1、Basic PATHOLOGYTodays contentsPneumoconiosis:SilicosisChronic cor pulmonalePulmonary carcinomaPneumoconiosisa term originally coined to describe the lung reaction to inhalation of mineral dusts and now has been broadened to include diseases induced by:organic particulatesinorganic particulateschemic
2、al fume-and vapor-The mineral dust pneumoconiosis:the three most common typesCoal Works Pneumoconiosis SilicosisAsbestosis and Asbestosis-related DiseaseConception:Silicosis is one of pneumoconiosis caused by deposition of silica particles in lungs.The characteristic lesion is silicotic nodule consi
3、sted of concentrated collagen fibers.SilicosisEtiology and pathogenesisSilica particles less than 5 m in diameter enter lungs and are phagocytozed by macrophages.Free particles and fibroblast stimulating factor are released from the dead macrophages.activation of pulmonary macrophagerelease of media
4、tors by pulmonary macrophage:IL1,TNF,Fibronectin Lipid mediatorsOxygen-derived free radicals Fibrogenic cytokinesCrystalline is the most toxic and fibrogenic,especially quartz.Ingested silica particlesMorphology1.Formation of silicotic nodules.2.Diffuse fibrosis of pulmonary stroma.The nodules are b
5、lack or gray-white in color and physically hard,tiny barely palpable,discrete ones in upper zones of the lungs.grating when cut.In an advanced case,the lungs may be almost completely solid.The hilar lymph nodes are much enlarged and pleura also involved even in the early stages,and their cut surface
6、 resembles the nodules.Microscopically,the silicotic nodule demonstrates concentrically arranged hyalinized collagen fibers surrounding an amorphous center.A“whorled”appearance of the collagen fibers typically.The merged silicotic nodules are demonstratedHistologically,the silicotic nodule often exp
7、erienced three stages:cellular nodulefibrotic nodulehyaline nodule.StagingStage:Lesion limited at the hilar lymph nodes and subpleural zones with the silicotic nodules is few in number.Stage:Lesion may scattered at upper and lower area in lung concentrated in the hilus with the silicotic nodules inc
8、rease in number.Stage:Lesion may occur at entire lung with progressive massive fibrosis with cavities.There is grating when cut.The merged silicotic nodules are enlarged in size and demonstrate a neoplasm-like mass.Complications1.Tuberculosis2.Cor pulmonale3.EmphysemaChronic cor pulmonale(Pulmonary
9、hypertensive heart disease)Definition:Defined as right sided heart disease secondary to thoracic and pulmonary diseases.Etiology and pathogenesisThoracic movement disorderPulmonary disease(emphysema,chronicDiseases ofpulmonary arterybronchitis,fibrosis,etc)chronic hypoxiapulmonary hypertensionchroni
10、c cor pulmonaleMorphology1.LungDiseases of the pulmonary parenchyma:etiological lesions such as emphysema,chronic bronchitis,bronchiectasis,fibrosis,etc.2.Pulmonary artery:Hypoxia spasm structural changes such as muscularization of arteriole.Hyperplasia of elastic and collagen fibers of intima and m
11、edia3.HeartHypertrophy and dilatation of right ventricle is the mark in diagnosis.A reference in diagnosis:Thickness of right ventricular wall at 2cm under pulmonary artery valves reaches5mm.4.Disorders affecting chest movementClinic-pathological aspects1.Primary pulmonary diseases2.Right heart fail
12、ure3.Pulmogenic brain disordersTri-symptomic groups:Earlier stageAdvanced stagePulmonary carcinoma1.Bronchogenic carcinoma2.Non-Bronchogenic carcinoma1.Bronchogenic carcinoma95%of primary lung tumors arise from the bronchial epithelium.Undoubtedly,the bronchogenic carcinoma is the number one cause o
13、f cancer related deaths in industrialized cities.The etiology of bronchogenic carcinoma is related to the smoking and air pollution with no doubt.Like all cancers,lung cancers result from an accumulation of genetic changes that affect oncogenes and tumor suppressor genes.There are 2 major histologic
14、al types of bronchogenic carcinomas:Squamous cell carcinoma AdenocarcinomaMorphologyGrossly,pulmonary carcinoma can be classified into 3 types:central type periphery type diffuse typeThey may be from intraluminal masses;they may invade the bronchial mucosa,infiltrating longitudinally in the peribron
15、chial connective tissue;or they may form large bulky masses pushing into adjacent lung parenchyma.Squamous cell carcinoma is more common in men than in women.They tend to arise centrally in major bronchi and eventually spread to localhilar nodes.Adenocarcinoma is equally common in men and in women,a
16、nd the association with smoking is weaker than forsquamous cell carcinoma.They are usually peripherally located.These tumors grow slowly,but tend to metastasize widely at an early stage.Small cell lung carcinoma(SCLC)lack cytological origin.SCLC are more common in men than is women.They generally ap
17、pear as pale gray,centrally located mass and early involvement of the hilar and mediastinal nodes and therefore are rarely resectable.The two-year survival rate is only 5 to 8%.Histologically,SCLC are composed of small,dark,round to oval,lymphocyte-like cells that have scant cytoplasm and hyperchrom
18、atic nuclei,among which mitoses are numerous.This is the classic“oat cell”.Bronchioloalveolar carcinoma(BAC)A special type of adenocarcinoma.There are 3 variants:2.Non-Bronchogenic carcinomaHistologically,these masses consist of tall columnar cells,regularly arrayed along preserved alveolar septa or
19、 irregularly aligned along the tumors fibrovascular stroma.BAC has a better prognosis than other pulmonary carcinoma,the localized single mass has a 50 to 70%five-year survival rate,and the multifocal variant has a 20 to 25%five-year survival rate.Large cell carcinomaA group of neoplasm that lack cy
20、tological differentiation and probably represent squamous carcinoma or glandular neoplasms that are too undifferentiated to permit categorization.The cell are usually anaplastic and have large vesicular nuclei.Sometimes a tumor is composed of wildly anaplastic giant cells;others may have clear cells
21、 or spindle-shaped cells.These neoplasms aregenerally bulky and are more peripheral than central.They have a poor prognosis because of their tendency to spread to distant sites early in their course.More than half involve the CNS at the time of diagnosis,and the five-year survival rate is 2 to 3%.To
22、days summary brieflySilicosis is characteristic of silicotic nodule and concentrated collagen fibers.Chronic cor pulmonale is defined as right sided heart disease secondary to thoracic and pulmonary diseases.Pulmonary carcinomaBronchogenic carcinomaSquamous cell carcinoma AdenocarcinomaSmall cell lung carcinomaNon-Bronchogenic carcinoma Bronchioloalveolar carcinoma Large cell carcinoma
