FACULTY OF ALLIED MEDICAL SCIENCESFACULTY OF ALLIED MEDICAL SCIENCES

Histopathology and CytologyHistopathology and Cytology

((MLHC-201MLHC-201))

THE LUNGSTHE LUNGS

THE PATHOLOGY OF THE LUNGSTHE PATHOLOGY OF THE LUNGS

SupervisionSupervision

Prof.Dr.Noha RagabProf.Dr.Noha Ragab

OutcomeOutcomess

1-To know the causes of Congenital anomalies 1-To know the causes of Congenital anomalies of the lungs.of the lungs.

2-To know types and causes of pulmonary 2-To know types and causes of pulmonary diseases.diseases.

3-To differentiate between atopic and non-3-To differentiate between atopic and non-atopic asthma.atopic asthma.

CONGENITAL CONGENITAL MALFORMATIONS OF THE MALFORMATIONS OF THE

LUNGSLUNGS Congenital anomalies of the lungs are, in most Congenital anomalies of the lungs are, in most

cases, due to a developmental defect of the fetus cases, due to a developmental defect of the fetus during intra-uterine life.during intra-uterine life.

  

1-1-TOTAL OR PARTIAL AGENESIS OF THE LUNG TOTAL OR PARTIAL AGENESIS OF THE LUNG (APLASIA AND HYPOPLASIA):(APLASIA AND HYPOPLASIA):

This consists of complete absence of oneThis consists of complete absence of one

or both lungs or any part of the lung. or both lungs or any part of the lung.

2-2-TRACHEO OR BRONCHO-ESOPHAGEAL TRACHEO OR BRONCHO-ESOPHAGEAL FISTULAFISTULA::

The gastrointestinal and respiratory tracts The gastrointestinal and respiratory tracts

begin in the embryo as a single tube that begin in the embryo as a single tube that later divides to give two independent later divides to give two independent systems .systems .

Any failure of separation of the two systems Any failure of separation of the two systems leads to an abnormal communication leads to an abnormal communication between any part of the respiratory between any part of the respiratory passages and the GI tract , the esophagus passages and the GI tract , the esophagus being the most commonly affected. being the most commonly affected.

The tracheo-esophageal or broncho-The tracheo-esophageal or broncho-esophageal fistula may be life threatening esophageal fistula may be life threatening and requires prompt surgical interference. and requires prompt surgical interference.

3- 3- PULMONARY SEQUESTRATIONPULMONARY SEQUESTRATION

This is a congenital anomaly in which a This is a congenital anomaly in which a part of the lung is isolated from the rest of part of the lung is isolated from the rest of the organ.the organ.

Atelectasis which is a failure of Atelectasis which is a failure of expansion or collapse of the lung expansion or collapse of the lung tissue that leads to loss of lung tissue that leads to loss of lung volume may be present at birth volume may be present at birth (neonatal atelectasis) or may appear (neonatal atelectasis) or may appear after birth (acquired atelectasis). after birth (acquired atelectasis).

PULMONARY ATELECTASISPULMONARY ATELECTASIS

Normal lung appearance

Thick alveolar wall

There is collapse of the alveolar spaces with thickening of alveolar walls

X-ray presenting left lung atelectasis

PULMONARY EMBOLISM AND PULMONARY EMBOLISM AND INFARCTIONINFARCTION

Pulmonary embolism is a very common cause of Pulmonary embolism is a very common cause of death (the third after myocardial infarction and death (the third after myocardial infarction and brain stroke). brain stroke).

PATHOLOGY:PATHOLOGY:

On pathological examination of a pulmonary On pathological examination of a pulmonary infarct: the affected area is (wedge-shaped).infarct: the affected area is (wedge-shaped).

On microscopic examination: features of On microscopic examination: features of ischaemic necrosis can be seen under a diffuse ischaemic necrosis can be seen under a diffuse infiltration of blood.infiltration of blood.

This is a group of chronic lung diseases This is a group of chronic lung diseases characterized by recurrent characterized by recurrent intrapulmonary obstruction of the air intrapulmonary obstruction of the air flow, a situation that is often associated flow, a situation that is often associated with a high morbidity and mortality rate. with a high morbidity and mortality rate.

The best known of such diseases are:The best known of such diseases are:1.1. EmphysemaEmphysema2.2. Chronic bronchitisChronic bronchitis3.3. Chronic Bronchial AsthmaChronic Bronchial Asthma4.4. BronchiectasisBronchiectasis

CHRONIC OBSTRUCTIVE CHRONIC OBSTRUCTIVE PULMONARY DISEASES PULMONARY DISEASES

(COPD)(COPD)

11 - -PULMONARY PULMONARY EMPHYSEMAEMPHYSEMA

The term pulmonary emphysema describes any permanent The term pulmonary emphysema describes any permanent dilatation of the pulmonary air spaces beyond the terminal dilatation of the pulmonary air spaces beyond the terminal bronchioles (alvroli) with destruction of their walls.bronchioles (alvroli) with destruction of their walls.

