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Pulmonary Pathology
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Intended for busy practitioners, Pulmonary Pathology is a pithy, pocket-sized guide to all of the key pulmonology entities and diagnoses that pulmonologists see in daily practice. It addresses non-neoplastic conditions including Infections, Granulomatous Diseases, Acute Lung Injury, Idiopathic Interstitial Pneumonias, Vasculitis, Histiocytoses, Lung Pathology in Systemic Diseases, Transplant-Related Lung Pathology, and Miscellaneous Non-Neoplastic Conditions. Neoplasia entities include Benign Epithelial Neoplasia, Pre-Invasive Neoplasia, Squamous Cell Carcinoma, Adenocarcinoma, Neuroendocrine Neoplasia, Other Epithelial Neoplasia, Mesenchymal Neoplasia, Lymphoproliferative Disorders, Pleural Tumors, Metastatic Tumors, and Tumor-Like Conditions. The book features a bulleted format replete with illustrations for quick information retrieval. It will be a handy summary and quick reference for pulmonary pathology residents and will serve as a portable refresher course for more experienced pathologists.
The Demos Surgical Pathology Guides series presents in summary and visual form the basic knowledge base that every practicing pathologist needs each working day. Series volumes cover the major specialty areas of surgical pathology, and coverage emphasizes the key entities and diagnoses that pathologists will see in practice, and that they must know whether in training or practice. The emphasis is on the basic morphology with newer techniques represented where they are frequently used. The series provides a handy summary and quick reference that any pathology resident or fellow will find useful. Experienced practitioners will find the series valuable as a portable refresher course or review tool.
Actions du livre
Commencer à lireInformations sur le livre
Pulmonary Pathology
Description
Intended for busy practitioners, Pulmonary Pathology is a pithy, pocket-sized guide to all of the key pulmonology entities and diagnoses that pulmonologists see in daily practice. It addresses non-neoplastic conditions including Infections, Granulomatous Diseases, Acute Lung Injury, Idiopathic Interstitial Pneumonias, Vasculitis, Histiocytoses, Lung Pathology in Systemic Diseases, Transplant-Related Lung Pathology, and Miscellaneous Non-Neoplastic Conditions. Neoplasia entities include Benign Epithelial Neoplasia, Pre-Invasive Neoplasia, Squamous Cell Carcinoma, Adenocarcinoma, Neuroendocrine Neoplasia, Other Epithelial Neoplasia, Mesenchymal Neoplasia, Lymphoproliferative Disorders, Pleural Tumors, Metastatic Tumors, and Tumor-Like Conditions. The book features a bulleted format replete with illustrations for quick information retrieval. It will be a handy summary and quick reference for pulmonary pathology residents and will serve as a portable refresher course for more experienced pathologists.
The Demos Surgical Pathology Guides series presents in summary and visual form the basic knowledge base that every practicing pathologist needs each working day. Series volumes cover the major specialty areas of surgical pathology, and coverage emphasizes the key entities and diagnoses that pathologists will see in practice, and that they must know whether in training or practice. The emphasis is on the basic morphology with newer techniques represented where they are frequently used. The series provides a handy summary and quick reference that any pathology resident or fellow will find useful. Experienced practitioners will find the series valuable as a portable refresher course or review tool.
À propos de l'auteur
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Aperçu du livre
Pulmonary Pathology - Cesar A Moran, MD
Preface
Pulmonary pathology is a dynamically evolving field with major advances in both neoplastic and nonneoplastic lung diseases. As medicine has become increasingly more interconnected and interdisciplinary, these advances have affected pulmonologists, surgeons, oncologists, and radiologists, as much as they have affected pathologists. Not surprisingly, many of these advances have been driven by developments in thoracic oncology, radiology, and surgery.
While lung cancer still remains a major public health issue with significant morbidity and mortality, encouraging progress has been made toward developing specific treatment modalities for certain types of lung cancer. These new advances have had important effects on pathological approach to the diagnosis and classification of lung cancer. Pathologists are now required to not only accurately diagnose and sub-classify lung tumors, but also ensure that tissue is triaged appropriately for important molecular pathology testing for predictive and prognostic markers. A greater degree of communication and dialog between pathologists, oncologists, and surgeons is a must to ensure the best outcomes for patients with lung cancer.
Medical
lung diseases are a vast and heterogeneous group of conditions which can pose tough diagnostic challenges. Some interstitial lung diseases are particularly difficult, requiring a great deal of clinical, radiological, and pathological correlation for correct diagnosis and appropriate management
This book has been designed to provide the reader with an overarching synoptic view of pulmonary pathology covering most important areas of nonneoplastic and neoplastic lung disease, along with coverage of some rarer entities. The nonneoplastic portion is divided into sections covering infections, granulomatous diseases, acute lung injury, idiopathic interstitial pneumonias, vasculitis, histiocytoses, lung involvement in systemic disease, transplantation associated lung pathology, and a miscellaneous section covering some rarer entities. The neoplastic component is divided into sections on benign neoplasia, preinvasive neoplasia, malignant epithelial tumors, mesenchymal tumors, lymphoproliferative disorders, pleural neoplasia, metastatic tumors to the lung, and a section on tumor-like conditions of the lung.
Each topic is covered under the following headings—definition, clinical features, pathologic findings, and differential diagnosis. Salient features are listed as bullet points to allow the reader a quick overview of each entity. Images, both gross and microscopic, are provided as necessary, to highlight the important pathologic features of each entity. Useful tables collating salient features of related entities are scattered throughout the text where deemed appropriate. Finally, a few references or suggested readings are provided for each topic, to allow the reader the opportunity to further their knowledge if necessary.
