Resp Pathology for Exam III

darodri6's version from 2016-10-16 23:46

Pathology of Occupational Lung Disorders

NameEtiologyClinicalKey Histo
Simple Coal Workers Pneumoconiosisinhalation of CARBON DUST--> ingested by alveolar macrophages --> release of inflammatory & fibrotic mediatorslittle or no pulmonary dysfunctionmicro = coal MACULES or NODULES, mostly in the UPPER LOBES or upper parts of lower lobes adjacent to resp bronchioles
Complicated Coal Workers Pneumoconiosisinhalation of CARBON DUST --> ingested by alveolar macrophages --> release of inflammatory & fibrotic mediatorsincreaseing level of pulm -dysfunction w/pulm HTN & cor pulmonale
-NO increase in lung cancer risk
macro = multiple black scars, sometimes with necrotic centers due to ischemia
micro = dense collagen & pigment
Silicosisinhlation of particles (sand blasters/hard rock miners) --> ingested by alveolar macrophages --> activation of inflammasome w/release of mediators (IL-1, IL-18) --> fibrotic nodules in UPPER LUNG-increased susceptibility to TUBERCULOSIS
-2x risk of LUNG CANCER
macro = tiny pale/blck collagenous nodules in UPPER LUNG. Can also occur in lymph nodes along with 'egg-shell calcification' --> can progress to massive fibrosis
micro = concentric layers of hyalinized collagen. Particles of causative agent may also appear as birefringent particles under polarized light.
Asbestosisinhalation of articles previously used to INSULATED HEATING/COOLING units. Two geometric forms: Amphibole = stiff & straight = more pathogenic form = assoc w/MESOTHELIOMA.
Inhaled fibers interact with epithelial cells & macrophages --> macrophages ingest fibers --> release proinflammatory&FIBROGENIC mediators. There is also an oncogenic response.
-5x risk of LUNC CANCER (55x if smoker)macro = fibrosis of the LOWER LOBES (subpleural area --> entire lung)
micro = FIBROSIS begins around bronchioles/alveolar ducts --> spreads to adjacent alveolar sacs/alveoli --> more fibrosis. HONEYCOMB fibrosis.ASBESTOS BODIES = asbestos fibers coated with an iron containing proteinaceous material = appear as golden brown, beaded rods = type of ferruginous body
Berryliumoccupational exposure to those in computer electronics, nuclear reactors, aircraft components. Irritant is a type of metal that resists corrosion and is transparent on x-ray.
Acute form: metals acts as direct chimcal irritant --> inflammatory rxn (rare nowadays)
Inhalation of particles (or contact through broken skin) --> T-cells specific to this particle produce IL-2 & IFN-gamma (MO activating cytokines) --> GRANULOMAS (must have a genetic predispostion to devleop a HS rxn)
NON-CASEATING GRANULOMAS on biopsy & must have a HS rxn to this irritant (blood/bronchoalveolar irritant lymphocyte proliferation test)NON-CASEATING GRANULOMA
Hypersensitivty Pneumonitis (aka Extrinsic Allergic Alveolitis)occupational exposure of FARMERS. Person has INTENSE PROLONGED EXPOSURE to INHALED ORGANIC Ag --> there are already specific Ab to Ag in their blood --> complement & Ig present in vessel walls = Type 3 HS (IMMUNE COMPLEX) OR GRANULOMA formation = Type 4 HS (Granuloma/T-cell mediated)-Reccurent episodes of FEVER, DYSPNEA, COUGH, LEUKOCYTOSIS (4-6 hrs after exposure)
-evidence of immunologically mediated dz (bronchialveolar lavage shows increased CD4/CD8 & inc proinflammatory mediators)
-important to recognize dz early on to prevent CHRONIC IRREVERSIBLE FIBROSIS of lungs
Micro = INTERSTITIAL PNEUMONITIS (composed of lymphocytes, plasma cells & MO...may also have alveolar infiltrate). NON-CAEATING GRANULOMAS in most pts

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