Download - DISEASES OF RESPIRATORY SYSTEM (3)
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DISEASES OF DISEASES OF RESPIRATORY RESPIRATORY SYSTEM (3)SYSTEM (3)
The Department of Pathology The Department of Pathology Zili Lv Zili Lv 吕自力吕自力1590781763415907817634
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ContentsContents
•Chronic diffuse interstitial lung diseases 慢性肺间质性病
•Nasopharyngeal carcinoma 鼻咽癌•Carcinoma of the lung 肺癌
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Chronic Interstitial Lung Chronic Interstitial Lung DiseasesDiseases
• Clinical history lasting months or years• Slowly increasing respiratory
insufficiency, dyspnea, cough and finger-clubbing
• Interstitial fibrosis, infiltration with lymphocytes and macrophages.
• Pneumoconioses 肺尘埃沉着病• Sarcoidosis 肺结节病
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PneumoconiosesPneumoconioses• Lung diseases caused by inhaled
dusts• Dusts may be inorganic or organic• Reaction may be inert, fibrous,
allergic or neoplastic• Co-existing disease may aggravate
the reaction• Silicosis 硅肺• Asbestosis 石棉肺
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SilicosisSilicosis 硅沉着病硅沉着病 p200p200•Reason : caused by inhalation of
crystalline silicon dioxide (silica) 二氧化硅 dust particles.
•Size: 1-5um in diameter•Basic pathological features : Progressive fibrosis + Numerous
silicotic nodules 硅结节
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A. PathogenesisA. Pathogenesis -- -- hypothesishypothesis
• > 5um, bronchial mucus layer, wafted upward by ciliary action to be expelled.
• < 1um, airborne and are exhaled
• 1-5 um, toxic to macrophages
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Pathogenesis of Pathogenesis of PneumoconiosisPneumoconiosis
Proteolytic enzymes
Fibroblast-stimulating factor
Fibrosis
Inflammatory mediator
Inflammatory cells infiltrate
Fibrosis
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•1. Silicotic nodule (硅结节)•2. Diffuse pulmonary fibrosis (肺弥漫纤维化)
B. Pathology*
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• 2 – 5 mm• Gray-black• Hard • Brittle• Hilum and
upper lobes• Fibrosis• Irregular
emphysema
Grossly
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Microscopically 1 、 Silicotic nodules 硅结节① Macrophages
② Fibroblast
③ Collagen
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2 、 Diffuse fibrosis
Microscopically
Restrictive ventilatory defect
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C. Clinical FeaturesC. Clinical Features
•Asymptomatic
•Slowly progressive dyspnea, pulmonary hypertension, cor pulmonale.
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D. ComplicationsD. Complications •Lung Tuberculosis 肺结核病•Chronic cor pulmonale • Infection of lungs•Lung emphysema•Lung carcinoma
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AsbestosisAsbestosis 肺石棉沉着症肺石棉沉着症p201p201
• Fire-resistant
• Be used for insulation and the manufacture of brake linings
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A. PathologyA. Pathology
1. Fibrosis*1. Fibrosis*
• Thickening of the parietal pleura • A plaque-like deposition of
hyalinized collagen• Lateral and diaphragmatic
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Pleural FibrosisPleural Fibrosis
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Pathology Pathology 2. Asbestos bodies*2. Asbestos bodies*
石棉小体石棉小体
•Coated in acid mucopolysaccharide 粘多糖 and encrusted with haemosiderin
•Brown and beaded
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Asbestos bodies 石棉小体
• Iron-containing glycoprotein
• Diagnostic changes
Asbestosis
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B. Clinical FeaturesB. Clinical Features
• Chronic dry cough• Progressive dyspnoea• Finger-clubbing• Asbestos bodies in the sputum• Rarely in respiratory failure• At a risk from malignant tumor:
bronchogenic carcinoma, malignant mesothelioma
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Silicosis AsbestosisSilicosis AsbestosisSilica Asbestos fiber
Coal-mining Shipyard worker
Silicotic nodules Asbestos bodies
Interstitial diffuse fibrosis
Upper, hilum Lower lobes
Hilar lymph nodule Pleural fibrosis
Tuberculosis Malignant tumor
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Respiratory System Respiratory System Malignant TumorsMalignant Tumors
• Nasopharyngeal Nasopharyngeal carcinoamacarcinoama
鼻咽癌鼻咽癌• Bronchogenic carcinomaBronchogenic carcinoma
支气管肺癌支气管肺癌
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NASOPHARYNGEANASOPHARYNGEACARCINOMA, NPCCARCINOMA, NPC
鼻咽癌鼻咽癌p205p205
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Nasopharyngeal carcinomaNasopharyngeal carcinoma
•Localized in nasopharynx•Arising from nasopharynx
epithelium• It shows a distinct racial and
geographical distribution.• It is more common in
Southeast Asia, North Africans than others
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Incidences of NPCIncidences of NPC
•Hong Kong, Guangdong, Guangxi
•40- 60 years old•Male:female = 2-3 : 1
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A. EtiologyA. Etiology• Infection with Epstein-Barr virus
