PATHOLOGY LAB

Diseases of the Respiratory Tract

Patient: 3 year old female
Chief Complaint: DOB
Clinical Findings:
◦ Productive cough for almost 2 weeks
◦ High grade fever
↓
◦ Cyanosis
◦ Fine crackles over both lung fields
↓
◦ Stuporous
◦ Hypotensive

CASE 1. BRONCHOPNEUMONIA
Gross Findings (Autopsy):
◦ Heavy consolidated lungs
◦ Patchy areas of purulent exudates in the lung
parenchyma
Histologic Findings
◦ Sloughed off respiratory ep.
◦ Acute inflammatory cells (ie. neutrophils) in the alveoli
◦ Congested blood vessel

CASE 1. BRONCHOPNEUMONIA
 Congested blood vessel

LPO

CASE 1. BRONCHOPNEUMONIA
 Inflamm infiltrates

Alveoli

HPO

CASE 1. BRONCHOPNEUMONIA
Notes (from discussion of Dr. Juarez):
Bronchopneumonia:
◦ Infection of the bronchial tree and the alveoli
Bronchopneumonia vs lobar pneumonia
◦ Bronchopneumonia = characterized by patchy
consolidation of the lung
◦ Lobar pneumonia = involves a large portion or the
entire lobe

CASE 1. BRONCHOPNEUMONIA
Patient: 16 year old male diagnosed with RHD
Chief Complaint: DOB
Clinical Findings:
◦ Easy fatigability
◦ 3 pillow orthopnea
◦ Confused, pale and weak looking
◦ Mid diastolic murmur at the apex
◦ PMI: 6th ICS left AAL
◦ Fine rales on both lung bases

CASE 2. PULMONARY EDEMA

Radiologic Findings:
◦ Severe pulmonary edema
Gross Findings (Autopsy):
◦ Heart
 Large heart (600 g)
 Valve: narrowed and thickened with fibrosis and
whitish deposits
◦ Lungs:
 Heavy, boggy, subcrepitant
 Upon pressing the parenchyma  Exudation of
frothy fluid from the surface of serial sections

CASE 2. PULMONARY EDEMA

 Alveolar wall

Intraalveolar pinkish
homogenous material

LPO

CASE 2. PULMONARY EDEMA

 Intraalveolar pinkish
homogenous material

HPO

CASE 2. PULMONARY EDEMA

 Intraalveolar pinkish
homogenous material
HPO

CASE 2. PULMONARY EDEMA

 Patient: 63 year old male, smoker
Chief Complaint: chronic cough and weight loss
Clinical Findings:
◦ Clubbing of fingers
Radiologic Findings:
◦ Cavitation within 3cm leasions near right hilum
Lab Findings:
◦ ↑Ca 11.8 mg/dL (N: 8.7-10.2)
◦ ↓P 2.4 mg/dL (N: 2.5-4.3)
◦ N Alb 3.9 g/dL (N: 3.5-5.5)

CASE 3. BRONCHOGENIC SMALL CELL CA

Histologic Findings:
◦ Highly atypical squamous cells with:
 (+) Amorphic nuclei
 (+) Intercellular bridges between adjacent cells
 Greater strength as compared to other cell types
 (+) Keratinization of cytoplasm with occasional
keratin pearls
 Keratinization = Characteristic of mature, well
differentiated squamous cells
 Keratin pearls = appear as rounded, darker pink
structures at the center of the whorl

CASE 3. BRONCHOGENIC SMALL CELL CA

Whorls with keratin pearls LPO

CASE 3. BRONCHOGENIC SMALL CELL CA

 Keratin pearl Whorl

Whorls with keratin pearls HPO

CASE 3. BRONCHOGENIC SMALL CELL CA

Squamous cells in solid sheets LPO

CASE 3. BRONCHOGENIC SMALL CELL CA

Squamous cells in solid sheets
Keratinization at the tip of the pointer HPO

CASE 3. BRONCHOGENIC SMALL CELL CA

 Squamouscells
Squamous cellsininsolid
solidsheets
sheets
Keratinizationatatthe
Keratinization thetiptipofofthe
thepointer
pointer HPO

CASE 3. BRONCHOGENIC SMALL CELL CA

 Keratin pearl

Squamous cells in solid sheets

Keratinization at the tip of the pointer HPO

CASE 3. BRONCHOGENIC SMALL CELL CA

 Notes
Adenocarcinoma
◦ Should be differentiated from small cell carcinoma
◦ Glandular
◦ (+) Mucin production in the cytoplasm
 Appear as clear areas in the cytoplasm

CASE 3. BRONCHOGENIC SMALL CELL CA

 Adenocarcinoma
Glandular formation
Contain mucin in the lumen

CASE 3. BRONCHOGENIC SMALL CELL CA

 Patient: 40 year old male, farmer
Chief Complaint: DOB
Clinical Findings:
◦ On and off cough
◦ Night sweats
◦ Low grade fever in late afternoon
◦ Weight loss and loss of appetite
◦ Chest pain
◦ (+) Blood tinged sputum upon coughing
◦ Stuporous
◦ Dyspnea, shallow breathing
◦ Cyanosis
◦ Weak pulse

CASE 4. PULMONARY TUBERCULOSIS

Gross Findings:
◦ Lungs
 Consolidation of both lungs with fibrocaseous lesions
 Numerous small gray white nodules along the
parenchyma
 Large cavity with caseous material along the RU lobe
◦ Liver, spleen, intestines = (+) Multiple nodules
◦ Enlarged regional lymph nodes; some were matted
together
Histologic Findings:
◦ Caseation necrosis with Langhans type giant cell
 Coalesced epithelioid cells (from macrophages)
 (+) Peripherally located nuclei

CASE 4. PULMONARY TUBERCULOSIS

CASE 4. PULMONARY TUBERCULOSIS
 LPO

CASE 4. PULMONARY TUBERCULOSIS

 HPO

CASE 4. PULMONARY TUBERCULOSIS