• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/91

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

91 Cards in this Set

  • Front
  • Back
Lobar pneumonia demonstrating filling of alveolar spaces with neutrophils
Organizing pneumonia: A sequela of lobar or bronchopneumonia is ORGANIZATION of the alveolar exudate into fibrous tissue within the alveolar spaces, sometimes called “Masson bodies”
Bronchopneumonia with necrosis. The alveoli are filled with a neutrophilic exudate. Note that there is loss of the existing alveolar architecture.
Staphalycoccal pneumonia: Highly virulent strains of Staphalococcus organisms typically produce large areas of necrosis in addition to pneumonia.
Pseudomonas bronchopneumonia. Pneumonia caused by Pseudomonas sp. Also tends to produces areas of necrosis. Clouds of organisms are often visualized, which in this case are primarily clustered around a blood vessel wall.
Interstitial pneumonitis. The inflammatory infiltrate is primarily composed of lymphocytes, and is largely confined to the alveolar septa. (Lymphocytic infiltrate within the alveolar septa.) This pattern of pneumonia is most often seen in association with mycoplasmal, viral and chlamydial infections.
Cellular bronchiolitis: Chronic inflammatory cells surround a bronchiole. This pattern may be seen in viral or Mycoplasma small airway injury.
Lung Abcess
Blastomycosis - Notice the thick refractile walls and internal structure of the yeasts. Blastomycosis is characterized by broad based budding. Gross: Multiple granulomas are scattered throughout the parenchyma.
Coccidioidomycosis: Coccidiodomycosis is characterized by large spherules filled with smaller endospores.
Cryptococcosis - Notice the clear yeast which vary in size and are separated by space from the cytoplasm of ingesting cells.
Disseminated Histoplasmosis (H&E) Notice the myriad punctate basophilic organisms that are present. (high power: Notice the numerous intracytoplasmic organisms.)
Candidiasis in tracheobronchial mucosa. Notice the inflammatory pseudomembrane with aggregates of yeast.
Aspergillus (GMS) Notice the dicotomous branching hyphae at acute angles.
Mucormycosis of Lung - Notice the infarcted lung parenchyma with broad hyphae of Zygomycete. (crinkled ribbon-like hypae)
Caseating granuloma: Granulomas may undergo central necrosis which is smooth and homogeneous (aka caseous). This appearance is classic for TB, but may be seen in fungal infections as well.
Non-caseating granuloma: Granuloma composed of epithelioid histiocytes and giant cells. Central necrosis is absent.
Ghon Complex, gross: The Ghon complex consists of the primary focus of infections, typically in the upper part of the lower lobe or the lower part of the upper lobe, combined with involvement of hilar lymph nodes.
Healed Ghon Focus with Dystrophic ossifcation, fibrous wall, and caseocalcific center.
Miliary TB: In miliary TB, the organisms become widely disseminated and produce innumerable tiny granulomatous foci.
Miliary TB (Liver - portal microgranuloma)
Pneumocystis Pneumonia. Note the alveolar fibrinous frothy exudate and mild interstitial mononuclear infiltrate.
Pneumocystis Pneumonia. Note the alveolar fibrinous frothy exudate and mild interstitial mononuclear infiltrate.
PCP (Gomori Methenamine Stain) - Silver positive cysts of pneumocystis in alveolar froth.
MAI - blue-grey Histiocytes containing M. avium-intracellulair.
Cytomegalovirus inclusions in alveolar pneumocytes. Note both intranuclear and intracytoplasmic inclusions.
Kaposi’s sarcoma: Kaposi’s involving the lung is typically around bronchioles or underneath the pleura. The characteristic lesion is a proliferation of spindled cells with numerous extravasated blood cells.
Bronchiectasis - permanent, abnormal dilitation of the airways, usually due to infection, obstruction or hereditary conditions such as cystic fibrosis or Kartagener syndrome.

