Pulmonaiy Pathology

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0bstiuction |usually mucusj pievents aii fiom ieaching
uistal aiiways

Tiappeu aii gets iesoibeu - alveolai collapse
Fiequent post op complication
Nechanical collapse of alveoli

Bue to pleuial effusions, elevation of the uiaphiagm aftei
suigeiy oi ascites |basal atelectasisj
Local oi geneializeu fibiotic |cicatiizationj changes in the
lung oi pleuia hampei expansion anu inciease elastic iecoil
uuiing expiiation |iiieveisiblej
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Acute phase |1-7uj - Biffuse uamage to the alveolai capillaiy inteiface |by PNNs anu Nqj
causes leakage of piotein iich fluiu into the alveolai aii space anu euema - hyaline
membianes foim which aie composeu of fibiin anu neciotic epithelial cells

0iganizing phase |1-Swj - piolifeiation of type II pneumocytes, oiganization of the fibiin
exuuate leaus to intiaalveolai fibiosis; thickening of the alveolai septa if theie is significant
loss of type II pneumocytes iesulting in collagen ueposition |iepaii insteau of iegeneiationj

Bas chaiacteiistics of a iestiictive lung uisease

Seconuaiy to uiiectinuiiect lung injuiy - i.e. sepsis, tiauma, BIC, uiugs, acute pancieatitis



Neonatal RBS - inauequate suifactant levels |uiffuse gianulaiity on CXRj
Naciophages seciete IL-1, IL-8 & TNF which attiacts PNN's - PNN's seciete PAF, LT's anu
pioteases |anu help foim R0Sj - tissue uamage |type I anu II pneumocytesj anu euema

uioss appeaiance of the lungs is fiim, heavy anu iubbeiy

Patients piesent with iapiu onset of hypoxemia anu cyanosis with iespiiatoiy uistiess uue
to thickening of the uiffusion baiiiei anu incieaseu suiface tension which causes atelectasis
- "white out" on chest x-iay

No tieatment is available, only suppoitive theiapy |ventilation with PEEPj - 02 theiapy
may be haimful

Patients that aie veiy olu, septic oi expeiiencing multi oigan failuie have a pooi piognosis,
but noimal function can ietuin aftei 6 - 12 months

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Complications: Abscess, Empyema, 0iganization |scai tissuej, bacteiemia, iecuiient pneumonias
Piimaiy: usually infects a healthy peison with a viiulent oiganism
Klebsiella, E. coli anu Pseuuomonas aie most commonly involveu in hospital acquiieu PNA |giam -vej
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viiulent 0iganisms
S. pneumoniae |most common community
acquiieuj
K. pneumoniae - thick mucoiu capsule anu
tissue uamage piouuce a ieu cuiiant jelly
sputum |uue to aspiiationj - moie
common in elueily, alcoholics anu uiabetics;
abscess

Spieaus thiough poies of Kohn

No tissue uamage - complete iecoveiy
Less viiulent oiganisms

S. auieus - usually supeiimposeu on a viial
infection of the 0RT; can be complicateu by
an abscess oi empyema
B. influenza - associateu with C0PB
P. aeiuginosa - CF patients
N. cataiihalis - community anu C0PB
L. pneumophila - tiansmitteu fiom watei
souices, intiacellulai oiganism |silvei stainj

Inteivening tissue uamage
Nycoplasma pneumoniae - ciowueu
institutions; associateu with AIBA
Chlamyuia pneumoniae
RSv, CNv, Influenza viius |- 2 Staphj
C. buinetii - Q fevei in faimeis anu vets

Euema, inflammation & hypeiemia in septa
but the lumen of the alveoli iemains cleai

Biffuse inteistitial infiltiates appeai as
incieaseu lung maikings on CXR

"iespiiatoiy uistiess out of piopoition to
clinical anu iauiogiaphic finuings" -
0sually it is milu with minimal sputum anu a
low fevei


0ccuis in people with an abnoimal gag
ieflex - alcoholics, comatose, post-
anesthesia

Can be chemical oi bacteiial ielateu
S. auieus accompanieu by:
Bacteioiues
Fusobacteiium
Peptococcus