(EBV)• Genetic susceptibility• Environmental factors• Smoking • Carcinogen contents are rich in
food
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LocationLocation 1. Nasopharyngeal
roof *
( 鼻咽顶部 )
2. Lateral wall
( 外侧壁 )
3. Pharyngeal recess
(咽隐窝)
B. Pathology*
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Grossly: nodular, ulcerative, infiltrative,
clauliflower
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HistopathologyHistopathology
1. Nonkeratinizing carcinoma (1) undifferentiated*:common (2) differentiated
2. Keratinizing squamous cell carcinomaWell, moderately, poorly differentiated
3. Basaloid squamous cell carcinoma
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Vesicular nuclei cell Vesicular nuclei cell carcinomacarcinoma
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Direct extensionDirect extension
1. upwards: skull
2. forwards: nasal, orbit
3. downwards: oraopharynx, tonsil
4. backwards: vertebra
5. lateral: middle
ear
C. Spread
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Metastasis* Metastasis* • Lymphatic*: Upper cervix lymph node 颈上深淋巴结
enlargement painless.
• Haematogenous: bone, lung, liver, brain, etc.
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Lymphatic metastasisLymphatic metastasis
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D. Clinical FeaturesD. Clinical Features•Early stage: asymptomatic 无症状•Nasal symptoms: blood stained
post-nasal drip 抽吸性血痰•Extensive spread: headache,
otitis, dizzy, tinnitus 耳鸣•Lymphatic : painless enlargement •Haematogenous : bone fracture
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Lung Carcinoma p206Lung Carcinoma p206Primary malignant tumor
1.1 million deaths annually worldwide
Most frequent and one of the most deadly cancer
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A. EtiologyA. Etiology • 1. Smoking*: 40/day, 20-fold
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A. EtiologyA. Etiology • 2. Air pollution: urban > country • 3. Occupational hazards:
asbestos, heavy metals( uranium, nickel, chromate, gold)
• 4. Radiation• 5. Molecular genetics: p53, c-
myc, K-ras
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B. Pathology*B. Pathology*
Grossly• Central or hilar tumors• Peripheral tumors• Diffuse type
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Central typeCentral type
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60-70% Hila typeHila type
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Peripheral tumors•30%, mainly
adenocarcinomas, arise in peripheral airways or alveoli
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Peripheral typePeripheral type
30-40%30-40%
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Diffuse type, rarelyDiffuse type, rarely
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HistologyHistology • 1. Small cell carcinoma (20%)• 2. Non-small cell carcinoma (80%)• (1) Squamous cell carcinoma• (2) Adenocarcinoma• (3) Large cell carcinoma
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Small cell lung carcinoma
Round to polygonal cells with scant cytoplasm. Note mitotic figure in center
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Squamous cell carcinoma*Squamous cell carcinoma*
• The commonest type• The most closely associated with the
cigarette smoking.• Most of them are central type.
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A. goblet-cell hyperplasia
B. basal cell (or reserve
cell) hyperplasia C. squamous metaplasia
Bronchogenioc carcinoma
The precursor lesions (the earliest "mild“ changes) of squamous cell carcinomas
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Bronchogenioc carcinoma
D. squamous dysplasia
E. Carcinoma-in-situ
F. invasive squamous carcinoma
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Adenocarcinoma
• Usually peripherally located• Derived from glandular cells• Having the weakest association
with a previous history of smoking
• Tend to metastasize widely at an early stage by blood spread
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Bronchioloalveolar carcinoma
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Large cell carcinomaLarge cell carcinoma
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•< 2cm in diameter•Confined to bronchial wall or infiltrate to the wall and surrounding tissues
•No lymph node metastasis•Carcinoma in situ in bronchial mucosa
C. Early lung cancer*C. Early lung cancer*
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• Intraluminal type (管内型)• Peribronchial type (管周型)• Infiltrative type (管壁浸润型)
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D. Occult lung cancerD. Occult lung cancer隐性肺癌隐性肺癌 **
• Both clinical and X-ray are negative
• Cytology of sputum smears shows cancer cells
• Biopsy and surgical materials are diagnosed as cancer in situ or early infiltrating carcinoma
• Without lymph node metastasis
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E. Spread of lung carcinoam1. Local: central tumors invade the surrounding lung.
