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139 Cards in this Set

  • Front
  • Back
two patterns for acute lung injury
Diffuse alveolar damage
• Organizing pneumonia
what are hyaline membranes made from
composed of dead cells
(nucleoplasm, cytoplasm,
DAD organizing phase vs. pneumonia
myofibroblasts and fibroblasts but no hyaline membranes in pneumonia
dad review
dad review
just for review
when do hyaline membranes peak in DAD, when fibrosis start
both day 2
"strange' cause of DAD
connective tissue dz
boop vs. pneumonia
boop vs. pneumonia
pneumonia - note fibroblastic foci is branching, new and distal
what, clinical term, pathology term, how much of lung, how treat
what, clinical term, pathology term, how much of lung, how treat
UIP (idiopathic pulmonary fibrosis for clinicians), diffuse bilateral, temporal and geographic heterogeneity,
bad prognosis, NOT steroids, transplant in young patients
where is UIP most often found
Periphery of lung and lower lobes
-subpleural, paraseptal
variation in fibrosis in UIP
Dense fibrosis with remodeling and usually honeycombing
Fibroblastic foci at edge of fibrosis
histologic fx of NSIP
Uniform septal thickening
Usually no honey combing/architectural
Fibrotic and cellular patterns
causes of NSIP
CVD, drugs, infection, pneumoconiosis
cellular phase of NSIP - expansion by plasma cells and lymphocytes
fibrotic phase of NSIP
how to think of DIP
DIP (smoking!)
think of primarily alveolar filling (with smoker's macs) and secondary interstitial fibrosis (uniformly, thick)
what is hamman-rich syndrome
AIP (aka organizing DAD), complete white out by CXR
cf LIP with cellular NSIP
more dense inflammatory infiltrate
what to associate with LIP
Assoc with HIV, CVD (Sjögren’s syndrome) , EBV, Pneumocystis
what are you at risk for developing with LIP
small% extranodal marginal zone lymphoma
new name for BOOP
when get COP
often 4-6 weeks post viral URI
ground glass opacities think
pathologic findings of COP
Patchy airway centered fibrous polyps of organizing
for collagen vascular dz what histologic lung patterns of injury do you most see
if see Follicular lymphoid hyperplasia – think
Sjögren’s syndrome
think: sjogren's syndrome, follicular lymphoid hyperplasia
acute hypersensitivity pneumonitis - what type of hypersensitivity
type III
chronic hypersensitivity pneumonitis
type IV hypersensitivity
histologic fx of hypersensitivity pneumonitis
Bronchiolocentric interstitial lymphoplasmacytic infiltrates
– Poorly formed interstitial granulomas
– Organizing pneumonia
– Chronic bronchiolar inflammation with peribronchiolar metaplasia
causes of eosinophilic pneumonia
1. loeffler's - allergic
2. Churg-strauss - if vasculitis, asthma
3. acute idiopathic if unknown (wiht DAD)
two diffuse alveolar hemorrhage syndromes
wegener's and goodpastures
what is granulomatosis with polyangiitis
triad for wegener's pathologically
Vasculitis, granulomas and geographic necrosis
what is the cANCA in wegener's against
serine proteinase-3
response of wegener's to steroids
great response, fatal if untreated
diffuse alveolar hemorrhage syndrome (wegener's vs. goodpastures
presentation of someone with goodpasture's
young male, hemoptysis
test for goodpasture's
DIF alveolar septal basement
membranes with IgG and complement (anti alveolar BM antibodies; linear staining)
pseudomonas - micro fx
Gram-negative, motile (polar flagellum), strictly
aerobic, oxidase positive, respiratory
metabolism NOT fermentative
three clinical settings for pseudomonas
– Cystic fibrosis
– Contaminated respiratory equipment
good stain for nocardia
Partial acid-fastness (Ziehl-Neelson+)
atypical pneumonias: two
mycoplasma, chylamydia
how does mycoplasma attach to ciliated resp epithelium
consequence of mycoplasma pneumonia
development of cold agglutinins to I rbc antigen
how does chylamydia get into to cells
attaches through elementary body
how acquire C. psittaci
bird droppings (parakeet)
CMV - dna, rna?
