Lung pathology


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  • PE
  • PE with Hemosiderin laden macrophages
  • ARDS (Diffuse alveolar damage
  • DAD hyaline membrane
  • What are the 4 classic histologic findings in bronchial asthma?Answer: 1) Inflammation 2) Bronchial narrowing 3) Increased Mucous 4) Smooth muscle hyperplasiaWhat is the 5th finding if the etiology is allergy? Ans: Eosinophils
  • Microscopically at high magnification, the loss of alveolar walls with emphysema is demonstrated. Remaining airspaces are dilated.
  • 15-14 usual Interstial pneumonia ( patchy interstitial fibrosis)
  • 15-15 ( fibroblast foci), honeycombing , hyperplesia and metaplasia in UIP
  • 15-17 CWP progressive pattren
  • 15-18 SILICOSIS
  • 15-20 asbestos body
  • 15-21 the most common manifestation of asbestosis(pleural plaques)
  • sarcoid noncaseating granuloma, with many giant cells.
  • 15-23 Hypersensitivity pneumonitis, histologic appearance. Loosely formed interstitial granulomas and chronic inflammation are characteristic.
  • 15-26
  • -15-27
  • 15-33
  • Bronchopneumonia: The pleural surface shows some serofibrinous deposits (1). Sectioned surface of the lung shows multiple, small, gray brown, firm, patchy or granular areas of consolidation around bronchioles (2)
  • Lobar pneumonia lung: pleural surface shows some serofibrinous deposits (1). Sectioned surface of the lung shows gray brown, firm area of consolidation affecting a lobe (2)
  • In part, this is due to the fact that most lobar pneumonias are due to Streptococcus pneumoniae (pneumococcus) and for decades, these have responded well to penicillin therapy so that advanced, severe cases are not seen as frequently.
  • Lung pathology

    2. 2. Review Of Anatomy & physiology • Cartilage is present to level of proximal bronchioles • Beyond terminal bronchiole gas exchange occurs • The distal airspaces are kept open by elastic tension in alveolar walls
    3. 3. Mechanics of Breathing • Inspiration – Active process caused mainly by contraction of diaphragm . Accessory muscles may used during exercise and distress • Expiration – Quiet breathing is a passive process but can become active , with forced expiration • Typical volume in normal breathing: 500 ml air
    4. 4. Pathology Congenital Anomalies Atelectasis Acute Lung injury Obstructive diseases Restrictive diseases Pulmonary vascular diseases Pulmonary Infections Tumors Pleural diseases
    5. 5. Pulmonary Atelectasis
    6. 6. Acute lung injury Pulmonary Edema Acute Respiratory Distress Syndrome Acute Interstitial Pneumonia
    7. 7. Obstructive Pulmonary Diseases Asthma Emphysema Chronic bronchitis Bronchiectasis
    8. 8. Asthma •Asthma is a chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night and/or in the early morning. •These symptoms are usually associated with widespread but variable bronchoconstriction and airflow limitation that is at least partly reversible, either spontaneously or with treatment.
    9. 9. Bronchial Asthma Extrinsic • type-I (IgE-mediated) hyper-sensitivity or allergic reaction • Triggered by environmental antigens (dust, pollens, food, ..) • family history of Atopy • Childhood Intrinsic • Not allergic • Triggered by respiratory tract infections &drugs (aspirin). • No family history • Adult
    10. 10. Pathology of asthma
    11. 11. These lungs appear essentially normal, but are normal-appearing because they are the hyperinflated lungs of a patient who died with status asthmaticus.
    12. 12. • Between the bronchial cartilage at the right and the bronchial lumen filled with mucus at the left is a submucosa widened by smooth muscle hypertrophy and inflammation (mainly eosinophils). • These are changes of bronchial asthma. The peripheral eosinophil count or the sputum eosinophils can be increased during an asthmatic attack.
    13. 13. • At high magnification, the numerous eosinophils are prominent from their bright red cytoplasmic granules in this case of bronchial asthma.
    14. 14. Bronchiectasis • Is the permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue
    15. 15. • This is another form of obstructive lung disease grossly in the mid lower portion of the lung, the patient has recurrent infections because of the stasis in these airways. • Copius purulent sputum production with cough is typical
    16. 16. • • A closer view demonstrates the focal area of dilated bronchi with bronchiectasis. Bronchiectasis tends to be localized with disease processes such as neoplasms and aspirated foreign bodies that block a portion of the airways. Widespread bronchiectasis is typical for patients with cystic fibrosis who have recurrent infections and obstruction of airways by mucus throughout the lungs
    17. 17. • • • Bronchiectasis is seen here. The repeated episodes of inflammation can result in scarring, which has resulted in fibrous adhesions between the lobes. Fibrous pleural adhesions are common in persons who have had past episodes of inflammation of the lung that involve the pleura. With extensive involvement, the pleural space may be obliterated.
