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35 Cards in this Set
- Front
- Back
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This lesion shows dense, intra-alveolar eosinophilic material with associated cholesterol clefts.
What are the causes? (4) What is the treatment? |
Lesion: Alveolar proteinosis
Causes: infections, acute silicosis, malignancies, idiopathic Treatment: Some resolve spontaneously; whole lung lavage is very effective for those who need it. |
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What are the EM findings in mesothelioma vs. adenoarcinoma?
ICH Mesothelial cells vs. Glandular cells: calretinin WT1 CK5/6 B72.3 BerEP4 LeuM1 (CD15) CEA p63 |
EM: Mesothelioma features long slender microvilli while adenocarcinoma features short microvilli.
Mesothelial Cells: calretinin + WT1 + CK5/6 + B72.3 - BerEP4 - LeuM1 (CD15) - CEA - p63 - Glandular Cells: calretinin - WT1 - CK5/6 - B72.3 + BerEP4 + LeuM1 (CD15) + CEA + p63 - |
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What condition is linked with mutations in BMPRII gene?
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Primary pulmondary hypertension
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Grossly, this lung lesion resembles cirrhotic liver on the surface due to scarring and retraction. Hstiologically, it is characterized by a peripheral lobular fibrosing process, resulting in dense fibrosis in the peripheral zones with loss of alveolar architecture. Pulmonary lobules show temporal heterogeneity.
What is meant by temporal heterogeneity? What is the treatment? |
Clinical idiopathic pulmonary fibrosis = pathological usual interstitial pneumonia
Temporal heterogeneity: uninvolved lung, fibroblastic/myofibroblastic proliferation, dense scarring all in the same biopsy. Treatment: lung transplant. Steroids don't do anything. |
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Define centrilobular emphysema and name a risk factor. What is the mechanism of damage? What lobes are more typically affected?
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Definition: Centrilobular emphysema = expansion of the respiratory bronchioles due to damage with sparing of the distal structures, alveoli.
Risk factor: Smoking Mechanism: Smoking causes an imbalance between proteases (increased) that damage connective tissue (e.g. elastin) and antiproteases (decreased). Location: upper lobes |
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Define panlobular emphysema and name the cause. What lobes are more typically affected?
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Definition: Panlobular emphysema = expansion of the respiratory acinus (respiratory bronchioles + alveoli)
Cause: alpha-1-antitrypsin deficiency Location: Lower lobes and anterior lung margins |
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Grossly, this lesion consists of marked dilation of the bronchi with dilation extending up to the pleura. The mucosa of the airway is discolored. There is significant loss of alveolar lung parenchyma with collapse.
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Bronchiectasis
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What generally causes bronchiectasis?
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Generally, anything that leads to chronic obstruction of airways will result in conducting airway remodeling which causes dilation and down-stream structures to eventually collapse and fibrose:
Repeated infection Allergic bronchopulmonary aspergillosis Associated with autoimmune diseases (RA, IBD) CF Kartagener's syndrome |
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Exposure to this substance causes an allergic reaction which histologically resembles sarcoidosis.
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Beryllium (berylliosis)
NOTE: Classically associated with beryllium mining or fluorescent light bulb manufacturing |
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This biphasic neoplasm is composed of papillary-like pojections lined by epithelioid cells with central proliferation of polygonal cells. Both populations are positive for EMA and TTF1. The epithelioid cells are positive for cytokeratin while the central polygonal cells are negative.
What population is more commonly affected? What is the cell of origin? What is the behavior? |
Tumor: sclerosing hemangioma of lung
Population: females in their 40s Cell of origin: type 2 pneumocyte Behavior: benign, though this rarely metastasizes to lymph nodes, no one dies of disease |
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Coccidioides immitis:
Transmission/geography Organism morphology Histology |
Coccidioides immitis:
Transmission/geography: dust/soil inhalation in Southwestern US Organism morphology: Spherules (30-100 um) containing endospores (2-5 um) Histology: chronic necrotizing granulomatous nodules with intact or fragmented spherules |
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Histoplasma capsulatum:
Transmission/geography Organism morphology Histology |
Histoplasma capsulatum:
Transmission/geography: inhalation of bird poop, Ohio River Valley and lower Mississippi River Valley Organism morphology: 2-4 um intracellular (macrophage) organisms with narrow based asymmetric buds Histology: necrotizing granuloma |
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Cryptococcus neoformans:
Transmission/geography Organism morphology Histology |
Cryptococcus neoformans:
Transmission/geography: inhalation of pigeon poop, found worldwide Organism morphology: 4-6 um with prominent polysaccharide capsule (India ink), asymmetric narrow based budding Histology: granulomatous or minimal reaction |
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Blastomyces dermatitidis:
Transmission/geography Organism morphology Histology |
Blastomyces dermatitidis:
Transmission/geography: inhalation of dust/soil, Southeastern (Mississippi River Valley) and Midwestern US Organism morphology: 8-15 um spheres with broad based budding Histology: suppurative and granulomatous |
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What are the manifestations of Aspergillus? (5)
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1. Aspergilloma
2. Minimal/chronic invasive 3. Invasive 4. Allergic bronchopulmonary aspergillosis 5. Necrotizing tracheobronchitis |
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This giant cell pneumonia contains distinctive giant cells cannibalizing histiocytes within its cytoplasm.
