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1、Basic PATHOLOGY,Basic PATHOLOGY,Respiratory Diseases,Respiratory Diseases,Review of,the architecture of the respiratory system,Review ofthe architecture of t,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,PULMONARY DUCT,Alveolus,BronchusBronchiolesAcute bronchitis,PULMONA
2、RY ACINUSRespiratory bronchioles Alveolar ductAlveolar cystEmphysema,Chronic bronchitisAsthmaBronchiectasis Bronchiolar pneumonia,Lobular pneumonia,Squamous cell carcinoma,Adenocarcinoma,Bronchioloalveolar carcinoma,Pulmonary tuberculosis,PULMONARY DUCTAlveolusBronchus,Pneumonia,Pneumonia,Pneumonia
3、can be very broadly Defined as any infection in the lung. Pathologically, it may be defined as any inflammation of lung.,Pneumonia can be very broadly,Classification of pneumonia,Classification of pneumonia,1.Etiological classification:bacterial pneumonia viral pneumonia fungal pneumonia etc.,1.Etio
4、logical classification:,2. Anatomical classification:lobar pneumonia lobular pneumonia interstitial pneumonia.,2. Anatomical classification:,呼吸系统病理1(英文版)课件,Clinically, etiological classification is more beneficial to the treatment; but the etiological classification usually can not be made readily.,
5、Clinically, etiological classi,The anatomical classification may give a great help to the etiological diagnosis sometimes., 90%: caused by Streptococcus pneumoniae (pneumococcus) ;interstitial pneumonia are caused by virus or mycoplasm.,The anatomical classification,Bacterial PneumoniaLobar pneumoni
6、aDef.In lobar pneumonia the contiguous air spaces of part or all of a lobe are homogenously filled with an exudates that can be visualized on radiographs as a lobar or segmental consolidation and is thus sometimes referred to as “air space” pneumonia.,Bacterial Pneumonia,The disease which is often s
7、een in previously healthy young adults has a sudden onset and is accompanied by chills, fever , cough with pink-foam sputa and chest-ache.,The disease which is often see,呼吸系统病理1(英文版)课件,Etiology and pathogenesis,90%S. pneumonia enter the lungs via the airwaysOccasionallyother organisms (Klebsiella pn
8、eumoniae, staphylococci, streptococci, Haemophilus influenzae).,Etiology and pathogenesis90%,Lobar pneumonia is initiated in periphery acinus, from there the exudative fluid containing etiologic agent flows into the adjacent air passage to infect adjacent lobules until a segment or entire lobe is in
9、fected.,Lobar pneumonia is initiated i,MorphologyFor purposes of description, it is convenient to divide the process into four phases:,Morphology,CongestionRed hepatizatio (consolidation)Gray hepatizationResolution,Congestion,1.Congestion stage,(1st-2nd days),The affected lobe is heavy, red and bogg
10、y. A frothy blood-stained fluid canbe squeezed from the cut surface.,1.Congestion stage(1st-2nd da,Histologically, there is vascular congestion with proteinaceous fluid, scattered neutrophils, and many bacteria in the alveoli.,Clinically, the onset is sudden with fever and rigors.,Histologically, th
11、ere is vascu,呼吸系统病理1(英文版)课件,2. Red hepatization stage(2nd-4th day),Liver-like in consistencySeptal capillaries are congested markedlyAlveolar spaces are packed with many red cells, and several neutrophils, fibrin.The pleura usually demonstrates a fibrinous or fibrinopurulent exudates.,2. Red hepatiz
12、ation stageLiver,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,3. Gray hepatization stage,(4th 8th day)More solid in consistencyPleural surface is covered with a confluent fibrinous exudates.The cut surface is dry and granular but of a grayish-white color.,3. Gray hepatization stage(4th,Histologically, congestion o
