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- Sarcoidosis
- Systemic noncaseating granulomatous disease – can affect perhaps every organ.
- Usual sites of granulomas are mediastinal lymph nodes, lungs, liver.
- Disease of exclusion
- Great variation in lung disease manifestation – from minimal subclinical to severe interstitial fibrosis with end stage restrictive lung disease.
- Histology shows well-formed non-caseating granulomas.
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- Sarcoidosis
- Histology shows well-formed non-caseating granulomas
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- Hypersensitivity Pneumonitis
- Hypersensitivity reaction to an inhaled antigen that results in chronic bronchocentric inflammation.
- May be acute, subacute (intermittent) or chronic.
- Acute reactions due to type III hypersensitivity; chronic reaction due to type IV hypersensitivity.
- Symptoms include: dyspnea, fever, malaise, weight loss, clubbing
- More than 300 antigens have been described. Common agents include bird peptides (especially parakeet) and fungi (living in moldy hay, dust, hot tubs, humidifiers)
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- Poorly Formed Granuloma
- hypersensitivity penumonitis, pt has restrictive lung disease; vs. if someone is acting clinically like they have TB and you see a granuloma, they prob have TB
- -question is very much in the presentation- ex. if granuloma is in the context of restrictive lung disease, vs in context of TB
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- Nonspecific Interstitial Pneumonia
- Pattern of uniform septal thickening
- Fibrotic and cellular patterns
- May be primary or secondary.
- Secondary causes include collagen vascular diseases (like lupus, rheumatoid arthritis), drugs, infection. Mimickers include lymphoma
- -NSIP: similar to UIP, but instead of having stark contrast btw normal & severe disease, there is a much more gradual transition
- fibrotic and cellular patterns- UIP is very fibrotic
- NSIP may be the manifestation of another disease
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- Usual interstitial pneumonia
- Histologic pattern seen in diffuse, bilateral interstitial lung disease~9/100/000, usually between 50-70
- Poor prognosis, mean length of survival 3.2-5.0 years
- Idiopathic, genetic and environmental risk factors known
- Characteristic clinical, radiologic, and histologic features
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- Usual interstitial pneumonia
- Histologic pattern seen in diffuse, bilateral interstitial lung disease
- ~9/100/000, usually between 50-70
- Poor prognosis, mean length of survival 3.2-5.0 years
- Idiopathic, genetic and environmental risk factors known
- Characteristic clinical, radiologic, and histologic features
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- Emphysema
- Centrilobular emphysema is the most common form and is associated with smoking. Damage to alveolar walls adjacent to respiratory bronchioles is observed.
- Panacinar (panlobular) emphysema is observed in alpha-1-antitrypsin deficiency. The entire lobule is involved
- -there has been complete destruction of the alveolar wall in the center;
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- Gross Emphysema
- -right: normal lung; if you felt it, it would be soft, smooth, cannot distinguish btw apex and base
- -left: cavitations in lung, and much of normal parenchyma has been lost; much worse at apex of lung than at the base of the lung (seen in smokers)
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- normal bronchiole
- epithelium should sit right on top of the smooth muscle
- if this bronchiole needed to expand, it has elasticity and has no problem expanding- this is why there are undulations of the epithelium; also, can constrict
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- Chronic Bronchitis
- clinical diagnosis defined as daily productive cough for 3 months, 2 years in a row.
- Histologic features:
- chronic inflammation
- goblet cell hyperplasia
- increase in submucosal mucous glands
- -in smokers, esp chronic smokers, you have scarring in the smaller airways
- -lumen should be 2x the size; if you lose half the surface area of the lumen, it will be much harder to get air through it
- also, scarring means there is fibrosis and loss of elasticity, so it doesn’t expand like you would want it to if more air is needed
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- mucostasis, inflammatory cells (but no eosinophils), edema; this is the bronchus, which we can tell bc of cartilage (upper left)
- -in a normal, healthy lumen, there is nothing there; here, there is mucus & debris (right side of pic)
- -this image won’t be on the test; generally, histologic pics will be cleaner
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- Status Asthmaticus
- this case came from a young man that died from asthma
- -all airways were full of mucus (mucostasis), bc mucous glands are hyperstimulated, causing obstruction to movement of air
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- Asthmatic Bronchitis
- eosinophils, basement membrane- classic picture for asthma; this is a “high-yield” histologic picture- KNOW THIS
- inflammed mucosa; there has been edema in the tissue, due to inflammation- fluid comes out of leaky capillaries
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Bronchus
- cartilage and submucosal glands
- can see plates of cartilage, telling you this is a bronchus and not a bronchiole
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