Post on 30-Dec-2015
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Organ Pathology Seminar / FAQ
Respiratory Tract Diseases
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
Respiratory tract
nose & paranasal cavities nasopharynx larynx trachea bronchi LUNG
Disease Nosologic Unit Definition Incidence , age/sex prevalence (if any) Etiology Possible clinical manifestation Pathogenesis
– macroscopy– microscopy– ultrastructure or other dg. tools – other (nonmorphological) dg. tools
Complications !!! Healing & prognosis !!!!
Diseases of the nose
and paranasal
cavities
Classification?
Most frequent/important ones ?
Non-neoplastic
– inflammation acute/chronic specific/non-specific superficial/intersticial
– pseudotumoursNeoplastic
Pseudotumours of the nasal
& paranasal cavities ?
Tumours of the nose & paranasal cavities?
Tumours of the nose & paranasal cavities
benign (papilloma, adenoma, hemangioma)
malignant - carcinoma– adenoca
–squamous cell
Nasopharyngeal tumours?
Nasopharyngeal tumours?
angiofibroma nasopharyngeal carcinoma (Schmincke´ lymphoepithelioma )
EBV
Larynx-diseases
Classification?
Most frequent/important ones ?
Non-neoplastic
– inflammation acute/chronic specific/non-specific superficial/intersticial
– pseudotumoursNeoplastic
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Laryngeal Pseudotumours
?
Laryngeal Neoplasms ?
NEOPLASIA – classification
HISTOGENETIC mesenchymal epithelial neuroectodermal mixed germ cell, teratoma
choriocarcinoma mesotelioma
Epithelial Tumours surface epithelium
papillomas carcinomas / papillocarcinomas
glandular epithelium adenomas adenocarcinomas
double diff.
mucoepidermoid
Laryngeal Neoplasms
papillomacarcinoma
Bronchi &Trachea
-diseases
Classification?
Most frequent/important ones ?
Non-neoplastic
– inflammation acute chronic
– pseudotumoursNeoplastic
Ca bronchogenes Definition Incidence , age/sex prevalence (if any) Etiology /risk factors Possible clinical manifestation Pathogenesis
– macroscopy !!!!!– microscopy– ultrastructure or other dg. tools – other (nonmorphological) dg. tools
Complications Healing & prognosis
Macroscopy (x-ray) forms of lung ca
central early symptoms peripheral surgery possible Pancoast Horner´ triad pulmopleural x meta pulmomediastinal x meta multifocal x meta lobar x non neopl. dis.
Classification of Lung Cancer (Clinical) (biology behaviour)
small cell
non small cell
Small Cell Ca
chemotherapy sensitive
symptomatic period short
distant meta at the time of dg.
common
expression of the myc oncogen
Non Small Cell Ca
chemotherapy insensitive
surgery (if possible = 20-40%)
mutation of K-ras oncogen
Histopathology Classification of Lung Cancer
small cell – highly malignant , with/without neuroendocrine diff.
spinocellular (epidermoid) adenocarcinoma
(subtype bronchioloalveolar ca) large cell (undifferentiated)
Risk factors for pleural &
lung (!) neoplasms ?
Lung Cancer - course
agressive cough, weight loss, pain, dyspnea 5 yr survival remains in non small cell ca 10%
Other Bronchial & Lung
Tumours ?
LUNG
-diseases
Classification?
Most frequent/important ones ?
