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Obstructive lungdiseases

FEV1/FVC > 0.7

Emphysema

Reversible enlargement of alveoli 

“Pink Puffer”

Centriacinar

Smoking

Gross:focal brionchioledilation

Panacinar

a1-AT deficiency

Gross: dilation of alveoli 

Chronic Bronchitis

Productive cough for 3 mo. in 2 years

Infections (fever) + Cor pulmonale

“Blue Bloater”

Asthma

Reversible bronchoconstriction

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

Non-a

Viral inf

Glandular hyperplasiaMucus hypersecretion

Smoking

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Restrictivelung disease

Normal FEV1/FVC

Fibrosing“UPI”

Idiopathic pulmonaryfibrosis

Honey-comb fibrosis

TERT/C mutations

Nonspecific interstitialpneumonia

Cellular pattern Fibrosing pattern

Cryptogenicorganizing

pneumonia

Masson Bodies

Pneumoconiosis

Coal-Workers type

Anthracosis

Simple

Carbon-leidenmacrophages (macules)

Complicated

Intense black scars

Silicosis

Nodular fibrosis in hilar LN

Whorled collagen

Asbestosi

Gross: Pleural pla

Micro: Asbestos knobbed ends)

Associated w/ me

Drug-indu

BleoAmi

ACE

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Restrictive lungdiseases

Granulomatosusdiseases

Sarcoidosis

1. Non-caseating granulomas

2. Multinucleated giant cells

2. Schaumann Bodies

3. Asteroid Bodies

Cell-mediated immune responsebilateral hilar lymphadenopathy

Hypersensitivitypneumonitis

Exposure to inhaled Ag caseatinggranulomas in alveolar walls

- Farmer’s lung

- Pigeon breeder’s lung

- Humidifier or A/C lung

Pulmonary Eosinophilia(Acute eosinophilic pneumonia

w/ respiratory failure)

Inc. eosinophils & IL-5

Smoking related restdiseases

Smoker’s macrop

Desquamating interstitialpneumonia

 Alveoli 

Ra

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Vascular lungdiseases

Pulmonary Embolism &Infarction

Risk factors: bed ridden, DVT

Emboli lodged at bifurcation ofpulmonary artery = “saddle embolus”

Pulmonary HTN

Idiopathicpulmonary arterial

HTN

BMPR2 mutation

Diffuse pulmonaryhemorrhage syndromes

Goodpasture’sIdiopathic pulmonary

hemosiderosis

Hemoptysis

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Lung Tumors

Adenocarcinoma

Small , peripherally located

TTF1 +ve

Squamous cellcarcinoma

Large, peripherally located

Keratinization

Small cellcarcinoma

Associated w/ paraneoplasticsyndromes (hypercalcemia)

1. Islands of small basophilic cells

2. Necrosis

3. Azzopardi effect

Large cellcarcinoma

Carcino

Neur

Typical

No necrosis

<2/10 mitotic figures per HPF

Smoking

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Pleural lungdiseases

Pleural Effusion

InflammatoryNon-inflammatory

(hydrothorax)

Pneumothorax

Associated w/ emphysema,

asthma, TB

Spontaneous

Cavity that communicatesdirectly w/ pleural spaceair escape

Traumatic

Perforation of chest wall

Therapeutic

Pleural

Primary

Solitary fibrosis

tumorWhorled collagen

CD34 +ve/ Keratin –ve

Mesothe90% are

CDKN2A

Epithelioid type Sarcom