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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

slide3
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

slide17
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

slide37
Patchy regions of interstitial inflammation and fibrosis alternating with normal lung parenchyma
  • Temporal heterogeneity
  • What’s the differential?
slide38
UIP
  • Asbetosis
  • Rheumatic disease
  • What’s the treatment?
bacterial pneumonia

Bacterial pneumonia

Diplococci and white cells from sputum sample

What are the common bacteria that cause this?

slide44
Streptococcus pneumoniae
  • Staphlococcus aureus
  • Hemophilus influenze (gram neg)
  • Klebsiella pneumonia (gram neg)
  • Pseudomonas aeruginosa
bronchiectasis

bronchiectasis

Purulent debris in lumen

Dilated bronchus

Def:?

slide47
Irreversible dilation of airways caused by inflammatory destruction of airway walls
  • Most common cause is infection
  • 2 non-obstructive causes =
slide48
Cystic fibrosis
  • Kartagener’s syndrome
  • (primary cilia dyskinesia syndrome)
pneumonia

pneumonia

Alveolar filling with PMNs

chronic bronchitis

Chronic bronchitis

Increased numbers of submucosal mucus glands

hypersensitivity pneumonia

Hypersensitivity pneumonia

Definition: immunologic response to an inhaled organic antigen

Causes?

slide59
Organic dusts
  • Almost always related to occupation
  • Farmers = Moldy hay
  • Bird breeders = bird proteins
  • Grain weevels
  • Hot tubs and air conditioners
  • What does pathologic examination show?
slide60
Loose granulomas
  • Often peribronchial in location, accounting for the obstruction of small airways
  • Interstitial chronic inflammation
  • What’s another name for this condition?
centrolobular emphysema1

Centrolobular emphysema

Dilation and septal destruction

Increased elastase activity

slide65

BOOP

Bronchiolitis obliterans

Fibroblastic proliferation in bronchiole lumen

asthma2

asthma

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

silicosis

silicosis

Interstitial lung disease resulting from exposure to silica

Who gets this?

slide70
Sandblasters
  • Rock miners
  • Quarry workers
  • Stonecutter
  • What does the path image show?
slide71
Silicotic nodule
  • Later this becomes fibrotic and eosinophilic
slide73

BOOP

Organizing pneumonia

Fibroblatic proliferation in alveolar airspaces

ferruginous body

Ferruginous body

What disease is this associated with?

asbestosis
Asbestosis
  • These are asbestos fibers that are coated by macrophages with iron-protein complex
proliferative phase of diffuse alveolar damage

Proliferative phase ofDiffuse Alveolar Damage

Note the fibroblasts in the interstitium

(What is the clinical term for DAD?)

acute resp distress syndrome
Acute Resp Distress Syndrome
  • 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
slide80
Caused by acute damage to type I epithelial cells
  • 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?
slide81
Adenocarcinoma; however, it is not known whether the tumor arises because of the scar or whether the scarring is secondary to the tumor…
metastatic melanoma
Metastatic melanoma
  • Note the pigment filled macrophages?
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