Pathology Resit

Subdecks (7)

Cards (248)

  • Thrombo - phebitis : Thrombotic disease of veins accompanied by varying degrees of inflammation
  • Thrombophlebitis : Association between deep vein thrombosis and presence of cancer in an internal organ (Trousseau syndrome = Migratory Thrombo-phlebitis). The majority of the tumours are mucin-producing Adeno-Carcinomas of the pancreas
  • Clinical features of Thrombophlebitis :
    • Minimal or marked oedema of the extremity
    Purulent Thrombo-Phlebitis: Marked chills and high temperature
  • Stasis ulcer is a long term complication of thrombophlebitis
  • Thrombangitis Obliterans (Buerger's disease) : Rare thrombotic and inflammatory disease of the arteries and veins of unknown aetiology
  • Epidemiology of Buerger's Disease :
    • Common in young men (20-35 years)
    • Exacerbation by heavy cigarette smoking
  • To the pathologist, vasculitis generally denotes the presence of primary vascular inflammation, in the absence of infection, infarction, or other secondary cause
  • Classification of vasculitis depends on at least three major features:
    1. Size and type of vessel involved
    2. Presence of immune complexes
    3. Association with known autoimmune disease, and systemic or localised distribution
    • Two vasculitic syndromes affect elastic arteries: Takayasu disease and Giant-cell arteritis
    • Two vasculitic syndromes affect muscular arteries in the absence of small vessel involvement: Polyarteritis nodosa and Kawasaki disease
  • A host of vasculitis syndromes affect small vessels (arterioles,capillaries, and venules)
    • These vasculitides are generally divided into:
    1. Those that are caused by immune complex deposition
    2. Those that are pauci - immune (often antineutrophil cytoplasmic antibody [ANCA] related)
  • Epstein-Barr virus causes Nasopharyngeal Carcinoma (Undifferentiated)
  • Sarcoidosis is a multisystem, non-infectious granulomatous disease that produces chronic interstitial fibrosis
  • Radiologic findings of Sarcoidosis :
    • Bilateral hilar lymphadenopathy ( butterfly - like appearance )
    • Interstitial lung disease (diffuse reticular densities)
  • Laboratory findings of Sarcoidosis:
    • Hypercalcaemia and hypercalciuria
    • Hypergammaglobulinaemia
    • Increased activity of serum Angiotensin-Converting Enzyme
  • Sarcoidosis has findings of Schaumann & asteroid bodies
  • Pulmonary form of Tbc: Inhalation of droplets with the organism
    Non-pulmonary form of Tbc: Ingestion of infected milk
  • Primary Tbc:
    • Initial infection, characterised by the primary or Ghon complex (Peripheral sub-pleural parenchymal lesion + Hilar lymph nodes)
    • Clinical picture: Asymptomatic; No clinically evident disease
    • Histopathology:
    • Tubercle (Granuloma of Tbc):
    • ➢ Central caseous necrosis
    • Langhans giant cells
  • Secondary Tbc:
    • Activation of a prior Ghon complex, with spread to a new pulmonary or extra-pulmonary site
    • Clinical features:
    • ➢ Progressive disability
    • ➢ Fever
    • ➢ Haemoptysis
    • ➢ Bloody pleural effusion
    • ➢ Generalised wasting
  • Secondary Tbc:
    • Macroscopic picture:
    • ➢ Localised lesions: Apical or posterior segments of the upper lobes
    • ➢ Involvement of hilar lymph nodes
    • Microscopic picture:
    • ➢ Liquefaction and expulsion of the caseous contents → Formation of cavitary lesions
    • Cavitation: Only in secondary Tbc
    • Caseation: Both primary and secondary Tbc
    • ➢ Scarring and calcification
  • Miliary Tbc:
    ➢ Secondary Tbc, complicated by lymphatic and haematogenous spread
    ➢ Involvement of distal organs with innumerable small seed – like lesions
    ➢ Extra-pulmonary Tbc:
    Tuberculous meningitis
    Pott disease of the spine
    Para-vertebral or psoas abscess
  • Emphysema : Irreversible enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls without obvious fibrosis
  • Emphysema is associated with cigarette smoking
