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Organ Pathology Seminar / FAQ Respiratory Tract Diseases Jaroslava Dušková Inst. Pathol.,1st Med. Faculty, Charles Univ. Prague
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Respiratory tract nose & paranasal cavities nasopharynx larynx trachea bronchi LUNG
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Disease Nosologic Unit Definition Incidence, age/sex prevalence (if any) Etiology Possible clinical manifestation Pathogenesis –macroscopy –microscopy –ultrastructure or other dg. tools –other (nonmorphological) dg. tools Complications !!! Healing & prognosis !!!!
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Diseases of the nose and paranasal cavities
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Classification? Most frequent/important ones ?
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Non-neoplastic – inflammation v acute/chronic v specific/non-specific v superficial/intersticial – pseudotumours Neoplastic
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Pseudotumours of the nasal & paranasal cavities ?
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Tumours of the nose & paranasal cavities?
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Tumours of the nose & paranasal cavities benign (papilloma, adenoma, hemangioma) malignant - carcinoma – adenoca –squamous cell
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Nasopharyngeal tumours?
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angiofibroma nasopharyngeal carcinoma (Schmincke´ lymphoepithelioma ) EBV
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Larynx - diseases
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Classification? Most frequent/important ones ?
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Non-neoplastic – inflammation v acute/chronic v specific/non-specific v superficial/intersticial – pseudotumours Neoplastic
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Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous
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Laryngeal Pseudotumours ?
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Laryngeal Neoplasms ?
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NEOPLASIA – classification HISTOGENETIC v mesenchymal v epithelial v neuroectodermal v mixed v germ cell, teratoma choriocarcinoma v mesotelioma
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Epithelial Tumours v surface epithelium papillomas carcinomas / papillocarcinomas v glandular epithelium adenomas adenocarcinomas v double diff. mucoepidermoid
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Laryngeal Neoplasms papilloma carcinoma
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Bronchi &Trachea - diseases
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Classification? Most frequent/important ones ?
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Non-neoplastic –inflammation v acute v chronic – pseudotumours Neoplastic
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Ca bronchogenes Definition Incidence, age/sex prevalence (if any) Etiology /risk factors Possible clinical manifestation Pathogenesis –macroscopy !!!!! –microscopy –ultrastructure or other dg. tools –other (nonmorphological) dg. tools Complications Healing & prognosis
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Macroscopy (x-ray) forms of lung ca central early symptoms peripheralsurgery possible PancoastHorner´ triad pulmopleuralx meta pulmomediastinalx meta multifocalx meta lobarx non neopl. dis.
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Classification of Lung Cancer (Clinical) (biology behaviour) small cell non small cell
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Small Cell Ca chemotherapy sensitive symptomatic period short distant meta at the time of dg. common expression of the myc oncogen
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Non Small Cell Ca chemotherapy insensitive surgery (if possible = 20-40%) mutation of K-ras oncogen
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Histopathology Classification of Lung Cancer small cell – highly malignant, with/without neuroendocrine diff. spinocellular (epidermoid) adenocarcinoma (subtype bronchioloalveolar ca) large cell (undifferentiated)
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Risk factors for pleural & lung (!) neoplasms ?
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Lung Cancer - course agressive cough, weight loss, pain, dyspnea 5 yr survival remains in non small cell ca 10%
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Other Bronchial & Lung Tumours ?
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LUNG - diseases
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Classification? Most frequent/important ones ?