13、f septal capillaries lightens. The fibrinous exudate persists within the alveoli and a fibrin net forms. There aremany neutrophils but is relatively depleted of red cells in the alveoli.,Histologically, congestion of,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,4. Resolution stage(8th-9th day),With
14、the elimination of bacteria, the inflammation subsides.Since there is no tissue destruction the lung return to normal apart from the pleura.,4. Resolution stageWith the el,X光肺叶密度增高,肺叶实变,X光肺叶密度增高肺叶实变,呼吸系统病理1(英文版)课件,Complications:,1. Carnification: Organization of intraalveolar fibrinous exudates inst
15、ead of resorption may convert areas of the lung into solid fibroustissue.,Complications:1. Carnification,2. Tissue destruction and necrosis may lead to abscess formation.,2. Tissue destruction and necr,3. Suppurative material may accumulate in the pleural cavity, producing purulent pleurisy andempye
16、ma.,3. Suppurative material may ac,4. Septicemia or pyemia:Bacteremic dissemination may lead to meningitis, arthritis, or infective endocarditis.,5.Infective shock:Failure of terminal circulation and appearance of toxic symptoms.,4. Septicemia or pyemia:5.Inf,Bronchopneumonia,Conception: Defined as
17、an acute purulent inflammation characterized by diffuse patchy pneumonic consolidation often withbronchiolitis inits center.,BronchopneumoniaConception: De,It is a threat chiefly to the vulnerable infants, the aged, and those suffering from chronic debilitating illness or immuno-suppression.,It is a
18、 threat chiefly to the,Children:Whooping cough and measles are important antecedentsAdult: influenza, chronic bronchitis, alcoholism, malnutrition, and carcinomatosis are all predisposing conditions.,Children:Whooping cough and m,Clinically, bronchopneumonia may appears as a complication of a diseas
19、e.,Clinically, bronchopneumonia m,Hypostatic pneumoniaThe patient with pulmonary edema from cardiac failure or heavy uremia, et al, is particularly vulnerable, who are necessary to keep themselves in bed in prolonged time.Aspiration pneumoniaThe patient in coma or apoplexy, heavyanesthesia and so on
20、 is particularly vulnerable.,Hypostatic pneumonia,Almost any organism may cause bronchopneumonia, frequent offenders are staphylococci, streptococci, haemophilus influenza, proteus species etc.,Etiology,Almost any organism may cause,Foci of inflammatory consolidation with a center of bronchiolitis a
21、re distributed in patches through one or several lobes, most frequently bilateral andbasal.,Morphology,Foci of inflammatory consolida,Well-developed lesions up to 3 or 4 cm (usually 0.5-1 cm) in diameter are slightly elevated, dry, granular, gray-red to yellow and demarcated distinctly.,Well-develop
22、ed lesions up to 3,呼吸系统病理1(英文版)课件,The lung substance immediately surrounding areas of consolidation is usually hyperemic and edematous, but the large intervening areas are generally normal.,The lung substance immediately,Histologically, the reaction consists of a suppurative exudates that fills the
23、bronchi,bronchioles, and adjacent alveolar spaces.,Hyperemia, edema and inflammatary infiltration can be seen in the walls of bronchioles.,Histologically, the reaction c,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,ComplicationThe same complication, as in lobar pneumonia.,Complication,Viral pneumoni
24、a and mycoplasmal pneumonia,They both belong to interstitial pneumonia,Viral pneumonia and mycoplasma,Def.an inflammatory process involving the interstitial tissue of the lungs.,Def.an inflammatory process i,Etiology and pathogenesis,The common agents are viruses and mycoplasma.,Etiology and pathoge
25、nesisThe c,Attachment of the organisms to the respiratory epithelium is followed by necrosis of the cells and an inflammatory response. Then, the inflammation extends to the interstitial tissue including peribronchial connective tissue and interalveolar septa.,Attachment of the organisms to,Morpholo
