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CAM201: Applied Pathology > Respiratory Path Pots > Flashcards

Flashcards in Respiratory Path Pots Deck (31)
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1

Describe the specimen

Specimen of left lung

Lung parenchyma shows honeycomb appearance, with large cyst-like spaces, particularly in upper lobe.

The lower lobe appears fibrotic

Usual Interstitial Pneumonia

2

UIP Aetiology

Largely Unknown.

Repeat cycles of Alveolitis caused by unidentified agent.

Associated with a Th2 response. Eosinophils, mast cells, IL-3, & IL-4 often found in lesions.

TGF-B1 released from injured Type I Alveolar cells favours production of collagen scar tissue in the lung

Cycles of injury and collagen scar wound healing lead to patchy interstitial fibrosis, and fibroblastic foci.

UIP tends to show early and late lesions, due to variable stages of inflammation and fibrosis.

Lower lobes predominantly show fibrosis. 

 

3

Clinical aspects of UIP?

Complications of UIP?

Patients present will increasing SOB, dry cough

Insidious onset with variable progression, usually <3 years. Rapid deterioration may occur.

Typically present at 40-70 years old

<20% of cases respond to steroids. 

Lung Transplant required.

Complications: Secondary pulmonary HTN, V/Q Mismatch, Respiratory Failure, Hypercapnia, etc.

4

UIP Micro?

Patchy Interstitial Fibrosis

Patchiness results from presence of early and late lesions: some showing inflammation, others showing collagen scar healing

Overall effect = destruction of lung parenchyma

Enlarged air-spaces with fibrous remodelling of airspace walls

Honeycomb lung formation - enlarged air spaces

5

Describe the specimen

Potted specimen shows the lower portion of the trachea where it bifurcates.

An undifferentiated carcinoma fills the bronchus, deforming the normal structure as it invades surrounding tissues.

Appears to be spreading into the oesophagus, posteriorly. 

6

Describe the pot

Specimen is a slice of lung

Carcinoma mostly occluding the main bronchus, and is infiltrating surrounding lung parenchyma. 

Lymph nodes appear largely replaced by carcinoma growth

The lung appears collapsed

There is bronchial thickening and dilation, indicative of bronchiectasis

7

Describe the specimen

Specimen is a section through the Right Lung and a section of 2 ribs

There is carcinoma growth about 7cm in diameter which appears to be arising from the upper lobe bronchus

Centre of the tumour appears friable and necrotic. 

Peripherally, the tumour appears to have invaded the pleura and is adherent to the two ribs, also included in the pot

8

Describe the Specimen

The specimen shows the bifurcation of the trachea, and portions of the left and right lungs. 

Bilateral carcinoma growth arising from the main bronchus of both lungs. Infiltration into adjacent lung parenchyma.

Tumour growth has replaced the hilar and (possibly inferior tracheobronchial) lymph nodes. 

Tumour growth has distorted normal form of bronchi

9

Describe the specimen

Specimen shows a section through the R lower lobe.

There is carcinoma growth arising from the bronchus.

Tumour cells have infiltrated two hilar lymph nodes. 

Tumour growth is also infiltrating surrounding lung parenchyma. 

The remainder of the lung parenchyma shows consolidation - confluent broncho-pneumonia

10

Describe the Specimen

Specimen shows a slice of lung

There is carcinoma growth of 6x8cm that appears to be arising from the upper bronchus. 

The tumour has infiltrated the lumen, resulting in a 1cm large mass protruding into the lumen.

The remainder of the lung shows patchy areas of pneumonia (consolidation) and emphysema.

There is carbon staining throughout the lung.

The pleura show fibrous adhesions 

11

Describe the Specimen

The specimen shows a slice through the left lung, showing both upper and lower lobes. 

The lung shows inflation classical of asthma

The bronchi appear prominent, with thickened walls and mucous plugging

12

Describe the specimen

The specimen shows a longitudinal section of lung.

The inflation is classic of asthma. 

bronchi The cut surface shows prominent bronchi with thickened walls and mucous plugging.

The surrounding tissue also appears oedematous. Haemorrhage might also be present?

13

Describe the specimen

Normal Lung

The amount of anthracosis is normal for an adult

The pulmonary lobules are easily seen

14

Describe

Specimen is a mounted Right Lung

Distorted by multiple emphysematous Bullae

These are most developed on the apical and anterior margins of the lung

Considerable carbon deposition in the pleural lymphatics

15

Describe the specimen

Section of R lung

On medial surface shows multiple cyctic blobs

A few of which have combined to coalesce into a large bullae

Interiorly, there may be emphysematous parenchymal changes

Lung also appears over-inflated

16

Describe

Specimen shows section of lung

Obvious overinflation

There is obvious pneumonia evidenced by consolidation

There are also widespread emphysemaous changes.