It is hoped that this manual will be an easy to use reference guide for practicing pathologists, pathologists in training and indeed medical students, providing updated knowledge on lung pathology, for use in daily practice and/or as a rapid review tool.
Demos Surgical Pathology Guides
Pulmonary Pathology
BACTERIAL
VIRAL
FUNGAL
MYCOBACTERIAL
Bacterial
DEFINITION
These infections cause inflammation of the lung due to a variety of bacterial organisms, affecting distal airspaces including respiratory bronchioles, alveolar ducts, and alveoli.
Bacterial pneumonias can be classified in several ways—according to epidemiology (community or hospital acquired), anatomic distribution (lobar or bronchopneumonia), clinical presentation, and specific bacterial agent.
Primary bacterial pneumonias can be exogenous (caused by inhalation of aerosolized organisms, e.g., Streptococcus pneumoniae) or endogenous (associated with aspiration of oropharyngeal secretions contaminated with bacteria; e.g., Actinomyces species).
Secondary pneumonias are caused by hematogenous dissemination from an infection in another organ (e.g., a subcutaneous abscess leading to pneumonia).
CLINICAL FEATURES
Clinical features vary according to the nature of the organism and the infection.
There is no single symptom or sign that allows for definitive clinical diagnosis of pneumonia—both community and hospital acquired.
Among the many symptoms are fever with or without chills and rigor, productive cough, hemoptysis, chest pain, shortness of breath, and constitutional symptoms including fatigue, headache, and loss of appetite.
PATHOLOGIC FINDINGS
Community acquired pneumonia is typically caused by S. pneumoniae.
Grossly, two patterns are seen—lobar pneumonia where the entire lobe is involved; and bronchopneumonia, which shows patchy involvement of the lung parenchyma surrounding bronchioles.
Microscopically, with both patterns, there are diffuse neutrophilic exudates filling alveolar spaces, admixed with red cells in the early stages, and with fibrin and proliferating fibroblasts in the later stages.
With certain organisms such as Legionella, specific pathologic features, including prominent nuclear debris forming part of the intra-alveolar exudate, can be seen (Figure 1-1A). Special stains such as Warthin–Starry may demonstrate the bacteria.
Actinomyces sp. infection is associated with sulfur granule formation (clusters of gram-positive, beaded, filamentous bacteria branching at right angles) (Figure 1-1B), accompanied by the Splendore-Hoeppli phenomenon—an eosinophilic substance deposited at the periphery of the mass of organisms.
Viral
DEFINITION
These infections cause inflammation of the lung, due to a variety of viral organisms.
Viral infections are the most common pulmonary infections, although they are infrequently seen in routine surgical pathology practice.
Only certain viruses produce cytopathic changes that are morphologically distinctive to enable recognition on histologic examination of lung specimens.
CLINICAL FEATURES
Common viruses such as cytomegalovirus (CMV) can affect healthy individuals where they remain dormant in white cells, and reactivate in immunocompromised hosts.
In addition to pneumonia, CMV can cause inflammation of other organs including the liver, gastrointestinal tract, and the brain.
PATHOLOGIC FINDINGS
CMV produces diffuse interstitial pneumonitis with or without inflammation and necrosis (Figure 1-2A). Based on its characteristic cytopathic changes in lung biopsies, CMV is the most commonly recognized viral pneumonia.
Infected cells may be few or numerous. CMV can infect respiratory epithelial cells, endothelial cells, fibroblasts, and macrophages. Special technique such as immunohistochemistry (Figure 1-2B) may help in detecting viruses in formalin-fixed paraffin-embedded sections.
Other viruses such as respiratory syncytial virus (RSV) produce bronchiolitis with focal ulceration and frequent presence of syncytial bronchial epithelial cells.
Herpes simplex virus (HSV) produces a necrotizing tracheobronchitis with interstitial pneumonitis, with recognizable viral cytopathic effect within epithelial cells in areas of ulceration.
Adenovirus is characterized by necrotizing bronchitis/bronchiolitis or an interstitial pneumonitis with associated acute lung injury. Two types of viral inclusions may be seen within the inflammatory infiltrate—a smudged
inclusion that is basophilic or amphophilic and covers the entire nucleus (Figure 1-2C); and a small eosinophilic inclusion surrounded by a halo.
Historically, measles pneumonia was a recognized complication, but with the advent of robust immunization, is rarely encountered now. Measles associated bronchopneumonia was typically associated with frequent giant cells (Warthin–Finkeldey giant cells).
Various other viral agents including influenza, parainfluenza, and many recently described agents such as severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) viruses produce a noncytopathic pattern of acute lung injury that may be indistinguishable from other causes of acute respiratory distress syndrome (diffuse alveolar damage). Careful correlation with clinical, serological, and virological data is important in such cases.
Fungal
DEFINITION
These infections cause inflammation of the lung, due to various fungal organisms.
Although fungal infections can be seen in both immunocompetent and immunosuppressed individuals, the progressive and disseminated forms of fungal infection typically occur in immunosuppressed patients.
Although special stains may enable detection of fungal organisms in formalin-fixed, paraffin-embedded tissue, the gold standard for diagnosis remains microbiologic confirmation.
CLINICAL FEATURES
Clinical symptoms vary depending on the type of fungal infection.
Localized forms of fungal infections may be asymptomatic.
Some localized fungal infections such as pulmonary aspergilloma may present with symptoms including hemoptysis.
Hypersensitivity reactions such as allergic bronchopulmonary aspergillosis may present with symptoms of asthma accompanied by peripheral blood eosinophilia.
Invasive, disseminated fungal infections can present with signs and symptoms of a necrotizing, rapidly progressive bronchopneumonia.
Chronic fungal infections, which usually develop following resolution of an acute infection may present with cavitary lung lesions
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