0ften complicateu by abscess

ueneially occuis in the iight lowei lobe oi in
giavity uepenuent aieas in beu-iiuuen
patients
Acute Congestion - heavy, ieu anu boggy uue to eaily PNNs anu RBCs
Reu Bepatization - alveoli lose theii lining anu aie packeu with PNNs, fibiin, anu RBCs
uiey Bepatization - Biy anu fiim aftei ieu cells have been lyseu, exuuate iemains
Resolution - Removal of exuuate |iesoiption, cough, maciophagesj

Enuogenous lipiu PNA -foamy Nq, goluen appeaiance uistal to obstiuction |i.e. SCLCj
Pulmonaiy Pathology

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BIv is the single most impoitant iisk factoi woiluwiue
Tiansmission is uiiect, thiough aeiosolization of the oiganism - BTB ieaction
Cough, Fevei, Night sweats with AFB
False -ve Nantoux skin test may be uue to viial infection, saicoiu, malnutiition, Bougkin
lymphoma, immunosuppiession oi oveiwhelming active TB |aneigyj

Piimaiy - uhon complex foims in the lowei lobes which may unueigo fibiosis anu
calcification to foim a Ranke complex

Seconuaiy - Reactivation of N. tubeiculosis commonly affects the apex of the lungs wheie
theie is a highei oxygen tension; caseating gianulomas can leau to cavitaiy lesions

Eithei stage can piogiess to miliaiy TB which uisseminates thioughout the bouy to an oigan
NAC, N. kansasii, N. abscessus

B('"+-$&'0+'(' - Rounu0val small yeast founu in the 0hio anu Nississippi iivei valleys

/+%%(5(+(5#' (00("(' - thick walleu non buuuing spheiules founu in the southwest 0S
Aka valley fevei

;$&'"+02%#' 5#,0&"("(5#' - iounuoval with BR0AB BASEB B0BBINu in the same
enuemic aieas as histoplasmosis

/C .#+8+,0&.' - buuuing yeast with a thick gelatinous capsule that giows in soil eniicheu
by pigeon uioppings
6D! (. "<# (001.+%+0-,+0('#5 4-(,+0#",2 &$E+,("<0 8+, ,#'",(%"(F# F' +:'",1%"(F# 5('#&'#
/AG - neonates anu the immunocompiomiseu |owls eye inclusionj
6/6 - cuppeu shapeu cysts with cotton canuy exuuate |jiiovecij
/&.5(5& - buuuing yeast with pseuuohyphae
!'-#,E($$1' - septate hyaline hyphae with acute angle bianching; foui types - fungal ball,
ABPA |IgE anu E0Sj, angioinvasive aspeigillosis, oi neciotizing
H2E+02%#"#' - Non-septate hyaline hyphae with iight angle bianching, seen in Nucoi
|BKAj, Rhizopus, anu Absiuia spp.; pieuilection foi invauing bloou vessels - infaict
IJGKLIG/ ,&"(+ - 3J/*J!4J3 =M NOP>Q @;4?*R/?7GJ |seveiity ueteimineu by FEv1j
l
Noimal
l
Look at TLC - > 8u% - Noimal
l
< 8u% - Restiictive
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Patients have uifficulty getting aii 00T of the lungs - aii tiapping in lungs that uo not empty piopeily leaus to an l TLC |hypeiinflationj
Spiiometiy - noimal oi slightly lFvC especially in the fiist seconu |i.e. llFEv1j - FEv1FvC iatio is ieuuceu, sometimes below Su%
veiy common uisease |4
th
leauing cause of ueathj affecting both men anu women
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/$(.(%&$ 5(&E.+'(' - piouuctive cough foi at least S consecutive months ovei a two yeai
peiiou. uefineu by mucus hypeisecietion

Piouuctive cough - "buckets of mucus"
Bighly associateu with smoking - hypeitiophy anu hypeiplasia of the seiomucinous glanus
|Reiu inuex is >Su%... noimal is <4u%j, squamous metaplasia, l goblet cells, anu
inflammatoiy cells |CB8+, Nacs, anu PNNs. no E0Sj
0n gioss inspection the aiiways aie hypeiemic anu swollen

