|Path Labs||CTools||Lab Instructors||ImageScope||Histology Normals||Histology Site||M1 Histopathology|
Respiratory Laboratory 1:
Reading Assignments (Robbins: Pathologic Basis of Disease, 8th)
|8th Edition||7th Edition|
|716||719 - 720||752||755 - 756|
|368 - 372||384 - 385||383 - 386||399 - 400|
|680 - 682||456 - 458||715 - 716||399 - 400|
|710 - 714||747 - 751||781 - 783|
An 83-year old man presents with an acute myocardial infarction and dies before intervention is performed. At autopsy, the pleural surfaces of both lungs were fibrotic. The cut surfaces of the lungs manifested diffuse fibrosis with extensive “honeycombing.” The hilar lymph nodes were not enlarged. When examining this slide, notice that many of the alveolar walls contain more nuclei than usual and that there are detached fragments of alveolar septa. Small deposits of anthracotic pigment are also evident. Many of the alveolar septa are thickened by fibrosis. Within these areas of fibrosis are golden brown beaded or “knobby” structures.
A 60-year-old man sought medical attention because of weight loss. During his evaluation, the patient also complained of a decreased appetite, weakness, and night sweats. A non-productive cough had recently developed. Physical examination revealed hepatomegaly and splenomegaly. A chest radiograph manifested a diffuse reticulonodular infiltrate. Laboratory evaluation disclosed an anemia with leukopenia and an elevated alkaline phosphatase level. A liver biopsy sample was obtained and a diagnosis was established. The patient responded promptly to treatment. Slide 26 was obtained from a similar patient at autopsy.
A 27 year old man presents for long-term follow up of a chronic medical disease to the pulmonology clinic. He has experienced cough productive of sputum since the age of two. He felt well until two years prior to this presentation, when he developed increasing shortness of breath and decreased energy. He has also experienced pancreatic insufficiency over the past several years. Eventually, he undergoes bilateral lung transplantation. These sections are taken from those explants
A 47 year old woman with a history of emphysema was admitted to the hospital with 2 weeks of shortness of breath. An initial chest x-ray was concerning for left upper lobe pneumonia. She was treated with antibiotics, but her oxygenation became progressively worse. She was eventually intubated, and evaluated for ECMO. Despite intensive management, the patient became increasingly hypoxemic and died. This section is prepared from autopsy material.
A 62-year old man sought medical attention because of increasing shortness of breath. He had a long history of mild exertional dyspnea and a minimal cough productive of small amounts of mucoid sputum. He had lost some weight and appeared distressed. His lower intercostal spaces retracted with each inspiration. The patient had a long history of cigarette smoking. He underwent lung volume reduction surgery to treat his symptoms.
A 24-year old man presented to the emergency room with dyspnea, cough, and wheezing. He previously had numerous similar episodes, usually triggered or exacerbated by exposure to cold air, physical activity, and exposure to cats and birds. Physical examination revealed wheezing prominent in both phases of respiration. Despite intensive therapy, the patient died from respiratory failure.
A 43-year old man was admitted to the hospital because of fever, night sweats, weight loss, and headache. He had felt well until the fever developed, 15 days earlier. Further questioning elicited a 4 month history of night sweats, a 3 month history of arthralgias, a 2 week history of headache, and a recent weight loss of 4-5 kilograms. His past medical history was unremarkable. There were no risk factors for HIV infection. The patient was a native of Morocco and had immigrated to this country just 4 months prior to admission.
The patient was thin but not acutely ill. His lungs were clear and the heart sounds were normal. The neck was questionably stuff. A complete metabolic panel was normal, as was a complete blood count. A urinalysis revealed proteinuria and microscopic hematuria; pyuria was absent. A chest x-ray revealed calcified nodules throughout the lungs, and punctate areas of increased density that raised the possibility of infection, neoplasm, or chronic interstitial lung disease. A CT study of the lungs confirmed the presence of the radiographic abnormalities.
A lumbar puncture yielded slightly yellowish cerebrospinal fluid that contained neutrophils and lymphocytes. The glucose level was abnormally low and the total protein content was increased. A lung biopsy was performed.
At this point, your instructor will illustrate the pathologic features present in the biopsy sample.
The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'