Squamous cell carcinoma Note keratin pearls and desmosomes Name some characteristics

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

Note the thickened BM and SM cells asthma Note the thickened BM and SM cells

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

Contamination of the sample Bad sputum sample Shows the normal squamous epithelial cells found in the upper respiratory tract… Contamination of the sample

Squamous cell carcinoma

Small cell carcinoma Note blue cells with high N/C ratio No nucleoli Salt n peppa neuroendocrine cells

Name the characteristics Adenocarcinoma Name the characteristics

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

Charchot-leyden crystals Found in what lung disease?

These are formed from granules of destroyed eosinophils asthma These are formed from granules of destroyed eosinophils

hamartoma

“discrete tumor of benign tissues in excess or disarray” Cartilage in excess

Ha—were you paying attention in hemonc?? Smudge cell Ha—were you paying attention in hemonc??

Large cell undifferentiated lung cancer Note that there are no glands, desmosomes, keratin Name some characteristics.

Located most often in the periphery Ummmm.

Large cell lung cancer

sarcoidosis

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

Usual Interstitial Pneumonitis

Patchy regions of interstitial inflammation and fibrosis alternating with normal lung parenchyma Temporal heterogeneity What’s the differential?

UIP Asbetosis Rheumatic disease What’s the treatment?

O2 therapy

sarcoidosis

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

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

Purulent debris in lumen Dilated bronchus Def:? bronchiectasis Purulent debris in lumen Dilated bronchus Def:?

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

Cystic fibrosis Kartagener’s syndrome (primary cilia dyskinesia syndrome)

Alveolar filling with PMNs pneumonia Alveolar filling with PMNs

Increased numbers of submucosal mucus glands Chronic bronchitis Increased numbers of submucosal mucus glands

Mycobacterium tuberculosis Acid fast stain

Centrolobular emphysema

Hypersensitivity pneumonia Definition: immunologic response to an inhaled organic antigen Causes?

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?

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

Extrinsic allergic alveolitis

Centrolobular emphysema Dilation and septal destruction Increased elastase activity

BOOP Bronchiolitis obliterans Fibroblastic proliferation in bronchiole lumen

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

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

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

Silicotic nodule Later this becomes fibrotic and eosinophilic

Organizing pneumonia Fibroblatic proliferation in alveolar airspaces BOOP Organizing pneumonia Fibroblatic proliferation in alveolar airspaces

What disease is this associated with? Ferruginous body What disease is this associated with?

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

Proliferative phase of Diffuse Alveolar Damage Note the fibroblasts in the interstitium (What is the clinical term for DAD?)

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

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 cells—attempt 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?

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

Metastatic breast adenocarcinoma

Metastatic GI adenocarcinoma

Metastatic ENT carcinoma

Metastatic renal adenocarcinoma

Metastatic melanoma Note the pigment filled macrophages?