Pathology of respiratory system
and pleura
Larynx
Trachea
Bronchi, bronchioles
Alveoles
Pleura
Pathology of the larynx and trachea
Congenital anomalies
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tracheo-oesophageal fistula: rare, risk of food aspiration
oesophageal atresia and tracheo-oesophageal fistula: more
frequent, more serious
Various lesions
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trauma: iatrogenic, tracheostomia
compression of trachea: expansion of thyroid
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foreign bodies: food
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Pathology of the larynx and trachea
Inflammation
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epiglottitis: serious complication of surrounding processes in
children – most frequent Haemophilus influensae, type B, oedema
of epiglottis may cause obstruction of respiratory tract. Typical
sign – stridor nad cyanosis
laryngitis and tracheitis: viral etiology is most frequent (parainfluenza viruses), in acute phase infiltration of mucosa with
lymphocytes, macrophages and neutrophils, dilatation of
capillaries, mucous oedema; sometime pseudomembranous
inflammation with necrosis; in chronic phase infiltration with
lymphocytes, signs of reparation, more goblet cells
Pathology of the larynx and trachea
Tumors and pseudotumors
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singer’s nodule: benign tumor-like lesion on vocal cords,
fibrous stroma, squamous mucosa
squamous papilloma: viral etiology (HPV), rarely may evolve
into squamous carcinoma
squamous carcinoma: frequent tumor related to tobbaco
smoking, four types:
glotic carcinoma: good prognosis, vocal cords preserved during
treatment, late metastases
 transglotic carcinoma: total laryngectomy is way of treatment,
high risc of hematogenous metastases
 supraglotic carcinoma: possible preservation of vocal cords in
some cases, higher risc of lymphogenous metastases
 infraglotic carcinoma: total laryngectomy is way of treatment,
high risc of hematogenous metastases and lymphogenous
metastases
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Pathology of the larynx and trachea
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less frequent malignant tumors: carcinomas of small salivary
glands, sarcomas, adenocarcinomas, malignant melanomas
tumors of trachea: very rare
Pathology of bronchi
Congenital anomalies
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bronchial atresia: rare
Pathology of bronchi
Inflammation
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common cold (influenza): frequent disease, congestion of
respiratory tract mucosa, infiltration with lymphocytes, may
progress into the pseudomembranous form
adenoviral infection: inflammation of bronches and bronchioles
healed by fibrosis and obliteration of small bronchioles – may
lead to collaps of the lung and bronchiectasia
RSV infection (respiratory syncytial virus): peribronchial
inflammation, small epidemies, fatal course is rare!
Pathology of bronchi
Inflammation
measles (morbilli): may occasionaly lead to obliteration of
bronchioles and bronchiectasias.
 whooping cough (pertusis): caused by Haemofilus pertusis, does
not exist in Central Europe
 fungi: Aspergilus or Candida, in immunosupressed
 bronchial and peribronchial abscess: after aspiration, frequently
in alcoholics
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Pathology of bronchi
Bronchial obstruction and aspiration
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atelectasis: airless lung from birth
collaps: airless lung developing during life, serious postoperative complication, aspiration of foreign body, bronchial
occlusion
Diffuse alveolar damage
ARDS - adult respiratory distress syndrome: sudden onset,
severe respiratory insufficience, cyanosis, hypoxemia which
does not react to oxygen therapy, hyaline membranes
Pathology of lungs
Pathology of lungs
Congenital anomalies
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agenesis, hypoplasia
less frequent lesions: vascular anomalies, congenital lobar
emphysema, congenital bronchogennic cysts, intralobular
and extrapulmonal sekvestration - no connection to
conducting airways
Pathology of lungs
Vascular and cardial diseases
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congestion: result of left ventricle failure
lung oedema: acute left ventricular failure or increased
capillary permeability
pulmonary embolism: thrombosis of venous system, sudden
death/pulmonary infarctu/asymptomatic
pulmonary hemorrhage: result of damaged vessel, necrosis,
inflammation and tumors
Pathology of lungs
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pulmonary infarct: ¾ of cases in basal lobes, usually
haemorrhagic; septic infarct is presented as pulmonary
abscess
pulmonary hypertension: if the pressure is higher than ¼ of
systemic pressure ; various causes – see our handouts
Pathology of lungs
Chronic obstructive pulmonary disease (COPD)
Main clinical symptom is breathless (dyspnoe). It contains four
entities – emphysema, chronic bronchitis, bronchial asthma,
bronchiectasia
Emphysema
4 types:
(1) centroacinar /centrolobular
(2) panacinar/vesicular
(3) paraseptal
(4) irregular/bulous
Chronic bronchitis
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Clinically defined as chronic cough for more that 3 months
without conducting airways conduction
Coused by chronic irritation
Hyperplasia of goblet cell
Increased number of alveolar macrophages
Lymphocytes and fibrosis
Squamous metaplasia
Bronchial asthma
Paroxysmal bronchoconstriction (spasmus)
Severe breathless
 2 types:
• exogenous
• endogenous
 Histology:
• occlusion of bronchi with mucus (Curschmann spirals),
• eosinophils,
• Charcot Leyden crystals
• thickening of basal membrane
• oedema,
• hypertrophy of bronchial muscles (within the wall)
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Pathology of lungs
Diffuse interstitial fibrosis
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pneumoconioses:
sarcoidosis: non-caseous granulomas, immunologic
abnormalities
idiopathic pulmonary fibrosis (Hamman-Rich syndrome, diffuse
(cryptogenic) fibrotizing alveolitis, DIP): etiology is not clear,
diffuse interstitial inflammation and fibrosis
Bronchiectasia
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Abnormal dilatation of bronchi and bronchioli
Infection
Cystic fibrosis
Immunedeficiency
Interstitial pneumonias
Pathology of lungs
Inflammation
Superficial, interstitial, specific and granulomatous
A. Superficial
 bronchopneumonia: catarrhal, crupous, necrotizing,
eosinophilic
B. Interstitial
 lung abscess:
 interstitial pneumonia:
•
viral
•
mycoplasma
•
ricketts
•
fungi
•
pneumocystis
•
idiopathic
•
desquamative pneumonitis
Pathology of lungs
C.
