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 Not associated with smoking Peripheral location Bronchograms are common Cough with frothy sputum Bad sputum sample Shows the normal squamous epithelial cells found in the upper respiratory tract… Contamination of the sample Squamous cell carcinoma Small cell carcinoma Note blue cells with high N/C ratio No nucleoli Salt n peppa neuroendocrine cells 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 Found in what lung disease? asthma These are formed from granules of destroyed eosinophils hamartoma “discrete tumor of benign tissues in excess or disarray” Cartilage in excess Smudge cell Ha—were you paying attention in hemonc?? Large cell undifferentiated lung cancer Note that there are no glands, desmosomes, keratin Name some characteristics. • Located most often in the periphery • Ummmm. Large cell lung cancer sarcoidosis Pneumocystis carinii Foamy stuff in alveolar spaces BAL is a good test for PCP Usual Interstitial Pneumonitis • Patchy regions of interstitial inflammation and fibrosis alternating with normal lung parenchyma • Temporal heterogeneity • What’s the differential? • UIP • Asbetosis • Rheumatic disease • What’s the treatment? • O2 therapy sarcoidosis Bacterial pneumonia Diplococci and white cells from sputum sample What are the common bacteria that cause this? • • • • • Streptococcus pneumoniae Staphlococcus aureus Hemophilus influenze (gram neg) Klebsiella pneumonia (gram neg) Pseudomonas aeruginosa bronchiectasis Purulent debris in lumen Dilated bronchus Def:? • Irreversible dilation of airways caused by inflammatory destruction of airway walls • Most common cause is infection • 2 non-obstructive causes = • Cystic fibrosis • Kartagener’s syndrome • (primary cilia dyskinesia syndrome) pneumonia Alveolar filling with PMNs Chronic bronchitis Increased numbers of submucosal mucus glands Mycobacterium tuberculosis Acid fast stain Centrolobular emphysema Hypersensitivity pneumonia Definition: immunologic response to an inhaled organic antigen Causes? • • • • • • 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? • Loose granulomas • Often peribronchial in location, accounting for the obstruction of small airways • Interstitial chronic inflammation • What’s another name for this condition? Extrinsic allergic alveolitis Centrolobular emphysema Dilation and septal destruction Increased elastase activity BOOP Bronchiolitis obliterans Fibroblastic proliferation in bronchiole lumen asthma Smooth muscle thickening, BM thickening, increased eosinophils, mucus cell hyperplasia silicosis Interstitial lung disease resulting from exposure to silica Who gets this? • • • • Sandblasters Rock miners Quarry workers Stonecutter • What does the path image show? • Silicotic nodule • Later this becomes fibrotic and eosinophilic BOOP Organizing pneumonia Fibroblatic proliferation in alveolar airspaces Ferruginous body What disease is this associated with? Asbestosis • These are asbestos fibers that are coated by macrophages with iron-protein complex Proliferative phase of Diffuse Alveolar Damage Note the fibroblasts in the interstitium (What is the clinical term for DAD?) 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 • • • • • • • • 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? • Adenocarcinoma; however, it is not known whether the tumor arises because of the scar or whether the scarring is secondary to the tumor… • Metastatic breast adenocarcinoma • Metastatic GI adenocarcinoma • Metastatic ENT carcinoma • Metastatic renal adenocarcinoma Metastatic melanoma • Note the pigment filled macrophages?