Pathology Exam 3

Chapter 10

Chapter 10 Diseases of the Respiratory Tract Occurrence Cause Sites of Origin Primary Tumor Local Symptoms Features Complications Treatment Carcinoma of Pharynx More frequent in men Usu. occurs b/t 40-70 years old Unknown in US Epstein-Barr virus (China & Africa) Nasopharynx Palatine Tonsils Hypopharynx Small, firm, gray Granular, friable surface Bleeds easily Obstruction (ex: Eustacian tube) Discharge Hemorrhage Pain Aggressive invade adjacent structures Poorly differentiated Squamous Regional lymph node metastases (early) Distant hematogenous metastases (late) Irradiation Chemotherapy Early cases often cured Carcinoma of Larynx More frequent in men 50-70 years old Smoking cigarettes Anterior 2/3 of one vocal cord Firm, gray plaque or nodule Becomes ulcerated Destruction of vocal cord Painless persistent horseness aphonia Slow growing Well differentiated Squamous Cervical lymph node metastases (far advanced cases) Laryngeal obstruction w/ dyspnea Surgery Irradiation Most cases cured

Atelectasis collapsed (airless) state of one or more parts of the lung Compression Atelectasis o Cause: pleural effusion or empyema, pneumothorax, or diaphragm elevation o Symptoms: Large foci mediastinum shifts away from atelecatic side Resorption (Obstructive) Atelectasis o More frequent o Cause: complete/nearly complete bronchial obstruction; air in obstructed area is resorbed by the blood Intraluminal mucus/pus Aspirated foreign bodies Bronchial neoplasms o Appearance: Shrunken, airless, rubbery, purple o Symptoms: Small foci none Large foci dull/flat percussion note, rightleft shunt of unaerated blood, hypoxia, dyspnea, & cyanosis; mediastinum shifts toward atelecatic side o Complication: bronchopneumonia

Pathology Exam 3

Chapter 10

Chronic Bronchitis & Obstructive Emphysema Features o Chronic, progressive, & irreversible o Persistent overdistention of lungs o Gradual loss of pulmonary tissue (esp. alveolar septa) o Bilateral, diffuse changes o Airflow obstructed during expiration (inflammation of airway) o COPD combo of chronic bronchitis & obstructive emphysema (CB/OE) Common in US More common in men Occurs after age 40 Chronic Bronchitis Chronic/repetitive inhalation of irritants (ex: tobacco smoke) Often occurs w/ bronchial carcinoma Other irritants: industrial/agricultural fumes & dust, urban smog Complicated by Bacterial Infection Due to ciliostatic effect Pneumococci Hemophilus influenzae, Moraxella catarrhalis Bronchial Asthma Causes obstruction to air flow (usu. episodic) Most do not develop obstructive emphysema asthmatic bronchitis can occur in pts w/ CB/OE asthma attacks due to episodes of acute bacterial bronchitis

Cause o

Pathologic Anatomy Lungs Large, soft, fluffy, black Cut surface porous, enlarged alveoli, thin remnants of alveolar septa Bronchi Thick walls, lumens filled w/ viscid mucin/pus Microscopic - mucous glands, smooth muscle, & fibrous tissue, inflammatory cells Complications Acute bronchopneumonia, lung abscesses, foci of pulmonary fibrosis Pathogenesis Chronic bronchitis Chronic overinflation Expiratory bronchiolar collapse Loss of effective cough

Causes partial bronchial obstruction (esp. during expiration) Causes lung atrophy (esp. alveolar septa) Enlargement of alveolar septal pores septa become threadlike Due to loss of tractional support of airway patency Causes airway resistance & ineffective cough Excess mucin Causes secondary bacterial infection & recurrent acute bacteria bronchitis & bronchopneumonia

Clinical Features o Cough initial symptom; mucinous sputum; worse in morning & in winter o Dyspnea on exertion o Acute bacterial bronchitis purulent sputum, cough o Barrel-shaped chest fixed state of inspiration, hyperresonant lungs, breath sounds, rales & wheezing, faint heart sounds, cyanosis

Pathology Exam 3

Chapter 10

Course: slowly progressive (5-10 yrs), develops dyspnea @ rest Eventual respiratory & cardiopulmonary failure (rt-sided high output failure) Death w/in 2 years of 1st respiratory failure

Bronchial Asthma (BA) Features o Allergic inflammation of bronchi humoral immunity involving IgE Inhaled allergens pollen, animal danders, mold spores, house dust Foods eggs, milk, wheat Drugs aspirin, anti-inflammatory agents o Recurrent proxysms of dyspnea & wheezing o More frequent in males; begins in childhood; genetic presdisposition & linked to hay fever; most improve after puberty Pathogenesis o Allergen reaches bronchi directly (inhalation) or via blood o Bronchoconstriction atopic rxn o Bronchial mucosal edema o secretion of viscid mucin o obstruction to airflow due to resistance, esp. during expiration Pathologic Anatomy o Lungs: overinflated w/out alveolar septal atrophy o Medium-sized bronchi: thick walls, small lumens; filled w/ viscid mucin; intraluminal mucin & eosinophils; mucosal edema, dilated mucous glands, thick smooth muscle Clinical Features o Severe dyspnea sense of suffocation o Wheezing prolonged inspiration & expiration; more prominent during expiration o Chest wall held in fixed inspiration o Timing Begins w/in 15 min. of inhaled allergen Peaks in 30 min. Stops w/in 3 hours Status asthmaticus begins slowly, persist for hours to days o Nonspecific bronchial hyperactivity attacks after exercise, stress, inhalation of nonantigenic agents o Death rare; severe hypoxia & shock

Carcinoma of Lung Features o Bronchial carcinoma (BC) usu. arises from epithelium lining large & medium bronchi incidence in all industrialized countries rare prior to 1900; due to smoking habits most frequent cause of death from cancer occurs b/t 50-70 years old aggressive widespread metastases common early on Cause o

Tobacco smoking esp. cigarettes w/ deep inhalation Directly related to # of cigarettes smoked Carcinogens benzopyrene Other inhaled irritants secondhand smoke, fumes, asbestos, radioactive dust Synergistic factor to smoking

Pathology Exam 3

Chapter 10

Pathologic Anatomy o Begins near lung hilum thickened granular focus in mucosa of segmental bronchus o Nodule enlarged focus; obstructs bronchus o Mass firm, large, gray-white; due to growth of nodule; invades adjacent lung & other tissues o Atelectasis & acute/chronic infection in lung distal to obstructed bronchus

Histologic Types of Lung Cancer Squamous carcinoma Large-cell undifferentiated carcinoma Small-cell Oat cell carcinoma undifferentiated Derived from pluripotential basal cells of bronchial epithelium carcinoma Neuroendocrine differentiation Adenocarcinoma Clinical Features o Persistent cough mucinous sputum o Hemoptysis o Dyspnea o Recurrent pneumonia fever, purulent sputum o Dull, pleuritic chest pain o Weight loss o Invasion of adjacent tissues Hoarseness recurrent laryngeal nerve Diaphragmatic paralysis phrenic nerve Cardiac arrythmias heart Congestion & edema of face & upper limbs superior vena cava Pain in shoulder & arm brachial plexus Timing Progress rapidly over several months Death w/in 1 year after onset of symptoms Cause of death complications of lung tumor, metastases, or cachexia

Treatment o Surgical resection o Most cases inoperable o Irradiation & chemotherapy small-cell only