Respiratory Disease

Pneumonia Pneumonitis Infection Infection marked inflammatory exudate that the alveolar septa and pulmonary filled the alveoli interstitium Consolidation in the CXR Absence of consolidation viruses, mycoplasma and Bacterial origin Chlamydia "primary atypical pneumonia "

Bronchopneumonia
Patchy distribution (multifocal) Bilateral Streptococcus pneumoniae and Klebsiella pneumoniae. Secondary infection (in patients The extremes of life (very young and very
old or how have Underlying chronic medical condition (malignancy ,cirrhosis.

Lobarpneumonia
Part or all of the lobe unilateral Streptococcus pneumonia Primary Infection (in a healthy individual or agent)

with a highly virulent

rare Pleural involvement Is Septal destruction organization Stages of lobar pneumonia: 1- congestion 2- red hepatization

common Pleural involvement Is

No septal destruction resolution or organization 3- gray hepatization 4- resolution

Complications of pneumonia: 1. Complete restitution (with therapy). 2. Abscess. 3. Empyema. 4. solid fibrous. 5. Meningitis. 6. arthritis, or infective endocarditis. v H. influenzae is the most common bacterial cause of acute exacerbation of COPD. v Klebsiella pneumoniae is the most frequent cause of gram-negative bacterial pneumonia. (with Thick and gelatinous sputum).

Lung Abscess:
suppurative necrosis within the pulmonary parenchyma. one or more large cavities. Anaerobic bacteria. vary in diameter. resulting from aspiration of infective material are much more common on the right side. Abscesses that develop in the course of pneumonia or bronchiectasis are commonly: 1- multiple 2- basal 3- diffusely scattered.
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 Clinically: 1- a prominent cough 2- large amounts of foul-smelling, purulent sputum 3- occasionally, hemoptysis occurs. Bronchogenic Cancer 10-15 % with infective abscess. ------------------------------------------------------------------------------------

LUNG TUMORS:
Lungs are frequently the site of metastases from cancers in extrathoracic organs, primary lung cancer is also a common disease. Bronchial epithelium is the site of origin of 95% of primary lung tumors (carcinomas). 5% are: bronchial carcinoids, mesenchymal malignancies (e.g., fibrosarcomas, leiomyomas), lymphomas, and a few benign lesions. Lung cancinoma is the number one cause of cancer-related deaths in industrialized countries. Prognosis: 5-year survival rate is about 15%.

Histologic Classification:
1. Squamous cell carcinoma. 2. Adenocarcinoma. a. Acinar, papillary, solid. b. bronchioloalveolar carcinoma. 3. Small-cell carcinoma. 4. Large-cell carcinoma. Adenocarcinomas in women, nonsmokers, and in persons younger than 45 years.

Squamous cell carcinomas:

in men, smoking (age group not young). arise centrally in major bronchi (so we can see it by brochoscopy). central necrosis, giving rise to cavitation. Sever heamoptsis. Changes: 1. goblet cell hyperplasia. 2. basal cell (or reserve cell) hyperplasia. 3. squamous metaplasia. squamous dysplasia Carcinoma-in-situ (CIS) Invasive squamous carcinoma. atypical cells may be identified in cytologic smears. well-defined tumor mass. arise very slowly. slowly + locally + late metastases easy to surgical therapy.

Adenocarcinomas:
peripherally located. "scar carcinomas". in women and nonsmokers. grow slowly, smaller masses than others, to metastasize widely at an early stage. Histologically, they assume a variety of forms, including acinar (gland forming) papillary, and solid types.
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 The precursor of peripheral adenocarcinomas has been described as atypical adenomatous hyperplasia (AAH) (resembling Clara cells). well-demarcated focus.

Bronchioloalveolar carcinomas:
subtype of adenocarcinomas. peripheral parts. pneumonia-like consolidation. their growth along preexisting structures and preservation of alveolar architecture. do not demonstrate destruction of alveolar architecture or stromal invasion.

Large-cell carcinomas:
undifferentiated malignant epithelial tumors. The cells typically have large nuclei, prominent nucleoli, and a moderate amount of cytoplasm. represent squamous cell or adenocarcinomas that are so undifferentiated.

Small-cell lung carcinomas (SCLCs):

centrally located masses. (but beneath the mucosa so we can not see it by bronchoscopy). early involvement of the hilar and mediastinal nodes. fusiform shape, scant cytoplasm, and finely granular chromatin. smoking (in young patient).

Prognosis of the lung cancer:

NSCLCs (squamous cell carcinomas or adenocarcinomas) have a better prognosis than SCLCs. NSCLCs are detected before metastasis or local spread, cure is possible by lobectomy or pneumonectomy. SCLCs, have invariably spread by the time they are first detected, even if the primary tumor appears small and localized. Thus, surgical resection is not a viable treatment. They are very sensitive to chemotherapy (with or without radiation) but invariably recur.

Bronchial Carcinoids:
Benign tumor from the Kulchitsky cells (neuroendocrine cells). The neoplastic cells contain dense-core neurosecretory granules in their cytoplasm. Rarely!!! may secrete hormonally active polypeptides. appear at an early age (mean 40 years) and represent about 5% of all pulmonary neoplasms. originate in main stem bronchi. Although 5% to 15% of these tumors have metastasized to the hilar nodes at presentation, distant metastasis is rare.
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28-12-2010