    18. 18. Chronic Bronchitis •Chronic productive cough on most days of 3 consecutive months in 2 consecutive years Providing other causes have been excluded.. •The pathological hallmarks of chronic bronchitis are congestion of the bronchial mucosa and a prominent increase in the number and size of the bronchial mucus glands.
    19. 19. • • • Chronic bronchitis does not have characteristic pathologic findings, but is defined clinically as a persistent productive cough for at least three consecutive months in at least two consecutive years. Most patients are smokers. Often, there are features of emphysema as well.
    20. 20. Emphysema • Abnormal and permanent dilatation of air spaces associated with destruction of their walls.
    21. 21. Types
    22. 22. Centriacinar Vs. Panacinar
    23. 23. • The chest cavity is opened at autopsy to reveal numerous large bullae apparent on the surface of the lungs in a patient dying with emphysema. • Bullae are large dilated airspaces that bulge out from beneath the pleura. • Emphysema is characterized by a loss of lung parenchyma by destruction of alveoli so that there is permanent dilation of airspaces.
    24. 24. • On cut section of the lung, the dilated airspaces with emphysema are seen. • Although there tends to be some scarring with time because of superimposed infections, the emphysematous process is one of loss of lung parenchyma, not fibrosis.
    25. 25. Restrictive Pulmonary Diseases Fibrosing Granulomatous Eosinophilic Smoking Related
    26. 26. IPF NSIP Cryptogenic Organizing pneumonia Fibrosing Diseases CT Diseases pneumoconiosis Drug reactions Radiation pneumonia
    27. 27. CWP Pneumoconiosis Silicosis Asbestosis
    28. 28. Granulomatous diseases Sarcoidosis Hypersensitivity pneumonia
    29. 29. sarcoidosis
    30. 30. Pulmonary vascular Diseases Pulmonary Embolism, Hemorrhage and Infarction Pulmonary Hypertension Diffuse Pulmonary Hemorrhage Syndrome
    31. 31. Community Acquired Pneumonia Community Acquired Atypical pneumonia Hospital Acquired Pneumonia Pulmonary Infections Aspiration Pneumonia Chronic Pneumonia Necrotizing Pneumonia Pneumonia of Immunocompromised Host
    32. 32. Morphological Types Lobar Pneumonia Bronchopneumonia
    33. 33. • The cut surface of this lung demonstrates the typical appearance of a bronchopneumonia with areas of tan-yellow consolidation. • Remaining lung is dark red because of marked pulmonary congestion. • Bronchopneumonia is characterized by patchy areas of pulmonary consolidation.
    34. 34. • Here is another example of a bronchopneumonia. • The lighter areas that appear to be raised on cut surface from the surrounding lung are the areas of consolidation of the lung.
    35. 35. • At higher magnification, the pattern of patchy distribution of a bronchopneumonia is seen.
    36. 36. • This is a lobar pneumonia in which consolidation of the entire left upper lobe has occurred. • This pattern is much less common than the bronchopneumonia pattern.
    37. 37. • A closer view of the lobar pneumonia demonstrates the distinct difference between the upper lobe and the consolidated lower lobe.
    38. 38. • The pleural surface at the lower left demonstrates areas of yellow-tan purulent exudate. • Pneumonia may be complicated by a pleuritis. • Initially, there may just be an effusion into the pleural space. There may also be a fibrinous pleuritis. • However, bacterial infections of lung can spread to the pleura to produce a purulent pleuritis. • A collection of pus in the pleural space is known as empyema.
    39. 39. Here is the gross appearance of a lung with tuberculosis. Scattered tan granulomas are present, mostly in the upper lung fields. Some of the larger granulomas have central caseation. Granulomatous disease of the lung grossly appears as irregularly sized rounded nodules that are firm and tan. Larger nodules may have central necrosis known as caseation
    40. 40. • This is another example of Granulomatous disease of the lung. • The pattern of smaller nodules which have a propensity for upper lobe involvement suggests a granulomatous process rather than metastatic disease.
    41. 41. On closer inspection, the granulomas have areas of caseous necrosis. This is very extensive granulomatous disease. This pattern of multiple caseating granulomas primarily in the upper lobes is most characteristic of secondary (reactivation) tuberculosis.
    42. 42. • When there is extensive caseation and the granulomas involve a larger bronchus, it is possible for much of the soft, necrotic center to drain out and leave behind a cavity. • Cavitation is typical for large granulomas with tuberculosis.
    43. 43. There is a small tan-yellow subpleural granuloma in the mid-lung field on the right. In the hilum is a small yellow tan granuloma in a hilar lymph node next to a bronchus. This is the "Ghon complex" that is the characteristic gross appearance with primary tuberculosis.
    44. 44. • The Ghon complex is seen here at closer range. • Primary tuberculosis is the pattern seen with initial infection with tuberculosis in children.