Respiratory epithelium is present at the top of the field representing an abnormally dilated airway. Note marked inflammation in the wall.
Bronchiectasis with squamous metaplasia: In long standing cases of bronchiectasis, the airway may undergo squamous metaplasia.
Pancreas with Cystic Fibrosis. Notice the laminated mucous plugs in ducts and acinar atrophy.
Chronic bronchitis - Notice the markedly increased Reid index (gland/wall thickness) and the hypertrophied mucinous acini.
Respiratory bronchiolitis: A central bronchiole and adjacent alveolar spaces are filled with pigmented “smoker’s” macrophages. Mild chronic inflammation is also present.
Alpha-1 Antitrypsin bodies in a Liver with Alpha-1 Antitrypsin Deficiency (PAS)
Centrilobular emphysema: Emphysema is characterized by abnormal permanent enlargement of airspaces accompanied by destruction of their walls. In Centrilobular emphysema, the central portion of the pulmonary acini are involved, and distal alveoli are spared. This is the type of emphysema most frequently seen in cigarette smokers.
Interstitial Emphysema
Asthma: Bronchial mucosa; goblet cell hyperplasia; festooned lumen
Asthma: Bronchial mucosa with basement membrane thickening and eosinophilic infiltrates.
Asthma: Eosinophils and Charcot-Lyden crystals in mucous plugs
Eosinophilic pneumonia. Low power demonstrating intra-alveolar fibrin, macrophages and prominent eosinophils. Eosinophils are present in both the alveolar exudate and within the alveolar septa.
Eosinophilic pneumonia. Higher power demonstrating prominent macrophages and eosinophils. A small focus of organizing pneumonia is also present in the center.
Sarcoidosis is characterized by tightly formed granulomas which lack central necrosis. The granulomas tend to follow the routes of the pulmonary lymphatics (a.k.a. "lymphangeitic distribution") and are therefore often found around bronchovascular bundles, along the interlobular septa and beneath the pleura.
Usual interstitial pneumonia (UIP) is characterized by patchy fibrosis which is typically more pronounced beneath the pleura and along the interlobular septa. In this picture the lung on the left is essentially normal, while the lung on the right is heavily involved by interstitial fibrosis.
Usual interstitial pneumonia. In addition to the patchy distribution of fibrosis, the fibrosis present in UIP shows evidence of "temporal heterogeneity", meaning that the fibrosis is of varying ages, indicating pulmonary insults occurring at different time or in an ongoing fashion. In this picture, one sees evidence of dense or "old" collagen in the form of the densely eosinophilic fibrosis, adjacent to an area of bluish-gray fibrous tissue known as a fibroblast focus. The fibroblast focus is indicative of the temporally heterogeneous fibrosis characterizing UIP.
Usual interstitial pneumonia/honeycomb lung. End stage fibrosis, or "honeycomb lung" is characterized by remodeling of the alveolar parenchyma by dense fibrosis. The residual airspaces are dilated and lined by metaplastic respiratory epithelium. Honeycomb lung is a frequent finding in UIP, but this type of end stage fibrosis may be encountered in most any fibrosing lung disease, for example sarcoidosis or chronic hypersensitivity pneumonitis.
Desquamative interstitial pneumonia(DIP) is characterized by diffuse filling of the alveolar spaces by macrophages. Associated interstitial fibrosis is typically minimal, or at least overshadowed by the amount of intra-alveolar macrophage accumulation.
Langerhan's cell histiocytosis (Eosinophilic granuloma). At low power, Langerhan's cell histiocytosis involving the lung, also known as eosinophilic granuloma, is characterized by peribronchiolar fibrosis which is often stellate in shape. In this picture, the bronchial epithelium is present on the right, and an adjacent area of fibrosis is observed, which has a stellate outline.
Langerhan's cell histiocytosis (Eosinophilic granuloma). At higher power, the fibrotic areas show an infiltration of large polygonal cells with irregular nuclei (Langerhan's cells) admixed with eosinophils.