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D.
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Specific
Tbc
syphilis: pneumonia alba
Granulomatous lung processes
alergic bronchioalveolitis:
sarcoidosis:
Pathology of lungs
Tumors
Benign/malignant
 Epithelial/mesenchymal/mesodermal
 Others/pseudotumors
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non-small cell carcinoma: adenocarcinoma (variants – tubular,
papillary, bronchiolo-alveolar), squamous cell carcinoma
(synonym – epidermoid carcinoma), large cell carcinoma,
anaplastic carcinoma
small cell carcinoma:
Pathology of lungs
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carcinoid
solitary fibrous tumor
epitheloid haemangioendothelioma
adenomatoid tumor
mesothelioma
papillary pneumocytoma (sclerosing haemangioma)
thymoma
lymphoma
Pathology of pleura
Pathologic content
hydrothorax: transudate
 pneumothorax: air, traumatic, rupture of emphysematous
bulla, open pneumothorax – communicating, valve
mechanism, colaps of the lung
 haemothorax: blood: trauma, rupture of aortic aneurysm
 empyema: pus
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Pathology of pleura
Inflammation – pleuritis
Associated with inflammation of lungs (pneumonia, abscesses,
septic infarct), mediastinum. Non-inflammatory pericarditis
(fibrinous) associated with pulmonary infarct.
serous pleuritis: frequent, good prognosis
 fibrinous pleuritis: more fibrin in exsudate – fibrous
adhesions
 haemorrhagic pleuritis: TBC, bleeding, metastases
 purulent pleuritis: empyema
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caseous pleuritis: TBC
Pathology of pleura
Tumors
mesothelioma: malignant epithelial, malignant sarcomatoid,
maligní epithelial – lymfohistiocytic variant, malignant
biphasic, well differentiated papillary, multicystic
 adenomatoid tumor: benign
 solitary fibrous tumor: usually benign, rarely malignant,
CD34+, Bcl-2+
 synoviální sarcoma: CK+, vimentin+, usually EMA+,
 epitheloid haemangioendothelioma: CD31+, CD34+, FVIII+
 myofibroblastic inflammatory tumor of pleura: rare
 secondary: metastatic
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Singer’s nodule
Carcinoma of larynx
Pseudomembranous tracheitis
Pseudomembranous tracheitis
Asthma bronchiale
Asthma bronchiale
CHOPN
CHOPN
Silicosis (compact fibrosis)
1
1
1
1 Fibrous centers
Silicosis – fibrous node
kopie
1
2
2
2
1 Fibrous center
2 Perifocal emphysema
Silicosis, crystals - polarised light
Silicosis, crystals - polarised light
kopie
Emphysema
A – centrolobular
B – panacinar
Normal lung x emphysema
Panacinar emphysema
Panacinar emphysema
Atelectasis
Atelectasis
Oedema of the lung
Bronchopneumonia
Bronchopneumonia
Catarrhal-purulent bronchitis
Catarrhal-purulent bronchitis
ARDS
ARDS, hyalinne membranes
1
1
2
2
2
2
1
1 Collapsed alveoli
2 Hyalinne membranes
ARDS
1
1
1
1 Hyalinne membranes
Crupous pneumonia
Crupous pneumonia
Carnification of the lung
Interstitial pneumocystic pneumonia
Interstitial pneumocystic pneumonia
Lung abscess
Caseous pneumonia
Caseous pneumonia
Caseous pneumonia
Cavernous TBC and fibrosis
Aspergilosis
Periosteal chondroma
copy
Chondrohamartoma
Chondroma, 100×
Chondrosarcoma
kopie
Atypical chondrocytes, nuclear
polymorphism
Squamous cell carcinoma
Small cell carcinoma
Small cell carcinoma
Adenocarcinoma
Adenocarcinoma
Adenocarcinoma
1
2
1
2
1 Necrosis
2 Thickening of pleura
Adenocarcinoma
Adenocarcinoma
Adenocarcinoma
1
1
1Mitoses
Adenocarcinoma, poor differentiation
Bronchioloalveolar carcinoma
Bronchioloalveolar carcinoma, mucinous type
Bronchioloalveolar carcinoma
Bronchioloalveolar carcinoma
Large cell carcinoma
1
2
1
1
1
1 Necrosis
2 Bronchi
Large cell carcinoma
Large cell carcinoma
Large cell carcinoma
1
1
1
1
2
1 Necrosis
2 Mitosis