Clinically piesents with the cough anu no othei iespiiatoiy uysfunction
Seveie cases: chionic bionchiolitis with goblet cell metaplasia - aiiflow obstiuction |i.e.
small aiiway uiseasej - luminal naiiowing uue to fibiosis, mucus anu inflammation
Complications - emphysema, infection

Excess mucusfibiosis plugs up the bionchioles tiapping C02 |lPaC02, lPa02j which causes
hypoxemia, hypeicapnia anu cyanosis uue to a vQ mismatch - iesoiption atelectasis

Bypoxic vasoconstiiction - pulmonaiy BTN - Rv Failuie |coi pulmonalej - peiipheial
euema
Bestiuction of the alveolai sacs - loss of elastic iecoil |i.e. l compliancej anu collapse of the
aiiways uuiing expiiation - aii tiapping
Bistal aiispaces become enlaigeu giving a moth-eatenspongy appeaiance to the lung
Theie is no associateu fibiosis; fiee floating septa seen on micioscopy

Imbalance between pioteases anu anti-pioteases coupleu with inauequate iepaii:
#1 cause is smoking |%#.",(&%(.&,L$+:1$&,j - excessive stimulation of PNN's anu Nacs;
mostly affects the iespiiatoiy bionchioles in the uppei lobe
u1-antitiypsin ueficiency |-&.&%(.&,L$+:1$&,j - misfolueu piotein gets stuck in the ER of
hepatocytes foiming pink PAS +ve gianules |also causes ciiihosisj
Nostly affects the lowei lobes uistal to RB
PiNN, PiNZ oi PiZZ |alleles aie locateu on chiomosome 14j
Polymoiphisms in TuF anu NNP genes can also be involveu
6&,&'#-"&$ emphysema |5('"&$ &%(.&,j - occuis next to atelectasis, fibiosis, anu scaiiing,
maigins, subpleuial, etc. moie commonly in the uppei lobe. Can foim bullae anu PTX
6&,&%(%&",(%(&$ |iiiegulaij emphysema foims neai a scai anu is asymptomatic

Clinical - uyspnea with a non-piouuctive |uiyj cough, piolongeu expiiation with puiseu
lips, weight loss, baiiel-chesteu |l FRCj, flatteneu uiaphiagm seen on CXR, noimal bloou gas
in the "acute" stage; late complications incluue hypoxemia anu coi pulmonale
MMP= matrix metalloproteinases
Pi gene on 14
No eosinophils in contrast to asthma
Overweight
Slim
Pulmonaiy Pathology

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Reveisible aiiway bionchoconstiiction
Lungs aie hypeiinflateu anu uistenueu with small aieas of atelectasis anu euema

Thick mucus plugs - aii tiapping
Cuischmann spiials |sheu epitheliumj anu Chaicot-Leyuen ciystals |E0S ueiiveu pioteinsj
Aiiway iemoueling - smooth muscle hypeitiophy anu thickening of the BN

Clinical - episouic |nights & eaily moiningsj attacks of uyspnea |on expiiationj anu
wheezingihonchi with tightness in the chest |piogiessive hypeiinflationj
FEv1 < Su% with hypeiventilation - hypoxia, hypeicapnia anu iesp. aciuosis
Tieat with bionchouilatois anu coiticosteioius
Status asthmaticus - seveiepiolongeu anu uoesn't iesponu to theiapy

!"+-(% - usually begins as chilu; associateu with ihinitis, uiticaiia, eczema, anu l IgE
Bue to a type I hypeisensitivity ixn - Th2 cells seciete IL-4, S, 1u, anu 1S
Acute phase: bionchoconstiiction, euema, anu mucus secietion meuiateu by vagal ieflexes
anu mast cells causes uegianulation - SRS-A, histamine, PuB2, etc.
Late phase: 4 - 8h latei, E0S amplify anu sustain the inflammatoiy iesponse |NBPj

D+.T&"+-(% - aiiway hypeiieactivity iesults in spasm with noimal seium IgE
Still have the same E0S iesponse so tieatment is the same as foi atopic
Thiesholu foi ieactivity may be loweieu by viial infections

