幻灯片 1

Size: px

Start display at page:

Download "幻灯片 1"

孝汗潘
5 years ago
Views:

Diseases of Respiratory System 邓红浙江大学医学院病理学系 2014/12/17 Pathology (DH) 1 hongdeng@zju.edu.

右上肺团片状阴影, 拟右上肺阴影待查收治入院既往史 15 年前曾患肺结核, 已治愈 ;5 年前因反复腹泻便血, 在外院行结肠镜检查, 诊断为溃疡性结肠炎, 予柳氮磺吡啶及中成药治疗 6 个月后, 症状缓解家族内无遗传病史不嗜烟酒入院检查 : Case

右肺上叶外侧段一亚段有脓性分泌物附着 ; 涂片见少量呈中度核异型上皮样细胞入院录 : 入院后, 常规检查风湿全套 CEA CA199 CA125 等肿瘤标记均无明显异常 ; 痰革兰染色抗酸染色细菌及真菌培养 2014/12/17 THE

13g/L,MCV 85fl,MCH 30pg 血沉 : 80 毫米 / 小时 Roentgenograph 血液生总蛋白 :65.1g/L, 白蛋白 :50.2g/L, 球蛋白 :29.9g/L,A/G 1.

1 Diseases of Respiratory System 邓红浙江大学医学院病理学系 2014/12/17 Pathology (DH) 1 hongdeng@zju.edu.cn 现病史男,44 岁, 农民因发热干咳 3 月余入院 3 月前起发热, 午后体温 38-39С, 夜间盗汗晨起降至正常, 伴有刺激性咳嗽, 少量咳痰, 偶带血丝于左氧氟沙星阿奇霉素头孢呋辛克林霉素培氟沙星等治疗, 症状无好转在外院 X 线胸片示右上肺团片状阴影, 拟右上肺阴影待查收治入院既往史 15 年前曾患肺结核, 已治愈 ;5 年前因反复腹泻便血, 在外院行结肠镜检查, 诊断为溃疡性结肠炎, 予柳氮磺吡啶及中成药治疗 6 个月后, 症状缓解家族内无遗传病史不嗜烟酒入院检查 : Case history 心率 100 次 / 分, 心率齐, 心音中等, 二尖瓣听诊区未闻杂音肝肋下未及, 两下肢轻度浮肿 X 线胸片示右上肺团片状阴影 ; X 线 CT 示右肺上叶团片状阴影约 5cm; 纵隔淋巴结肿大 ; 纤维支气管镜检查检查 : 右肺上叶外侧段一亚段有脓性分泌物附着 ; 涂片见少量呈中度核异型上皮样细胞入院录 : 入院后, 常规检查风湿全套 CEA CA199 CA125 等肿瘤标记均无明显异常 ; 痰革兰染色抗酸染色细菌及真菌培养 2014/12/17 THE lung(reform)5y-dh 2 痰找病理细胞等均阴性 Lab examinations 血常规 : 红细胞 410 万 /mm 3, 白细胞个 / mm 3 ; 白细胞分类 : 中性粒细胞 75%, 单核细胞 2%, 淋巴细胞 15% Hb 13g/L,MCV 85fl,MCH 30pg 血沉 : 80 毫米 / 小时 Roentgenograph 血液生总蛋白 :65.1g/L, 白蛋白 :50.2g/L, 球蛋白 :29.9g/L,A/G 1.7 化检查 : ALT 24 U/L,AST 30 U/L,AKP 92 U/L, AFP <20μg; 总胆红素 7.5 μmol/l, 直接胆红素 2.9 μmol/l, 间接胆红素 11.0 μmol/l 2014/12/17 THE lung(reform)5y-dh /12/17 THE lung(reform)5y-dh 4 Roentgenograph CT 2014/12/17 THE lung(reform)5y-dh /12/17 THE lung(reform)5y-dh 6 1

2 Macropathology CT 2014/12/17 THE lung(reform)5y-dh /12/17 THE lung(reform)5y-dh 8 Microscopic pathology Microscopic pathology: immunohistopathology 2014/12/17 THE lung(reform)5y-dh /12/17 THE lung(reform)5y-dh 10 Diagnosis? 2014/12/17 THE lung(reform)5y-dh /12/17 Pathology (DH) 12 2

Pneumonia Interstitial lung disease (ILD)

carcinoma of the larynx, carcinoma of the

3 2014/12/17 Pathology (DH) /12/17 Pathology (DH) /12/17 Pathology (DH) /12/17 Pathology (DH) 16 Chronic obstructive pulmonary disease Pneumonia Interstitial lung disease (ILD) Chronic cor pulmonale Tumors (NPC, carcinoma of the larynx, carcinoma of the lung) 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 18 3

4 Chronic obstructive pulmonary disease Pneumonia Interstitial lung disease (ILD) Chronic cor pulmonale Tumors (NPC, carcinoma of the larynx, carcinoma of the lung) A group of conditions that share a major symptom dyspnea and are accompanied by chronic obstruction to air flow within the lungs 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 20 Bronchial asthma Bronchial asthma 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 22 Etiology A persistent productive cough for at least 3 consecutive months in at least 2 consecutive years 1. Infection Virus/ Bacteria 2. Physical chemical factors (1)Smoking (2)Air pollution (3)Cold (4)Others: neuroendocrine, nutrition 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 24 4

