Respiratory Pathology Kristine Krafts, M.D. Normal lung: alveolar - - PowerPoint PPT Presentation

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Respiratory Pathology Kristine Krafts, M.D. Normal lung: alveolar - - PowerPoint PPT Presentation

Feb 19, 2024 102 likes •857 views

Respiratory Pathology Kristine Krafts, M.D. Normal lung: alveolar spaces Respiratory Pathology Outline Acute respiratory distress syndrome Obstructive lung diseases Restrictive lung diseases Vascular diseases Infections

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Respiratory Pathology

Kristine Krafts, M.D.

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Normal lung: alveolar spaces

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases
  • Restrictive lung diseases
  • Vascular diseases
  • Infections
  • Carcinoma

Respiratory Pathology Outline

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  • Acute respiratory distress syndrome

Respiratory Pathology Outline

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  • Symptoms: rapid onset respiratory insufficiency

that doesn’t respond to oxygen

  • Associated with pneumonia, aspiration of gastric

contents, sepsis, severe trauma

  • Pathogenesis: Damage to alveolar capillary

membrane; neutrophils play a big role

  • Morphology: “diffuse alveolar damage” with

hyaline membranes

Acute respiratory distress syndrome

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Diffuse alveolar damage: hyaline membranes

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases

Respiratory Pathology Outline

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases
  • Emphysema
  • Chronic bronchitis
  • Asthma
  • Bronchiectasis

Respiratory Pathology Outline

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  • Destruction/enlargement of airspaces
  • Centriacinar emphysema
  • Destruction of proximal acinus
  • Worse in upper lobes of lung
  • Smoking
  • Panacinar emphysema
  • Destruction of entire acinus
  • Worse in lower lobes of lung
  • Alpha-1-antitrypsin deficiency

Emphysema

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Smoking α-1 antitrypsin deficiency

Pathogenesis of emphysema

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Emphysema: dilated air spaces

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Emphysema: dilated air spaces

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  • Definition: persistent, productive cough

for ≥ 3 months in ≥ 2 consecutive years

  • Pathogenesis: hypersecretion of mucous
  • Cause: smoking (mostly) and pollution

Chronic Bronchitis

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Chronic bronchitis: mucous gland hyperplasia

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  • Chronic inflammatory disease of airways

leading to bronchial constriction

  • Symptoms: wheezing, breathlessness
  • Hallmarks: intermittent, reversible airway
  • bstruction, chronic inflammation,

increased mucus.

  • Atopic (allergic) vs. non-atopic
  • Triggers: allergens, infection, smoke,

cold, exercise

Asthma

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How is asthma triggered?

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Then what happens?

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  • Permanent dilation of bronchi and

bronchioles due to chronic inflammation

  • Secondary to:
  • obstruction (tumor)
  • congenital conditions (cystic fibrosis)
  • bad pneumonia

Bronchiectasis

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Bronchiectasis

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases
  • Restrictive lung diseases

Respiratory Pathology Outline

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  • Patchy, progressive lung fibrosis
  • Symptoms: gradual onset cough, dyspnea.

Respiratory failure and cor pulmonale within about 3 years

  • Radiologic and histologic term: “usual

interstitial pneumonia”

Idiopathic pulmonary fibrosis

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IPF: fibrotic lung

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IPF: tons of fibrosis

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  • Disorders caused by inhalation of mineral dusts
  • Size matters (1-5 μm particles are worst)
  • Three main dust particles:
  • Carbon (coal workers)
  • Silica (sandblasting, mining, ceramics)
  • Asbestos (mining, insulation removal)

Pneumoconioses

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Asbestos fibers

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases
  • Restrictive lung diseases
  • Vascular diseases

Respiratory Pathology Outline

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  • Most arise from leg veins
  • Small emboli may be asymptomatic, cause

infarction, or cause hemoptysis

  • Medium-sized emboli (less common) cause

shortness of breath and infarction

  • Large emboli (even less common) can cause

sudden death

Pulmonary embolism

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Pulmonary embolism

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Pulmonary infarcts

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases
  • Restrictive lung diseases
  • Vascular diseases
  • Infections

Respiratory Pathology Outline

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  • 1/6 of all deaths in the US!
  • Can be acute or chronic
  • Causes: bacteria, viruses
  • Different anatomic patterns
  • Different clinical settings