3,1ET7.51%#5 - Aspiiin is the most common cause |l LT aftei selective C0X inhibitionj
Associateu with nasal polyps |noimal in auults, may inuicate CF in chiluienj uiticaiia anu
bionchospasm

@%%1-&"(+.&$ - uevelops aftei iepeateu exposuie to woikplace Ag
Peimanent uilation of the bionchi anu bionchioles - loss of aiiway tone iesults in aii
tiapping |along with obstiuction uue to mucus oi neciotic tissuej

Not a piimaiy uisease, but seconuaiy to chionic neciotizing infection |S. auieus anu
Klebsiella spp.j oi obstiuction, causes incluue:
Bionchial obstiuction by a tumoi, FB, mucus, etc.
Cystic Fibiosis |mucus plugging causes iecuiient infectionj
Immunoueficiency
Kaitagenei's synuiome |AR uefect in uynein aim of ciliaj
Alleigic bionchopulmonaiy aspeigillosis |seen in asthmatics anu patients with CFj

Peiibionchiolai fibiosis - tiaction anu ectasia on uistal aiiways
0bstiuction uecieases cleaiance of piimaiy infection - weakening of bionchial wall

0sually affects the lowei lobes anu can be eithei geneializeu oi local

Clinical - cough, uyspnea, anu foul smelling sputum that is loaueu with pus anu
inflammatoiy paiticles; patients may also have hemoptysis
0sually piecipitateu by a 0RT infection

Complications - hypoxemia, coi pulmonale, AA amyloiu ueposition |2 amyloiuosisj
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Nainly affects males ovei 6u |that smokej

Piogiessive bilateial fibiosis in peiipheial
anu basal locations '0' - hypoxia anu
cyanosis anu peiipheial euema

Tempoial anu spatial heteiogeneity

Cobblestone pleuia & Boneycomb change
|cystic spaces lineu by type II pneumocytes
oi iespiiatoiy epitheliumj

Relentless piogiession - suivival < Sy
without a tiansplant
Bx of exclusion
Nainly affects youngei patients i.e. Su yof

0nifoim fibiosis with chicken wiie
appeaiance. two types
/#$$1$&, - bettei outcome

I(:,+'(.E - may have tempoial
heteiogeneity

N0 honeycomb change oi fibioblast foci

Tieat with steioius oi immunomouulatois
Patchy peiibionchial oi subpleuial
consoliuation

Patients piesent with cough anu uyspnea

Nasson bouy - mucus anu loose CT plugs
with a neciotic coie in the small aiiways

Aichitectuie iemains intact

Nust R0 othei uiseases such as PNA oi
collagen vasculai uisease

Capable of causing pulmonaiy fibiosis

Examples
Rheumatoiu Aithiitis
Systemic Scleiosis
Beimatomyositis polymyositis

Can also have pleuial involvement
Aspirin causes asthma symptoms cuz it blocks cox
pathway but not lipooxygenase pathway favoring
leukotrieenes and brochospasm Eosinophilic granuloma?
Birbrck granules= little tennis racket..
Pulmonary langerhan cell histiocytosis..and eosinophilic
granuloma
Better prognosis
Upper and lower lobe
Alveolar
Recover spontaneously or with steroids
SLE
Pulmonaiy Pathology

!%1"# 7."#,'"("(&$ 6D! 920-<+(5 7."#,'"("(&$ 6D! U,&.1$+0&"+1'
Bamman-Rich synuiome

Aggiessive ILB which may be ielateu to an
acceleiateu phase of IPF

Piesents similai to ARBS with hyaline
membianes anu uiffuse alveolai uamage
Expansion of the inteistitium by sheets of
lymphoiu cells

Iuiopathic, but occuis in connection with CT
uiseases, autoimmune uiseases, oi BIv

Can tiansfoim to lymphoma
4&,%+(5+'(' B2-#,'#.'("(F("2 6D!
0ccuis moie often in young auults |<4uj
Banish, Sweuish, Afiican Ameiican
Noie common in N0N smokeis

Non-caseating epithelioiu gianuloma
Bilateial hilai LAB

Type Iv BS ixn |IL-2 anu IFN! from CD4j
Aneigy - False +ve PPB because all the T-
cells aie busy in the lungs

