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the dilated airspaces (distal).the emphysematous process is one of loss of lung parenchyma, not fibrosis.

There are two major types of emphysema: centrilobular (centriacinar) andpanlobular (panacinar). The former involves primarily the upper lobes while the

latter involves all lung fields, particularly the bases. Centrilobular emphysemaoccurs with loss of the respiratory bronchioles in the proximal portion of theacinus, with sparing of distal alveoli. This pattern is most typical for smokers.Panacinar emphysema occurs with loss of all portions of the acinus from the

respiratory bronchiole to the alveoli. This pattern is typical for alpha-1-antitrypsindeficiency.

the dilated airspaces (distal).the emphysematous process is one of loss of lung parenchyma, not fibrosis.

There are two major types of emphysema: centrilobular (centriacinar) andpanlobular (panacinar). The former involves primarily the upper lobes while the

latter involves all lung fields, particularly the bases. Centrilobular emphysemaoccurs with loss of the respiratory bronchioles in the proximal portion of theacinus, with sparing of distal alveoli. This pattern is most typical for smokers.Panacinar emphysema occurs with loss of all portions of the acinus from the

respiratory bronchiole to the alveoli. This pattern is typical for alpha-1-antitrypsindeficiency.

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Microscopically at high magnification, the loss of alveolar walls withemphysema is demonstrated. Remaining airspaces are dilated.

Microscopically at high magnification, the loss of alveolar walls withemphysema is demonstrated. Remaining airspaces are dilated.

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- The diagnostic feature of chronic bronchitis in the trachea and larger bronchi issecreting glands-enlargement of the mucus

- The magnitude of the increase in size is assessed by the ratio of- the thickness of thesubmucosal gland layer to that of the bronchial wall (the Reid index-normally 0.4).

- The diagnostic feature of chronic bronchitis in the trachea and larger bronchi issecreting glands-enlargement of the mucus

- The magnitude of the increase in size is assessed by the ratio of- the thickness of thesubmucosal gland layer to that of the bronchial wall (the Reid index-normally 0.4).

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Spirals).Curschmann(The mucous contain whorls of shed epithelium(collections of crystalloids made up ofLeyden crystals-CharcotwitheosinophilsNumerous

eosinophil proteins)

Spirals).Curschmann(The mucous contain whorls of shed epithelium(collections of crystalloids made up ofLeyden crystals-CharcotwitheosinophilsNumerous

eosinophil proteins)

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-Is the permanent dilation of bronchi and bronchioles (proximal)

-destruction of the muscle and the supporting elastic tissue, resulting from or associatedwith chronic necrotizing infections

-Is the permanent dilation of bronchi and bronchioles (proximal)

-destruction of the muscle and the supporting elastic tissue, resulting from or associatedwith chronic necrotizing infections

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Well-defined granulomas are seen here. They have rounded outlines. The onetoward the center of the photograph contains several Langhans giant cells.

Granulomas are composed of transformed macrophages called epithelioid cellsalong with lymphocytes, occasional PMN's, plasma cells, and fibroblasts. The

localized, small appearance of these granulomas suggests that the immuneresponse is fairly good.

Without caseatione.g.sarcoidosis

Well-defined granulomas are seen here. They have rounded outlines. The onetoward the center of the photograph contains several Langhans giant cells.

Granulomas are composed of transformed macrophages called epithelioid cellsalong with lymphocytes, occasional PMN's, plasma cells, and fibroblasts. The

localized, small appearance of these granulomas suggests that the immuneresponse is fairly good.

Without caseatione.g.sarcoidosis

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The edge of a granuloma is shown here at high magnification. At the upper rightis amorphous pink caseous material composed of the necrotic elements of the

granuloma as well as the infectious organisms. This area is ringed by theinflammatory component with epithelioid cells, lymphocytes, and fibroblasts.

The edge of a granuloma is shown here at high magnification. At the upper rightis amorphous pink caseous material composed of the necrotic elements of the

granuloma as well as the infectious organisms. This area is ringed by theinflammatory component with epithelioid cells, lymphocytes, and fibroblasts.