ds DNA
which HSV (1 or 2) is GU, which is respiratory
HSV1 - respiratory
clinical findings for measles
1-2 wk incubation, then fever, Koplik’s spot, giant cell pneumonia
if see giant cell pneumonia think:
RSV or measles
what type of giant cells are seen with measles
Warthin-Finkeldey cells
adenovirus: DNA, RNA, ds or ss
ds DNA virus (nonenveloped)
pulmonary pattern for adenovirus
bronchiolitis (can be severe, necrotizing)
what is in walls of mycobacterium TB
mycolic acid
what is Ranke’s complex
calcified hilar nodes + GHon complex
mechanism of entry of TB
Alveolar bacilli are ingested by neutrophils and
macrophages - macrophages may go to regional
lymph nodes
compare granulomas of Wegener's vs. TB
those of TB tend to be more round, no vasculitis too
use for auramine-rhodamine IF
to identify TB
where see MAI most commonly in lungs
middle lobe (hard to get secretions out, lady windemere)
association with MAI
hot tubs
where are granulomas found in MAI
airway baesd granulomas
findings in Allergic bronchopulmonary aspergillosis
Tide mark lines
– Collections of eos
– Mucous
– Charcot-Leiden
since often too small to see on H&E, here's what to look for:
Intra alveolar macrophages and hob nailed pneumocytes
Intracellular (exist in macrophages)
may see round necrotizing granulomas
clinical setting for cocciodiodes
40% have flu-like illness for 1-3 wks
– 20% have erythema multiforme or erythema nodosum
clinical setting for blastomyces
likes to disseminate to skin and bone but can go to lung
clinical setting for cryptococcus
lung, hematogenous to cerebromeningeal
new name for P carinii
Pneumocystis jirovecki
histol fx for pneumocystis
Intra-alveolar frothy material with minimal inflammation
– GMS stains show 7-8 micron non-budding cysts
– Dented ping-pong balls
– Some with central black dot
– PAS negative
what does Peudoallescheria boydii look like histologically
like actinomyces
what does Peudoallescheria boydii cause clinically
Associated with allergic bronchopulmonary
three forms of toxo
– Tachyzoite (invasion, proliferation)
– Tissue cyst (reservoir for tachyzoites) - cat is reservoir
– Oocyst (infectious after sporulation)
what to think of
what to think of
acute necrotizing pneumonia - toxo
bag of jelly beans, toxo
filiform larva of strongyloides
Protoscolices containing teeth-like hooklets - ecchinococcus
where find echinococcus
liver in adults
lungs in kids
what associated with Michaelis-Gutman bodies in lungs
Rhodococcus equi
Aerobic Grampositive/ variable coccobacillus
what stain can be used for michaelis-gutman bodies
mineralization stain - von Kossa
host and vector for Bartonella quintana or hensalae
Cat is common host; transmission by flea,
Ctenocephalides felis
useful stain for bartonella spp
warthin-starry (gram neg rods)
causes of secondary pulmonary hypertension
Obstructive or interstitial lung disease
– Heart disease
– Recurrent thromboemboli
in whom is PPH seen and what is the underlying problem
young to middle age women, endothelial dysfunction
specific fx in scope on PPH
Plexiform lesion (anastomosing vessels)
– Angiomatoid lesion (plexiform+dilation)
– Necrotizing arteritis

applicable to both primary and secondary causes: smc proliferation in intima and media
what is Capillary hemagiomatosis
prominence of septal vessels
what, in whom, syndromic association, family of tumors
what, in whom, syndromic association, family of tumors
Cystic lung disease with numerous cysts lined by plump
smooth muscle cells
young women
TS, PEComa
another name for eosinophilic granuloma
langerhans cell histiocytosis X
association for eosinophilic granuloma in adults
smoking, DIP
eosinophilic granuloma (LCH)

*Stellate centrilobular scar with eosinophils
and Langerhans cells (coffee bean shape, grooves)
causes of alveolar proteinosis
-congenital (surfactant defect)
- inhale dusts
- problems with GM-CSF (where Macs can't consume surfactant and it accumulates)
what, ddx (how distinguish)
what, ddx (how distinguish)
pulmonary alveolar proteinosis
No small dots as seen in pneumocystis