ETIOLOGYETIOLOGY

Emphysema is more common among males, people with a Emphysema is more common among males, people with a history of cigarette smoking, people exposed to certain history of cigarette smoking, people exposed to certain industrial fumes and people living in areas with a high industrial fumes and people living in areas with a high concentration of air pollutant. concentration of air pollutant.

Pathogenesis of emphysemaPathogenesis of emphysema

The pathogenesis of emphysema is based on the The pathogenesis of emphysema is based on the permanent loss of elasticity of the respiratory units due to permanent loss of elasticity of the respiratory units due to destruction of the elastin component of the alveolar septa. destruction of the elastin component of the alveolar septa.

X-ray demonstrate emphysemaEmphysematous lung with Large bullae formation

1- Centriacinar or centrilobular emphysema:1- Centriacinar or centrilobular emphysema:In this type of emphysema, only the central or In this type of emphysema, only the central or

proximal portions of the acini are affected. proximal portions of the acini are affected.

2- 2- Panacinar or Panlobular emphysemaPanacinar or Panlobular emphysema::The entire pulmonary acinus from the terminal The entire pulmonary acinus from the terminal

bronchiole to the alveolar wall is dilated. bronchiole to the alveolar wall is dilated.

3- 3- Distal acinar emphysema:Distal acinar emphysema:Only the distal segments of the acini are dilated while Only the distal segments of the acini are dilated while

the proximal areas are of normal size.the proximal areas are of normal size.

ClassificationClassification

4- 4- Irregular emphysemaIrregular emphysema::

This is the most common form of This is the most common form of emphysema encountered at autopsy.emphysema encountered at autopsy.

It does not follow a regular pattern inside It does not follow a regular pattern inside the acinus. the acinus.

Usually associated with extensive scar Usually associated with extensive scar formation in the lungs as the presence of formation in the lungs as the presence of healed pulmonary tuberculosis and chronic healed pulmonary tuberculosis and chronic bronchitis. bronchitis.

Emphysema

22 - -CHRONIC BRONCHITISCHRONIC BRONCHITIS Common among heavy smokers and Common among heavy smokers and

inhabitants of pollution-laden cities. inhabitants of pollution-laden cities.

More frequent among middle aged men and More frequent among middle aged men and 90% of the cases are found in chronic 90% of the cases are found in chronic smokers.smokers.

Symptoms:Symptoms:Any condition associated with repeated Any condition associated with repeated

episodes of persistent cough with copious episodes of persistent cough with copious sputum production for more than 3 months sputum production for more than 3 months duration is considered as a chronic case of duration is considered as a chronic case of bronchitis.bronchitis.

PATHOLOGYPATHOLOGY The epithelial lining may show The epithelial lining may show

hypertrophy, hyperplasia or some hypertrophy, hyperplasia or some metaplastic changes. metaplastic changes.

Narrowing of the airway passages: that Narrowing of the airway passages: that may be occluded by mucus plug, may be occluded by mucus plug, inflammatory cells and fibrosis of the wall. inflammatory cells and fibrosis of the wall.

Chronic bronchitis

Mucosal hyperplasia

Inflammatory infiltrateAnd blood vs congestion

33 - -BRONCHIAL ASTHMABRONCHIAL ASTHMA

Definition:Definition: Sudden paroxysmal narrowing of the Sudden paroxysmal narrowing of the

airways (bronchospasm) in response to airways (bronchospasm) in response to stimulation of the bronchial mucosa. stimulation of the bronchial mucosa.

PATHOGENESIS OF BRONCHIAL ASTHMAPATHOGENESIS OF BRONCHIAL ASTHMA The pathogenesis is based on the action of The pathogenesis is based on the action of

the different components of the the different components of the inflammatory process namely the inflammatory process namely the inflammatory cellsinflammatory cells and the and the inflammatory mediators.inflammatory mediators.

Hyperinflated lung in status asthmaticus

A- ATOPIC ASTHMAA- ATOPIC ASTHMA

This form of asthma usually diagnosed This form of asthma usually diagnosed during childhood during childhood

The stimulus usually an extrinsic The stimulus usually an extrinsic environmental antigen (dust, pollen, environmental antigen (dust, pollen, animal dander, food) triggers the animal dander, food) triggers the inflammatory reaction in a person with a inflammatory reaction in a person with a genetic predisposition and hyper-genetic predisposition and hyper-responsiveness of the airways.responsiveness of the airways.