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Hard metal (cobalt and tungsten) pneumoconiosis
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TSC1 and TSC2
Alternative names Chromosome |
TSC1
Alternative names: - tuberous sclerosis protein 1 - haartin Chromosome: 9 TSC2 Alternative names: - tuberous sclerosis protein 2 - tuberin Chromosome: 16 |
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Cytopathic change:
Adenovirus |
Smudge cell
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Cytopathic change:
CMV |
Enlarged cell with nuclear and cytoplasmic inclusions. Nuclear inclusion with halo.
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Cytopathic change:
HSV |
Multinucleation with nuclear inclusions (steel gray nuclei) with nuclear molding
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Cytopathic change:
Measles |
Large cells with multinucleation with nuclear and cytoplasmic inclusions (Warthin-Finkeldey cells)
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Are ferruginous bodies specific for asbestos?
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No, though ferruginous bodies indicate asbestos, not all ferruginous bodies are due to asbestos.
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What is a chemodectoma?
What population is at risk? What is the mechanism of development and is it a neoplasm? |
Chemodectoma: minute pulmonary meningothelial-like nodule
Population: women Mechanism: associated with states of chronic tissue hypoxia; is a neoplasm (clonality) |
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This lesion is characterized by alveolar spaces packed by pigmented macrophages. There may also be mild smooth muscle thickening. What is this lesion due to?
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Respiratory bronchiolitis due to smoking
NOTE: symptomatic people have the clinical diagnosis of respiratory bronchiolitis-interstitial lung disease |
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This lesion characterized by grooved histiocytes is strongly associated with smoking and pneumothorax due to traction emphysema.
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Langerhan's cell histiocytosis
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What is another name for idiopathic bronchiolitis obliterans organizing pneumonia (BOOP)? What are some of the causes of BOOP? What is the treatment? Do people develop ILD?
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BOOP = cryptogenic organizing pneumonia (COP)
Causes: adjacent lung mass, infection, rheumatologic, idiopathic Treatment: steroids, responds well ILD: not usually (no permanent scarring) |
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This medium vessel autoimmune vasculitis is characterized by eosinophilic granulomatous inflammation. Involved areas include lung, GI tract, and peripheral nerves. Patient's are P-ANCA positive.
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Churg-Strauss
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This systemic vasculitis, typically affecting skin, is characterized by deposition of immune complexes containing IgA. The disease is usually self-limited though 1% of people develop irreversible renal failure. One third of patients have relapse.
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Henoch-Schonlein purpura
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Wegener's granulomatosis, microscopic polyangiits, SLE, mixed cryoglobulinemia, Henoch-Schonlein purpura, antiphospholipid antibody syndrome, and Goodpasture's syndrome can all present with this in the lungs, histologically characterized by: alveolar walls with dense infiltrate of neutrophils associated with neutrophilic debris, prominent fibrin, capillaritis.
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Diffuse pulmonary hemorrhage syndrome
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This lesion is characterized by interstitial lymphocytic inflammation involving alveolar walls. The process is seen more commonly in children with AIDS, but may also be seen in adults with AIDS. It can be seen in autoimmune disease such as Sjogren's syndrome as well as medication reaction.
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Lymphocytic interstitial pneumonia (LIP)
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This lesion is characterized by airways whose lumens are completely obliterated and replaced by fibrous tissue. Causes include infections (e.g. adenovirus), autoimmune disease (e.g. RA), and medications especially penicillamine. This may occur in lung transplant patients over time and sometimes occurs with fume exposures. This process is sometimes idiopathic.
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Constrictive bronchiolitis (AKA obliterative bronchiolitis)
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This lesion, more commonly found in the bladdr, is grossly characterized by ulcer, plaque, or papule and microscopically contains Michaelis-Gutmann bodies admixed with histiocytes forming large areas of consolidation. This can be seen in immunosuppression and is asociated with Rhodococcus equi infection.
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Malakoplakia
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What special stain can be used to visualize Legionella pneumophilia?
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Dieterle stain
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Define:
Carcinoid tumorlet Typical carcinoid Atypical carcinoid Large cell neuroendocrine carcinoma |
Define:
Carcinoid tumorlet: less than 0.5 cm Typical carcinoid: less than 2 mites per 10 HPF, no necrosis Atypical carcinoid: 2-10 mites per 10 HPF, necrosis present Large cell neuroendocrine carcinoma: - NE differentiation by morphology, IHC, or EM - Greater than 10 mites per 10 HPF - Necrosis - Non-small cell morphology |
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What is rounded atelectasis? What is it associated with?
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Atelectasis formed from adhesion between a parietal pleural plaque and the visceral pleura resulting in progressive fibrosis and retraction entrapping (and folding up) lung parenchyma (rounded atelectasis).
Association: asbestos exposure |