Schaumann Bouy - Ca anu piotein
Asteioiu Bouy - stellate giant cell inclusion

Nikulicz synuiome - laciimal anu paiotiu
involvement mimics Sjogien synuiome

uiauual onset of symptoms
Elevateu seium ACE anu hypeicalcemia -
1u-hyuioxylase activity activates vit. B
Bx of exclusion |iecuis aftei tiansplantj
Aiiway centeieu
Chionic Inflammation |with E0Sj
0iganizing PNA
uiant Cells
Pooily foimeu, non-caseating gianulomata

Affects the uppei lung zones moie often

Nix of type II anu III hypeisensitivity

Symptoms have a tempoial ielationship
with the exposuie - chionic exposuie leaus
to inteistitial fibiosis

Becieaseu BLC0, compliance, anu TLC

Biiu Fancieis Lung
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3#'V1&0&"(F# 7."#,'"("(&$ 6D! *#'-(,&"+,2 ;,+.%<(+$("(' W("< 793
Raie

Alveolai spaces aie filleu with smokeis
maciophages |uusty biown pigmentj
Thickening the of alveolai septa

Ninimal fibiosis
Smokeis maciophages accumulate in the
lumen of iespiiatoiy bionchioles -
peiibionchiolai fibiosis

uiounu glass |fiosteuj appeaiance

Tieat with steioius oi smoking cessation

Same as BIP but moie centeieu on the
bionchioles
6.#10+%+.(+'#'
/+&$ X+,S#,' 6.#10+%+.(+'(' 4($(%+'(' !':#'"+'('
Caibon builus up in maciophages accumulates along the
lymphatics - anthiacosis "black lung"

Nassive exposuie to coal uust - uiffuse fibiosis
Caplan Synuiome - associateu with iheumatoiu aithiitis
Exposuie to silica - IL-1, TNF, fibionectincytokines, anu
R0S ieleaseu fiom maciophages - inteistitial fibiosis

Fibiotic nouules in the uppei lobes can eventually leau to
PNF

Nouules - whoileu collagen fibeis with biiefiingent
paiticles aie acellulai anu eosinophilic
Eggshell calcification in LN

7.%,#&'#' "<# ,('S 8+, ?; Q '($(%& (0-&(,' "<# 8+,0&"(+.
"<# -<&E+$2'+'+0# :2 "<# 0&%,+-<&E#
Amphibole is moie uangeious type of fibei

Lowei lung zones anu subpleuial
Piouuctive cough with sputum
Fibiosis of the lung anu pleuia - plaque foimation
Asbestos bouies |Feiiuginous bouyj

Cough with piouuctive sputum

Lung CA an mesothelioma
;#,2$$(+'('
Woikeis in the aeiospace inuustiy |NASAj - histoiy
uiffeientiates fiom saicoiuosis

Non-caseating gianulomas in the lungs, hilai LN anu
systemic oigans
Incieaseu iisk foi lung cancei
Restiictive lung uisease can also be uue to exteinal causes |obesity, chest wall uefoimityj oi E0S ielateu |Loefflei's synuiome, uiug-inuuceu oi chionicj
61$0+.&,2 J5#0& 61$0+.&,2 ?<,+0:+#0:+$('0
Caiuiogenic - tiansuuate
Non-caiuiogenic - exuuate |ARBS, etc.j

Biffeiential - pulmonaiy alveolai pioteinosis anu PCP can mimic euema
viichow's Tiiau
Seconuaiy hypoxia - ieuuceu suifactant anu atelectasis, wiuening of the A-a giauient,
anuoi a iight to left shunt thiough a PF0 |Su%j
Bual bloou supply - infaict only occuis when theie is unueilying caiuiovasculai
compiomise |ieu, weugej

If you've hau 1 PE, you have Su% chance of having anothei
Aii, fat, amniotic fluiu, Iv uiugs, BN aie othei common causes
IV
Pulmonaiy Pathology

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;&'(% 6,(.%(-$#' 6,(0&,2 61$0+.&,2 B?D 4#%+.5&,2 61$0+.&,2 B?D
NAP > 2SmmBg |noimal is about 1u mmBgj - > 14
th
of
systemic piessuie

Atheioscleiosis of pulmonaiy tiunk

Intimal anu smooth muscle cell piolifeiation - wall
thickening of the meuium sizeu musculai aa.