Pathogenesis Hypersecretion of mucus: Hypersecretion of the bronchial mucous glands Hypertrophy of mucous glands Metaplastic formation of mucin-secreting goblet cells in the surface epithelium of

secretions 2014/12/17 Pathology (DH) 25 2014/12/17 Pathology (DH) 26 LM Injury/ repair of respiratory epithelium cilia epithelium injured: adhere, detachment, degeneration, squamous metaplasia

5 Pathogenesis Hypersecretion of mucus: Hypersecretion of the bronchial mucous glands Hypertrophy of mucous glands Metaplastic formation of mucin-secreting goblet cells in the surface epithelium of bronchi NE Mucosal lining of the larger airways is hyperemic and swollen by edema fluid, covered by a layer of mucinous or mucopurulent secretions Smaller bronchi and bronchioles filled with similar secretions 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 26 LM Injury/ repair of respiratory epithelium cilia epithelium injured: adhere, detachment, degeneration, squamous metaplasia Hyperplasia and hypertrophy of the mucous cells and an increased proportion of mucous cells Chronic inflammation in the bronchial wall 2014/12/17 Pathology (DH) 27 (degeneration, necrosis of the bronchial epithelium with loss of ciliated cells) 2014/12/17 Pathology (DH) 28 Clinical pathologic correlation & Complications Cough and sputum production Hypercapnia, hypoxemia, and cyanosis Most patients have a mixture of chronic bronchitis and emphysema Chronic cor pulmonale or respiratory failure Mucous glandular metaplasia 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 30 5

Bronchial asthma A condition of the lung characterized by abnormal permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls.

6 Bronchial asthma A condition of the lung characterized by abnormal permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls. 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 32 Etiology and Pathogenesis Obstructive ventilate dysfunction of bronchioles: narrowing of bronchioles 1 -antitrypsin deficiency Smoking 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 34 Types Alveolar emphysema Centroacinar Panacinar Periacinar Interstitial emphysema Others Types Alveolar emphysema Centroacinar Panacinar Periacinar Interstitial emphysema Others 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 36 6

2014/12/17 Pathology (DH) 37 2014/12/17 Pathology

Paracicatrical emphysema Bullae lung (>2cm) Senile

2014/12/17 Pathology (DH) 39 2014/12/17 Pathology

pale/gray-white, soft Thinning and destruction of

Alveolar capillaries diminished Alveolar emphysema

7 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 38 Interstitial emphysema Others Paracicatrical emphysema Bullae lung (>2cm) Senile emphysema (overinflation) Compensatory emphysema 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 40 NE LM Voluminous with round margin, pale/gray-white, soft Thinning and destruction of alveolar walls Abnormal enlargement of alveoli Alveolar capillaries diminished Alveolar emphysema Pale, voluminous 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 42 7

Clinical pathologic correlation & Complications Hypercapnia, hypoxemia, and cyanosis Most patients have a mixture of chronic bronchitis and emphysema Chronic cor pulmonale or respiratory failure

8 Clinical pathologic correlation & Complications Hypercapnia, hypoxemia, and cyanosis Most patients have a mixture of chronic bronchitis and emphysema Chronic cor pulmonale or respiratory failure Alveolar emphysema (marked enlargement of airspaces, with thinning and destruction of alveolar septa. ) 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 44 Bronchial asthma Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue, resulting from or associated with chronic necrotizing infections 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 46 Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue, resulting from or associated with chronic necrotizing infections Etiology and pathogenesis Infective destruction of bronchi Congenital or hereditary condition Cartagener syndrome (sterility) Cystic fibrosis Immunodeficiency state 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 48 8

bronchial walls Fibrosis 2014/12/17 Pathology (DH) 49 2014/12/17 Pathology (DH) 50.

9 NE Bronchi and bronchioles dilate, inflammatory exudation within the lumens of the affected bronchi and bronchiole LM Acute and chronic inflammation Destroy of the bronchial or bronchial walls Fibrosis 2014/12/17 Pathology (DH) /12/17 Pathology (DH) 50. Cut surface:lung shows transected, markedly distended peripheral bronchi. 2014/12/17 Pathology (DH) 51 9

<4D F736F F F696E74202D C1D9B4B2C7B0B8C5C2DBC9CFBFCEB0E6205BBCE6C8DDC4A3CABD5D>

<4D F736F F F696E74202D C1D9B4B2C7B0B8C5C2DBC9CFBFCEB0E6205BBCE6C8DDC4A3CABD5D> Pre-Clinic Curriculum Pathology Part 2015-03 Introduction of Diseases ZHOU REN 周韧 Prof., M.D., Ph.D. Institute of Pathology & Forensic Medicine Department of Pathology & Patho-physiology Zhenjiang University