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Squamous cell carcinoma. Note keratin pearls and desmosomes Name some characteristics. Only in smokers Centrally located Hypercalcemia  PTH like substance is made CLUBBING. asthma. Note the thickened BM and SM cells. Bronchoalveolar Carcinoma. Subset of adenocarcinoma

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Squamous cell carcinoma

Squamous cell carcinoma

Note keratin pearls and desmosomes

Name some characteristics


  • Only in smokers

  • Centrally located

  • Hypercalcemia  PTH like substance is made

  • CLUBBING


Asthma

asthma

Note the thickened BM and SM cells


Bronchoalveolar carcinoma
Bronchoalveolar Carcinoma

  • Subset of adenocarcinoma

  • Not associated with smoking

  • Peripheral location

  • Bronchograms are common

  • Cough with frothy sputum


Bad sputum sample

Bad sputum sample

Shows the normal squamous epithelial cells found in the upper respiratory tract…

Contamination of the sample



Small cell carcinoma

Small cell carcinoma

Note blue cells with high N/C ratio

No nucleoli

Salt n peppa neuroendocrine cells


Adenocarcinoma

Adenocarcinoma

Name the characteristics


  • Mucin

  • Glands

  • Peripheral

  • Most common type of lung CA

  • Can occur at sites of scars

  • Clubbing

  • Most common type of lung CA in non smokers


Charchot leyden crystals

Charchot-leyden crystals

Found in what lung disease?


Asthma1

asthma

These are formed from granules of destroyed eosinophils




Smudge cell

Smudge cell

Ha—were you paying attention in hemonc??


Large cell undifferentiated lung cancer

Large cell undifferentiated lung cancer

Note that there are no glands, desmosomes, keratin

Name some characteristics.





Pneumocystis carinii

Pneumocystis carinii

Foamy stuff in alveolar spaces

BAL is a good test for PCP




  • UIP alternating with normal lung parenchyma

  • Asbetosis

  • Rheumatic disease

  • What’s the treatment?


  • O2 therapy alternating with normal lung parenchyma


Sarcoidosis1

sarcoidosis alternating with normal lung parenchyma


Bacterial pneumonia

Bacterial pneumonia alternating with normal lung parenchyma

Diplococci and white cells from sputum sample

What are the common bacteria that cause this?


  • Streptococcus pneumoniae alternating with normal lung parenchyma

  • Staphlococcus aureus

  • Hemophilus influenze (gram neg)

  • Klebsiella pneumonia (gram neg)

  • Pseudomonas aeruginosa


Bronchiectasis

bronchiectasis alternating with normal lung parenchyma

Purulent debris in lumen

Dilated bronchus

Def:?



  • Cystic fibrosis destruction of airway walls

  • Kartagener’s syndrome

  • (primary cilia dyskinesia syndrome)


Pneumonia

pneumonia destruction of airway walls

Alveolar filling with PMNs


Chronic bronchitis

Chronic bronchitis destruction of airway walls

Increased numbers of submucosal mucus glands


Mycobacterium tuberculosis

Mycobacterium tuberculosis destruction of airway walls

Acid fast stain


Centrolobular emphysema

Centrolobular emphysema destruction of airway walls


Hypersensitivity pneumonia

Hypersensitivity pneumonia destruction of airway walls

Definition: immunologic response to an inhaled organic antigen

Causes?


  • Organic dusts destruction of airway walls

  • Almost always related to occupation

  • Farmers = Moldy hay

  • Bird breeders = bird proteins

  • Grain weevels

  • Hot tubs and air conditioners

  • What does pathologic examination show?


  • Loose granulomas destruction of airway walls

  • Often peribronchial in location, accounting for the obstruction of small airways

  • Interstitial chronic inflammation

  • What’s another name for this condition?


Extrinsic allergic alveolitis

Extrinsic allergic alveolitis destruction of airway walls


Centrolobular emphysema1

Centrolobular emphysema destruction of airway walls

Dilation and septal destruction

Increased elastase activity


BOOP destruction of airway walls

Bronchiolitis obliterans

Fibroblastic proliferation in bronchiole lumen


Asthma2

asthma destruction of airway walls

Smooth muscle thickening, BM thickening, increased eosinophils, mucus cell hyperplasia


Silicosis

silicosis destruction of airway walls

Interstitial lung disease resulting from exposure to silica

Who gets this?


  • Sandblasters destruction of airway walls

  • Rock miners

  • Quarry workers

  • Stonecutter

  • What does the path image show?


  • Silicotic nodule destruction of airway walls

  • Later this becomes fibrotic and eosinophilic


BOOP destruction of airway walls

Organizing pneumonia

Fibroblatic proliferation in alveolar airspaces


Ferruginous body

Ferruginous body destruction of airway walls

What disease is this associated with?


Asbestosis
Asbestosis destruction of airway walls

  • These are asbestos fibers that are coated by macrophages with iron-protein complex


Proliferative phase of diffuse alveolar damage

Proliferative phase of destruction of airway wallsDiffuse Alveolar Damage

Note the fibroblasts in the interstitium

(What is the clinical term for DAD?)


Acute resp distress syndrome
Acute Resp Distress Syndrome destruction of airway walls

  • Occurs when there is an identifiable lung injury within the last 2 weeks

  • “temporally uniform”

  • Ex: MVA, septic shock, inhalation of noxious chemical

  • Contrast to BOOP: this is in the interstitium, not the alveolar spaces

  • Contrast to UIP: this is temporally uniform, not heterogeneous


  • Caused by acute damage to type I epithelial cells destruction of airway walls

  • Early phase is called “exudative phase”

  • Fluid enters the interstitial space of the alveolar septum

  • Influx of inflammatory cells

  • Hyaline membranes begin to deposit

  • Causes more pulmonary edema

  • Evolves into the proliferative phase

  • Hyperplastic type II epithelial cells—attempt to replace the damaged type I cells

  • Accumulation of fibroblasts in the pulmonary parenchyma

  • Can result in scar tissue

  • The scar tissue could make one more susceptible to which type of lung cancer?







Metastatic melanoma
Metastatic melanoma arises because of the scar or whether the scarring is secondary to the tumor…

  • Note the pigment filled macrophages?


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