Workshop 18

w-orksh** 18

Respiraia;y pa f*oiog3. Topie

lI

}-{ICR*SC*PY

. .

Interstitialpneumonia Interstitial pneumaaia with Pnerrr**eystis carinii

. "

Fulmonarytubercul+sis Hyaiiae mer';braae disease Silic*sis

ider::castrativ= e)

EfACRGSCiiFY . Fuim*narytubercuicsis

.

Bronc.ho-pulmonary carcinoma

F-{FCR*SC*PV Inf srstif ial p*ex rmex i* ' Atyp'i*el pnel.:n:*ais $!+*ns ghe absen+* +f tire rntra*alEe*lar cx,Jdet+ " Interstitial rneans the inflammatcry exude.te is located in the alvealar I'ralls . Eticlcgy: Mirc*pias;*a p;:eumonia* Viruses - infrtrenze, respiratcr_v sinciiiai. measies .4,.{ier*se<rpy

' .

aeuteneerCItisingbrr:nchioiitis alveolar wails, m+a*nuclear in{larnmat*ry infiitrate {lyrnphccytesi and edeara parieto-alveoiar capillary congestion --* thickeiiiag ofthe alveolat -*-ail with sreatioa of an alveola-capillarv' L]ILTL-K

Aiveolar lume* is free

Esterstiti*l p*eiime*ia wi€h P*exmcrcysiis tsrEttii . It ceeiirs in c*llectiviti*s af dystr*phie infarits and childr** rvirh repeated hospitali zatic* s {AIDS} * Etial*gy: Pnzum*eystis sarisii t

Aiveoiar walls: i:lflammati*a wit?: lymphcei'tes and plasma cells:*ith thicke*ing 1?

Aive,tlar iumea: foamy exudaie looking as "scap bub,bles"

P*kncnary ir:bereulssis " Fr:kncnary inftctious

diseaee wiih aercgerue traiismittion caused by M tuberculosis determiniag graaulcnlatous infl ammation

*f

tl':e

-

'r-.,*^r yuss

Primary {prirnai nfec.ti on} . shildhoad Secandary {reir:fe-etian or reactivaiiaa} P!

i*oscopy -

tu

n*.,,i;XllHX.',.,,,-

't fw.ec ni celic

e

-

-

muitinucieated Langhans giant ceils

epitheJic':d ceJl-t sp+cifi e serrsiii'ing T i=;mph+eites Feafures,

.

D,.-:^^

t I-lSltJlt

F* ecrasis cf cazei frcat ian Hyaline rnembr*ne dise*se . lt oecurs in premature newbcrns " Cause. instrilicienc'; in aiveciar surfac€ant f*mati*n Microscopy . eolapsed. un-expanded alvenli " Alve.alar chaneifs and alveoii are iined by eosinophilie homagene*us mernbranes { h,1,al in * mem hra* e*s} +:1**:* *..,^^*.-t: .^t -*:,{^., I lt.,r rlir trruL.Jpurtagtrfl trJtlr

alveclar cel I neci-osis

. c:l:

It resr:lts sn slr,'ss*{*-eapillary bl*ek, eausing *eute respira-tor''; distr*ss

-- -:-

. .

It is a pneumocani
ryIACEIOSCSFY

PULMONARY TUBERCUTOSIS " Pulmcind{v iubercui*sis iTB} is an infectiaus lung disease w:iih air transmittiog determined b-y M. tuberculoiis" which causes a tiisuiar granulomatous iaflammati*n.

.

Tuberculous granulom* is the morphaiogical substrate

o'-:"':H,'J*l,Tj:?T".,|;:jr,ix;["{;.ffff

clTB:

L?i

' mcn*rtlieiear +eils - mai:riy iyrxphacat+s {L3ri Cider granulomas: it present to the periphery rim of fibroblasts and fi brous ronnective tissue Types sf Fi:im**ary Tubmillssis-TB A. Primary E. Secondan

Primary pi:irno**ry TB a chi

' .

I

ihc*d tuberculcsi s ipri rrrary

l*fecticsl rlcfurs thr*ugfr iahalarioa fc*q-rrrxi*it +f

t**

*fM.

infecti on).

tubereelasis. wirich ca*ses fire

characteristis. lesi<.*s

The characteristic lesions af primary infectioir: a. Ghan scmcler Ghcn f*cus Tbc limphade*itis #. pregrsssio.'e pdmar-r.' pulmanarl' fu$ercui*sis E',,olutiorr af Gh+n ccmr-rlex . Favcrable. Healir:g'+iith ijbraus sear t?--rrnati+a- ctr en,i:a suiatian and caicificatian i,:ure'j pni:]arir +t--rn:pi exi M. tuberculosis can persist in a latent furni {latent tubercglosisi Uniar.*rable ' prcgres sir: e pri mar'; puim+nary.. tubcreulcsi s b. Fregressive primary p*lmonary tuberculssis . Cazesus pneumonia . Tubersuicus caverna . Ple*raj effusirrs ' il.€iitiarl t'-:bercul*sis

Seroudary Tub*er:I*sis ii is $r*:iiiested as. a. Apical ***ular iesions {"Assmaaa focus'} b. Frogre

ssi r,-e

secorrrjary pu I *:*nar,v

t u i:

ertu

ir: sj s

Evolutian ef Apieat aadular lesians {..Assmann feeus"}

.