By electron microscopy, Langerhan's cells have characteristic tennis racquet shaped inclusions known as Bierbeck granules.
Pulmonary alveolar proteinosis (PAP) is characterized by the filling of alveolar spaces with dense, eosinophilic granular material which has properties similar to that of surfactant.
Diffuse alveolar damage (DAD) is characterized by diffuse, uniform involvement of the pulmonary interstitium, indicating injury of uniform age. The alveolar walls are expanded by loose fibroblastic tissue and edema fluid. The alveolar spaces are lined by hyaline membranes, which is the histologic hallmark of DAD
Bronchiolitis Obilterans with endogenous lipoid pneumonia. (Oil Red O stain shows red color neutral lipid droplets admixed with delicate fibrous tissue of Bronchiolitis Obilterans)
Bronchiolitis Obilterans
Septal fibrosis and ferrugenous body with clear mineral core. (Asbestos body)
Asbestosis: Numerous ferrugenous bodies in a background of interstitial fibrosis.
Fibrous pleural plaque: Pleural plaques are often seen in persons exposed to asbestos and are composed of dense fibrous tissue arranged in a loose "basket weave" pattern. The fibrous tissue is eosinophilic and homogeneous giving it a hyalinized appearance.
Malignant Mesothelioma (epithelial pattern)
Malignant Mesothelioma (spindle)
Nodular Silicosis with whorled fibrous nodules
Silica and silicate birefringent particles surrounding silicotic fibrous nodule
Conglomerate silicosis with confluent whorled flibrous nodules
Silicoproteinosis: With heavy exposure to silica the alveolar spaces may become filled with granular, eosinophilic proteinaceous material identical to that seen in patients with pulmonary alveolar proteinosis who have not had exposure to silica. In other areas of the lung accumulation of histiocytes of fibrotic areas may be seen. Birefringent silica crystals may be identified by polarized light.
Silicoproteinosis
Silicoproteinosis with widened interstitium and histiocytes
Silicoproteinosis with widened interstitium and birefringent silica and silicate particles
Wegener's granulomatosis. At low power, there are irregular areas of necrosis (a.k.a. "geographic necrosis") which appear bluish due to presence of large numbers of neutrophils and neutrophilic debris. Scattered giant cells surround the areas of necrosis
Wegener's granulomatosis. Higher power demonstrating areas of necrosis with prominent neutrophils surrounded by giant cells.
Wegener's granulomatosis. Necrotizing vasculitis of medium sized pulmonary blood vessel
Alveolar hemorrhage syndrome. Low power demonstrates diffuse filling of alveolar spaces with fresh blood and hemosiderin-laden macrophages. This type of histology can be seen in Goodpasture's syndrome, idiopathic pulmonary hemosiderosis, lupus or occasionally in Wegener's granulomatosis.
Alveolar hemorrhage syndrome. Higher power demonstrating intra-alveolar hemosiderin-laden macrophages
Pulmonary HTN: Grade 1 lesion. Muscular pulmonary artery with thickened media
Pulmonary HTN: Grade 2 lesion. Occlusive myointimal hyperplasia. Note the residual circumferential medial muscle fibers
Pulmonary HTN: Grade 3 Lesion. Elastic stain. Note the mature collagenous concentric intimal fibrosis and reduplication of the internal elastic lamina.
Pulmonary HTN: Grade 4 plexiform lesions.
Pulmonary HTN secondary to recanalization of thromboembolus
Pulmonary HTN: Embolic secondary to IVDA: Notice the recanalized vascular lumen and giant cells containing foreign material, that is birefringent on polarizing microscopy.
Pulmonary veno-occlusive disease (Gross): Notice the thickened interlobular septa and brown coloration of lung parenchyma reflecting chronic congestion.
Pulmonary veno-occlusive disease: elastic stains show occluded recanalized pulmonary veins.
Pulmonary infarct gross: Visible pulmonary infarcts are typically subpleural and wedge shaped. The “base” of the wedge is along the pleural surface and the “point” is within the lung parenchyma, usually at the location of the occluded vessel. Pulmonary infarcts are hemorrhagic in appearance due to the dual blood supply of the lung.
Squamous cell carcinoma is composed of malignant cells which show features of squamous differentiation such as intercellular bridges, individual cell keratinization or, as seen in this picture, keratin pearl formation. Typically centrally located (gross) and may undergo central cavitation or necrosis. (Most laryngeal carcinomas are squamous cell carcinomas.)
Adenocarcinomas are typically peripherally located and are composed of malignant cells forming glandular structures, as seen here.
Small cell carcinomas are very aggressive and tend to be centrally located. They are composed of relatively small cells with hyperchromatic nuclei and very little cytoplasm. Mitoses are prominent.
Derived from pulmonary neuroendocrine cells (Kulchitzky cells), carcinoid tumors are typically composed of a uniform population of cells arranged in small nests.
Pulmonary hamartoma. Typically presenting as a peripheral nodule, pulmonary hamartomas contain varying proportions of cartilage, fat and respiratory epithelium.
Thymoma, a tumor of thymic epithelial cells typically presents as an anterior mediastinal mass an is characterized by a lobulated pattern of growth. In this picture, lobules of tumor are separated by broad fibrous bands.
Thymomas are composed of a variable number of neoplastic thymic epithelial cells (large eosinophilic cells with vesicular nuclei) admixed with variable numbers of benign lymphocytes, which are T-cells.
Pleuritis. In this section the pleura is markedly thickened and is covered with a fibrinous exudate on the surface.
Malignant mesothelioma. Mesotheliomas often form prominent papillary structures and tubules. In this picture, the surface demonstrates a prominent papillary configuration which merges with an underlying invasive component forming tubular/glandular structures.
Malignant mesothelioma. Mesotheliomas typically are composed of cuboidal cells which are fairly uniform in appearance. Differentiating mesothelioma from adenocarcinoma is difficult and requires the use of special stains and sometime electron microscopy for definitive diagnosis
Localized fibrous tumor. Localized fibrous tumor is a tumor derived from submesothelial connective tissue and is composed of spindled cells arranged in a haphazard pattern. Prominent "wire-like" collagen is a classic feature, as seen in this micrograph.
Laryngeal carcinoma, gross: A fungating ulcerated mass involves the vocal cords. The overwhelming majority of laryngeal carcinomas are squamous cell carcinomas.
Nasopharyngeal carcinoma, micro: Nasopharyngeal carcinomas are typically high grade undifferentiated carcinomas frequently associated with numerous benign lymphocytes, hence the old name "lymphoepithelioma"
Laryngeal papilloma, micro: A squamous papilloma is characterized by benign squamous epithelium covering a fibrovascular core.