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 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.

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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.