Thickening, meuial hypeitiophy anu ieuuplication of the
IEL anu EEL of the aiteiioles

Plexifoim lesions in seveiechionic cases - multiple lumina
with a small aiteiy iesembles a tuft of capillaiies

Exeitional uyspnea anu iight heait failuie
Young auult females affecteu moie often

Associateu with BNPR2 inactivation alteis TuF signaling
aftei which vasculai smooth muscle piolifeiation anu
stenosis occuis

Seiotonin tianspoitei gene |S-BTTj also implicateu in
spoiauic foim

Fatigue, syncope, chest pain

Beath fiom iight heait failuie in 2-S yeais

Tieat with vasouilatois, anti-thiombotic agents, lung
tiansplant

Any age at onset

Bue to unueilying caiuiopulmonaiy uisease that cause
hypoxemia oi incieaseu volume within the ciicuit such as:
C0PB
Inteistitial lung uisease
Recuiient PE
Congenital heait uefect, etc.


3(881'# !$F#+$&, B#0+,,<&E# 42.5,+0#'
Immune meuiateu uiseases with a tiiau of hemoptysis, anemia anu uiffuse pulmonaiy infiltiates
U++5-&'"1,#Y' 75(+-&"<(% B#0+'(5#,+'(' X#E#.#, U,&.1$+0&"+'('
Aka: pulmonaiy ienal synuiome
Ab's taiget the uS chain of type Iv collagen

Rapiuly piogiessive glomeiulonephiitis anu hemoiihagic
pneumonitis

Beavy lungs with a ieu-biown consoliuation

Alveolai hemoiihage with patchy neciosis of alveolai walls
Septal thickening anu intia-alveolai hemosiueiin

Anti-BN Ab shows a lineai ueposition of Igu, IgA, oi IgN

Tieat with plasmapheiesis, immunosuppiession, oi ienal
tiansplant in seveie cases

Raie
0ccuis moie in chiluien than auults

Same histopathology as uooupastuie's but without ienal
involvement oi anti-BN Ab

Beait Failuie cells seen within the alveoli
Aka: pulmonaiy angiitis anu gianulomatosis
Nainly affects men in theii 4us
Involves 0RT, LRT anu Kiuneys
ueogiaphic neciosis with neutiophilic micioabscesses

Pooily foimeu gianulomas - fiee giant cells
Foim in the lung anu 0RT anu also iesults in
glomeiulonephiitis

Neciotizing vasculitis anu capillaiitis
Autoimmune - cANCA |PRSj
91.E /&.%#,
Single most impoitant cause of cancei ielateu ueath in inuustiializeu countiies
Inciuence on the iise in women, but ueclining in men; at the time of uiagnosis, Su% have metastases
Common siteu to metastasize: LN, livei, auienal, biain, bone, kiuney
ueneial Classification: Small Cell oi Non-small cell - uiffeient types of tieatment
Peiipheial tumois aie clinically silent, but cential tumois can cause: obstiuction, infection, atelectasis
Typing of piimaiy lung neoplasms: EuFR - tieat with tyiosine kinase inhibitois |gefitinibeilotinibj; pemetiexeu foi NSCLC; Bevacizumab contiainuicateu in squamous cell caicinoma
which can leau to seveie hemoiihage
Polycyclic aiomatic hyuiocaibons in cigaiette smoke aie the most mutagenic

Pulmonaiy Pathology

40&$$ /#$$ /&,%(.+0& 4V1&0+1' /#$$ /&,%(.+0& !5#.+%&,%(.+0&
Almost all have mets at time of ux, so tieatment is with
chemotheiapy

CentialBilai insteau of peiipheial, eaily mets to the
meuiastinal LN, smoking

Rounu, scant cytoplasm with finely gianulai chiomatin,
fiagile cells - ciush aitifact, nucleai moluing anu extensive
neciosis
Bigh mitotic iate
Caicinoma so it stains with keiatin in a classic iim anu uot
pattein |N0 peailsj
Also chiomogianin, synaptophysin, anu CBS6 +ve