26、gyMacroscopically: red-blue, congested, and subcrepitant. Because much of the reaction is interstitial, little inflammatory exudates escapes on sectioning of the lung, although there may be slight oozing of red, frothy fluid.,Morphology,Histologically, the inflammatory process is largely confined wi
27、thin the walls of the alveoli. The septa are widened and edematous; they usually contain a mononuclear infiltrate of lymphocytes, histiocytes and occasionally plasma,cells.,Histologically, the inflammato,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,In virus infection, inclusion bodies may be formed
28、within cytoplasm or nucleus of the epithelial cells of bronchioles and alveoli.In severe cases alveolar damage with hyaline membranes may develop.,In virus infection, inclusion,A TRY,A TRY,Chronic obstructive pulmonary disease(COPD),chronic bronchitisemphysemabronchial asthmabronchiectasis,Chronic o
29、bstructive pulmonary,Chronicbronchitis,Def. A persistent productive cough for at least three consecutive months in at least two consecutive years.,ChronicbronchitisDef. A persi,Etiology and Pathogenesis,Etiology and Pathogenesis,smoking, air pollution (SO2, NO2)directly or through,neurohumoral pathw
30、ays,proliferation of bacteria,hypersecretion of bronchial mucous glandhypertrophy of mucousgland, Goblet cell metaplasiaof bronchial epitheliumchronic bronchitis,loss of ciliated epitheliumretention ofsecretion,microbial infection,smoking, air pollution (SO2,Morphology,Morphology,Grossly,mucosal lin
31、ing of the larger airways is usually hyperemic and swollen by edemafluid;it is covered by a layer of mucinous or mucopurulent secretions. The smaller bronchi and bronchioles may also be filled with similarsecretions.,Grosslymucosal lining of the,3. 病理变化,部位主要特征 眼观:,早期 进展,3. 病理变化部位早期 进展,镜检:(1)腺体肥大,分泌亢
32、进后期腺体萎缩,分泌耗竭 (2)气管粘膜上皮细胞的损伤 (3)支气管壁的病变Histologically:Hypertrophy of mucous gland and goblet cell metaplasia of bronchial wall.,镜检:,the diagnostic feature : enlargement of the mucus-secreting glands.Reid index: the ratio of the thickness of the submucosal gland layer to that of the bronchial wall .No
33、rmal : 1:3Chronic bronchitis : usually exceeds 1:2.,the diagnostic feature : enla,粘液腺肥大、增生; 浆液腺发生粘液化生。,粘液分 泌亢进上皮鳞化粘液腺 增生肥大,粘液腺肥大、增生; 浆液腺发生粘液化生。粘液分 泌亢进,Increased number of goblet cells in the lining epithelium with concomitant loss of ciliated epithelial cells.squamous metaplasia of lining epithelium
34、 followed by dysplastic changes.,Increased number of goblet ce, Mucosal and submucosal lining of bronchi are hyperemic and swollen . inflammatory infiltration (lymphocytes , plasmacytes, sometimes admixed with neutrophils)., Mucosal and submucosal linin,支气管粘膜慢性炎伴上皮鳞状化生,支气管粘膜慢性炎伴上皮鳞状化生,ComplicationsE
35、mphysemacor pulmonalsBronchiectasisBronchopneumoniabronchogenic carcinoma of lung,Complications,EmphysemaDef.characterized by abnormal permanent enlargement of the air space distal to the terminal bronchiole accompanied by destruction of their walls.,Emphysema,呼吸系统病理1(英文版)课件,Etiology,1. Alveolar wal
36、l destruction and airspace enlargement invokes excess protease or elastase activity unopposed by appropriate antiprotease regulation,Etiology1. Alveolar wall destr,Increase either the number of PMN and MP in the lungIncrease release of protease from PMN and MP oxidants in cigarette,smoke and O -,2ra
37、dicals secreted byPMN & MP inhibit the active of 1-AT and decrease net anti-elastase activity in smokers,DeficiencyPiMM/PiZZ (Chr14),Emphysem,Antiprotease 1-antitrypsin inhibitionSmoking,Protease : elastase collagenase,1-antitrypsin,Destruction of elastin and collagen of the lung,Increase either the
38、 number o,2. Obstruction of the bronchioles.,Air enter into the alveoli distal to the obstructed bronchiole through Kohns pore (interalveolar pore), and air is trapped during expiration because the pore is closed. Emphysema is ended.,2. Obstruction of the bronchio,（四）病因与发病机理(1)病因(2)发病的二个基本环节细支气管阻塞和狭
