND GIANT CELLS

Possible causes: hypersensitivity pneumonitis, fungal, sarcoid, aspiration, mycobacterial disease (esp. in acute phase)

Question 11

Answer 11

HONEYCOMB LUNG

Question 12

Answer 12

HYALINE MEMBRANES

Early (exudative) phase of ARDS

Question 13

Answer 13

BRONCHOPNEUMONIA

Question 14

Answer 14

BRONCHIECTASIS

If isolated: most likely in right lower lobe

Causes: aspiration, foreign body, tumor

Question 15

Answer 15

SQUAMOUS CELL CARCINOMA

Features: keratinization, intercellular cross-bridges

Question 16

Answer 16

BRONCHOPNEUMONIA

Features: airway filled w/inflammatory cells that are spreading to contiguous alveoli

Question 17

Answer 17

NORMAL ALVEOLUS

Question 18

Answer 18

HIGH-GRADE NEUROENDOCRINE TUMOR

Salt and pepper chromatin

Question 19

Answer 19

GRANULOMAS, FIBROSIS

Causes: sarcoid, healed histoplasmosis

Question 20

Answer 20

GOHN COMPLEX

Lung lesion + draining lymph node

Question 21

Answer 21

INTERSTITIAL LUNG DISEASE

Widened alveolar septae

Intact alveolar framework

Causes: atypical pneumonia, hypersensitivity pneumonitis

Note: not a good picture for UIP b/c interstitium is inflammatory here

Question 22

Answer 22

CHRONIC BRONCHITIS

Question 23

Answer 23

CARCINOID TUMOR

Low-grade neuroendocrine tumor

Most occur centrally

Uniform cells

Question 24

Answer 24

EMPHYSEMA

Question 25

Answer 25

CALCIFIED GRANULOMA Causes: TB, sarcoid, fungal

Question 26

Answer 26

LOWER LOBE ABSCESS

Question 27

Answer 27

LATE ARDS: FIBROPROLIFERATIVE PHASE

Question 28

Answer 28

MESOTHELIOMA Pleural-based tumor related to asbestos exposure Features of asbestosis: interstitial fibrosis, diaphragm plaques, pleural effusions, pleural fibrosis

Question 29

Answer 29

NECROTIZING GRANULOMA Causes: TB, Fungal Should be cultured to determine causative organism

Question 30

Answer 30

EMPHYSEMA

Question 31

Answer 31

SOLITARY FIBROUS TUMOR Benign-behaving Relatively well-circumscribed White, whorled Soft tissue-like

Question 32

Answer 32

CAVITATION Compatible with: aspergilloma, aspergillus, fungal infections, TB

Question 33

Answer 33

ADENOCARCINOMA Mass at the periphery Most common tumor subtype in non-smokers More commen in women

Question 34

Answer 34

EMPHYSEMA Location: apex Cause: smoking

Question 35

Answer 35

HAMARTOMA Most common benign-behaving lung lesion Mesenchymal in origin

Question 36

Answer 36

ASTHMA Thickened basement membranes Smooth muscle proliferation Goblet cells

Question 37

Answer 37

CENTRAL TUMOR + BRONCHIECTASIS, POST-OBSTRUCTIVE PNEUMONIA Most likely squamous cell carcinoma Could be small cell, but that usually presents as extensive metastatic disease, and this is a resected specimen

Question 38

Answer 38

PASSIVE CONGESTION No pulmonary edema or acute inflammation

Question 39

Answer 39

LOBAR PNEUMONIA

Question 40

Answer 40

GRANULOMA

Question 41

Answer 41

MUCUS PLUG Possible cause: chronic bronchitis

Question 42

Answer 42

HAMARTOMA Location: periphery Well-circumscribed, appears to pop up from the surface

Question 43

Answer 43

ACUTE PASSIVE CONGESTION Red, wet, heavy lungs May be an early phase of ARDS If more chronic process, would be rusty color

Question 44

Answer 44

ADENOCARCINOMA IN SITU Left: picket fence proliferation Right: mucinous type

Question 45

Answer 45

CARCINOID TUMOR Polypoid lesion in an airway Well-circumscribed, cherry-red lesion Usually centrally located Low-grade neuroendocrine tumor

Question 46

Answer 46

HONEYCOMB LUNG, PLEURAL COBBLESTONING Location: Lower lobe Cause: IPF This same picture in the upper lobe would be more characteristic of emphysema caused by smoking

Question 47

Answer 47

BRONCHIECTASIS IN CYSTIC FIBROSIS Location: upper lobe

Question 48

Answer 48

ASTHMA Airway filled with eosinophils Thickened basement membrane

Question 49

Answer 49

NECROSIS, INFLAMMATION DDx: infection, granuloma, etc.

Question 50

Answer 50

ARDS Organizing Diffuse fibrosis

Question 51

Answer 51

BRONCHIECTASIS Dilated, tortuous airway Mucus plug

Question 52

Answer 52

DIFFUSE INTERSTITIAL INFLAMMATION Causes: viral pneumonia, connective tissue disease, hypersensitivity pneumonitis

Question 53

Answer 53

FATAL ASTHMA Hyperinflated and atelectatic areas Lots of air trapping

Question 54

Answer 54

HONEYCOMBING OF ADVANCED SARCOID Location: upper and middle lobes

Question 55

Answer 55

ASPIRATION

Question 56

Answer 56

LARGE CELL CARCINOMA Cells w/prominent nucleoli

Question 57

Answer 57

ASTHMA Goblet cell metaplasia Thickened basement membrane

Question 58

Answer 58

SCATTERED GRANULOMAS Causes: TB, fungal infections, mycobacterial disease

Question 59

Answer 59

Neutrophils and necrosis in the alveolar spaces DDx: bacterial pneumonia, aspiration pneumonia, early phase of TB, fungal pneumonia