Difference between revisions of "Asthma"

From Libre Pathology
Jump to navigation Jump to search
(redirect)
 
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
#redirect [[Medical_lung_diseases#Asthma]]
+
'''Asthma''' is a common respiratory disease. It occasionally can be fatal and may be seen in the context of [[forensic pathology]].
 +
 
 +
The [[cytopathology]] of asthma is dealt with in ''[[Pulmonary_cytopathology#Asthma|pulmonary cytopathology (asthma)]]''.
 +
 
 +
==General==
 +
*The bread and butter of respirology.
 +
*May be associated with atopy (allergies), medications (e.g. [[NSAID]]s), occupational exposures.<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref>
 +
*[[Clinical diagnosis]] - diagnosis based on symtpoms/response to therapy<ref name=pmid20176271>{{Cite journal  | last1 = Lemanske | first1 = RF. | last2 = Busse | first2 = WW. | title = Asthma: clinical expression and molecular mechanisms. | journal = J Allergy Clin Immunol | volume = 125 | issue = 2 Suppl 2 | pages = S95-102 | month = Feb | year = 2010 | doi = 10.1016/j.jaci.2009.10.047 | PMID = 20176271 }}</ref> +/-methacholine challenge testing.<ref name=pmid25326695>{{Cite journal  | last1 = Lim | first1 = SY. | last2 = Jo | first2 = YJ. | last3 = Chun | first3 = EM. | title = The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma. | journal = BMC Pulm Med | volume = 14 | issue =  | pages = 161 | month =  | year = 2014 | doi = 10.1186/1471-2466-14-161 | PMID = 25326695 }}</ref>
 +
 
 +
Treatment:
 +
*Bronchodilators.
 +
*+/-Steroids.
 +
 
 +
===Pathogenesis===
 +
*T-cell response T<sub>H</sub>2 dominant.
 +
 
 +
Sequence:<ref name=Ref_PCPBoD8_370-2>{{Ref PCPBoD8|370-2}}</ref>
 +
*Antigen T<sub>H</sub>2 lymphocyte -> IgE B-cell -> [[mast cell]] IgE Fc -> leukotrienes + other mediators -> bronchospasm, edema, leukocyte recruitment -> airway remodeling.
 +
 
 +
==Gross==
 +
*Lung over-inflation.
 +
*Mucous plugs.
 +
*Focal resorption atelectasis,<ref name=Ref_PCPBoD8_363>{{Ref PCPBoD8|363}}</ref> i.e. collapse.
 +
 
 +
==Microscopic==
 +
Features:<ref name=Ref_Klatt108>{{Ref Klatt|108}}</ref>
 +
*Edema.
 +
*Mucous (plugs).
 +
*+/-Smooth muscle hypertrophy.
 +
*+/-Inflammation - especially with [[eosinophil]]s.
 +
*+/-Charcot-Leyden crystals (formed from eosinophil granules -- breakdown product).
 +
**Sharp edge, diamond shaped, pink on [[H&E]].
 +
 
 +
Notes:
 +
*''Leyden'' in ''Charcot-Leyden'' is also seen written as ''Leiden''.
 +
**Finding associated with hypereosinophilia<ref name=pmid6162378>{{Cite journal  | last1 = Dincsoy | first1 = HP. | last2 = Burton | first2 = TJ. | last3 = van der Bel-Kahn | first3 = JM. | title = Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome. | journal = Am J Clin Pathol | volume = 75 | issue = 2 | pages = 236-43 | month = Feb | year = 1981 | doi =  | PMID = 6162378 }}</ref> - ''not'' pathognomonic for asthma.
 +
*[[Pulmonary cytopathology]]:
 +
**''Curschmann's spirals'' =  spiral-shaped mucous plugs.<ref name=pmid9812228>{{cite journal |author=Cenci M, Giovagnoli MR, Alderisio M, Vecchione A |title=Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution |journal=Diagn. Cytopathol. |volume=19 |issue=5 |pages=349–51 |year=1998 |month=November |pmid=9812228 |doi= |url=}}</ref>
 +
**''Creola bodies'' = clusters of (ciliated) bronchial epithelial cells.<ref name=pmid2818212>{{Cite journal  | last1 = Isohima | first1 = K. | last2 = Takahashi | first2 = K. | last3 = Soda | first3 = R. | last4 = Hukasaka | first4 = N. | last5 = Tanabe | first5 = K. | last6 = Ozaki | first6 = K. | last7 = Nakato | first7 = H. | last8 = Araki | first8 = M. | last9 = Tuzi | first9 = M. | title = [The clinical significance of Creola body in the sputum of asthmatic patients]. | journal = Arerugi | volume = 38 | issue = 7 | pages = 542-8 | month = Jul | year = 1989 | doi =  | PMID = 2818212 }}</ref>
 +
 
 +
DDx:
 +
*Infection - fungal.
 +
 
 +
===Images===
 +
<gallery>
 +
Image:Charcot-Leyden_crystals,_HE_3.jpg | Charcot-Leyden crystals. (WC/Patho)
 +
Image:Charcot-Leyden_crystals,_HE_2.jpg | Charcot-Leyden crystals. (WC/Patho)
 +
</gallery>
 +
www:
 +
*[http://www.udel.edu/medtech/dlehman/medt372/Ch-lyd.html Charcot-Leyden crystals (udel.edu)].
 +
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168024/figure/F1/ Charot-Leyden crystals (nih.gov)].
 +
 
