DISEASES OF RESPIRATORY SYSTEM (3)

1. DISEASES OF RESPIRATORY SYSTEM (3) The Department of Pathology Zili Lv 吕自力 15907817634 E-mail:lvzili@yahoo.com.cn

2. Contents • Chronic diffuse interstitial lung diseases慢性肺间质性病 • Nasopharyngeal carcinoma 鼻咽癌 • Carcinoma of the lung 肺癌

3. Chronic Interstitial Lung Diseases • 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

4. Pneumoconioses • Lung diseases caused by inhaleddusts • Dusts may be inorganicor organic • Reaction may be inert, fibrous, allergic or neoplastic • Co-existing disease may aggravate the reaction • Silicosis 硅肺 • Asbestosis 石棉肺

5. Silicosis硅沉着病p200 • 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

9. A. Pathogenesis -- hypothesis • > 5um, bronchial mucus layer, wafted upward by ciliary action to be expelled. • < 1um, airborne and are exhaled • 1-5 um, toxic to macrophages

10. Pathogenesis of Pneumoconiosis Fibroblast-stimulating factor Inflammatory mediator Proteolytic enzymes Inflammatory cells infiltrate Fibrosis Fibrosis

11. B. Pathology* • 1. Silicotic nodule（硅结节） • 2. Diffuse pulmonary fibrosis（肺弥漫纤维化）

12. Grossly • 2 – 5 mm • Gray-black • Hard • Brittle • Hilum and upper lobes • Fibrosis • Irregular emphysema

13. Microscopically 1、Silicotic nodules硅结节 ①Macrophages ② Fibroblast ③ Collagen

14. Microscopically 2、Diffuse fibrosis Restrictive ventilatory defect

15. C. Clinical Features • Asymptomatic • Slowly progressive dyspnea, pulmonary hypertension, cor pulmonale.

16. D. Complications • Lung Tuberculosis肺结核病 • Chronic cor pulmonale • Infection of lungs • Lungemphysema • Lung carcinoma

17. Asbestosis肺石棉沉着症p201 • Fire-resistant • Be used for insulation and the manufacture of brake linings

18. A. Pathology1. Fibrosis* • Thickening of the parietal pleura • A plaque-like deposition of hyalinized collagen • Lateral and diaphragmatic

19. Pleural Fibrosis

20. Pathology 2. Asbestos bodies*石棉小体 • Coated in acid mucopolysaccharide粘多糖 and encrusted with haemosiderin • Brown and beaded

21. Asbestos bodies石棉小体 • Iron-containing glycoprotein • Diagnostic changes Asbestosis

22. B. 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

23. Silicosis Asbestosis Silica 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

24. Respiratory System Malignant Tumors Nasopharyngeal carcinoama 鼻咽癌 Bronchogenic carcinoma 支气管肺癌

25. NASOPHARYNGEACARCINOMA, NPC鼻咽癌p205

26. Nasopharyngeal 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

27. Incidences of NPC • Hong Kong, Guangdong, Guangxi • 40- 60 years old • Male:female = 2-3 : 1

28. A. Etiology • Infection with Epstein-Barr virus (EBV) • Genetic susceptibility • Environmental factors • Smoking • Carcinogen contents are rich in food

29. Location B. Pathology* • Nasopharyngeal roof * • (鼻咽顶部) • 2. Lateral wall • (外侧壁) • 3. Pharyngeal recess • （咽隐窝）

30. Grossly: nodular, ulcerative, infiltrative, clauliflower

31. Histopathology • Nonkeratinizing carcinoma (1) undifferentiated*:common (2) differentiated 2. Keratinizing squamous cell carcinoma Well, moderately, poorly differentiated 3. Basaloid squamous cell carcinoma

32. Vesicular nuclei cell carcinoma

33. Direct extension C. Spread 1. upwards: skull 2. forwards: nasal, orbit 3. downwards: oraopharynx, tonsil 4. backwards: vertebra 5. lateral: middle ear

34. Metastasis* • Lymphatic*: Upper cervix lymph node颈上深淋巴结 enlargement painless. • Haematogenous: bone, lung, liver, brain, etc.

35. Lymphatic metastasis

36. D. 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

37. Lung Carcinoma p206 Primary malignant tumor 1.1 million deaths annually worldwide Most frequent and one of the most deadly cancer

38. A. Etiology • 1. Smoking*: 40/day, 20-fold

39. A. 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

40. B. Pathology* Grossly • Central or hilar tumors • Peripheral tumors • Diffuse type

41. Central type

42. 60-70% Hila type

43. Peripheral tumors • 30%, mainly adenocarcinomas, arise in peripheral airways or alveoli

44. Peripheral type 30-40%

45. Diffuse type, rarely

46. Histology • 1. Small cell carcinoma (20%) • 2. Non-small cell carcinoma (80%) • (1) Squamous cell carcinoma • (2) Adenocarcinoma • (3) Large cell carcinoma

47. Small cell lung carcinoma Round to polygonal cells with scant cytoplasm. Note mitotic figure in center

48. Squamous cell carcinoma* • The commonest type • The most closely associated with the cigarette smoking. • Most of them are central type.

49. A. goblet-cell hyperplasia B. basal cell (or reserve cell) hyperplasia C. squamous metaplasia Bronchogenioccarcinoma The precursor lesions (the earliest "mild“ changes) of squamous cell carcinomas

50. Bronchogenioccarcinoma D. squamous dysplasia E. Carcinoma-in-situ F. invasive squamous carcinoma