LMR-CNS, LUNG AND THYROID

Hyaline membrane disease

❖ Hyaline membranes accompanied by epithelial cell necrosis, scattered neutrophils, and

macrophages and edema
❖ Damage to endothelial and alveolar epithelial cells with incited secondary inflammation
is the main initiating event and the basis of damage to the lungs.

Emphysema

❖ Permanent and irreversible enlargement of airspaces distal to terminal bronchioles

along with wall destruction
❖ Important cause: Smoking
❖ The elastase released by inflammatory cells is normally inhibited by alpha-1 antitrypsin
❖ Types of Emphysema and important points:
• Centriacinar (most common type): associated with smoking
• Panacinar: associated with alpha-1 antitrypsin deficiency
• Distal acinar (paraseptal)
• Irregular

Lung Carcinoma

❖ Squamous cell carcinoma: Most common type in smokers associated with cavitation
best prognosis. Hypercalcemia most common paraneoplastic syndrome with SCC

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❖ Adenocarcinoma: Most common. Periphery in location. Napsin-A, TTF-1, k-ras mutation

❖ Small cell carcinoma lung: Salt and pepper chromatin. Azzopardi phenomen. Worst
prognosis and highly aggressive

❖ Large cell carcinoma:

Asbestosis

Beaded dumbbell-shaped asbestos bodies (Ferruginous bodies)

Composed of iron, glycoproteins, organic and inorganic dust fibers

Pleural plaques: Most common manifestation

Microscopy: Diffuse interstitial fibrosis

Ferruginous bodies: most commonly seen with asbestosis

Malignancy: Lung carcinoma (most common cancer associated with asbestosis).

Malignant mesothelioma (most specific)

Sarcoidosis:

Non-caseating granulomas

Most common site affected: Lungs

Microscopy:

1. Non caseating granulomas

2. Schaumann bodies

3. Asteroid bodies

Findings:

1. Accumulation of CD 4+ T helper cells

2. Increased ACE levels

3. Hypergammaglobulinemia

4. Pulmonary function test: Restrictive pattern

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5. Hypercalcemia

Pathogenesis of Tuberculosis

Pathogenesis of Tuberculosis (along with microscopic differences between granulomas of

Sarcoidosis (Non caseating) and Tuberculosis (Caseous necrosis) have been covered in the
videos)

CNS:

Alzheimers disease:

❖ Degenerative disease

❖ Most common cause of dementia in elderly

❖ Microscopy:

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 • Neuritic plaques (spherical collection of dilated tortous neuritic processes around a
central amyloid core). Increase in number indicates advanced age and severity of
dementia

• Neurofibrillary tangles (hyperphosphyrylated tau protein)

• Cerebral amyloid angiopathy-vessel wall deposition of A-beta (predominantly A-beta

40)

• Hirano bodies (composed of actin)

Brain Tumors

❖ Gliomas:

(i) Astrocytoma
(ii) Oligodendroglia’s
(iii) Ependymoma

❖ Glioblastoma: Characteristic: Palisading necrosis (that is the nuclei are palisading around
the central necrosis)

❖ Oligodendroglioma: characteristic halo around the cell and the chicken wire network of
anastomosing capillaries

❖ Ependymoma: Perivascular pseudorosettes

❖ Medulloblastoma: Small blue cell tumor

❖ Meningioma: Whorling pattern with psammoma bodies

Meningioma Oligodendroglioma Glioblastoma Multiform

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VHL: Mechanism of action: Inhibits hypoxia-induced transcription factors

Von Hippel Lindau syndrome: Cerebellar Hemangioblastoma

Retinal angioma

Renal cell carcinoma

THYROID

Papillary carcinoma Follicular carcinoma Medullary carcinoma

Most common (75% cases)
Excellent prognosis Good prognosis
Spreads through lymph Hematogenous spread
nodes
Papillae with fibro vascular Micro follicles Amyloid deposition
stalk Capsular and vascular Spindle stroma and atrophic
Orphan Annie eye nuclei invasion follicles

(Explained with help of images in the videos..)

Hashimotos thyroiditis: Oncocytic metaplasia (due to mitochondria), large lymphoid follicles

Graves disease: Scalloping borders of colloid, Follicles lined by tall, columnar epithelium
(Image shown)

Scalloping of colloid

❑ ❑ ❑

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