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Non-neoplastic –inflammation v acute/chronic v specific/non-specific v superficial/intersticial – pseudotumours Neoplastic
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Non-neoplastic – childhood – atelectasis, bronchopulmonary dysplasia,newborn RDS, SIDS – vascular - acute and chronic venostasis – inflammation v acute/chronic (obstructive & restrictive lung dis.) v specific/non-specific v superficial/intersticial –pseudotumours Neoplastic
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Atelectasis – imperfect expansion at birth Collapse – return to airless state Atelectasis - Collapse
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Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous
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Idiopathic int. Pneumonitis –fibrosing alveolitis Fibrosis without recognized cause, immune complex deposition Progressive dyspnea, resp. failure, cor pulmonale Usual IP (UIP)- acute phase is followed by proliferation of fibroblasts producing Collagen-fibrosis, derangement of alv. walls Desquamative IP (DIP)- macrophages in alveoli,good prognosis Lymphocytic IP (LIP) - extensive inf. of the interstitium with lymphocytes and plasma cells Giant cell IP- after inhalation of fumes of hard metals alloys Interstitial pneumonitis and fibrosis
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After inhalation of antigens Farmer´s dis actinomycete in moldy hay Mushroom´s worker´s dis – Bird-fancier´s lung- bird dropping Maple bark stripper´s dis – maple bark Malt worker´s lung – barely malt Suberosis – mouldy cork dust Pituitary snuff takers lung- pituitary snuff Pathology -acute interst. pneumonitis Granulomas with giant cells bronchiolitis fibrosis Hypersensitivity pneumonitis- extrinsic allergic alveolitis
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After inhalation of antigens Farmer´s dis actinomycete in moldy hay Mushroom´s worker´s dis – Bird-fancier´s lung- bird dropping Maple bark stripper´s dis – maple bark Malt worker´s lung – barely malt Suberosis – mouldy cork dust Pituitary snuff takers lung- pitutitary snuff Pathology -acute interst. pneumonitis granulomas with giant cells bronchiolitis fibrosis Hypersensitivity pneumonitis - extrinsic allergic alveolitis
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Definition – permanent overdistension of the air passages distal to the terminal bronchioles. It is ass. with destruction of the walls of airspaces within the acini Etiology – cigarette smoking, atmospheric pollution,infection, genetic defect Classification – proximal acinar e.(centriacinar) panacinar em. distal acinar e. irregular e. Symptoms – dyspnea, chronic coughing, chest „barrel shaped“ Ribs almost horizontal, prominent sternoclavicular muscles Pulmonary hypertension, prolonged expiration, respir. acidosis, hypoxia Pathology – lungs are voluminous, pale, edges of lung are rounded, bullae like bubbles at the periphery, the heart is obscured during autopsy Histology – thining and destruction of alv. walls, alveoli are confluent, Large airspaces, capillaries are diminished in number Emphysema
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Entrance of air into the connective tissue of the lung, mediastinum and soft tissue Spontaneously – incr. intraalveolar pressure, cough In patiens on respiratore, lung trauma – fractured ribs Symptoms – swelling of the neck and head Crackling crepitation Interstitial emphysema
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Etiology – viruses- measles v., adenoviruses, cytomegalovirus Chlamydia psittaci Rickettsiae- C. Burneti Mycoplasma pneumoniae Pathology- alveolar septa expanded-hyperemia, lympho-plasmocytic inf. hyaline mebranes viral inclusion bodies multinucleated giant cells- measles, RSV Complication – interstitial fibrosis Acute interstitial pneumonia
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pleural plaques, diffuse pleural thickening interstitial fibrosis-asbestos bodies mesotheliomas carcinoma of the lung asbestos body – fibre coated with layers of iron containing proteins fine septal scarring, changes in resp. bronchioles macrophages release the cytokines and growth factors proliferation of fibroblasts Asbestosis
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toxic effect of the crystalline silica on the lysosomal membranes lysosomal rupture, release of enzymes Pathology: diff. reticular fibrosis small nodules having a whorled pattern fusion of nodules- massive fibrosis Silicosis inhalation of silica or silicon dioxide
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Simple form-small black macule containing dust- laden macrophages Macule progress to become nodules containing collagen Complicated form – progressive masive fibrosis Nodules exceeding 1cm in diameter Coal miner´s pneumoconiosis
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Tuberculosis ?
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Disease Nosologic Unit Definition Incidence, age/sex prevalence (if any) Etiology Possible clinical manifestation Pathogenesis –macroscopy –microscopy –ultrastructure or other dg. tools –other (nonmorphological) dg. tools Complications Healing & prognosis
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TUBERCULOSIS Mycobacterium tuberculosis (Koch 1882) Mycobacterium bovis acidoresistance M. avium,intracellulare, Kansasii atypical mycobacterioses
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Vasculitis & necrotizing granulomas Alergic granulomatosis (Churg-Strauss) Wegener´s granulomatosis
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TUBERCULOSIS Type of infection v childhood (primary, preimmune) v adult (postprimary, immune)
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TUBERCULOSIS Morphological features primary infect (Ghon´s focus) & primary complex caseification isolated organ metastasis tubercle, exsudate, cavity early and late generalisation – milliary spread
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TUBERCULOSIS Terms –Forms– Locations : phtisis gallopans scrofulosis meningitis basillaris lupus vulgaris mallum Potti, cold absces
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