FACULTY OF ALLIED MEDICAL SCIENCES Histopathology and Cytology (MLHC-201)

THE LUNGS THE PATHOLOGY OF THE LUNGS Supervision Prof.Dr.Noha Ragab

Outcomes 1-To know the causes of Congenital anomalies of the lungs. 2-To know types and causes of pulmonary diseases. 3-To differentiate between atopic and non-atopic asthma.

CONGENITAL MALFORMATIONS OF THE LUNGS Congenital anomalies of the lungs are, in most cases, due to a developmental defect of the fetus during intra- uterine life. 1-TOTAL OR PARTIAL AGENESIS OF THE LUNG (APLASIA AND HYPOPLASIA): This consists of complete absence of one This consists of complete absence of one or both lungs or any part of the lung. or both lungs or any part of the lung.

2-TRACHEO OR BRONCHO-ESOPHAGEAL FISTULA: The gastrointestinal and respiratory tracts begin in the embryo as a single tube that later divides to give two independent systems. The gastrointestinal and respiratory tracts begin in the embryo as a single tube that later divides to give two independent systems. Any failure of separation of the two systems leads to an abnormal communication between any part of the respiratory passages and the GI tract, the esophagus being the most commonly affected. Any failure of separation of the two systems leads to an abnormal communication between any part of the respiratory passages and the GI tract, the esophagus being the most commonly affected. The tracheo-esophageal or broncho-esophageal fistula may be life threatening and requires prompt surgical interference. The tracheo-esophageal or broncho-esophageal fistula may be life threatening and requires prompt surgical interference.

3- PULMONARY SEQUESTRATION This is a congenital anomaly in which a part of the lung is isolated from the rest of the organ. This is a congenital anomaly in which a part of the lung is isolated from the rest of the organ.

Atelectasis which is a failure of expansion or collapse of the lung tissue that leads to loss of lung volume may be present at birth (neonatal atelectasis) or may appear after birth (acquired atelectasis). Atelectasis which is a failure of expansion or collapse of the lung tissue that leads to loss of lung volume may be present at birth (neonatal atelectasis) or may appear after birth (acquired atelectasis). PULMONARY ATELECTASIS

Normal lung appearance Thick alveolar wall There is collapse of the alveolar spaces with thickening of alveolar walls X-ray presenting left lung atelectasis

PULMONARY EMBOLISM AND INFARCTION Pulmonary embolism is a very common cause of death (the third after myocardial infarction and brain stroke). PATHOLOGY: On pathological examination of a pulmonary infarct: the affected area is (wedge-shaped). On pathological examination of a pulmonary infarct: the affected area is (wedge-shaped). On microscopic examination: features of ischaemic necrosis can be seen under a diffuse infiltration of blood. On microscopic examination: features of ischaemic necrosis can be seen under a diffuse infiltration of blood.

This is a group of chronic lung diseases characterized by recurrent intrapulmonary obstruction of the air flow, a situation that is often associated with a high morbidity and mortality rate. This is a group of chronic lung diseases characterized by recurrent intrapulmonary obstruction of the air flow, a situation that is often associated with a high morbidity and mortality rate. The best known of such diseases are: The best known of such diseases are: 1. Emphysema 2. Chronic bronchitis 3. Chronic Bronchial Asthma 4. Bronchiectasis CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD)

1- PULMONARY EMPHYSEMA The term pulmonary emphysema describes any permanent dilatation of the pulmonary air spaces beyond the terminal bronchioles (alvroli) with destruction of their walls. The term pulmonary emphysema describes any permanent dilatation of the pulmonary air spaces beyond the terminal bronchioles (alvroli) with destruction of their walls.ETIOLOGY Emphysema is more common among males, people with a history of cigarette smoking, people exposed to certain industrial fumes and people living in areas with a high concentration of air pollutant. Emphysema is more common among males, people with a history of cigarette smoking, people exposed to certain industrial fumes and people living in areas with a high concentration of air pollutant. Pathogenesis of emphysema The pathogenesis of emphysema is based on the permanent loss of elasticity of the respiratory units due to destruction of the elastin component of the alveolar septa. The pathogenesis of emphysema is based on the permanent loss of elasticity of the respiratory units due to destruction of the elastin component of the alveolar septa.

X-ray demonstrate emphysema Emphysematous lung with Large bullae formation

1- Centriacinar or centrilobular emphysema: In this type of emphysema, only the central or proximal portions of the acini are affected. 2- Panacinar or Panlobular emphysema: The entire pulmonary acinus from the terminal bronchiole to the alveolar wall is dilated. 3- Distal acinar emphysema: Only the distal segments of the acini are dilated while the proximal areas are of normal size. Classification

4- Irregular emphysema: This is the most common form of emphysema encountered at autopsy. It does not follow a regular pattern inside the acinus. Usually associated with extensive scar formation in the lungs as the presence of healed pulmonary tuberculosis and chronic bronchitis.

Emphysema

2- CHRONIC BRONCHITIS Common among heavy smokers and inhabitants of pollution-laden cities. Common among heavy smokers and inhabitants of pollution-laden cities. More frequent among middle aged men and 90% of the cases are found in chronic smokers. More frequent among middle aged men and 90% of the cases are found in chronic smokers.Symptoms: Any condition associated with repeated episodes of persistent cough with copious sputum production for more than 3 months duration is considered as a chronic case of bronchitis.