Bronchi appear thickened with mucous plugging. 

Thus, there is underlying COPD (chronic bronchitis and emphysema)

17

Describe

Mounted specimen shows an inflated left lung

There is widespread centrilobar emphysema

Apical Bullae (perhaps visible on the other side?) 

And an apical scar

Bronchopneumonia also present

Evidenced by prominent, thickened bronchi with mucous plugging

18

Describe

Specimen is a left lung with emphysema

There are multiple, large, sub-pleural bullae of the upper lobe

Some of the smaller enlarged airspaces can be seen surrounding bronchi, indicating that this is centrilobar emphysema

19

Describe

Specimen of left lung

Upper lobe shows diffuse consolidation of the whole lobe, and sparing of only a small slither anteriorly/superiorly. 

The upper lobe shows grey hepatisation stage pneumonia 

The lower lobe also shows diffuse consolidation, but in the red hepatisation stage of pneumonia

 

20

Describe

The specimen is a slice through the Right Lung

Diffuse consolidation, suppuration and necrosis is seen throughout all three lobes, with some sparing of parenchyma towards the inferior aspect of the lower lobe

There are multiple creamy yellow, variably sized foci

the largest of which shows cavitation - abscess formation

This is evident of beonchopneumonia with an abscess

The parts of the lung unaffected by the bronchopneumonia appear emphysematous

There is an apical scar which may be from old TB 

21

CAP common organisms?

Streptococcus pneumoniae


Hemophilus influenzae


Mycoplasma pneumoniae


Influenza

 

22

Nosocomial Pneumonia organisms?

Mainly gram negatives

E. coli

Proteus Mirabilus

PSeudomonas Aeruginosa

 

23

Immunosuppressed Pneumonia organisms?

Usually the same as CAP but can also be caused by numerous, less virulent organisms

Viruses: Herpex Simplex, Cytomegalovirus

Fungi: Aspergillus, Candida

Protozoa: Toxoplasmosis

24

Describe

Specimen is a slide of the left lung

Shows apical cavitation indicative of Post-Primary TB

There is diffuse consolidation throughout the remainder of lung, including the lower lobe, with caseous-looking foci

 

Lower lobe caseation is consistent with confluent tuberculosis bronchopneumonia

25

Describe

Specmen shows slice through R lung (TB)

Cavitation of apical region of upper lobe, and dissemination of the infective process into the lower lobe, marked by diffuse consolidations, centred around the bronchi.

This is suggestive of tuberculosis bronchopneumonia

There is sparing of the middle lobe

26

Describe

The specimen consists of a portion of the right lung. 

The lung parenchyma is studded with multiple variably sized rounded nodules of grey-white tumour tissue showing focal areas of haemorrhage and early cystic change. 

Many nodules also bulge from the visceral pleural surface. The lung parenchyma between the nodules is compressed and slightly congested. 

Metastasies**

27

Describe

Specimen shows section through R lung

There is a sharply demarkated yellow/grey tumour about 1.8cm in diameter sitting centrally in the lower lobe

Does not appear to have any connection to bronchi

Metastatic tumour

28

Describe

Specimen shows medial half of the left lung

Numerous bullae are evident.

Thickened, fibrotic septae spread through the bullae.

Homeycomb lung formation is also present - fibrotic thickenings of airspace walls, and enlarged airspaces.

Central area of consolidation, and thickened bronchi

Emphysematous changes throughout

Consolidation suggestive of pneumonia

Also fibrotic adhesions of the pleura present

29

Describe

Specimen shows section through the lung.

There is pinky/creamy/whitish homogenous tunour tissue that appears to be extending in from the periphery of the lung. 

The tumour has almost completely destroyed the lung tissue, which is compressed in the centre of the tumous growth. 

The tumour growth measures up to 7 cm in diameter and encircles the small section of lung parenchyma left centrally. 

 

Mesothelioma - arising from the mesothelial cells of the pleura

30

Mesothelioma: Aetiology, clinical features, prognosis

Mesotheliomas arise from the mesothelial surface of the pleura. Most commonly occur in the lungs, but can occur elsewhere.

Associated with heavy exposure to asbestos.

Note that people with asbestos exposure who also smoke are more likely to develop lung carcinoma, rather than mesothelioma*

Clinical Features: latent period of 25-45 years before development of asbestos-related mesothelioma

~7-10% lifetime risk in exposed individuals

Presents with chest pain, dyspnoea, recurrent pleural effusions

Lung is directly invaded and there is often metastatic spread to surrounding lymph nodes

Prognosis:

Poor. 50% die within 12 months. Few survive beyond 2 years. Aggressive surgery, chemo- and raiotherapy can help to improeve the prognosis somewhat