    45. 45. Well-defined granulomas are seen here. They have rounded outlines. The one toward the center of the photograph contains Langhans giant cells. Granulomas are composed of transformed macrophages called epithelioid cells along with lymphocytes, occasional PMN's, plasma cells, and fibroblasts. The localized, small appearance of these granulomas suggests that the immune response is fairly good.
    46. 46. At low magnification, this photomicrograph reveals multiple granulomas.
    47. 47. • The edge of a granuloma is shown here at high magnification. • At the upper right is amorphous pink caseous material composed of the necrotic elements of the granuloma as well as the infectious organisms. • This area is ringed by the inflammatory component with epithelioid cells, lymphocytes, and fibroblasts
    48. 48. • At high magnification, the granuloma demonstrates that the epithelioid macrophages are elongated with long, pale nuclei and pink cytoplasm. • The macrophages organize into committees called giant cells. The typical giant cell for infectious granulomas is called a Langhans giant cell and has the nuclei lined up along one edge of the cell.
    49. 49. • In order to find the mycobacteria in a tissue section, a stain for acid fast bacilli is done (AFB stain).
    50. 50. • Seen here are two lung abscesses, one in the upper lobe and one in the lower lobe of this left lung. • An abscess is a complication of severe pneumonia, most typically from virulent organisms such as S. aureus.
    51. 51. • At higher magnification can be seen a patchy area of alveoli that are filled with inflammatory cells. • The alveolar structure is still maintained, which is why a pneumonia often resolves with minimal residual destruction or damage to the lung.
    52. 52. • At high magnification, the alveolar exudate of mainly neutrophils is seen. The surrounding alveolar walls have capillaries that are dilated and filled with RBC's. Such an exudative process is typical for bacterial infection. • This exudate gives rise to the productive cough of purulent yellow sputum seen with bacterial pneumonias.
    53. 53. • More virulent bacteria and/or more severe pneumonias can be associated with destruction of lung tissue and hemorrhage. • Here, alveolar walls are no longer visible because there is early abscess formation. There is also hemorrhage.
    54. 54. • At higher magnification, early abscessing pneumonia is shown. • Alveolar walls are not clearly seen, only sheets of neutrophils.
    55. 55. Lung Tumors
    56. 56. Squamous Cell CA Small Cell CA Adenocarcinoma Lung Tumors Large Cell CA Adenosquamous CA Carcinoid Tumor CA of Salivary gland type Unclassified CA
    57. 57. • This is a squamous cell carcinoma of the lung that is arising centrally in the lung (as most squamous cell carcinomas do). • It is obstructing the right main bronchus. • The neoplasm is very firm and has a pale white to tan cut surface
    58. 58. • This is a larger squamous cell carcinoma in which a portion of the tumor demonstrates central cavitation, probably because the tumor outgrew its blood supply. • Squamous cell carcinomas are one of the more common primary malignancies of lung and are most often seen in smokers
    59. 59. • In this squamous cell carcinoma at the upper left is a squamous eddy with a keratin pearl. • At the right, the tumor is less differentiated and several dark mitotic figures are seen.
    60. 60. • This is a peripheral adenocarcinoma of the lung. • Adenocarcinomas and large cell anaplastic carcinomas tend to occur more peripherally in lung. • Adenocarcinoma is the one cell type of primary lung tumor that occurs more often in non-smokers and in smokers who have quit.
    61. 61. • This is Bronchioloalveolar carcinoma. • Seen here is the multifocal variant that appears grossly as a pneumonic consolidation. • Most of the upper lobe toward the right has a pale tan to grey appearance
    62. 62. • Microscopically, the bronchioloalveolar carcinoma is composed of columnar cells that proliferate along the framework of alveolar septae. • The cells are well-differentiated. These neoplasms in general have a better prognosis than most other primary lung cancers
    63. 63. • Arising centrally in this lung and spreading extensively is a small cell anaplastic (oat cell) carcinoma. • The cut surface of this tumor has a soft, lobulated, white to tan appearance. • Oat cell carcinomas are very aggressive and often metastasize widely before the primary tumor mass in the lung reaches a large size
    64. 64. • Here is an oat cell carcinoma which is spreading along the bronchi. • The speckled black rounded areas represent hilar lymph nodes with metastatic carcinoma. • The prognosis is poor. • Oat cell carcinomas occur almost exclusively in smokers.
    65. 65. • This is the microscopic pattern of a small cell anaplastic (oat cell) carcinoma in which small dark blue cells with minimal cytoplasm are packed together in sheets
    66. 66. • The dense white encircling tumor mass is arising from the visceral pleura and is a mesothelioma. • These are big bulky tumors that can fill the chest cavity. • The risk factor for mesothelioma is asbestos exposure.
    67. 67. • Here are larger but still variably-sized nodules of metastatic carcinoma in lung
    68. 68. • These tan-white nodules are characteristic for metastatic carcinoma. • Metastases to the lungs are more common even than primary lung neoplasms.
    69. 69. Thanks