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Difference between revisions of "Pulmonary pathology"
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*Inadequacy rate for percutaneous biopsies ~5% in one series.<ref name=pmid22977650>{{Cite journal | last1 = McSweeney | first1 = SE. | last2 = O'Regan | first2 = KN. | last3 = Mc Laughlin | first3 = PD. | last4 = Crush | first4 = L. | last5 = Maher | first5 = MM. | title = Evaluation of the efficacy and safety of percutaneous biopsy of lung. | journal = Open Respir Med J | volume = 6 | issue = | pages = 82-8 | month = | year = 2012 | doi = 10.2174/1874306401206010082 | PMID = 22977650 }}</ref> | *Inadequacy rate for percutaneous biopsies ~5% in one series.<ref name=pmid22977650>{{Cite journal | last1 = McSweeney | first1 = SE. | last2 = O'Regan | first2 = KN. | last3 = Mc Laughlin | first3 = PD. | last4 = Crush | first4 = L. | last5 = Maher | first5 = MM. | title = Evaluation of the efficacy and safety of percutaneous biopsy of lung. | journal = Open Respir Med J | volume = 6 | issue = | pages = 82-8 | month = | year = 2012 | doi = 10.2174/1874306401206010082 | PMID = 22977650 }}</ref> | ||
*Length 0.5-1.5 cm enough for EGFR testing.<ref name=pmid22006985>{{Cite journal | last1 = Zhuang | first1 = YP. | last2 = Wang | first2 = HY. | last3 = Shi | first3 = MQ. | last4 = Zhang | first4 = J. | last5 = Feng | first5 = Y. | title = Use of CT-guided fine needle aspiration biopsy in epidermal growth factor receptor mutation analysis in patients with advanced lung cancer. | journal = Acta Radiol | volume = 52 | issue = 10 | pages = 1083-7 | month = Dec | year = 2011 | doi = 10.1258/ar.2011.110150 | PMID = 22006985 }}</ref> | *Length 0.5-1.5 cm enough for EGFR testing.<ref name=pmid22006985>{{Cite journal | last1 = Zhuang | first1 = YP. | last2 = Wang | first2 = HY. | last3 = Shi | first3 = MQ. | last4 = Zhang | first4 = J. | last5 = Feng | first5 = Y. | title = Use of CT-guided fine needle aspiration biopsy in epidermal growth factor receptor mutation analysis in patients with advanced lung cancer. | journal = Acta Radiol | volume = 52 | issue = 10 | pages = 1083-7 | month = Dec | year = 2011 | doi = 10.1258/ar.2011.110150 | PMID = 22006985 }}</ref> | ||
=Basic approach= | =Basic approach= | ||
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=Normal lung= | =Normal lung= | ||
:''Benign lung'' redirects here. | :''Benign lung'' redirects here. | ||
==Lung anatomy== | ===Lung anatomy=== | ||
===Airway=== | ====Airway==== | ||
*Bronchus = has cartilage. | *Bronchus = has cartilage. | ||
*Bronchiole = non-cartilaginous airway. | *Bronchiole = non-cartilaginous airway. | ||
===Pleura=== | =====Small airways===== | ||
The trip to the alveolus:<ref>Hegele. 27 October 2009.</ref> | |||
#Membranous bronchiole. | |||
#Terminal bronchiole - dilation distal to this = emphysema. | |||
#Respiratory bronchiole. | |||
#Alveolar duct - dilated in [[ARDS]]. | |||
#Alveolus. | |||
====Pleura==== | |||
*Visceral pleura = covers the lung.<ref>URL: [http://www.ouhsc.edu/histology/Glass%20slides/14_15.jpg http://www.ouhsc.edu/histology/Glass%20slides/14_15.jpg]. Accessed on: 10 October 2012.</ref> | *Visceral pleura = covers the lung.<ref>URL: [http://www.ouhsc.edu/histology/Glass%20slides/14_15.jpg http://www.ouhsc.edu/histology/Glass%20slides/14_15.jpg]. Accessed on: 10 October 2012.</ref> | ||
*Parietal pleura = covers the chest wall. | *Parietal pleura = covers the chest wall. | ||
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*[[Pleural invasion]] is an important prognosticator in lung cancer and should be considered if the tumour is close to the pleura. | *[[Pleural invasion]] is an important prognosticator in lung cancer and should be considered if the tumour is close to the pleura. | ||
===Lung lobule=== | ====Lung lobule==== | ||
Lung lobule:<ref>[http://lib.hku.hk/denlib/exhibition/rarebook/mouth_hygiene_plate.jpg http://lib.hku.hk/denlib/exhibition/rarebook/mouth_hygiene_plate.jpg]</ref> | Lung lobule:<ref>[http://lib.hku.hk/denlib/exhibition/rarebook/mouth_hygiene_plate.jpg http://lib.hku.hk/denlib/exhibition/rarebook/mouth_hygiene_plate.jpg]</ref> | ||
*Arterial vessels travels with the bronchus. | *Arterial vessels travels with the bronchus. | ||
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*'''A'''rteries (which were once thought to contain air) are with the '''a'''irway. | *'''A'''rteries (which were once thought to contain air) are with the '''a'''irway. | ||
==Lung histology== | ===Lung histology=== | ||
===Cells=== | ====Cells==== | ||
Common: | Common: | ||
*Type I pneumocyte - cover most of the alveolar surface. | *Type I pneumocyte - cover most of the alveolar surface. | ||
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***Synaptic vesicle 2. | ***Synaptic vesicle 2. | ||
====Images==== | =====Images===== | ||
<gallery> | <gallery> | ||
Image: Benign bronchial epithelium -- low mag.jpg | BBE - low mag. (WC) | Image: Benign bronchial epithelium -- low mag.jpg | BBE - low mag. (WC) | ||
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*[http://www.proteinatlas.org/dictionary/normal/lung/detail+1/magnification+1 Pneumocytes (proteinatlas.org)]. | *[http://www.proteinatlas.org/dictionary/normal/lung/detail+1/magnification+1 Pneumocytes (proteinatlas.org)]. | ||
=== | ===Sign out=== | ||
====Missed endobronchial biopsy==== | |||
<pre> | |||
RIGHT UPPER LOBE, ENDOBRONCHIAL BIOPSY: | |||
- SMALL FRAGMENT OF BENIGN BRONCHIAL MUCOSA WITH INFLAMMATION. | |||
COMMENT: | |||
The clinical history of a mass is noted. | |||
This biopsy does not show neoplastic tissue; however, the biopsy may not be representative | |||
of the lesion seen. | |||
</pre> | |||
=====Alternate===== | |||
<pre> | |||
Lung, Left Lower Lobe, Endobronchial Biopsy: | |||
- Respiratory bronchiolitis. | |||
- Benign bronchial epithelium. | |||
- NEGATIVE for granulomatous inflammation. | |||
- NEGATIVE for evidence of mass lesion. | |||
Comment: | |||
Immunostains were done and compatible with bronchial epithelium (napsin negative, | |||
TTF-1 negative, CK7 positive, CK20 negative, CDX2 negative, beta-catenin membranous | |||
staining) and lung parenchyma (napsin positive, TTF-1 positive, CK7 positive, | |||
CK20 negative, CDX2 negative, beta-catenin membranous staining). | |||
</pre> | |||
=Pathology terminology= | =Pathology terminology= | ||
*Siderophages = mononuclear phagocyte with hemosiderin.<ref>http://medical-dictionary.thefreedictionary.com/siderophore</ref> | *Siderophages = mononuclear phagocyte with hemosiderin.<ref>http://medical-dictionary.thefreedictionary.com/siderophore</ref> | ||