B- NON-ATOPIC ASTHMAB- NON-ATOPIC ASTHMA

1- Infectious asthma1- Infectious asthma is triggered by an infection is triggered by an infection usually viral in nature or very rarely bacterial. usually viral in nature or very rarely bacterial.

2- Drug-induced asthma attack2- Drug-induced asthma attack. In sensitive . In sensitive individuals, a very small dose of the drug may trigger a individuals, a very small dose of the drug may trigger a severe asthma attack. severe asthma attack.

3- Occupational asthma 3- Occupational asthma is caused by the fumes, the is caused by the fumes, the dusts of organic and chemical substances found in dusts of organic and chemical substances found in many industries. many industries.

4- Certain emotional stresses, some strenuous 4- Certain emotional stresses, some strenuous exercises and the cold weather exercises and the cold weather have been known to have been known to provoke asthma attacks in sensitive persons. provoke asthma attacks in sensitive persons.

PATHOLOGYPATHOLOGY The The basic pathological findingbasic pathological finding in bronchial in bronchial

asthma following the sudden bronchial spasm is asthma following the sudden bronchial spasm is trapping of air distal to a mucus plug causing the trapping of air distal to a mucus plug causing the respiratory distress very characteristic of this respiratory distress very characteristic of this disease. disease.

The mucus plug contains the The mucus plug contains the Curshman spiralsCurshman spirals made of shed epithelial cells, eosinophils and made of shed epithelial cells, eosinophils and CharcotCharcot LeydenLeyden crystals. crystals.

The Charcot Leyden crystals are needle-like The Charcot Leyden crystals are needle-like structures made of eosinophilic granules that structures made of eosinophilic granules that coalesce. coalesce.

Mucous Mucous plugplug

BRONCHIECTASISBRONCHIECTASIS::Defintion:Defintion: Permanent abnormal dilatation of the bronchial Permanent abnormal dilatation of the bronchial

airways proximal to the terminal bronchioles, airways proximal to the terminal bronchioles, secondary to a chronic necrotizing infection of secondary to a chronic necrotizing infection of the bronchi and the bronchioles. Bronchiectasis the bronchi and the bronchioles. Bronchiectasis can occur at any agecan occur at any age

The etiological factors The etiological factors 1.1. Bronchial obstructionBronchial obstruction2.2. Bronchial infection Bronchial infection 3.3. Congenital malformations Congenital malformations 4.4. Cystic fibrosisCystic fibrosis

X-ray show dilated bronchulesDilated bronchules seen in bronchiectasis

PathogenesisPathogenesis . . Repeated attacks of obstruction and Repeated attacks of obstruction and

Infection of the bronchi leading to Infection of the bronchi leading to permanent dilatation of the airways. permanent dilatation of the airways.

Repeated infection destroy the bronchial Repeated infection destroy the bronchial walls and lead to permanent dilatationwalls and lead to permanent dilatation

Microscopic examinationMicroscopic examination:: The affected bronchial walls are heavily The affected bronchial walls are heavily

infiltrated with inflammatory cells and the infiltrated with inflammatory cells and the lumen is filled with inflammatory exudate. lumen is filled with inflammatory exudate.

The mucosal surface may show squamous The mucosal surface may show squamous metaplastic changes. metaplastic changes.

Bronchiactasis

Questions: CompleteComplete::

11--The gastrointestinal and respiratory tracts begin in the embryo The gastrointestinal and respiratory tracts begin in the embryo as a ………that later divides to giveas a ………that later divides to give..…………………… ..……………………

2-PULMONARY SEQUESTRATION is.…………………………………………

3- CHRONIC OBSTRUCTIVE PULMONARY DISEASESCHRONIC OBSTRUCTIVE PULMONARY DISEASES are …………….,…………….,…………….and.…………

4-……….is the most common form of emphysema encountered 4-……….is the most common form of emphysema encountered at autopsy. at autopsy.

5- Microscopic examination of Microscopic examination of BRONCHIECTASIS is ……………….BRONCHIECTASIS is ……………….

Benign Tumors of the BreastBenign Tumors of the Breast

السنهوري محمد رمضان جمال السنهوري سمية محمد رمضان جمال سمية عارف الحسن ابو عارف شروق الحسن ابو شروق على المنعم عبد كمال على شروق المنعم عبد كمال شروق نصير ميلود نصير صالح ميلود صالح يوسف الدين عز يوسف غادة الدين عز غادة الفتاح عبد علي الفتاح فاطمة عبد علي فاطمة هندى فهمى زغلول هندى محمد فهمى زغلول محمد