Respiratory Tract Pathology

Muhammad Takbir
Departemen Patologi Anatomik
FK-UNKHAIR
 Lungs
Normal anatomy & histology!!
• Paired intrathoracic organs  lobes
• Right  3 lobes
• Left  2 lobes
 • Trachea
• Bronchi
• Bronchiolus
• Terminal
bronc
• Respiratory
bronc
• alveoli

http://www.fpnotebook.com/_media/lungXsGrayBB962.gif
http://virtualslides.med.umich.edu/Histology/Respiratory%20System/129_HISTO_20X.svs/view.
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• Endothel
• Interstitium
• Alveolar
epithelium:
– Type I (respiration)
– Type II (surfactant,
stem cell)
• Macrophage
alveolar (dust cell)
 Primary Lung Disease
• Airways

• Interstitium

• Vascular
Atelectasis (Collapse)
• Loss of lung volume 
inadequate expansion
• Mechanism:
– Resorption: obstruction 
mucopurulent plug,
– Compression:
accumulation fluid, blood,
air  pleural cavity
– Contraction/ cicatrization:
local/ generalized fibrotic
Robbins Basic Pathology 9th ed, 2013
 Acute Lung Injury (ALI)
• Bilateral pulmonary
damage
• Epithelial – endothelial
• ALI  ARDS (acute
respiratory distress
syndrome)
• Diffuse alveolar
damage
Robbins Basic Pathology 9th ed, 2013
• Left: ALI & ARDS – pink hyaline membrane
• Right: healing stage – type II pneumocyte
Robbins Basic Pathology 9th ed, 2013
 Obstructive
VS
Restrictive ??
 Obstructive lung disease
• Emphysema
COPD  tobacco
• Chronic bronchitis
• Asthma
• Bronchiectasis
 Emphysema
• Permanent enlargement
• Destruction, fibrosis (-)
• Distal terminal bronchus
• Subtypes:
– Centroacinar (smoking related)
– Panacinar (α1-antitrypsin def)
– Distal acinar
– Irregular
 Chronic bronchitis
• Persistent & Productive cough 3 months
• Cigarette smoking, air pollutant
 Asthma
• Airway obstruction – reversible, intermitten
• Chronic inflammation: eosinophil
• Hypertrophy smooth muscle
• Mucus secretion >>
 Bronchiectasis
• Permanent dilation: bronchi – bronchioles
• Destruction: muscle – elastic tissue
• Secondary: post pneumonia, TB
 Restrictive lung disease
• Reduced compliance – pressure >> to expand
lung – stiff
• Dyspnea
• Fibrosing disease: IPF (idiopathic pulmonary
fibrosis), ……
• Pneumoconioses: occupational, coal miner’s
lung
• Granulomatous: sarcoidosis
• Massive fibrosis
• Black pigment >>
 Pulmonary vascular disease
• Pulmonary emboli – immobilisasi, surgery
• Pulmonary hypertension – COPD
• Hemorrhagic syndromes: Good Pasture
syndrome
 Pulmonary infection
• PNEUMONIA
• 1/6 all deaths in US
• WHY:
– Exposed microbial contaminants
– Nasopharyngeal flora aspirates during sleep
• Streptococcus pneumonia > 90%
• Bronchopneumonia – lobar pneumonia
• Anatomic n radiologic
BLURRY…..
Classify – etiology or clinical settings
 CAP - HAP
• Community acquired pneumonia
S. pneumonia, H. influenzae,….

• Hospital acquired pneumonia

P. aeruginosa, K. pneumonia,….
• Community acquired atypical pneumonia
• Aspiration pneumonia
 CAP - HAP
Era before antibiotics

Morphology: congestion – red hepatization –

gray hepatization – resolution
 Chronic pneumonia
• TB
• Histoplasmosis
• Blastomycosis
• Coccidioidomycosis
 TB
• M. Tbc
• Chronic granulomatous disease
• Lung – extrapulmonal
 Kasus Otopsi Klinik
• Laki-laki (Tn. YS) berusia 52 tahun, ditemukan
jatuh terlentang di pinggir jalan dengan mulut
dan hidung keluar darah, meninggal tanpa
diketahui riwayat penyakit semasa hidup atau
menjelang kematian.
• Pemeriksaan luar jenazah  tidak ditemukan
tanda trauma yang menyebabkan kematian.
Paru kanan, lobus atas
Paru kanan lobus atas menunjukkan gambaran nekrosis perkijuan yang luas serta
ditemukan bakteri tahan asam pada pemeriksaan Ziehl Nielsen. Di tempat lain sebagian
alveolus melebar dan terdapat fibrosis interstitial. Tidak tampak kelainan bermakna pada
paru kiri.
Caseating
necrosis

Multinucleated
Langhans cell
ZN (+)
 Lung Tumors

AS
Cancer statistics, 2015
 Lung Tumors

AS
Cancer statistics, 2015
New cases Death

Globocan, 2012
 WHO, 2004

60 – 70%

Poor prognosis…
 Lung tumors
• Benign - malignant, epithelial – mesenchymal
• 90-95 %  carcinoma
• 5-10%: carcinoids, lymphoma
• SMOKING RELATED…TOBACCO EPIDEMIC !!!
polycyclic aromatic hydrocarbons, such as
benzopyrene, anthracenes, radioactive
isotopes
• EGFR – KRAS mutation  personalized
therapy
 Lung tumors
TOBACCO EPIDEMIC !!!
 Lung tumors
• Small cell lung cancer (SCLC)

• Non-small cell lung cancer (NSCLC)

– Adenocarcinoma
– Squamous cell carcinoma
– Large cell carcinoma

• Why?? Management…
 SCLC
• Small cells, scant cytoplasm, ill defined cell
border, finely granular chromatin,
inscopicuous nucleoli
• Expression neuroendocrine marker
• Hilar/ perihilar mass, lymphadenopathy (+)
WHO, 2004
 NSCLC
Squamous Cell Carcinoma (SCC)
• Keratinization/ intercellular bridges arises
from bronchial epithelium
• Mainstem lobar – centrally located
• Superior located – Pancoast tumor – Horner’s
syndrome
 Pancoast tumor:
• Apex location
• NSCLC
• Horner’s syndrome ?

• Netter illlustrated human pathology, 2014

Precursor lesion – invasive SCC
Robbins Basic Pathology 9th ed, 2013
 NSCLC
Adenocarcinoma
• Glandular differentiation or mucin production
• Steadily rising – woman, never smoker, Asian
• Peripherally located
Terima kasih…