Direct extension into pleura, pericardium, superior vena cava
2. Lymphatic spread: carcinomas spread to the peri-bronchial and hilar lymph nodes ----> supraclavicular node (Virchow node).
3. Seeding of cancers: tumor cells may seed within the pleural cavity, causing a malignant pleural effusion.
4. Haematogenous spread: to the brain, bone, liver, and adrenal glands.
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F. Clinical features•Silent, no early symptoms;
•The presenting symptoms of lung cancer are
Bronchial obstruction: cough, haemoptysis, chest pain
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Clinical features
Local invasion symptoms: hoarseness
Pancoast’s syndrome: Horner syndrome
Metastatic : brain (mental changes), liver (hepatomegaly), or bones (pain).
Paraneoplastic syndrome
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Paraneoplastic syndrome, 副肿瘤综合征
Cushing syndrome
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G. Methods for lung G. Methods for lung cancer diagnosiscancer diagnosis
•Sputum cytology, pleural effusion cytology•Fiberbronchoscope examination and biopsy•X-ray examination and CT•Fine-needle aspiration biopsy
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• Pneumonia
• Chronic Obstructive Passive Diseases
• Silicosis
• NPC and Lung cancer
Summary Summary
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Air space
pneumonia
Lobar pneumonia
Lobular pneumonia
Interstitial
pneumonia
Viral pneumonia
Mycoplasma pneumonia
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COPD & SilicosisCOPD & SilicosisCOPD: Chronic bronchitis Asthma Emphysema Bronchiectasis
Silicosis
Asbestosis
Pulmonary hypertension
Chronic cor pulmonale
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NPC & Lung carcinomaNPC & Lung carcinoma NPC• EBV infection• Nasopharygeal
roof• Non-keratinizing
squamous carcinoma
• Lymphatic route metastasis
Lung carcinoma• Smoking • Hilar, periphera,
diffuse type• Squamous
carcinoma and small cell carcinoma
• Haematogenous spread
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Case abstract 1Case abstract 1•Male, 70, he had suffered from
cough and sputum for 15 years, rapid and short breath after physical labor for 5 years, lower limbs edema repeatedly for 1 year. These symptoms aggravated 4 days ago with fever and purulent sputum.
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•Blood WBC: 10.2 X 109/L•X-ray: The lungs are enlarged,
Several scattered patchy shadows evidently in bilateral lower lobes.
•Biopsy: Thinning and destruction of alveolar walls, large airspaces formation. Terminal bronchiole and alveoli are filled with neutrophil.
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Chronic bronchitisChronic bronchitis
Emphysema Emphysema
Chronic Cor pulmonaleChronic Cor pulmonale
Lobular pneumoniaLobular pneumonia
COMPLICATED WITH
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• 65, woman, cough with purulent sputum after catching cold 15 years ago.
• She developed cough and expectoration of white spumy sputum every winter and spring.
• Since 3 years ago, she felt breath shortness and palpitation after physical labor.
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•Pitting edema occurred repeatedly on her lower limbs for 2 years.
•Two months ago after catching cold, she developed fever, cough with purulent sputum, palpitation, breath shortness, and abdominal distension, and could not lie down.
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Physical examination: • T: 37.6℃, HR:102 times/min, R: 30
times/min. • Chronic sickness appearance, up-
straight sit breathing, sleepiness, dark purple lip and skin, cervix venous engorgement
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Chest: Barrel-shape chest, hyper-resonance to percussion, scattered dry and moist rales.
Abdomen: Abdominal bulge, a large amount of ascites, the liver is hard with the rim under the rib 7.8 cm, lower limbs show pitting edema.
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QuestionsQuestions
•1. what is the pathological diagnosis of the patient?
•2. how to explain the process of the development of the diseases about the patient.
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Pathological diagnosisPathological diagnosis• Chronic bronchitis• Emphysema • Chronic cor pulmonale complicated with: (1) right heart failure---- liver
congestion, lower limbs edema, ascites
(2) pulmonary encephalopathy
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The relationshipThe relationship
•Chronic bronchitis---- emphysema----
chronic cor pulmonale---- right heart failure and pulmonary encephalopathy.
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