DISEASES OF RESPIRATORY SYSTEM (3)

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

2. Contents • Chronic diffuse interstitial lung diseases • Nasopharyngeal carcinoma Carcinoma of the lung

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. • Fibrosing diseases • Granulomatous diseases

4. Pneumoconioses尘肺 • 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

7. Silicosis硅沉着病 • Reason：silicon dioxide (silica) 二氧化硅dust particles. • Size: 1-5um in diameter • Basic pathological features： Progressive fibrosis 进行性纤维化 Numerous silicotic nodules 硅结节

8. 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

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

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

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

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

13. Microscopically 2、Diffuse fibrosis Restrictive ventilatory defect

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

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

16. Asbestosis肺石棉沉着症

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

18. Pleural Fibrosis

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

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

21. 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 （恶性胸膜瘤）

22. 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

23. Fibrosing diseasesIdiopathic pulmonary fibrosis (IPF) Unknown etiology Diffuse interstitial fibrosis Usual interstitial pneumonia The pleural surfaces have the appearance of cobblestones

24. Idiopathic pulmonary fibrosis Fibrosis Lower lobes

25. Usual interstitial pneumonia

26. Usual interstitial pneumonia

27. Sarcoidosis The etiology remains unknown < 40 years old Danish and Swedish Several immunologic abnormalities Nonsmokers

28. Morphology Noncaseating epithelioid granuloma

29. Asteroid body

30. Schaumann body

31. Extrapulmonary sarcoidosis Lymph nodes Skin lesions: erythema nodosum Eye and lacrimal glands Spleen Liver Bone marrow

32. Skin lesions: erythema nodosum

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

34. NASOPHARYNGEACARCINOMA, NPC鼻咽癌 Localized in nasopharynx It shows a distinct racial and geographical distribution. It is more common in Southeast Asia, North Africans than others

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

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

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

38. Grossly: nodular, ulcerative, infiltrative, clauliflower

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

40. Vesicular nuclei cell carcinoma泡状核细胞癌

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

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

43. Lymphatic metastasis

44. 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

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

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

47. 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

48. B. Pathology* 组织起源： 支气管粘膜上皮* 支气管腺体 细支气管粘膜上皮clara细胞 嗜银细胞 II型肺泡上皮

49. Grossly Type • Hilar：最常见，位于肺门 • Peripheral：发生于段以下支气管 • Diffuse：少见

50. 60-70% Hila type