Docstoc

Patologie dychacího systému a pleury

Document Sample
Patologie dychacího systému a pleury Powered By Docstoc
					Pathology of respiratory system
          and pleura

               Larynx
              Trachea
         Bronchi, bronchioles
              Alveoles
               Pleura
           Pathology of the larynx and trachea

                       Congenital anomalies

   tracheo-oesophageal fistula: rare, risk of food aspiration
   oesophageal atresia and tracheo-oesophageal fistula: more
    frequent, more serious
                           Various lesions

 trauma: iatrogenic, tracheostomia
 compression of trachea: expansion of thyroid

   foreign bodies: food
           Pathology of the larynx and trachea
                            Inflammation

   epiglottitis: serious complication of surrounding processes in
    children – most frequent Haemophilus influensae, type B, oedema
    of epiglottis may cause obstruction of respiratory tract. Typical
    sign – stridor nad cyanosis
   laryngitis and tracheitis: viral etiology is most frequent (para-
    influenza viruses), in acute phase infiltration of mucosa with
    lymphocytes, macrophages and neutrophils, dilatation of
    capillaries, mucous oedema; sometime pseudomembranous
    inflammation with necrosis; in chronic phase infiltration with
    lymphocytes, signs of reparation, more goblet cells
         Pathology of the larynx and trachea
                   Tumors and pseudotumors

   singer’s nodule: benign tumor-like lesion on vocal cords,
    fibrous stroma, squamous mucosa
   squamous papilloma: viral etiology (HPV), rarely may evolve
    into squamous carcinoma
   squamous carcinoma: frequent tumor related to tobbaco
    smoking, four types:
   glotic carcinoma: good prognosis, vocal cords preserved during
    treatment, late metastases
   transglotic carcinoma: total laryngectomy is way of treatment,
    high risc of hematogenous metastases
   supraglotic carcinoma: possible preservation of vocal cords in
    some cases, higher risc of lymphogenous metastases
   infraglotic carcinoma: total laryngectomy is way of treatment,
    high risc of hematogenous metastases and lymphogenous
    metastases
         Pathology of the larynx and trachea

   less frequent malignant tumors: carcinomas of small salivary
    glands, sarcomas, adenocarcinomas, malignant melanomas
   tumors of trachea: very rare
                   Pathology of bronchi

                         Congenital anomalies

   bronchial atresia: rare
                 Pathology of bronchi
                           Inflammation

   common cold (influenza): frequent disease, congestion of
    respiratory tract mucosa, infiltration with lymphocytes, may
    progress into the pseudomembranous form
   adenoviral infection: inflammation of bronches and bronchioles
    healed by fibrosis and obliteration of small bronchioles – may
    lead to collaps of the lung and bronchiectasia
   RSV infection (respiratory syncytial virus): peribronchial
    inflammation, small epidemies, fatal course is rare!
                  Pathology of bronchi
                            Inflammation

   measles (morbilli): may occasionaly lead to obliteration of
    bronchioles and bronchiectasias.
   whooping cough (pertusis): caused by Haemofilus pertusis, does
    not exist in Central Europe
   fungi: Aspergilus or Candida, in immunosupressed
   bronchial and peribronchial abscess: after aspiration, frequently
    in alcoholics
                Pathology of bronchi
                Bronchial obstruction and aspiration

   atelectasis: airless lung from birth
   collaps: airless lung developing during life, serious post-
    operative complication, aspiration of foreign body, bronchial
    occlusion
                        Diffuse alveolar damage

   ARDS - adult respiratory distress syndrome: sudden onset,
    severe respiratory insufficience, cyanosis, hypoxemia which
    does not react to oxygen therapy, hyaline membranes
Pathology of lungs
                   Pathology of lungs
                       Congenital anomalies

   agenesis, hypoplasia
   less frequent lesions: vascular anomalies, congenital lobar
    emphysema, congenital bronchogennic cysts, intralobular
    and extrapulmonal sekvestration - no connection to
    conducting airways
                 Pathology of lungs
                 Vascular and cardial diseases

   congestion: result of left ventricle failure
   lung oedema: acute left ventricular failure or increased
    capillary permeability
   pulmonary embolism: thrombosis of venous system, sudden
    death/pulmonary infarctu/asymptomatic
   pulmonary hemorrhage: result of damaged vessel, necrosis,
    inflammation and tumors
                   Pathology of lungs
   pulmonary infarct: ¾ of cases in basal lobes, usually
    haemorrhagic; septic infarct is presented as pulmonary
    abscess
   pulmonary hypertension: if the pressure is higher than ¼ of
    systemic pressure ; various causes – see our handouts
                  Pathology of lungs
         Chronic obstructive pulmonary disease (COPD)

Main clinical symptom is breathless (dyspnoe). It contains four
entities – emphysema, chronic bronchitis, bronchial asthma,
bronchiectasia
                           Emphysema
4 types:
(1) centroacinar /centrolobular
(2) panacinar/vesicular
(3) paraseptal
(4) irregular/bulous
                        Chronic bronchitis

   Clinically defined as chronic cough for more that 3 months
   without conducting airways conduction
   Coused by chronic irritation
   Hyperplasia of goblet cell
   Increased number of alveolar macrophages
   Lymphocytes and fibrosis
   Squamous metaplasia
                       Bronchial asthma

 Paroxysmal bronchoconstriction (spasmus)
 Severe breathless
 2 types:
• exogenous
• endogenous
 Histology:
• occlusion of bronchi with mucus (Curschmann spirals),
• eosinophils,
• Charcot Leyden crystals
• thickening of basal membrane
• oedema,
• hypertrophy of bronchial muscles (within the wall)
                   Pathology of lungs

