Respiratory System Pathology 1- Galbraith lecture Flashcards Preview

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Flashcards in Respiratory System Pathology 1- Galbraith lecture Deck (27):
1

Infectious Rhinitis

usually viral, self limiting:
Adenovirus
Rhinovirus
Echovirus

Nasal mucosa edematous and hyperemic
-catarrhal secretion
May get bacterial superinfection --> mucopurulent secretion

2

Allergic rhinitis

Hypersensitivity reaction - IgE

Nasal mucosa edematous and hyperemic
-catarrhal secretion

3

Nasal polyps

Edematous protrusions of nasal mucosa

prominent eosinophils, lymphocytes, plasma cells, neutrophils

can be secondary to repeated episodes of rhinitis

no link to atopy

can cause obstruction (3-4 cm)

4

Sinusitis

Allergic or oral cavity microbial infection

Impaired drainage - mucosal edema of rhinitis or physical blockage

Severe chronic sinusitis - caused or complicated by fungi, seen in DM its or immunocompromised
-Mucormycosis
-Aspergillus

Discomfort, malaise
Can spread to bone, orbit, cranial vault

5

Pharyngitis and tonsilitis

most commonly viral:
-Adenovirus
-echovirus
-rhinovirus

Bacterial causes primary or superinfection
-usually beta-hemolytic streptococci
-occasionally S. aureus
-associated with whitish exudative material overlying reddened, swollen tonsils

6

Causes of necrotizing ulceration of upper respiratory tract

acute fungal infection

Granulomatosis with polyangiitis

Extra nodal EK/T cell lymphoma- nasal type
-associated with EBV
-male, 40-50s, Asian and Latin American
-Aggressive

7

Nasopharyngeal angiofibroma

Vascular tumor
Adolescent males - red-haired, fair-skinned

Arises in posterolateral roof of the nasal cavity
-benign
-Locally aggressive
-extend intracranially

8

Sinonasal (Schneiderian) papilloma

respiratory mucosa "benign" tumor
-nasal cavity and paranasal sinuses

M>F
30-60

Subtypes:
-Exophytic (fungating)
-Inverted (endophytic)
-Cylindrical

Exophytic and inverted associated with HPV 6 and 11

Epithelium respiratory or squamous

9

Inverted sinonasal papilloma

papillomatous growth of squamous cell-lined fronds downward from mucosal surface into underlying stromal tissue

May recur if not completely excised

May extend into orbit or cranial vault

10% malignant transformation

10

Olfactory neuroblastoma

esthesioneuroblastoma

neuroectoderm in superior nasal cavity

Small, round blue cell tumor

peaks at ages 15 and 50

11

Nasopharyngeal carcinoma

EBV related
African children, Chinese adults

May take form of:
-Keratinizing squamous cell carcinoma
-Nonkeratinizing squamous cell carcinoma
-undifferentiated basaloid carcinoma with numerous tumor-associated lymphocytes

Tx: radiation
-Keratinized carcinoma least radiosensitive
-Undifferentiated carcinoma most radiosensitive

12

Laryngitis

Secondary to infection, allergy, or environmental exposure (e.g. smoke)

may compromise airway in small children

Causes:
-RSV
-H. influenzae
-Beta-hemolytic streptococci

13

Reactive nodules

Smooth round small protrusion on true vocal cords

repeated vocal cord strain (singer's nodules) or heavy smokers

lead to hoarseness

Benign

14

Squamous papillomas

Squamous-lined fronds with fibrovascular cores

Single or multiple

Children or adults

HPV 6 and 11

Benign, may recur

15

Laryngeal carcinoma

squamous cell carcinoma

men, 50s, smoker

Squamous hyperplasia --> dysplasia --> carcinoma

Bulky, fungating mass protruding from laryngeal surface, often with ulceration

16

Pulmonary hypoplasia

congenital

decreased weight, volume and acini for age/body weight

compression of lung(s) in utero - diaphragmatic hernia

If severe - fatal shortly after birth

17

Foregut cyst

Congenital

bronchogenic, esophageal, or enteric

18

Pulmonary sequestration

congenital

Segment of lung tissue without connection to airway
with systemic circulatory supply (not pulmonary)

19

Resorption atelectasis

complete obstruction of an airway (FB, secretions, tumor, anything that can physically block the airway)

air within dependent lung is resorbed --> collapse

Mediastinum shifts TOWARD the affected lung

20

Compression atelectasis

Fluid, tumor, or air accumulate within the pleural space
-prevents expansion

Mediastinum shifts AWAY from affected lung

21

Contraction atelectasis

pulmonary or pleural fibrosis preventing normal expansion

not reversible

Mediastinum shifts TOWARD the affected lung

22

Hemodynamic pulmonary edema

Intra-alveolar fluid accumulation
-increased hydrostatic pressure in pulmonary circulation

Basally at first

Alveolar capillaries congested
Intra-alveolar transudate seen - pink and granular

Hemosiderin-laden macrophages within alveoli ("heart failure cells") with chronic pulmonary edema
-lungs become brown and indurated

Decreased oxygenation
Increased chance of infection

23

Pulmonary edema secondary to microvascular (alveolar) injury

Injury to and inflammation of alveolar vascular endothelium and/or respiratory epithelium

infectious or toxic insults

localized or diffuse

24

Acute lung injury - general

Inflammation induced vascular permeability
--> diffuse pulmonary edema and rapid onset of hypoxemia

Severe form - acute respiratory distress syndrome (ARDS)

Predisposing:
infectious agents
physical injury
toxic substances
Hemodynamic disturbances

sepsis, diffuse pulmonary infection, gastric aspiration, head trauma account for >50% of cases

25

Pathogenesis of acute lung injury

Endothelial activation

Neutrophil accumulation and activation

Accumulation of intraalveolar fluid and hyaline membranes

Resolution of injury

26

Morphology of acute lung injury

Diffuse alveolar damage (DAD)

Grossly: heavy, firm, wet longs

Micro: congested, interstitial and idntraalveolar edema, necrosis of Type I and Type II pneumocytes, presence of hyaline membranes, collapse of some alveoli

Resolution: granulation tissue may form and resolve, reestablishing functional tissue
-occasional interstitial scarring

27

Clinical course of acute lung injury

depends on underlying cause and severity of lung injury

Mortality ~40%