Download Respiratory tract diseases

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
– pseudotumours
Neoplastic
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
– pseudotumours
Neoplastic
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
papilloma
carcinoma
Bronchi
&Trachea
-diseases
Classification?
Most
frequent/important
ones ?
Non-neoplastic
– inflammation
acute
 chronic

– pseudotumours
Neoplastic
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
 peripheral
 Pancoast
 pulmopleural
 pulmomediastinal
 multifocal
 lobar
early symptoms
surgery possible
Horner´ triad
x meta
x meta
x meta
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
– pseudotumours
Neoplastic
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 - Collapse
Atelectasis – imperfect expansion at birth
Collapse – return to airless state
Inflammation -
Classification:
Type of exsudate:





serous
nonpurulent –
lymphoplasmocellular
purulent
fibrinous
gangrenous
Interstitial pneumonitis and fibrosis
Idiopathic int. Pneumonitis –fibrosing alveolitis
Fibrosis without recognized cause, immune complex
deposition
Progressive dyspnea, resp. failure, cor pulmonale
Usual IP (UIP)-acute phase is followed by proliferation of
fibroblasts producing
Collagen-fibrosis, derangement of alv. walls
Desquamative 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
Hypersensitivity pneumonitisextrinsic 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- pituitary snuff
Pathology -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 snuff
Pathology -acute interst. pneumonitis
granulomas with giant cells
bronchiolitis
fibrosis
Emphysema
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 defect
Classification – 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,
hypoxia
Pathology – lungs are voluminous, pale, edges of lung are rounded, bullae like
bubbles at the periphery, the heart is obscured during autopsy
Histology – thining and destruction of alv. walls, alveoli are confluent,
Large airspaces, capillaries are diminished in number
Interstitial emphysema
Entrance of air into the connective tissue of the
lung, mediastinum and soft tissue
Spontaneously – incr. intraalveolar pressure, cough
In patiens on respiratore, lung trauma – fractured
ribs
Symptoms – swelling of the neck and head
Crackling crepitation
Acute interstitial pneumonia
Etiology – viruses- measles v., adenoviruses,
cytomegalovirus
Chlamydia psittaci
Rickettsiae- C. Burneti
Mycoplasma pneumoniae
Pathology- alveolar septa expanded-hyperemia,
lympho-plasmocytic inf.
hyaline mebranes
viral inclusion bodies
multinucleated giant cells- measles, RSV
Complication – interstitial fibrosis
Asbestosis
pleural plaques, diffuse pleural thickening
interstitial fibrosis-asbestos bodies
mesotheliomas
carcinoma of the lung
asbestos body – fibre coated with layers of iron
containing proteins
fine septal scarring, changes in resp. bronchioles
macrophages release the cytokines and growth
factors
proliferation of fibroblasts

Silicosis inhalation of silica or
silicon dioxide
• 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
Coal miner´s pneumoconiosis
Simple form-small black macule containing
dust- laden macrophages
Macule progress to become nodules containing
collagen
Complicated form – progressive masive fibrosis
Nodules exceeding 1cm in diameter
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
TUBERCULOSIS
Mycobacterium 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)
TUBERCULOSIS
Morphological features
 primary infect (Ghon´s focus) &
primary complex
 caseification
 isolated organ metastasis
 tubercle, exsudate, cavity
 early and late generalisation
– milliary spread
TUBERCULOSIS
Terms –Forms– Locations:
 phtisis gallopans
 scrofulosis
 meningitis basillaris
 lupus vulgaris
 mallum Potti, cold absces