Asthma

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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 asthma in pulmonary cytopathology.

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.

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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.