  • Types of emphysema (according to anatomic distribution within the lobule):
    1. Centri - acinar (95% of cases)
    2. Pan - acinar
    3. Para - septal
    4. Irregular
  • Clinical features:
    • Pink puffer ” vs. “Blue bloater” (Chronic Bronchitis)
    • ↑ Antero-posterior chest-diameter (“ Barrel ” chest)
    • ↑ Total vital capacity
    • Hypoxia
    • Cyanosis
    • Respiratory acidosis
    • Pursed lip breathing
  • Assumed causes of Emphysema:
    • Action of proteolytic enzymes (e.g. elastase) on the alveolar wall
    • Elastase:
    • Induces destruction of elastin
    • Neutralised by the opposing action of alpha1-antitrypsin
    • Cigarette smoking:
    • Attracts neutrophils and macrophages (sources of elastase)
    • Inactivates alpha1-antitrypsin
  • Centri - acinar (Centri - lobular) Emphysema
    • Affects central or proximal parts of the acini, formed by respiratory bronchioles
    • Sparing of distal alveoli
    • More common and more severe in the upper lobes, particularly in the apical segments
    • Presence of large amounts of black pigment in the walls of the emphysematous spaces
    • Inflammation around bronchi and bronchioles
    • Association with heavy cigarette smoking and chronic bronchitis
  • Pan - acinar (Pan-lobular) Emphysema
    • Characterised by evenly enlarged acini from the level of respiratory bronchiole to the terminal blind alveoli (entire acinus: alveoli, alveolar ducts and respiratory bronchioles)
    • Uniform distribution throughout the entire lung
    • Occurrence mainly in the lower zones and in the anterior margins of the lung; Most severe at the bases
    • Association with a1 - antitrypsin deficiency
  • Distal Acinar (Para - septal) Emphysema
    • Dilatation of the distal part of the acinus (alveoli and lesser alveolar ducts)
    • Normal proximal portion of the acinus
    • Localised adjacent to the pleura (along the lobular connective tissue septa), and at the margins of the lobules
    • Occurrence adjacent to areas of fibrosis, scarring, or atelectasis
    • More severe in the upper half of the lungs
    • Multiple, continuous enlarged airspaces (0.5-2.0cm) → Large sub-pleural bullae or blebs → Pneumothorax
  • Irregular Emphysema
    • Irregular involvement of the acinus
    • Airspace enlargement with fibrosis
    • Pathogenesis: Inflammatory process → Scarring within the walls of enlarged air spaces → Irregular Emphysema
  • Complications of Emphysema:
    • Chronic Bronchitis
    • Interstitial Emphysema : Tear in the airways → “Leakage” of air into the interstitial tissue of the chest
    • Rupture of a surface bleb (apical bulla) → Pneumothorax
  • Bullous Emphysema
    • Localised accentuation of emphysema, resulting in the formation of large sub-pleural blebs or bullae (>1cm; distended state)
    • Occurrence, possible in any type of emphysema
    • Sometimes, in relation to old tuberculous scarring
  • Interstitial Emphysema
    • Entrance of air into the connective tissue stroma of the lung, mediastinum, or subcutaneous tissue
    • Cause/Pathology: Coughing + bronchiolar obstruction → Sharply increased pressures within the alveolar sacs → Alveolar tears → Entrance of air into the lung’s stroma
    • Other Causes:
    • Wound of the chest → Entrance of air within the lung substance
    • Fractured rib → Puncture of the lung parenchyma → Entrance of air within the lung substance
  • Papilloma is a benign tumour
  • Papilloma is localised in the large bronchi
  • Multiple papilloma is associated with HPV infection in children
  • Solitary papilloma is associated with middle to old age with no association to HPV
  • Papilloma has a fibro - vascular stalk as a microscopic finding
  • Solitary pulmonary nodules have a coin lesion upon US
  • The risk of a coin lesion becoming malignant increases over 50 years old
  • Causes of Primary Solitary Nodules:
    • Granulomas (e.g. Tbc, Histoplasmosis)
    • Malignancy (primary Cancer)
    • Bronchial (Chondroid) Hamartoma