2. Squamous cell carcinoma
Note keratin pearls and desmosomes
Name some characteristics

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

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

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

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

12. Squamous cell carcinoma

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

16. Name the characteristics
Adenocarcinoma
Name the characteristics

17. 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

19. Charchot-leyden crystals
Found in what lung disease?

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

22. hamartoma

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

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

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

28. Located most often in the periphery
Ummmm.

30. Large cell lung cancer

32. sarcoidosis

34. 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

36. Usual Interstitial Pneumonitis

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

38. UIP
Asbetosis
Rheumatic disease
What’s the treatment?

39. O2 therapy

41. sarcoidosis

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

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

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

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

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

50. Alveolar filling with PMNs
pneumonia
Alveolar filling with PMNs

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

54. Mycobacterium tuberculosis
Acid fast stain

56. Centrolobular emphysema

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

59. 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?

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

61. Extrinsic allergic alveolitis

63. Centrolobular emphysema
Dilation and septal destruction
Increased elastase activity

65. BOOP Bronchiolitis obliterans
Fibroblastic proliferation in bronchiole lumen

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

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

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

71. Silicotic nodule
Later this becomes fibrotic and eosinophilic

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

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

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

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

79. 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

80. 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?

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

84. Metastatic breast adenocarcinoma

86. Metastatic GI adenocarcinoma

88. Metastatic ENT carcinoma

90. Metastatic renal adenocarcinoma

92. Metastatic melanoma
Note the pigment filled macrophages?