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?