39、窄小气道及肺泡支撑组织的破坏,（四）病因与发病机理,呼吸系统病理1(英文版)课件,Classification and Morphology,Alveolar emphysema: centriacinar emphysemapanacinar emphysema periacinar emphysemaInterstitial emphysema:Others: paracicatrical emphysemabullae lungsenile emphysema compensatory emphysema,Classification and MorphologyA,Diagram of
40、 the fundamental unit of the lung centriarclinal and panacinar emphysema.,Diagram of the fundamental uni,MorphologyThe lesions of centriacinar emphysema are more common and severe in the upper lobes particularly in the apical segments.,Morphology,腺 泡 中 央 型 肺 气 肿,腺 泡 中 央 型 肺 气 肿,Panacinar emphysema:,
41、pale, voluminous lungs,Panacinar emphysema:pale, volu,全腺泡型肺气肿,全腺泡型肺气肿,Microscopicfeatures:,Thinning and destruction of alveolar walls.Adjacent alveoli become confluent, creating large air spaces.Capillaries in alveolar septa decreased.,Microscopicfeatures:Thinning,Terminal and respiratory bronchiole
42、s may be deformed because of the loss of septa.,Terminal and respiratory bronc,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,Bullous emphysema,Bullous emphysema,呼吸系统病理1(英文版)课件,囊泡型肺气肿（大泡直径3cm）,囊泡型肺气肿（大泡直径3cm）,呼吸系统病理1(英文版)课件,Conditions related to emphysema.There are several conditions in which enlargem
43、ent of air spaces is not accompanied by destruction; this is more correctly called overinflation.,Conditions related to emphysem,Compensatory emphysema Senile emphysema,Compensatory emphysema Senile,Interstitial emphysema designates the entrance of air into the connective tissue of the lung, mediast
44、inum and subcutaneous tissue.,Interstitial emphysema designa,This may occur spontaneously with a sudden increase in intraalveolar pressure (as withvomiting or violent coughing) that cause a tear, with dissection of air into the interstitium.,This may occur spontaneously w,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)
45、课件,Complications:,Cor pulmonalePneumothoraxRespiratory failure,Complications:Cor pulmonale,Bronchiectasis,Def. Permanent dilatation of bronchi and bronchiole due to destruction of the muscle and elastic supporting tissue.The characteristic symptom:cough and expectoration of copious amounts of purule
46、nt sputum.,BronchiectasisDef. Permanent d,Etiology and pathogenesis,Etiology and pathogenesis,Bronchial obstruction (tumor, enlarged lymph node,foreign body),rise of intrabronchial,pressure during respiration,bronchial dilatation,loss of ciliated epithelium,congenital orhereditory conditions,retenti
47、on of secretioncough,infection,Weakeningand loss ofelastic tissue，muscle andcartilage of bronchus,Bronchial obstruction (tumor,MorphologyGrossly: usually affects the lower lobes bilaterally, particularly those air passages that are most vertical.,Morphology,The airways may be dilated as much as 4 ti
48、mes their usually diameter and can be followed nearly to the pleural surfaces.,(By contrast, in normal lungs the bronchioles cannot be followed by ordinary gross examination beyond a point 2 to 3 cm from the plural surface.),The airways may be dilated as,Patterns of dilatation: cysticcylindrical,Pat
49、terns of dilatation: cysti,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,呼吸系统病理1(英文版)课件,Histologically,there is an intense acute and chronic inflammatory exudates within the wall of the bronchi and bronchioles and desquamation of lining epithelium leaving extensive areas of ulcerated epithelium.,Histologically,ther
50、e may be squamous metaplasia of the lining epithelium.In some instances, the necrosis destroys the bronchial or bronchiolar walls and forms a lung abscess.When healing occurs, granulation tissue forms the base of ulcer.,there may be squamous metapla,Clinicopathological correlation,Postural coughing