Non-neoplastic
– inflammation acute/chronic specific/non-specific superficial/intersticial
– pseudotumoursNeoplastic
Non-neoplastic– childhood – atelectasis, bronchopulmonary
dysplasia,newborn RDS, SIDS
– vascular - acute and chronic venostasis
– inflammation acute/chronic (obstructive & restrictive lung
dis.) specific/non-specific superficial/intersticial
– pseudotumours
Neoplastic
Atelectasis – imperfect expansion at birth
Collapse – return to airless state
Atelectasis - Collapse
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Idiopathic int. Pneumonitis –fibrosing alveolitis Fibrosis without recognized cause, immune complex
deposition Progressive dyspnea, resp. failure, cor pulmonaleUsual IP (UIP)-acute phase is followed by proliferation of fibroblasts producing Collagen-fibrosis, derangement of alv. wallsDesquamative IP (DIP)-macrophages in alveoli,good
prognosis Lymphocytic IP (LIP) - extensive inf. of the interstitium with lymphocytes and plasma cells Giant cell IP- after inhalation of fumes of hard metals alloys
Interstitial pneumonitis and fibrosis
After inhalation of antigens Farmer´s dis actinomycete in moldy hay Mushroom´s worker´s dis – Bird-fancier´s lung- bird dropping Maple bark stripper´s dis – maple bark Malt worker´s lung – barely malt Suberosis – mouldy cork dust Pituitary snuff takers lung- pituitary snuffPathology -acute interst. pneumonitis Granulomas with giant cells bronchiolitis fibrosis
Hypersensitivity pneumonitis- extrinsic allergic alveolitis
After inhalation of antigens Farmer´s dis actinomycete in moldy hay Mushroom´s worker´s dis – Bird-fancier´s lung- bird dropping Maple bark stripper´s dis – maple bark Malt worker´s lung – barely malt Suberosis – mouldy cork dust Pituitary snuff takers lung- pitutitary snuffPathology -acute interst. pneumonitis granulomas with giant cells bronchiolitis fibrosis
Hypersensitivity pneumonitis - extrinsic allergic alveolitis
Definition – permanent overdistension of the air passages distal to the terminal bronchioles. It is ass. with destruction of the walls of airspaces within the acini
Etiology – cigarette smoking, atmospheric pollution,infection, genetic defectClassification – proximal acinar e.(centriacinar) panacinar em. distal acinar e. irregular e.Symptoms – dyspnea, chronic coughing, chest „barrel shaped“ Ribs almost horizontal, prominent sternoclavicular muscles Pulmonary hypertension, prolonged expiration, respir. acidosis, hypoxiaPathology – lungs are voluminous, pale, edges of lung are rounded, bullae like bubbles at the periphery, the heart is obscured during autopsyHistology – thining and destruction of alv. walls, alveoli are confluent, Large airspaces, capillaries are diminished in number
Emphysema
Entrance of air into the connective tissue of the lung, mediastinum and soft tissue
Spontaneously – incr. intraalveolar pressure, coughIn patiens on respiratore, lung trauma – fractured ribs
Symptoms – swelling of the neck and head Crackling crepitation
Interstitial emphysema
Etiology – viruses- measles v., adenoviruses, cytomegalovirus Chlamydia psittaci Rickettsiae- C. Burneti Mycoplasma pneumoniaePathology- alveolar septa expanded-hyperemia, lympho-plasmocytic inf. hyaline mebranes viral inclusion bodies multinucleated giant cells- measles, RSVComplication – interstitial fibrosis
Acute interstitial pneumonia
pleural plaques, diffuse pleural thickeninginterstitial fibrosis-asbestos bodiesmesotheliomascarcinoma of the lungasbestos body – fibre coated with layers of iron
containing proteinsfine septal scarring, changes in resp. bronchiolesmacrophages release the cytokines and growth
factorsproliferation of fibroblasts
Asbestosis
• toxic effect of the crystalline silica on the
lysosomal membranes• lysosomal rupture, release of enzymes
Pathology:
diff. reticular fibrosis
small nodules having a whorled pattern
fusion of nodules- massive fibrosis
Silicosis inhalation of silica or
silicon dioxide
Simple form-small black macule containing dust- laden macrophages Macule progress to become nodules containing collagen
Complicated form – progressive masive fibrosisNodules exceeding 1cm in diameter
Coal miner´s pneumoconiosis
Tuberculosis ?
Disease Nosologic Unit Definition Incidence , age/sex prevalence (if any) Etiology Possible clinical manifestation Pathogenesis
– macroscopy– microscopy– ultrastructure or other dg. tools – other (nonmorphological) dg. tools
Complications Healing & prognosis
TUBERCULOSISMycobacterium tuberculosis
(Koch 1882)
Mycobacterium bovis acidoresistance M. avium,intracellulare, Kansasii
atypical mycobacterioses
Vasculitis & necrotizing granulomas
Alergic granulomatosis (Churg-Strauss)
Wegener´s granulomatosis
TUBERCULOSIS
Type of infection
childhood (primary, preimmune)
adult (postprimary, immune)
TUBERCULOSISMorphological features primary infect (Ghon´s focus) &
primary complex caseification isolated organ metastasis tubercle, exsudate, cavity early and late generalisation
– milliary spread
TUBERCULOSISTerms –Forms– Locations:
phtisis gallopans scrofulosis meningitis basillaris lupus vulgaris mallum Potti, cold absces