Pneumonia

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Community-acquired

  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Mycoplasma pneumoniae
  • viruses

Typical bugs in different clinical settings

Nosocomial

  • gram-negative rods
  • Staphylococcus aureus

Aspiration

  • Anaerobic bacteria

Immunocompromised

  • Cytomegalovirus
  • Pneumocystis jiroveci
  • Aspergillus

Chronic

  • Mycobacterium tuberculosis
  • Histoplasma capsulatum
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Alveolar

  • Streptococcus pneumoniae*
  • Staphylococcus aureus
  • Hemophilus influenzae

Most community-acquired pneumonias are one of these:

Interstitial

  • viruses
  • Mycoplasma pneumoniae

* Most common

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Viral pneumonia Bacterial pneumonia

interstitial inflammation alveolar inflammation

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  • Localized collection of pus
  • Bugs: Staph, Strep, gram-negative bugs,

anaerobes, or mixture

  • Pathogenesis: aspiration of infected material

(from teeth, sinuses), aspiration of gastric contents, as complication of nasty bacterial pneumonia

Lung abscess

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Lung abscess

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  • Cause: Mycobacterium tuberculosis
  • Chronic, granulomatous disease that can

involve any organ but often involves lungs

  • Spread by respiratory droplet
  • Primary (initial) TB: Ghon complex.
  • Secondary (reactivation) TB: Cavitating

granulomas.

Tuberculosis

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Caseating granuloma Regular (non-caseating) granuloma

just macrophages (no necrotic debris) lymphocytes necrotic debris macrophages

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Caseating granuloma

necrotic debris regular macrophages foreign-body giant cells

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TB organisms (acid-fast stain)

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Ghon complex: lung lesion + involved nodes

lung lesion involved lymph nodes

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Secondary TB: tons of caseating, cavitating necrosis

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Spleen: miliary TB

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  • Affect immunosuppressed patients (patients

with AIDS, cancer, post-transplant)

  • Unusual organisms:
  • Pneumocystis jiroveci
  • Aspergillus
  • Cytomegalovirus

Opportunistic pneumonias

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Crescent shaped

  • rganisms

Crushed Ping-Pong ball shaped organisms

Pneumocystis

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Aspergillus

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Cytomegalovirus (two kinds of inclusions)

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  • Acute respiratory distress syndrome
  • Obstructive lung diseases
  • Restrictive lung diseases
  • Vascular diseases
  • Infections
  • Carcinoma

Respiratory Pathology Outline

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Types of lung cancer

Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma

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Types of lung cancer

Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma NSCLC SCLC

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Potentially curable

  • asymptomatic
  • cough
  • hemoptysis

Presenting symptoms

Usually incurable

  • dyspnea
  • chest pain
  • anorexia & weight loss
  • hoarseness
  • bone pain
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  • At diagnosis, >50% have metastases
  • Overall (all stages) 5ys = 16%
  • Localized disease 5ys = 45%

Survival statistics…bad.

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  • Most common type, especially in

women and non-smokers

  • Usually peripheral

Adenocarcinoma

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Adenocarcinoma

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  • Was called bronchioalveolar carcinoma
  • A rare type of adenocarcinoma
  • 5 year survival better (40%)
  • Grows along existing architecture

Adenocarcinoma in situ

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Adenocarcinoma in situ

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Adenocarcinoma in situ

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  • Malignant tumor of squamous cells
  • Usually centrally located
  • Usually preceded by distinct lesions

Squamous cell carcinoma

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Squamous cell carcinoma precursor lesions

squamous metaplasia dysplasia carcinoma in situ

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Squamous cell carcinoma

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Squamous cell carcinoma

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  • Composed of large cells
  • Kind of a “wastebasket” term
  • Many are probably just anaplastic squamous

cell carcinomas or adenocarcinomas

Large cell carcinoma

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Large cell carcinoma

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  • VERY high mortality
  • Small cells, minimal cytoplasm, “molding”
  • Paraneoplastic syndromes
  • High growth fraction yet treatment ineffective
  • Median survival (with treatment) = 1 year

Small cell carcinoma

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Small cell carcinoma

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  • Malignant tumor of mesothelial cells
  • Most patients have had asbestos exposure
  • Not related to smoking
  • Highly malignant; short survival.

Mesothelioma

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Mesothelioma