Basic PATHOLOGY - Zhejiang Universitym-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20130618124716768.… · Basic PATHOLOGY 周韧 ZHOU REN Prof., Ph.D. Department of Pathology

Basic PATHOLOGY周 韧ZHOU REN

Prof., Ph.D.

Department of Pathology & Patho-physiology Institute of Pathology & Forensic Medicine

Zhejiang University Judicial Evidence & Evaluation Center

Zhejiang University School of Medicine

[email protected]

http://doc.zju.edu.cn/blx/

Today’s contents

Pneumoconiosis: SilicosisChronic cor pulmonalePulmonary carcinoma

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Pneumoconiosis a term originally coined to describe the lung reaction to inhalation of mineral dusts and now has been broadened to include diseases induced by:

organic particulatesinorganic particulateschemical fume- and vapor-

The mineral dust pneumoconiosis: the three most common types—

Coal Work’s PneumoconiosisSilicosisAsbestosis and Asbestosis-related Disease

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Conception:

Silicosis is one of pneumoconiosiscaused by deposition of silica particles in lungs. The characteristic lesion is silicotic nodule consisted of concentrated collagen fibers.

Silicosis

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Etiology and pathogenesis

Silica particles less than 5 μm in diameter enter lungs and are phagocytozed by macrophages.

Free particles and fibroblast stimulating factor are released from the dead macrophages.

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Crystalline is the most toxic and fibrogenic, especially quartz.

activation of pulmonary macrophage

release of mediators by pulmonary macrophage:IL1, TNF,FibronectinLipid mediatorsOxygen-derived free radicalsFibrogenic cytokines

Ingested silica particles

Morphology

1. Formation of silicotic nodules.

2. Diffuse fibrosis of pulmonary stroma.

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The nodules are black or gray-white in color and physically hard, tiny barely palpable, discrete ones in upper zones of the lungs.

grating when cut.

In an advanced case, the lungs may be almost completely solid.

The hilar lymph nodes are much enlarged and pleura also involved even in the early stages, and their cut surface resembles the nodules.

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Microscopically, the silicotic nodule demonstrates concentrically arranged hyalinized collagen fiberssurrounding an amorphous center. A “whorled”appearance of the collagen fibers typically.

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The merged silicotic nodules are demonstrated

Histologically, the silicotic nodule often experienced three stages:

cellular nodule fibrotic nodule hyaline nodule.

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Staging

Stage Ⅰ: Lesion limited at the hilar lymph nodes and subpleural zoneswith the silicotic nodules is few in number.

Stage Ⅱ:Lesion may scattered at upper and lower area in lung concentrated in the hilus with the silicotic nodules increase in number.

Stage Ⅲ:Lesion may occur at entire lung with progressive massive fibrosis with cavities. There is grating when cut . The merged silicotic nodules are enlarged in size and demonstrate a neoplasm-like mass.

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Complications

1. Tuberculosis 2. Cor pulmonale3. Emphysema

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Chronic cor pulmonale(Pulmonary hypertensive heart disease)

Definition:

Defined as right sided heart disease secondary to thoracic and pulmonary diseases.

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Etiology and pathogenesis

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Thoracic movement disorder

Pulmonary disease (emphysema, chronic bronchitis,fibrosis,etc)

Diseases of pulmonary artery

↙↘ ↓

chronic hypoxia↓

pulmonary hypertension↓

chronic cor pulmonale

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Morphology

1. LungDiseases of the pulmonary parenchyma:

etiological lesions such as emphysema, chronic

bronchitis, bronchiectasis, fibrosis, etc.

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2. Pulmonary artery:

Hypoxia → spasm → structural changessuch as muscularization of arteriole.

Hyperplasia of elastic and collagen fibers of intima and media

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3. HeartHypertrophy and dilatation of right ventricle is the mark in diagnosis.

A reference in diagnosis:

Thickness of right ventricular wall at 2cm under pulmonary artery valves reaches ≥5mm.

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4. Disorders affecting chest movement

Clinic-pathological aspects

1. Primary pulmonary diseases2. Right heart failure3. Pulmogenic brain disorders

Tri-symptomic groups:

Earlier stage

Advanced stage

Pulmonary carcinoma

1. Bronchogenic carcinoma2. Non- Bronchogenic carcinoma

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1. Bronchogenic carcinoma

95% of primary lung tumors arise from the bronchial epithelium. Undoubtedly, the bronchogenic carcinoma is the number one cause of cancer related deaths in industrialized cities.

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The etiology of bronchogenic carcinoma is related to the smoking and air pollution with no doubt. Like all cancers, lung cancers result from an accumulation of genetic changes that affect oncogenes and tumor suppressor genes.

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There are 2 major histological types of bronchogenic carcinomas:

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Squamous cell carcinomaAdenocarcinoma

Morphology

Grossly, pulmonary carcinoma can be classified into 3 types:

central typeperiphery type diffuse type

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They may be from intraluminal masses; they may invade the bronchial mucosa, infiltrating longitudinally in the peribronchial connective tissue; or they may form large bulky masses pushing into adjacent lung parenchyma.

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Squamous cell carcinoma is more common in men than in women. They tend to arise centrally in major bronchi and eventually spread to local hilar nodes.

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Adenocarcinoma is equally common in men and in women, and the association with smoking is weaker than for squamous cell carcinoma.

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They are usually peripherally located. These tumors grow slowly, but tend to metastasize widely at an early stage.

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Small cell lung carcinoma(SCLC)

lack cytological origin.

SCLC are more common in men than is women. They generally appear as pale gray, centrally located mass and early involvement of the hilar and mediastinal nodes and therefore are rarely resectable. The two-year survival rate is only 5 to 8%.

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Histologically, SCLC are composed of small, dark, round to oval, lymphocyte-like cells that have scant cytoplasm and hyperchromatic nuclei, among which mitoses are numerous. This is the classic “oat cell”.

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Bronchioloalveolar carcinoma (BAC)

A special type of adenocarcinoma. There are 3 variants:

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2. Non- Bronchogenic carcinoma

Histologically, these masses consist of tall columnar cells, regularly arrayed along preserved alveolar septa or irregularly aligned along the tumor’s fibrovascular stroma.

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BAC has a better prognosis than other pulmonary carcinoma, the localized single mass has a 50 to 70% five-year survival rate, and the multifocal variant has a 20 to 25% five-year survival rate.

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Large cell carcinoma

A group of neoplasm that lack cytological differentiation and probably represent squamous carcinoma or glandular neoplasms that are too undifferentiated to permit categorization.

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The cell are usually anaplastic and have large vesicular nuclei. Sometimes a tumor is composed of wildly anaplastic giant cells; others may have clear cells or spindle-shaped cells. These neoplasms are generally bulky and are more peripheral than central.

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They have a poor prognosis because of their tendency to spread to distant sitesearly in their course. More than half involve the CNS at the time of diagnosis, and the five-year survival rate is 2 to 3%.

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Today’s summary brieflySilicosis is characteristic of silicotic nodule and concentrated collagen fibers.Chronic cor pulmonale is defined as right sided heart disease secondary to thoracic and pulmonary diseases.Pulmonary carcinoma

Bronchogenic carcinomaSquamous cell carcinoma

AdenocarcinomaSmall cell lung carcinomaNon- Bronchogenic carcinoma

Bronchioloalveolar carcinomaLarge cell carcinoma

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