 +
==Stains==
 +
Features - crystals:
 +
*PAS-D -ve.
 +
*GMS -ve.
 +
 
 +
==Sign out==
 +
<pre>
 +
BRONCHIAL CAST, RIGHT LOWER LOBE, REMOVAL:
 +
- CHARCOT-LEYDEN CRYSTALS.
 +
- CELLULAR DEBRIS WITH NEUTROPHILS AND ABUNDANT EOSINOPHILS.
 +
- RESPIRATORY MUCOSA WITH PROMINENT SMOOTH MUSCLE.
 +
- NEGATIVE FOR MALIGNANCY.
 +
 
 +
COMMENT:
 +
GMS and PAS-D stains are negative for fungal organisms. The findings are non-specific;
 +
however, they would be compatible with asthma. Clinical and microbiological correlation
 +
is required.
 +
</pre>
 +
 
 +
==See also==
 +
*[[Medical lung diseases]].
 +
 
 +
==References==
 +
{{Reflist|2}}
  
 
[[Category:Diagnosis]]
 
[[Category:Diagnosis]]
 +
[[Category:Medical lung diseases]]

Latest revision as of 00:31, 13 March 2015

Asthma is a common respiratory disease. It occasionally can be fatal and may be seen in the context of forensic pathology.

The cytopathology of asthma is dealt with in pulmonary cytopathology (asthma).

General

  • The bread and butter of respirology.
  • May be associated with atopy (allergies), medications (e.g. NSAIDs), occupational exposures.[1]
  • Clinical diagnosis - diagnosis based on symtpoms/response to therapy[2] +/-methacholine challenge testing.[3]

Treatment:

  • Bronchodilators.
  • +/-Steroids.

Pathogenesis

  • T-cell response TH2 dominant.

Sequence:[4]

  • Antigen TH2 lymphocyte -> IgE B-cell -> mast cell IgE Fc -> leukotrienes + other mediators -> bronchospasm, edema, leukocyte recruitment -> airway remodeling.

Gross

  • Lung over-inflation.
  • Mucous plugs.
  • Focal resorption atelectasis,[5] i.e. collapse.

Microscopic

Features:[6]

  • Edema.
  • Mucous (plugs).
  • +/-Smooth muscle hypertrophy.
  • +/-Inflammation - especially with eosinophils.
  • +/-Charcot-Leyden crystals (formed from eosinophil granules -- breakdown product).
    • Sharp edge, diamond shaped, pink on H&E.

Notes:

  • Leyden in Charcot-Leyden is also seen written as Leiden.
    • Finding associated with hypereosinophilia[7] - not pathognomonic for asthma.
  • Pulmonary cytopathology:
    • Curschmann's spirals = spiral-shaped mucous plugs.[8]
    • Creola bodies = clusters of (ciliated) bronchial epithelial cells.[9]

DDx:

  • Infection - fungal.

Images

www:

Stains

Features - crystals:

  • PAS-D -ve.
  • GMS -ve.

Sign out

BRONCHIAL CAST, RIGHT LOWER LOBE, REMOVAL:
- CHARCOT-LEYDEN CRYSTALS.
- CELLULAR DEBRIS WITH NEUTROPHILS AND ABUNDANT EOSINOPHILS.
- RESPIRATORY MUCOSA WITH PROMINENT SMOOTH MUSCLE.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
GMS and PAS-D stains are negative for fungal organisms. The findings are non-specific; 
however, they would be compatible with asthma. Clinical and microbiological correlation 
is required.

See also

References

  1. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 370. ISBN 978-1416054542.
  2. Lemanske, RF.; Busse, WW. (Feb 2010). "Asthma: clinical expression and molecular mechanisms.". J Allergy Clin Immunol 125 (2 Suppl 2): S95-102. doi:10.1016/j.jaci.2009.10.047. PMID 20176271.
  3. Lim, SY.; Jo, YJ.; Chun, EM. (2014). "The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma.". BMC Pulm Med 14: 161. doi:10.1186/1471-2466-14-161. PMID 25326695.
  4. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 370-2. ISBN 978-1416054542.
  5. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 363. ISBN 978-1416054542.
  6. Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 108. ISBN 978-1416002741.
  7. Dincsoy, HP.; Burton, TJ.; van der Bel-Kahn, JM. (Feb 1981). "Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome.". Am J Clin Pathol 75 (2): 236-43. PMID 6162378.
  8. Cenci M, Giovagnoli MR, Alderisio M, Vecchione A (November 1998). "Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution". Diagn. Cytopathol. 19 (5): 349–51. PMID 9812228.
  9. Isohima, K.; Takahashi, K.; Soda, R.; Hukasaka, N.; Tanabe, K.; Ozaki, K.; Nakato, H.; Araki, M. et al. (Jul 1989). "[The clinical significance of Creola body in the sputum of asthmatic patients].". Arerugi 38 (7): 542-8. PMID 2818212.