PAS+, unlike pneumocystis
name, assoc/cause
name, assoc/cause
lipoid pneumonia, aspiration
noncaseating granulomas: two prominent ddx
two findings in sarcoid
asteroid bodies
schaumann bodies

note granulomas usu around bronchovascular bundle
what is a type I hypersensitivity in lung
causes CF, Kartagener's (lack dynein arms on cilia)
which emphysema is found where
centrilobular: bronchi-centered, upper lobes
panacinar: diffuse, lower lobe predominant
when clinical sx worse than path, what to consider
constrictive bronchiolitis (often just a little fibrosis or a little inflammation)
can get an obliterated bronchus
what, location, ihc
what, location, ihc
inflammatory myofibroblastic tumor
Bland spindle cells, inflammatory cells and
usu. endobronchial
sma, alk in 40%
two additional names for sclerosing hemangioma
pneumocytoma and sclerosing epithelioma
cell of origin of a sclerosing hemangioma
Tumor of primitive respiratory epithelium, not
vascular tumor (not hemangioma)
sclerosing hemangioma
Type 2 pneumocytes (hobnailing) line the surface of
papillary structures with underlying round cells
staining pattern for cells of sclerosing hemangioma
Surface epithelial cells (hobnailed cells)
keratin +, EMA+ TTF1+
– Round cells (bland cells): keratin -, EMA +, TTF1+
molecular targets in lung ca
EGFR, drug (cetuximab, gefitinib, erlotinib),
– Non smokers, women, asian
EML4-ALK (crizotinib), young non-smokers
VEGF, drug (avastin, ect)
HER2, drug herceptin
KRAS, smokers
what to test for molecularly in lung ca
EGFR and ALK if adenoca component
ihc for lung scca
p63+, CK5/6+, 34βe12 +, CK7+, CK20-
is lung scca a/w EGFR mutations
ihc for lung adenoca
TTF1+, napsin+, mucin+ CK5/6 -
if adenoca in lung and egfr mutation, think:
women, nonsmoker, asian
if adenoca lung with alk mutation, think:
young, nonsmoker
what does atypical adenomatous hyperplasia lead to (<5mm)
adenoca precursor (call it a BAC if >5mm)
does mucinous BAC have egfr mutations
nope, and worse prognosis
mits and necrosis for neuroendocrine tumors of lungs
carcinoid <2 mits/10 hpf, no necrosis
atypical 2-10 mits, necrosis
small and large cell >10/10 mits, lots of necrosis, just cell size dependent at that point
fx of acute rejection
Changes in alveoli
– Intraparenchymal perivascular
mononuclear infiltrates
– More PMNs, eos and macrophages as
disease develops
– Endothelialitis
fx of grade b rejection in lung
Lymphcytic bronchiolitis
– Combined large and small airway inflammation
fx of grade C rejection in lung
chronic Chronic airway rejection
– Bronchiolitis obliterans
fx of grade d rejection
chronic vascular rejection
Fibrointimal thickening of arteries and
SFT ihc
CD34, Bcl-2, CD99
ihc for mesothelioma
calretinin (cyto and nuclear),
CK 5/6, thrombomodulin, WT-1 (nuclear)
Sarcomatoid mesothelioma loss of these
– may only be calretinin +
Types of asbestos
– Serpentines – curly flexible fibers
1) Chrysotile – most U.S. asbestos
2) Less pathogenic
– Amphiboles – straight stiff fibers
1) More pathogenic
2) Amosite, crocidolite
association aspergillus?
fx of legionella pneumonia
alveolar exudates of PMNs, macrophages
with fibrin +/- hyaline membranes.
Dieterle stain - small intra/extracellular coccobacillary organisms (Gram - )
appearance: Pseudomonas pneumonia –
acute necrotizing vasculitis
Allergic pulmonary Aspergillosis histology
bronchocentric granulomas
see giant cell pneumonia, think
two imp't facts about lung scca
most associated with hypercalcemia
lung ca most a/w paraneoplastic syndromes
small cell ca
know the gross fx of chondroid hamartoma
see epithelial clefting
fx and ihc of sft
SFT, pleural pedunculated plaque, patternless pattern and staghorn
vessels CD34/CD99/BCL-2 +
most common site of a plasmacytoma
upper respiratory tract
clear cell sarcoma a/w
ts and lam
ihc for mesothelioma
+ for calretinin and CK5/6+,- for CEA/EMA/LeuM1
Definition of Good Pastures
to antigens in basement membrane
where find centrilobular emphysema
upper lobes
and upper potions of lower lobes
anthrasilicosis - coal mine lung