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The Lung 成因/症狀

Name

Pathology

Congenital anomalies Pulmonary hypoplasia

擠壓肺部、Diaphragmatic Hernia、oligohydramnios (羊水過少)/體重減輕、Acini 縮小

肺部中間有 Cyst 產生

Foregut Cysts

原上腸異常脫離 可手術摘除

位置:Hilum, Mid mediastinum 現象:Infection, Rupture/ Bronchogenic (esophageal, enteric) cyst

Sequestration

血液供應自 Systemic,與氣管脫離 (左下肺葉易有)

Extralobar: Vein 也是 Systemic,伴隨其他異常/新生兒 Intralobar: infection, bronchiectasis/老人

不完全擴張

可逆-Resorption: 氣管阻塞/ Compression: hydrothorax, effusion 不可逆-Contraction: Fibrosis, Scar

Atelectasis (Collapse) Acute Lung Injury →Diffuse Alveolar Damage = acute interstitial pneumonia

Middle Lobe syndrome Acute Respiratory Distress Syndrome (ARDS) →Pancreatitis, Uremia, Infection, Cytokines, Paraquat

Pulmonary Edema (Interstitial) 造成呼吸不足

原因不明/ Hamman-Rich Disease/ 急性症狀

Alveolar Damage, Respiratory failure, fulminant

Hyaline membrane (Fibrin + Edema + Necrotic Cell) Exudate (Acute, 可逆)→Proliferative (Organizing, 可逆)→Fibronic (Chronic, 不可逆)

Obstructive Disease

Obstructive: 氣道狹窄、 失去彈性(FEV1 下降) Restrictive: 胸壁問題、間質性 (Total Lung Capacity 下降)

Chronic Bronchitis

Bronchus, Tobacco, cough, sputum/ 連續兩年有三個月以上的咳嗽/ Cor Pulmonale

Gland Hyperplasia, hypersecretion/ Blue (Cyanosis) Reid (黏膜厚度/整體) > 0.4

Bronchus, infection/ cough, sputum Bronchial obstruction (cystic fibrosis, sequestration)

Airway dilation and scarring (不可逆)

Bronchiectasis

Asthma

Exudative inflammation, ulceration, fibrosis

Immotile cilia (Kartagener Syndrome), necrotizing pneumonia Bronchus, immunologic, wheezing Extrinsic: Type I 過敏 Antigen/ ABPA (Allergic bronchopulmonary aspergillosis) Intrinsic: Aspirin, Viral, cold, exercise

Lung Pathology [2014.01] NYMU 10001085

SMC hyperplasia, inflammation


成因/症狀

Name Obstructive Disease (續)

Emphysema

Pathology

Acinus, tobacco, Dyspnea/ 高 Protease

Airspace enlargement, 無回彈力量/ Pink

Centriacinar: respiratory bronchiole Panacinar: Resp. bronchiole, alveolus, a-AT 下降

Irregular: scarring Compensatory: hyperinflation

Distal acinar: tobacco

Senile emphysema, bullous emphysema, interstitial emphysema

Bronchiolitis Bronchiole, Tobacco, dyspnea Diffuse interstitial Disease 浸潤、限制型

Inflammatory scarring

Fibrosing Usual Interstitial Pneumonia TGF-beta1 活化→活化 Fibroblast Idiopathic pulmonary fibrosis 發展慢, 對 Steroid 無效, 死亡率高 死亡低 Collagen vascular disease, drug reaction Non-specific Interstitial

TGF-beta1 活化→上皮細胞受損(Apoptosis)→Fibrosis Geographic and temporal heterogeneity, Honeycombing 均質, Interstitial 變寬

Pneummonia Cryptogenic Organizing Pneumonia

Pneumoconiosis

= organizing Pneumonia / Bronchiolitis Obliterans Organizing Pneumonia (BOOP) 大→小: Impaction, sedimentation, diffusion Coal workers: anthracosis (simple CWP) progressive massive fibrosis (complicated CWP) Silicosis Asbestosis-related diseas

Lung Pathology [2014.01] NYMU 10001085

Pore of Khon, Fibroblastic proliferation, Fibroblast plug (Masson body), (Bronchiolar lumen, peribronchiolar airspace) Organic dust: Hypersensitivity Pneumonitis/ Asthm Caplan Syndrome= Pneumoconiosis + RA Caplan Syndrome, Collagenous nodule Fibrous plaques, Mesothelioma, Asbestos body, Caplan


成因/症狀

Name Granulomatous

Sarcoidosis Systemic noncaseating granulomas

Pathology 界線清楚 Hilary lymphadenopathy, 肺部、脾臟、肝臟轉移, Asteroid body

Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis) Inhalation of amoeba, chemical…Small bronchiole 旁 Non-necrotizing granuloma 界線不清楚 Eosinophilic

Loffler syndrome: simple pulmonary eosinophilia Secondary eosinophilia: mucoid impaction,

Allergic mucin

Aspergillosis Smoking-Related

Desquamative interstitial pneumonia

非上皮細胞!為間質性的疾病 Uniform distribution, intra-alveolar pigmented macrophages (Smoker’s microphage), 無 Fibroblastic

Respiratory bronchiolitis associated interstitial lung diseases (RB-ILD) 吸菸、Dyspnea, cough, 停止抽菸預後好

Pigmented macrophages (Smoker’s microphage)

Pulmonary alveolar proteinosis 後天性(90%), Capillary 問題造成 Leakage,

Dyspnea, cough, lamellar bodies, Pulmonary edema 治療: Whole lung lavage (全肺沖洗)

Lymphoid interstitial Pneumonia (LIP)

Diffuse alveolar septum Follicular bronchitis/ bronchiolitis/ lymphoid hyperplasia

往 Septum 浸潤, 融合 Nodule→MALtoma

Drug Induced Lung disease

Bleomycin toxicity

Chronic interstitial pneumonia, DAD, BOOP

Radiation induced disease

Acute radiation pneumonitis (1-6 mths) Acute/ organizing DAD, cytolytic atypia of alveolar Chronic radiation pneumonitis (>6 mths)

Lung Pathology [2014.01] NYMU 10001085

Foam cell in intima and media Non-specific fibrosis, hyaline and foam cell

Pathology lung  
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