Respiratory System
Tumors in the Lungs and the Pleura
TABLE 3-1
CONDITIONS THAT CAN CAUSE ARDS/DAD*
Conditions | Causes |
Infectious diseases | Septicemia with DAD and DIC (especially gram negative), diffuse pneumonitis by virus, mycoplasma, pneumocystis, tuberculosis (certain forms, e.g., typhobacillosis Landouzy) |
Chemical injury and inhalants | Oxygen, irritant gases and inhaled chemicals, barbiturate overdose, salicylic acid, paraquat, heroin or methadone overdose, cytotoxic drugs, uremic pneumonitis, gastric aspiration |
Physical injury | Trauma to lungs (contusion), head injury, fat embolism of various causes, air embolism, burns, ionizing radiation |
Other | Shock of any cause, acute pancreatitis, near drowning aspiration |
TABLE 3-2
CLASSIFICATION OF IDIOPATHIC PULMONARY FIBROSIS*
Feature | NSIP | UIP | DIP | AIP | LIP | COP |
Interstitial inflammation | Prominent | Scant | Scant | Scant | Prominent | Scant |
Interstitial fibrosis | ||||||
Collagen | Variable, diffuse | Patchy | Variable, diffuse | No | Some areas | No |
Fibroblast foci | Occasional | No | No | Yes, diffuse | No | No |
BOOP | Occasional, focal | Occasional, focal | No | Occasional, focal | No | Prominent |
Intraalveolar macrophages | Occasional, patchy | Occasional, patchy | Yes, diffuse | No | Patchy | No |
Hyaline membranes | No | No | No | Yes, focal | No | No |
Honeycombing | Rare | Yes | No | No | Sometimes | No |
*AIP indicates acute interstitial pneumonitis; BOOP, bronchiolitis obliterans organizing pneumonitis; DIP, desquamative interstitial pneumonitis; NSIP, nonspecific interstitial pneumonitis; UIP, usual interstitial pneumonitis, LIP lymphocytic interstitial pneumonitis, COP cryptogenic organizing pneumonitis.
From Leslie KO, Wick MR. Practical Pulmonary Pathology. Philadelphia, 2005, Churchill Livingstone.
TABLE 3-3
CLINICAL AND PATHOLOGIC FEATURES OF PNEUMOCONIOSES*
Entity | Clinical Appearance | Pathologic Changes |
Coal miner’s lung | Black lung disease | Diffusely distributed, small focal anthracosilicosis, initially centriacinar and peribronchiolar with many carbon-laden macrophages and perifocal emphysema; extent of fibrosis depends on admixture of quartz |
Silicosis | Acute silicosis (uncommon) | Alveolar lipoproteinosis and progressive diffuse interstitial fibrosis secondary to inhalation of small particulate silica crystals (e.g., after sand blasting) |
Nodular silicosis (common) | Multiple growing silicotic nodules, usually 2 mm to 1 cm in diameter: fibrosing granulomas with concentric fibrous layering, some anthracotic pigment, small slitlike spaces, and needle-shaped crystalline spicules on polarization; perifocal emphysema | |
Progressive massive silicosis | Multiple silicotic granulomas up to 10 cm in diameter, both lungs involved, massive and rapidly progressive fibrosis | |
Asbestosis and asbestosrelated diseases | Asbestosis per se | Alveolitis with progressive interstitial fibrosis, deposition of asbestos bodies (golden-brown beaded rods consisting of asbestos fibers coated by ferroproteinaceous material); final stage: honeycombing lung |
Pleural plaques and rounded atelectasis | Recurrent pleural fibrinous effusions, pleural fibrosis and pleural plaques (“sugar coating”), focal atelectasis secondary to pleural fibrosis | |
Neoplasms | Malignant mesothelioma (↑ risk of bronchogenic carcinoma) | |
Berylliosis | Berylliosis per se | Acute and recurrent pneumonitis, systemic sarcoidlike and fibrosing granulomas |
Talcosis | Talcosis per se | Foreign body granulomas with birefringent talcum deposits, micronodular and diffuse interstitial fibrosis |
TABLE 3-4
INFECTIOUS AGENTS CAUSING PNEUMONIA
Class | Etiologic Agent | Type of Pneumonia |
Bacteria | Streptococcus pneumoniae | |
Streptococcus pyogenes | ||
Staphylococcus aureus | ||
Klebsiella pneumoniae | ||
Pseudomonas aeruginosa | ||
Escherichia coli | ||
Yersinia pestis | ||
Legionella pneumophila | Legionnaires disease | |
Peptostreptococcus, Peptococcus | Aspiration (anaerobic) pneumonia | |
Bacteroides | ||
Fusobacterium | ||
Veillonella | Bacterial pneumonias | |
Actinomycetes | Actinomyces israelii | Pulmonary nocardiosis |
Nocardia asteroides | Pulmonary actinomycosis | |
Fungi | Coccidioides immitis | Coccidioidomycosis |
Histoplasma capsulatum | Histoplasmosis | |
Blastomyces dermatitidis | Blastomycosis | |
Aspergillus | Aspergillosis | |
Phycomycetes | Mucormycosis | |
Rickettsia | Coxiella burnetii | Q fever |
Chlamydia | Chlamydia psittaci | Psittacosis |
Ornithosis | ||
Mycoplasma | Mycoplasma pneumoniae | Mycoplasmal pneumonia |
Viruses | Influenza virus, adenovirus, respiratory syncytial virus, etc. | Viral pneumonia |
Protozoa | Pneumocystis carinii | Pneumocystis pneumonia (plasma cell pneumonia) |
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