Lungs Hist.txt

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Author:
emm64
ID:
141699
Filename:
Lungs Hist.txt
Updated:
2012-03-16 13:54:34
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Wallace Lung
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Wallace Lung
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    • Sarcoidosis
    • Systemic noncaseating granulomatous disease – can affect perhaps every organ.
    • Usual sites of granulomas are mediastinal lymph nodes, lungs, liver.
    • Disease of exclusion
    • Great variation in lung disease manifestation – from minimal subclinical to severe interstitial fibrosis with end stage restrictive lung disease.
    • Histology shows well-formed non-caseating granulomas.
    • Sarcoidosis
    • Histology shows well-formed non-caseating granulomas
    • Hypersensitivity Pneumonitis
    • Hypersensitivity reaction to an inhaled antigen that results in chronic bronchocentric inflammation.
    • May be acute, subacute (intermittent) or chronic.
    • Acute reactions due to type III hypersensitivity; chronic reaction due to type IV hypersensitivity.
    • Symptoms include: dyspnea, fever, malaise, weight loss, clubbing
    • More than 300 antigens have been described. Common agents include bird peptides (especially parakeet) and fungi (living in moldy hay, dust, hot tubs, humidifiers)
    • Poorly Formed Granuloma
    • hypersensitivity penumonitis, pt has restrictive lung disease; vs. if someone is acting clinically like they have TB and you see a granuloma, they prob have TB
    • -question is very much in the presentation- ex. if granuloma is in the context of restrictive lung disease, vs in context of TB
    • Nonspecific Interstitial Pneumonia
    • Pattern of uniform septal thickening
    • Fibrotic and cellular patterns
    • May be primary or secondary.
    • Secondary causes include collagen vascular diseases (like lupus, rheumatoid arthritis), drugs, infection. Mimickers include lymphoma
    • -NSIP: similar to UIP, but instead of having stark contrast btw normal & severe disease, there is a much more gradual transition
    • fibrotic and cellular patterns- UIP is very fibrotic
    • NSIP may be the manifestation of another disease
  1. Normal lung parenchyma


    • Usual interstitial pneumonia
    • Histologic pattern seen in diffuse, bilateral interstitial lung disease~9/100/000, usually between 50-70
    • Poor prognosis, mean length of survival 3.2-5.0 years
    • Idiopathic, genetic and environmental risk factors known
    • Characteristic clinical, radiologic, and histologic features
    • Usual interstitial pneumonia
    • Histologic pattern seen in diffuse, bilateral interstitial lung disease
    • ~9/100/000, usually between 50-70
    • Poor prognosis, mean length of survival 3.2-5.0 years
    • Idiopathic, genetic and environmental risk factors known
    • Characteristic clinical, radiologic, and histologic features
    • Emphysema
    • Centrilobular emphysema is the most common form and is associated with smoking. Damage to alveolar walls adjacent to respiratory bronchioles is observed.
    • Panacinar (panlobular) emphysema is observed in alpha-1-antitrypsin deficiency. The entire lobule is involved
    • -there has been complete destruction of the alveolar wall in the center;
    • Gross Emphysema
    • -right: normal lung; if you felt it, it would be soft, smooth, cannot distinguish btw apex and base
    • -left: cavitations in lung, and much of normal parenchyma has been lost; much worse at apex of lung than at the base of the lung (seen in smokers)
    • normal bronchiole
    • epithelium should sit right on top of the smooth muscle
    • if this bronchiole needed to expand, it has elasticity and has no problem expanding- this is why there are undulations of the epithelium; also, can constrict
    • Chronic Bronchitis
    • clinical diagnosis defined as daily productive cough for 3 months, 2 years in a row.
    • Histologic features:
    • chronic inflammation
    • goblet cell hyperplasia
    • increase in submucosal mucous glands
    • -in smokers, esp chronic smokers, you have scarring in the smaller airways
    • -lumen should be 2x the size; if you lose half the surface area of the lumen, it will be much harder to get air through it
    • also, scarring means there is fibrosis and loss of elasticity, so it doesn’t expand like you would want it to if more air is needed
    • mucostasis, inflammatory cells (but no eosinophils), edema; this is the bronchus, which we can tell bc of cartilage (upper left)
    • -in a normal, healthy lumen, there is nothing there; here, there is mucus & debris (right side of pic)
    • -this image won’t be on the test; generally, histologic pics will be cleaner
    • Status Asthmaticus
    • this case came from a young man that died from asthma
    • -all airways were full of mucus (mucostasis), bc mucous glands are hyperstimulated, causing obstruction to movement of air
    • Asthmatic Bronchitis
    • eosinophils, basement membrane- classic picture for asthma; this is a “high-yield” histologic picture- KNOW THIS
    • inflammed mucosa; there has been edema in the tissue, due to inflammation- fluid comes out of leaky capillaries
  2. Bronchus
    • cartilage and submucosal glands
    • can see plates of cartilage, telling you this is a bronchus and not a bronchiole

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