Respiratory System Block

DEPARTEMEN PATOLOGI
ANATOMI
Fakultas Kedokteran Universitas
Sumatera Utara Medan-2011

TUBERCULOSIS

 TUBERCULOSIS

 TUBERCULOSIS

PRIMARY PULMONARY
TUBERCULOSIS, Ghon
complex
The gray-white
parenchymal focus
(under pleura in the
lower part of upper
lobe)
Hilar lymph nodes with
caseation (on the left)

GHON COMPLEX

HISTOLOGICALLY
Sites of active involvement are
marked by a characteristic :

That forms both tubercles

&

THE MORPHOLOGIC
SPECTRUM OF
TUBERCULOSIS

A characteristic tubercle at low

magnification :
Central caseation surrounded by epithelioid
& multinucleated giant cells.

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas

Southwestern Medical School, Dallas, TX.)

Central caseation surrounded by

epithelioid & multinucleated giant
cells.

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas

Southwestern Medical School, Dallas, TX.)

In immunocompetent
individuals,
tubercular granulomas might not show
central caseation

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas

Southwestern Medical School, Dallas, TX.)

In immunosuppressed
individuals,
tuberculosis may not elicit a granulomatous
response ("nonreactive tuberculosis)

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas

Southwestern Medical School, Dallas, TX.)

 TUBERCULOSIS

Secondary pulmonary
tuberculosis

The upper parts of both lungs are riddled with :

Gray-white areas of caseation &
Multiple areas of softening & cavitation.

Cavitary Tuberculosis
When necrotic tissue is
coughed up cavity
Typical for large
granulomas
More common in the
secondary reactivation
tuberculosis - upper
lobes.

Tuberculous Granulomas

 TUBERCULOSIS

Miliary tuberculosis of
the spleen
The cut surface
shows numerous
gray-white
granulomas

Lymphadenitis

Adrenal TB - Addison
Disease

Testes TB Orchitis

TB Peritonitis + Liver
Miliary TB

TB Brain Caudate

TB Intestine

Prostate TB

Spinal TB - Potts Disease

Granuloma / LH giant cell is not

pathagnomonic of TB!

Foreign body
granuloma
Fat necrosis
Fungal infections
Sarcoidosis
Crohns disease

PNEUMONIA

PNEUMONIA

PNEUMONIA

The Anatomic distribution of

bronchopneumonia & lobar
pneumonia

BRONCHOPNEUMONIA
(Pathogenesis)

 Bronchopneumonia (Pathogenesis)

Infant & old

Weakness patient
Carcinoma, cardiac failure, chronic kidney
failure, traumatic cerebrovascular

Acute bronchitis
Chronic obstruction respiratory tract, or
Cystic fibrosis &
Post operative

BRONCHOPNEUMONIA

LOBAR PNEUMONIA

PNEUMONIA (STADIUM)

 PNEUMONIA (STADIUM)

 PNEUMONIA (STADIUM)

 PNEUMONIA (STADIUM)

SPECIAL PNEUMONIA

PNEUMONIA NONINFECTION
ASPIRATION

 PNEUMONIA NON INFECTION

LIPID PNEUMONIA

 PNEUMONIA NON INFECTION

EOSINIPHYLIC PNEUMONIA

OBSTRUCTION LUNG
DISEASE

LOCAL OBSTRUCTION LUNG

DISEASE

DIFUSE OBSTRUCTION LUNG

DISEASE

CHRONIC BRONCHITIS

Severe
Hypercapnia
Hypoxia & cyanosis (blue bloaters)]

Chronic Bronchitis

Reid Index
= Ratio of thickness of mucous gland layer (CD) to
the thickness between the epithelium and the
cartilage (AB) (normally 0.4).
The closer to 1 means thickness & correlated to
progression of disease

Normal
CD/AB = 0.4

Chronic Bronchitis
Clinical course

Bronchi & bronchioles are obstructed by mucus plugs

bronchiolitis obliterans.
In long-standing cases,
squamous metaplasia & dysplasia (precancerous)
predisposes for squamous cell carcinoma
?

EMPHYSEMA

EMPHYSEMA

A.Diagram of normal
structures within the
acinus, the fundamental
unit of the lung. A
terminal bronchiole (not
shown) is immediately
proximal to the
respiratory bronchiole.
B. Centriacinar
emphysema with dilation
that initially affects the
respiratory bronchioles.
C. Panacinar emphysema
with initial distention of
the peripheral structures
(i.e., the alveolus and
alveolar duct); the
disease later extends to
affect the respiratory
bronchioles.

ASTHMA

BRONCHUS IRRITABLE (+)

BRONCHUS SPASM

MUCOUS (>>) OBSTRUCTION

DYSPNOE

TYPE : - ATOPIC
- NON ATOPIC
- ASPIRINE INDUCED
- OCCUPATIONAL
- ALLERGIC (ASPERGILLUS)

Bronchial Asthma

NON ATYPIC ASTHMA

T. RESP. INFECTION
CHRONIC BRONCHITIS
ALLERGEN TEST (-)
LOCAL IRRITATION BRONCHUS
CONSTRICTION

ASPIRINE INDUCED ASTHMA

MECHANISM (?)
+/- PROSTAGLANDINE
DECREASE / LEUKORINE
INCREASE RESP. TR.
IRRITABLE
RHINITIS, NASAL POLYPS,
URTICARIA (+)

OCCUPATIONAL ASTHMA

REACTIVE HYPERSENSIVITY
(ALLERGEN)
DYSPNOE
COUGH (CHRONIC)
ALLERGEN :
- WOOD
- CHEMICAL
- ETC

ASPERGILLUS BRONCHITIS
ALLERGY

SPORA ASPERGILLUS FUMIGATUS

HYPERSENSITIVITAS REAC.
DYSPNOE
MUCOUS GLOBULE ASPERGILLUS
HYPAE (+)

BROCHIECTASIS.

ETIO :
- BRONCHUS OBSTRUCTION
- INFECTION (SEVERE)
- CONGENITAL (<<<)
BRONCHUS & BRONCHIOLUS DILATATION
COUGH (CHRONIC), DYSPNOE, SPUTUM (>>>)
+ BLOOD

BRONCHIECTASIS

CLINIC :
- LOBUS INFERIOR + INFECTION
- CLUBBING FINGER

COMPLICATION
PNEUMONIA, EMPIEMA,
SEPTICAEMIA, MENINGITIS,
ABSCESS METASTASIS
(CEREBRAL), AMYLOID (+)

Bronchiectasis
Gross

Distended peripheral
bronchi (Due to weakening of
wall)

LUNG NEOPLASMA

PRIMARY LUNG CA
ANOTHER LUNG NEOPLASMA
- BENIGN
- MALIGNANT
SECONDARY LUNG
NEOPLASMA

"It is nice to have money and the

things that money can buy, but it's
important to make sure you
haven't lost the things money can't
buy."
George Lorimer
1867-1937, Editor of "Saturday Evening Post"