Fiequent vasculai invasion

6&,&.#+-$&'"(% '2.5,+0#'
ACTB - Cushing's |bilateial auienal hypeiplasiaj
ABB - SIABB |hyponatiemiaj
uastiin ieleasing peptiue
Calcitonin

uenetics: myc, pSS anu Rb; Sp ueletion
0sually cential
Affects men moie than women
Associateu with smoking
Common site of spieau to hilai LN

Can cause an obstiuction which leaus to iesoiption
atelectasis anu infection

Sequence: metaplasia - uysplasia - in-situ - invasive

Cential neciosis may cause cavitation

0btain samples foi cytology by BAL, washings oi biushings
Whoils, peails, pickles anu biiuges - keiatin peails anu
uesmosomal inteicellulai biiuges

Stains: p6S, cytokeiatin S6, cytokeiatin 9uS

6&,&.#+-$&'"(% '2.5,+0#:
PTBiP - Bypeicalcemia
Nost common piimaiy lung tumoi |Su-SS%j
0ccuis in women, non-smokeis <4S
ueneially locateu at the peiipheiy; associateu with a scai
uiows slowly, but mets eaily

Begins as Atypical Auenomatous Bypeiplasia |AABj
Z ?2-#':
!5#.+%&,%(.+0& (.T'("1 |foimeily BACj: not invasive -
butteiflies on a fence, aiises fiom Claia cells
Wiuening of septa - giounu glass on x-iay
Nimic an infection
A(.(0&$$2 (.F&'(F#: <Smm invaues, Smm total
7.F&'(F#: >Smm; acinai, papillaiy, soliu, miciopapillaiy

Iuentification:
ulanus anuoi mucin |PAS +ve anu uiastase iesistantj
Stain with TTF-1, cytokeiatin-7, napsin A |soliuj

uenetics |all NSCLCj - Sp ueletion, p16CBKN2a
Specific to aueno: KRAS, EuFR |implications in tieatmentj
ALK in signet iing, non smokeis
9&,E# /#$$ /&,%(.+0& /$(.(%&$ 8#&"1,#' +8 91.E /&.%#, /&,%(.+(5 ?10+,
0nuiffeientiateu malignancy - lacks featuies of small cell,
glanuulai oi squamous uiffeientiation

Bas a pooi piognosis anu mets eaily

?W+ "2-#'[
Laige cell caicinoma |unuiffeientiateuj - no maikeis
Laige cell neuioenuociine caicinoma - chiomogianin,
synaptophysin, anu CBS6 +ve
Cough, weight loss, hemoptysis, uyspnea |non-specificj
Pulmonaiy osteoaithiopathy - clubbing
Boaiseness anu Chest pain
Pleuial anu peiicaiuial effusion |auenoj
SvC synuiome
Boinei synuiome |ipsilateialj
6&,&.#+-$&'"(% '2.5,+0#': gonauotiopins can cause
gynecomastia

Pancoast - hypothenai wasting, T12 uestiuction, Boinei's,
euema, laiyngeal neive palsy, uysphagia, chylothoiax

Benign Lesions:
uianuloma
Bamaitoma

Nets: cannonball lesions on CXR, moie common than
piimaiy tumois of the lung
Piimaiy lung tumois have mets to the auienal
Neuioenuociine tumoi of the lung that aiises fiom
Kulchitsky cells
Centially locateu, polypoiu giowth; tenus to be localizeu, but
can have mets
Affects people in theii 4us anu has a goou piognosis

0n histology: unifoim iounu cells with iaie mitosis
Clinical: obstiuction, cough, hemoptysis, infection

Episouic attacks of: vasomotoi uistuibances, uIT
hypeimotility, asthma attacks - caicinoiu synuiome |SBTj

Chiomogianin, synaptophysin, anu CBS6 +ve

Biffuse pulmonaiy neuioenuociine cell hypeiplasia
|BIPNECj
Caicinoiu tumoilets |<Smmj
Typical
Atypical vaiiants - neciosis anuoi elevateu mitotic count