Theme 27. Chronic obstructive pulmonary diseases. Pneumoconioses.

Cor
pulmonale.
Actuality. Diseases of respiratory system include a great group of different disorders, many of
which are life-threatening. Understanding of their pathogenesis and morphologic signs is
important for all physicians.

Aim. To study the main theoretical statements, modern classifications and general characteristic
of each group of pulmonary diseases. To be able to explain pathogenesis, describe and recognize
in gross examination and slide the main morphologic features of adult respiratory distress
syndrome, emphysema, chronic bronchitis, silicosis, lung canceer, laryngeal cancer

Integration with other disciplines. The study of diseases is based on the specific knowledge of
embryology, anatomy, histology and physiology of respiratory system. In order to understand
adaptative reactions it is necessary to remind structural and functional specifities of defensive
mechanisms in this systems. Understanding of the course of the disease is based on the knowledge
of the sequence of typical pathologic processes (general pathology).

Learning objectives:

• To give a list of the main groups of pulmonary diseases and the most common examples
of these groups
• To define the main forms of pulmonary vascular diseases (pulmonary edema, pulmonary
embolism, adult respiratory distress syndrome, hemorrhage and infarction, pulmonary
hypertension, cor pulmonale)
• To describe pathogenesis, morphologic features and complications of adult respiratory
distress syndrome
• To define the main forms of chronic obstructive pulmonary diseases (emphysema, chronic
bronchitis, bronchiectasis, bronchial asthma, bronchiolitis)
• To describe pathogenesis, morphologic features and complications of emphysema and its
main forms
• To describe pathogenesis, morphologic features and complications of chronic bronchitis
• To define the main forms of restrictive pulmonary diseases (pneumoconiosis, sarcoidosis,
hypersensitivity pneumonites, idiopathic pulmonary fibrosis, alveolar proteinosis)
• To describe pathogenesis, morphologic features and complications of silicosis
• To define the main forms of tumors of respiratory tract (bronchogenic carcinoma,
bronchioloalveolar carcinoma, bronchial carcinoid, mesothelioma, tumors of the larynx)
• To describe pathogenesis, morphologic features and complications of bronchogenic
carcinoma
• To describe pathogenesis, morphologic features and complications of laryngeal carcinoma

Be able to recognize in gross examination:

Bronchoectatic diseases
Emphysema
Compression atelectasis
Silicosis – nodular changes
Bronchogenic carcinoma
Massive lung carcinoma
Multiple metastases in the lung
Mesothelioma

Fill in the scheme, accentuating the role of smoking in the pathogenesis of emphysema and
chronic bronchitis.

Smoking

Imbalanced Recruitment and activation Chronic irritation

protease- of neutrophils of the epithelium
antiprotease
mechanism Macrophage activation

Inactivation of a-1 antitripsin

Hypersecretion of mucus

Bronchial metaplasia

Bronchiolitis
Airflow Infectious agents
obstruction

Show the possible pathogenetic events (complications of emphysema and chronic bronchitis) in
the development of chronic obstructive airway disease

Chronic bronchitis Emphysema

Chronic obstructive airway disease

Complications: respiratory acidosis, atelectasis, bronchiectasis, pulmonary hypertension,
bronchial obstruction by mucus plug, plexogenic pulmonary arteriopathy, cor pulmonale, collaps
of the lung, alveolo-capillary block, bronchial sclerosis

Fill in the table with the most common tumors of the lung

Tumor Macroscopic changes, localisation Histologic changes Clinical features

Bronchogenic
carcinoma
Bronchioloalveolar
carcinoma
Carcinoid
Hamartoma
Mesothelioma

Describe the main types of pleural lesions:

Causative factors Morphologic features Outcomes/clinical

significance
Pleuritis
Serofibrinous
Empyema
Noninflammatory pleural
effusions
Hydrothorax
Hemothorax
Chylothorax
Pneumothorax
Tumors

Slide 125. Emphysema. Examine the slide and write the appropriate descriptions. Determine the
type of emphysema
Slide 127 . Pneumoconiosis. Examine the slide and write the appropriate descriptions
Slide Bronchogenic carcinoma. Examine the slide and write the appropriate descriptions