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Obstructive lung

diseases
FEV1/FVC > 0.7
Glandular hyperplasia
Mucus hypersecretion

Smoking

Emphysema

Chronic Bronchitis

Reversible enlargement of alveoli


Pink Puffer

Centriacinar

Asthma

Productive cough for 3 mo. in 2 years

Reversible bronchoconstriction

Infections (fever) + Cor pulmonale


Blue Bloater

Panacinar

Smoking

a1-AT deficiency

Gross: focal brionchiole dilation

Gross: dilation of alveoli

Obstruction + Infection =

Bronchiectasis
Sm. m. & elastic tissue damage irreversible
dilation of bronchi/ bronchioles fibrosis
Associated w/ CF
Desquamation of epithelium ulceration
hemoptysis & orthopnea

Atopic

Non-atopic

Allergen type I hypersensitivity reaction


IgE mediated (early) leukocyte mediated (late)
1. Goblet cell hyperplasia
2. Sub-BM fibrosis
3. Eosinophilic inflammation
Diagnosis: Eosinophilia in peripheral blood smear,
Curschmann spirals & Charcot-Leyden crystals in BAL

Viral infections

Restrictive
lung disease
Normal FEV1/FVC

Fibrosing
UPI

Idiopathic pulmonary
fibrosis

Nonspecific interstitial
pneumonia

Honey-comb fibrosis
TERT/C mutations

Cellular pattern

Cryptogenic
organizing
pneumonia

Pneumoconiosis

Drug-induced
Bleomycin
Amiodarone

Masson Bodies

ACE-I

Fibrosing pattern

Coal-Workers type

Anthracosis

Silicosis

Asbestosis

Nodular fibrosis in hilar LN

Gross: Pleural plaques

Whorled collagen

Micro: Asbestos Body (beading &


knobbed ends)
Associated w/ mesothelioma

Simple
Carbon-leiden
macrophages (macules)

Complicated
Intense black scars

Radiation-induced

Restrictive lung
diseases

Pulmonary Eosinophilia

Granulomatosus
diseases

(Acute eosinophilic pneumonia


w/ respiratory failure)
Inc. eosinophils & IL-5

Sarcoidosis
1. Non-caseating granulomas

Hypersensitivity
pneumonitis

2. Multinucleated giant cells

Exposure to inhaled Ag caseating


granulomas in alveolar walls

2. Schaumann Bodies

- Farmers lung

3. Asteroid Bodies

- Pigeon breeders lung

Cell-mediated immune response


bilateral hilar lymphadenopathy

- Humidifier or A/C lung

Smoking related restrictive


diseases
Smokers macrophages

Desquamating interstitial
pneumonia
Alveoli

Respiratory bronchiolitisassociated interstitial lung


disease
Bronchi/ bronchioles

Vascular lung
diseases

Pulmonary Embolism &


Infarction

Diffuse pulmonary
hemorrhage syndromes

Pulmonary HTN

Risk factors: bed ridden, DVT


Emboli lodged at bifurcation of
pulmonary artery = saddle embolus

Idiopathic
pulmonary arterial
HTN

BMPR2 mutation

Goodpastures

Idiopathic pulmonary
hemosiderosis

Hemoptysis

Vasculitis-associated
hemorrhage

Lung Tumors

Adenocarcinoma
Small, peripherally located
TTF1 +ve

Squamous cell
carcinoma

Smoking

Large, peripherally located


Keratinization

Small cell
carcinoma

Large cell
carcinoma

Carcinoid Tumors

Associated w/ paraneoplastic
syndromes (hypercalcemia)

Neuroendocrine origin

1. Islands of small basophilic cells


2. Necrosis
3. Azzopardi effect

Typical

Atypical

No necrosis

Necrosis

<2/10 mitotic figures per HPF

2-10/10 mitotic figures per HPF

Pleural lung
diseases

Pleural Effusion

Pneumothorax

Pleural Tumors

Associated w/ emphysema,
asthma, TB

Inflammatory

Non-inflammatory
(hydrothorax)

Spontaneous
Cavity that communicates
directly w/ pleural space
air escape

Traumatic

Therapeutic

Primary

Secondary

Perforation of chest wall

Solitary fibrosis
tumor

Mesothelioma

Whorled collagen

90% are asbestos related

CD34 +ve/ Keratin ve

CDKN2A/ INK4a homozygous deletion

Epithelioid type

Sarcomatoid type

Mixed (biphasic)
type