PATHOLOGY The epithelial lining may show hypertrophy, hyperplasia or some metaplastic changes. The epithelial lining may show hypertrophy, hyperplasia or some metaplastic changes. Narrowing of the airway passages: that may be occluded by mucus plug, inflammatory cells and fibrosis of the wall. Narrowing of the airway passages: that may be occluded by mucus plug, inflammatory cells and fibrosis of the wall.

Chronic bronchitis Mucosal hyperplasia Inflammatory infiltrate And blood vs congestion

3- BRONCHIAL ASTHMA Definition: Definition: Sudden paroxysmal narrowing of the airways (bronchospasm) in response to stimulation of the bronchial mucosa. Sudden paroxysmal narrowing of the airways (bronchospasm) in response to stimulation of the bronchial mucosa. PATHOGENESIS OF BRONCHIAL ASTHMA The pathogenesis is based on the action of the different components of the inflammatory process namely the inflammatory cells and the inflammatory mediators. The pathogenesis is based on the action of the different components of the inflammatory process namely the inflammatory cells and the inflammatory mediators.

Hyperinflated lung in status asthmaticus

A- ATOPIC ASTHMA This form of asthma usually diagnosed during childhood This form of asthma usually diagnosed during childhood The stimulus usually an extrinsic environmental antigen (dust, pollen, animal dander, food) triggers the inflammatory reaction in a person with a genetic predisposition and hyper- responsiveness of the airways. The stimulus usually an extrinsic environmental antigen (dust, pollen, animal dander, food) triggers the inflammatory reaction in a person with a genetic predisposition and hyper- responsiveness of the airways.

B- NON-ATOPIC ASTHMA 1- Infectious asthma is triggered by an infection usually viral in nature or very rarely bacterial. 1- Infectious asthma is triggered by an infection usually viral in nature or very rarely bacterial. 2- Drug-induced asthma attack. In sensitive individuals, a very small dose of the drug may trigger a severe asthma attack. 2- Drug-induced asthma attack. In sensitive individuals, a very small dose of the drug may trigger a severe asthma attack. 3- Occupational asthma is caused by the fumes, the dusts of organic and chemical substances found in many industries. 3- Occupational asthma is caused by the fumes, the dusts of organic and chemical substances found in many industries. 4- Certain emotional stresses, some strenuous exercises and the cold weather have been known to provoke asthma attacks in sensitive persons. 4- Certain emotional stresses, some strenuous exercises and the cold weather have been known to provoke asthma attacks in sensitive persons.

PATHOLOGY The basic pathological finding in bronchial asthma following the sudden bronchial spasm is trapping of air distal to a mucus plug causing the respiratory distress very characteristic of this disease. The basic pathological finding in bronchial asthma following the sudden bronchial spasm is trapping of air distal to a mucus plug causing the respiratory distress very characteristic of this disease. The mucus plug contains the Curshman spirals made of shed epithelial cells, eosinophils and Charcot Leyden crystals. The mucus plug contains the Curshman spirals made of shed epithelial cells, eosinophils and Charcot Leyden crystals. The Charcot Leyden crystals are needle-like structures made of eosinophilic granules that coalesce. The Charcot Leyden crystals are needle-like structures made of eosinophilic granules that coalesce.

Mucous plug

BRONCHIECTASIS: Defintion: Permanent abnormal dilatation of the bronchial airways proximal to the terminal bronchioles, secondary to a chronic necrotizing infection of the bronchi and the bronchioles. Bronchiectasis can occur at any age Permanent abnormal dilatation of the bronchial airways proximal to the terminal bronchioles, secondary to a chronic necrotizing infection of the bronchi and the bronchioles. Bronchiectasis can occur at any age The etiological factors 1. Bronchial obstruction 2. Bronchial infection 3. Congenital malformations 4. Cystic fibrosis

X-ray show dilated bronchules Dilated bronchules seen in bronchiectasis

Pathogenesis. Repeated attacks of obstruction and Infection of the bronchi leading to permanent dilatation of the airways. Repeated attacks of obstruction and Infection of the bronchi leading to permanent dilatation of the airways. Repeated infection destroy the bronchial walls and lead to permanent dilatation Repeated infection destroy the bronchial walls and lead to permanent dilatation Microscopic examination: The affected bronchial walls are heavily infiltrated with inflammatory cells and the lumen is filled with inflammatory exudate. The affected bronchial walls are heavily infiltrated with inflammatory cells and the lumen is filled with inflammatory exudate. The mucosal surface may show squamous metaplastic changes. The mucosal surface may show squamous metaplastic changes.

Bronchiactasis

Questions:Complete: 1-The gastrointestinal and respiratory tracts begin in the embryo as a ………that later divides to give …………………….. 2-PULMONARY SEQUESTRATION is…………………………………………. CHRONIC OBSTRUCTIVE PULMONARY DISEASES 3- CHRONIC OBSTRUCTIVE PULMONARY DISEASES are …………….,…………….,…………….and…………. 4-……….is the most common form of emphysema encountered at autopsy. Microscopic examination of BRONCHIECTASIS is ………………. 5- Microscopic examination of BRONCHIECTASIS is ……………….

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