Organ Pathology

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?


Non-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

papillomacarcinoma

Bronchi &Trachea

-diseases

Classification?


Non-neoplastic

– inflammation acute chronic


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?


Non-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 – 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

Documents

Organ Pathology