Fav*rab!*:

Heali ng b.v-.- iibrosi s aad cai cii-i caticn Lrnfhvorabie iwitirout treatme*ti Pr*gr*ssive sec*ndary prilmr-r::a,iy tub*reu1,:sis b. Progressive sef, sndary pul*ronary t*berculosis 1. Apicai tubercuio*s infiltrate - Apieai rel;ercr:iaus iniliirate resuiis b'y exjensicn aicazecus aecr+sis t+ ?he entire iung apex (fr*m Assrsann focus) r Masroscopicaiiy, iirere is an extensive apical area of cazcous ilsrrosis witi: ,iestructicrr *f rr,:rrin=l iurrg siructr:re ilac*: cf ai-rtirrac',.-tic pigmerrt) r In ev,:lution, prcgressing io apicai *ribrc-cazecus cavitary iuberculosis 2. api*ai irbra-cazecus ea\..itary tubercui{-;si s e Apical i ecent 'Javernae * Different fcrms *f tuberculaus disseminati*n i. ?ubeiculous bronci:*pneumcnia

.

z. Miiliarv ii.r-berculcsis 3. Sero-flbrinous pieuresia

3.

. .

Adva;iced fr-bro-caeeous caviiary' tiii:erculcsis Invoivement ol i, niore than one, or ail puimonary lebes Cha::acteristic lesir:rs cl d *ia verna-e'i..r,.'iih r.'ari** s ii gi;'ib cli ic:; o'

":*

1i;[:-J:?i:;:*:"*s em

. .

4!.

rPierrrrI rLur ar

i

a at i o

n

&.tiilia,,i. _.ubersuicsis

Ser+-frbrin*uspieuresy Dge t+ exte*-*ian althe inJla:r:::':e:ia* l+ ii:e r,.isc*;al pler::e ii*a,iin g i; rv fi brr: si s r'": itir intr-apienrai a,j irei enr-. e fo iila r i err

^ j^ qvrnr-L' s-1 rrrpii_! 5I5

It results

b-y' conneciive ai-aaii'izaiicn i;f pieuial ser*-fibriiicus exudate witir iorniation af acinei-enccs bctw'een the tw'o plci;i-ai ia'uei-s and fibi-cits liiickening oi'thcm

BR+NCH *FLTLSf *NA RY TLI MGPTS . There are 3 major categcries oiiung tumors.

. t,

secondan' lung tumnrs br*nehcpiii r,r*;:ar ca:gitr* *:a bronchopulmonar hrenign furnors Mei-st tiimcrs are r*aliq$aslt*:-a*t*-ste*ses

Er.:rrchap*lmenar earcincm* {CBP}

It ir +h+ mnr* c,rmmnn

lrrnc tiisnr '.",.'"''-

The n:ajai risi,: i'a,rors are represented'uri'srnoi:ing, an,i in,iustr-iai air paiiuianrs (asbestosi, radiatioa, genetic factcrs

Drigin

.

r;sus!!r,:, the tum+r has origin in the main irronchial epitheiium (orrler

i, ii, iII;

and

mucous glandular epithelium.

Lccaticn . After lscatisn, there are 2 ruacr*seopical types: iai tire ser:trsJ I i:ilar turncr {irfiJrraiirie tun:*ri r

!'4iar*.n=e**ir.+!!r.

l"rr.^,n'-hi*i ;':rc::r<^.ln+ !ht!=r

brcncliial lurr,en and inliltrates

bron*hiai -rvell

f r rmrlr!

ic q

f r rmr:r

rr,hirh r*,hltn r,-i r

with extending into iung

ln nrrlr*nrrqr'r, *lo,rt,-

^o.o--hr,^rq iiri tir+ nprin i:prq i ir i *1,1r* ir'.r.i

.

r ir r rrir^rr-\r

Macroscopieally, is a buiky. ncdular tumor. single or multiple, white-gray in solor. soiiri. vritir iiresuiar mar*qins. because oilocai infiitrative ieature. The tumor coniains areas of-necrosis and hemorrhaqe.

lI. Secandarv

.

iiiq

luftg tuniors or- lui-rg rieiasias€S Mscroscopically" the tumcrs appeer as *rultiple nodules, clearly defined, various sizes, with random distribution w-ithin bilateral lung lobes.