                      Diffuse interstitial fibrosis

   pneumoconioses:
   sarcoidosis: non-caseous granulomas, immunologic
    abnormalities
   idiopathic pulmonary fibrosis (Hamman-Rich syndrome, diffuse
    (cryptogenic) fibrotizing alveolitis, DIP): etiology is not clear,
    diffuse interstitial inflammation and fibrosis
                         Bronchiectasia

 Abnormal dilatation of bronchi and bronchioli
 Infection
 Cystic fibrosis
 Immunedeficiency
 Interstitial pneumonias
                   Pathology of lungs
                           Inflammation
Superficial, interstitial, specific and granulomatous
A. Superficial
 bronchopneumonia: catarrhal, crupous, necrotizing,
   eosinophilic
B. Interstitial
 lung abscess:
 interstitial pneumonia:
   •   viral
   •   mycoplasma
   •   ricketts
   •   fungi
   •   pneumocystis
   •   idiopathic
   •   desquamative pneumonitis
                 Pathology of lungs

C.   Specific
    Tbc
    syphilis: pneumonia alba

D.   Granulomatous lung processes
    alergic bronchioalveolitis:
    sarcoidosis:
                   Pathology of lungs
                             Tumors
   Benign/malignant
   Epithelial/mesenchymal/mesodermal
   Others/pseudotumors

   non-small cell carcinoma: adenocarcinoma (variants – tubular,
    papillary, bronchiolo-alveolar), squamous cell carcinoma
    (synonym – epidermoid carcinoma), large cell carcinoma,
    anaplastic carcinoma
   small cell carcinoma:
                 Pathology of lungs
   carcinoid
   solitary fibrous tumor
   epitheloid haemangioendothelioma
   adenomatoid tumor
   mesothelioma
   papillary pneumocytoma (sclerosing haemangioma)
   thymoma
   lymphoma
              Pathology of pleura

                     Pathologic content

   hydrothorax: transudate
   pneumothorax: air, traumatic, rupture of emphysematous
    bulla, open pneumothorax – communicating, valve
    mechanism, colaps of the lung
   haemothorax: blood: trauma, rupture of aortic aneurysm
   empyema: pus
              Pathology of pleura
                    Inflammation – pleuritis


Associated with inflammation of lungs (pneumonia, abscesses,
septic infarct), mediastinum. Non-inflammatory pericarditis
(fibrinous) associated with pulmonary infarct.

 serous pleuritis: frequent, good prognosis
 fibrinous pleuritis: more fibrin in exsudate – fibrous
  adhesions
 haemorrhagic pleuritis: TBC, bleeding, metastases
 purulent pleuritis: empyema

   caseous pleuritis: TBC
            Pathology of pleura
                          Tumors

 mesothelioma: malignant epithelial, malignant sarcomatoid,
  maligní epithelial – lymfohistiocytic variant, malignant
  biphasic, well differentiated papillary, multicystic
 adenomatoid tumor: benign
 solitary fibrous tumor: usually benign, rarely malignant,
  CD34+, Bcl-2+
 synoviální sarcoma: CK+, vimentin+, usually EMA+,
 epitheloid haemangioendothelioma: CD31+, CD34+, FVIII+
 myofibroblastic inflammatory tumor of pleura: rare
 secondary: metastatic
Singer’s nodule
Carcinoma of larynx
Pseudomembranous tracheitis
Pseudomembranous tracheitis
Asthma bronchiale
Asthma bronchiale
CHOPN
CHOPN
    Silicosis (compact fibrosis)


1




                                    1

      1




                            1 Fibrous centers
        Silicosis – fibrous node
                                                 kopie




                   1


2




    2                    1 Fibrous center
        2                2 Perifocal emphysema
Silicosis, crystals - polarised light
Silicosis, crystals - polarised light
                                        kopie
             Emphysema




A – centrolobular        B – panacinar
Normal lung x emphysema
Panacinar emphysema
Panacinar emphysema
Atelectasis
Atelectasis
Oedema of the lung
Bronchopneumonia
Bronchopneumonia
Catarrhal-purulent bronchitis
Catarrhal-purulent bronchitis
ARDS
    ARDS, hyalinne membranes

                  1
                                     1
2




                      2                  2

              2


          1               1 Collapsed alveoli
                          2 Hyalinne membranes
    ARDS




           1

1                   1




               1 Hyalinne membranes
Crupous pneumonia
Crupous pneumonia
Carnification of the lung
Interstitial pneumocystic pneumonia
Interstitial pneumocystic pneumonia
Lung abscess
Caseous pneumonia
Caseous pneumonia
Caseous pneumonia
Cavernous TBC and fibrosis
Aspergilosis
  Periosteal chondroma




copy
Chondrohamartoma
Chondroma, 100×      Chondrosarcoma
                                                   kopie




                  Atypical chondrocytes, nuclear
                  polymorphism
Squamous cell carcinoma
Small cell carcinoma
Small cell carcinoma
Adenocarcinoma
Adenocarcinoma
                Adenocarcinoma




1




    2       1
        2

                                 1 Necrosis
                                 2 Thickening of pleura
Adenocarcinoma
Adenocarcinoma
               Adenocarcinoma


           1




                                1


1Mitoses
Adenocarcinoma, poor differentiation
Bronchioloalveolar carcinoma
Bronchioloalveolar carcinoma, mucinous type
Bronchioloalveolar carcinoma
Bronchioloalveolar carcinoma
        Large cell carcinoma



    1
                        2
1
            1




        1

                               1 Necrosis
                               2 Bronchi
Large cell carcinoma
Large cell carcinoma
                 Large cell carcinoma

             1


                   1            1




                         1




                                    2
1 Necrosis
2 Mitosis

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:116
posted:12/13/2010
language:English
pages:84