Squamous cell carcinoma

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Squamous cell carcinoma

• Note keratin pearls and desmosomes
• Name some characteristics

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• Only in smokers
• Centrally located
• Hypercalcemia ? PTH like substance is made
• CLUBBING

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asthma

• Note the thickened BM and SM cells

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Bronchoalveolar Carcinoma

• Subset of adenocarcinoma
• Not associated with smoking
• Peripheral location
• Bronchograms are common
• Cough with frothy sputum

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Bad sputum sample

• Shows the normal squamous epithelial cells found
  in the upper respiratory tract
• Contamination of the sample

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Squamous cell carcinoma
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Small cell carcinoma

• Note blue cells with high N/C ratio
• No nucleoli
• Salt n peppa neuroendocrine cells

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Adenocarcinoma

• Name the characteristics

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• Mucin
• Glands
• Peripheral
• Most common type of lung CA
• Can occur at sites of scars
• Clubbing
• Most common type of lung CA in non smokers

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Charchot-leyden crystals

• Found in what lung disease?

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asthma

• These are formed from granules of destroyed
  eosinophils

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hamartoma
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discrete tumor of benign tissues in excess or
disarray

• Cartilage in excess

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Smudge cell

• Hawere you paying attention in hemonc??

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Large cell undifferentiated lung cancer

• Note that there are no glands, desmosomes,
  keratin
• Name some characteristics.

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• Located most often in the periphery
• Ummmm.

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Large cell lung cancer
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sarcoidosis
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Pneumocystis carinii

• Foamy stuff in alveolar spaces
• BAL is a good test for PCP

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Usual Interstitial Pneumonitis
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• Patchy regions of interstitial inflammation and
  fibrosis alternating with normal lung parenchyma
• Temporal heterogeneity
• Whats the differential?

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• UIP
• Asbetosis
• Rheumatic disease
• Whats the treatment?

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• O2 therapy

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sarcoidosis
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Bacterial pneumonia

• Diplococci and white cells from sputum sample
• What are the common bacteria that cause this?

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• Streptococcus pneumoniae
• Staphlococcus aureus
• Hemophilus influenze (gram neg)
• Klebsiella pneumonia (gram neg)
• Pseudomonas aeruginosa

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bronchiectasis

• Purulent debris in lumen
• Dilated bronchus
• Def?

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• Irreversible dilation of airways caused by
  inflammatory destruction of airway walls
• Most common cause is infection
• 2 non-obstructive causes

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• Cystic fibrosis
• Kartageners syndrome
• (primary cilia dyskinesia syndrome)

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pneumonia

• Alveolar filling with PMNs

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Chronic bronchitis

• Increased numbers of submucosal mucus glands

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Mycobacterium tuberculosis

• Acid fast stain

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Centrolobular emphysema
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Hypersensitivity pneumonia

• Definition immunologic response to an inhaled
  organic antigen
• Causes?

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• Organic dusts
• Almost always related to occupation
• Farmers Moldy hay
• Bird breeders bird proteins
• Grain weevels
• Hot tubs and air conditioners
• What does pathologic examination show?

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• Loose granulomas
• Often peribronchial in location, accounting for
  the obstruction of small airways
• Interstitial chronic inflammation
• Whats another name for this condition?

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Extrinsic allergic alveolitis
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Centrolobular emphysema

• Dilation and septal destruction
• Increased elastase activity

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BOOP

• Bronchiolitis obliterans
• Fibroblastic proliferation in bronchiole lumen

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asthma

• Smooth muscle thickening, BM thickening,
  increased eosinophils, mucus cell hyperplasia

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silicosis

• Interstitial lung disease resulting from exposure
  to silica
• Who gets this?

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• Sandblasters
• Rock miners
• Quarry workers
• Stonecutter
• What does the path image show?

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• Silicotic nodule
• Later this becomes fibrotic and eosinophilic

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BOOP

• Organizing pneumonia
• Fibroblatic proliferation in alveolar airspaces

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Ferruginous body

• What disease is this associated with?

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Asbestosis

• These are asbestos fibers that are coated by
  macrophages with iron-protein complex

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Proliferative phase ofDiffuse Alveolar Damage

• Note the fibroblasts in the interstitium
• (What is the clinical term for DAD?)

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Acute Resp Distress Syndrome

• Occurs when there is an identifiable lung injury
  within the last 2 weeks
• temporally uniform
• Ex MVA, septic shock, inhalation of noxious
  chemical
• Contrast to BOOP this is in the interstitium,
  not the alveolar spaces
• Contrast to UIP this is temporally uniform, not
  heterogeneous

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• Caused by acute damage to type I epithelial cells
• Early phase is called exudative phase
• Fluid enters the interstitial space of the
  alveolar septum
• Influx of inflammatory cells
• Hyaline membranes begin to deposit
• Causes more pulmonary edema
• Evolves into the proliferative phase
• Hyperplastic type II epithelial cellsattempt to
  replace the damaged type I cells
• Accumulation of fibroblasts in the pulmonary
  parenchyma
• Can result in scar tissue
• The scar tissue could make one more susceptible
  to which type of lung cancer?

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• Adenocarcinoma however, it is not known whether
  the tumor arises because of the scar or whether
  the scarring is secondary to the tumor

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• Metastatic breast adenocarcinoma

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• Metastatic GI adenocarcinoma

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• Metastatic ENT carcinoma

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• Metastatic renal adenocarcinoma

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Metastatic melanoma

• Note the pigment filled macrophages?