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noncaseating epithelioid granulomaساركویدcompact collection of epithelioid cells rimmed by an outer zone of CD4+ T cells and the

epithelioid cells are derived from macrophagesmultinucleated giant cells in the centre

noncaseating epithelioid granulomaساركویدcompact collection of epithelioid cells rimmed by an outer zone of CD4+ T cells and the

epithelioid cells are derived from macrophagesmultinucleated giant cells in the centre

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In order to find the mycobacteria in a tissue section, a stain for acid fast bacilliis done (AFB stain). The mycobacteria stain as red rods, as seen here at high

magnification.

In order to find the mycobacteria in a tissue section, a stain for acid fast bacilliis done (AFB stain). The mycobacteria stain as red rods, as seen here at high

magnification.

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-Lymphocytes predominate

indicating type III hypersensitivity-- Interstitial noncaseating granulomas are present in more than two thirds of cases,

usually in a peribronchiolar location-

suggests a role for type IV hypersensitivity as well

-Lymphocytes predominate

indicating type III hypersensitivity-- Interstitial noncaseating granulomas are present in more than two thirds of cases,

usually in a peribronchiolar location-

suggests a role for type IV hypersensitivity as well

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Regardless of the etiology for restrictive lung diseases, many eventually lead toextensive fibrosis. The gross appearance, as seen here in a patient with

organizing diffuse alveolar damage, is known as "honeycomb" lung because ofthe appearance of the irregular air spaces between bands of dense fibrous

connective tissue.

Regardless of the etiology for restrictive lung diseases, many eventually lead toextensive fibrosis. The gross appearance, as seen here in a patient with

organizing diffuse alveolar damage, is known as "honeycomb" lung because ofthe appearance of the irregular air spaces between bands of dense fibrous

connective tissue.

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idiopathic pulmonary fibrosis… The alveolitis that produces fibroblastproliferation and collagen deposition is progressive over time.

PatchyThe typical finding is the existence of both early and late lesions called (temporal

heterogeneity)

The earliest lesions demonstrate exuberant fibroblastic proliferation and appear asfibroblastic foci

The cut surface shows fibrosis (firm, rubbery white areas), with lower lobe predominanceand a distribution in the subpleural regions and along the interlobular septa

The pleural surfaces of the lung have the appearance of cobblestones

idiopathic pulmonary fibrosis… The alveolitis that produces fibroblastproliferation and collagen deposition is progressive over time.

PatchyThe typical finding is the existence of both early and late lesions called (temporal

heterogeneity)

The earliest lesions demonstrate exuberant fibroblastic proliferation and appear asfibroblastic foci

The cut surface shows fibrosis (firm, rubbery white areas), with lower lobe predominanceand a distribution in the subpleural regions and along the interlobular septa

The pleural surfaces of the lung have the appearance of cobblestones

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١٦

On histologic examination, cryptogenic organizing pneumonia is characterized by thepresence of polypoid plugs of loose organizing connective tissue within alveolar ducts,

alveoli, and often bronchioles

The connective tissue is all of the same age, and the underlying lung architecture is normal

On histologic examination, cryptogenic organizing pneumonia is characterized by thepresence of polypoid plugs of loose organizing connective tissue within alveolar ducts,

alveoli, and often bronchioles

The connective tissue is all of the same age, and the underlying lung architecture is normal

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Hyaline membrane

١٨

in which endothelial proliferation,lesionsplexiformforms multiple lumina within small arteries where they branch from a medium-sized

artery.

in which endothelial proliferation,lesionsplexiformforms multiple lumina within small arteries where they branch from a medium-sized

artery.

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This is the microscopic appearance of squamous cell carcinoma…..nests

keratin pearls and intercellular bridges

This is the microscopic appearance of squamous cell carcinoma…..nests

keratin pearls and intercellular bridges

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Gross apperance of primary rather than metastatic.

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Microscopically, the bronchioloalveolar carcinoma is composed of columnarcells that proliferate along the framework of alveolar septae. The cells are well-

differentiated. These neoplasms in general have a better prognosis than mostother primary lung cancers.

Microscopically, the bronchioloalveolar carcinoma is composed of columnarcells that proliferate along the framework of alveolar septae. The cells are well-

differentiated. These neoplasms in general have a better prognosis than mostother primary lung cancers.

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