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Respiratory System Pathology Slides (Part 1)
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Chronic congestion of the lung (brown induration) (302)
Chronic LVF - impairment of the exit of the blood from the lungs Increased pressure in the alveolar capillaries Microhemorrhages into the alveoli, red blood cells are phagocytosed by
macrophages (heart failure cells) (macrophages laden with hemosiderin)
Fibrosis of the interstitial spaces of the lung Lung is brown and firm brown induration Consequences of higher pressure in capillaries is pulmonary
hypertension, which may lead to right heart failure.
spaces filled by air (might be filled by edematous fluids)
Coal dust (Black irregular spots)
Heart failure cells (Single cells containing dark dots)
alveolar walls
Emphysema of the lung (2)
Chronic lung disease characterized by permanent enlargement of the airspaces
Visible enlargement of the airspaces.
major cause cigarette smoking (protease-antiprotease theory)
Alpha-1 antitrypsin (1-AT) deficiency 1% cases
Emphysema is classified according to the location of the lesions within the pulmonary acinus: Centriacinar (Centrilobular) Panacinar (Panlobular) Paraseptal Irregular
Ruptured alveoli, forming large airspaces (less surface area)
Coal dust (smoking?)
Pores of Kohn
Bronchus?
Bronchopneumonia (303)
Caused by infection of air way (trachea, bronchi) Streptococci, staphylococci Multifocal changes Four stages, but we can observe different stages in every focus.
Pneumonia has 4 stages: Congestion Red hepatization Gray hepatization Resolution
macro: multifocal changes. Inflammations are yellow. Usually complication of bronchitis. Slide:
Normal area: some fluid in normal area (septa visible). Inflamed area: Septa almost invisible (lots of cells in exudate
compresses the septa). Bronchi filled by pus (inflammation start in bronchi, then involves other areas) (neutrophils, cellular debris).
Lots of rbc and neutrophils
Bronchioles filled with pus
Interstitial pneumonia (305)
The most common cause is viral infection of the lung CMV, Varicella, HSV Viruses affect the alveolar epithelium and cause mononuclear infiltration
Children, elderly patients Often asymptomatic, no changes in x-ray picture
Dilated interstitial parts of the lung, airspaces preserved Symptoms: cough for a long time. Reduced lung capacity.
Necrosis of type I epithelial cells and hyaline membranes formation Morphology: no circumscribed changes. More yellow areas suspected (in
autopsy sample). Newborn might die from interstitial pneumonia slide: thickened septa containing cells (Inflammatory cells (lymphocytes,
plasma cells). Dilated capillaries. Hyaline membrane covers septa wall (from necrotic debris of injured cells). Can cause death when large areas covered. Bronchi normal with no infiltration.
Wide bronchoalveolar septa filled with inflammatory cells
Necrotic debris on wall of septa, forming hyaline membranes. Serious state
Enlarged capillary in septa filled with blood cells
Empty alveolar spaces
Artery?
No infiltration in bronchus
Fibrocaseous tuberculosis of the lung (306)
Caused by Mycobacterium tuberculosis Inhaled M. tuberculosis is deposited in the alveoli, usually in the
lower and middle lobes and anterior segments of upper lobes. Generally is transmitted from person to person by aerosolized
droplets Caseous granuloma - Classic lesion of tuberculosis
Soft, semisolid core surrounded by epithelioid cells, Langhans giant cells, lymphocytes and peripheral fibrous tissue Caseous necrosis in center
This is why this form of tuberculosis is called fibrocaseous tuberculosis
Gross: large nodule (white, chalky appearance), caseous necrosis. Granuloma at the edge.
Slide: Edges of necrosis fibrosis (fibrous connective tissue surrounds granulomas). Lesions are large (unlike in miliary tuberculosis)
Large area of necrotic debris
Langhans giant cellepithelioid cells
Inflammatory infiltrates
Tuberculoma (319)
Firm, round tumor (not neoplastic) Lung, meninges Solitary mass with central caseous necrosis surrounded by granulomatous tissue Encapsulated Can form when treating tuberculosis. If treatment stops, new granuloma forms
around healing areas (fibrotic areas). Up to 10 cm. Looks like malignant tumor. In tumor with central necrosis, need to check border to determine cell type to
differentiate form neoplasm.
Slide: part of slide pink, other area darker. Large, light pink area = necrosis. Many new, small granuloma around large area of necrosis. Epithelioid cells (elongated nucleus). Can be layers of necrosis mixed with layers of fibrosis
fibrosis
Necrosis (old granuloma)
New granuloma on the edge
Sarcoidosis of the lung (313)
Worldwide disease affecting all races and sexes Causes are multifactorial environmental and genetic (BTNL gene) lung, lymph nodes, spleen, liver, skin, uveal tract, bone marrow Granulomatous inflammation
No caseous necrosis multiple, sarcoid granulomas are scattered in the interstitium of the lung granuloma lymphocytes, giant cells, epithelioid cells (macrophages) Asteroid bodies (star shaped crystals) may be seen Schaumann bodies (small calcifications with a laminar structure) may be present
inside Langhans cells. slide: lymphocytes on the edges, central part with epithelioid cells (not just on the
edge like regular granuloma). Giant cells. Many granulomas.
Silicosis of the lung (323)
Caused by the inhalation of silicon dioxide Silica particles are ingested by alveolar macrophages Macrophages are destroyed by silica particles dead cells release free silica particles and fibrogenic factors fibrogenic factors form nodules of collagen fibers.
Usually slowly progressing, nodular, fibrosing pneumoconiosis. Silicotic nodule is composed of concentric whorls of dense, sparsely cellular collagen Infiltration composed of lymphocytes and macrophages At the edge of the nodule dust with carbon pigment and silica particles
silica particles are hard to see Slide: nodule surrounded by chronic inflammatory cells (Coal dusts, macrophages,
lymphocytes). Few cells in nodule (collagen fibers).
Whorl of collagen
Chronic congestion of the lung (brown induration) (302)Emphysema of the lung (2)Bronchopneumonia (303)Interstitial pneumonia (305)Fibrocaseous tuberculosis of the lung (306)Tuberculoma (319)Sarcoidosis of the lung (313)Silicosis of the lung (323)