By John H. Sinard MD PhD
Yale college, New Haven, CT. experiences in define layout of the most important (and many minor) non-neoplastic and neoplastic disorder procedures. contains suitable anatomy, embryology, cellphone biology, and body structure. For citizens. comprises syndromes and our bodies appendix. DNLM: Pathology outlines.
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Sinard Page 37 Progressive Massive Fibrosis May complicate silicosis, asbestosis, coal workers pneumoconiosis, mixed dust fibrosis, etc. 5 yrs) “Lung” Poor prognosis - most die within 6 months Organizing diffuse alveolar damage with bronchiolar and alveolar epithelial atypia: cytomegaly, nuclear pleomorphism, prominent nucleoli Chronic interstitial pneumonia, pulmonary ossification, and pulmonary alveolar proteinosis have also been reported Cyclophosphamide Unpredictable latent period Organizing diffuse alveolar damage most common - less epithelial atypia than seen with busulfan Have also seen chronic interstitial pneumonia, BOOP Chlorambucil Chronic interstitial pneumonia NITROSOUREAS Carmustine (BCNU) Used to treat primary brain neoplasms Direct relationship between cumulative dose and toxicity 20-30% overall incidence of toxicity; 50% for larger doses Acute and organizing DAD most common lesion; less commonly CIP, veno-occlusive disease, pleural disease ANTIBIOTICS Bleomycin 3-5% incidence; higher for: higher doses, elderly, prior irradiation, recent previous use of Bleomycin DAD most common, predominantly lower lobes, with alveolar hemorrhage, pleural fibrosis, eosinophilic pneumonia BOOP, PVOD can be seen Prognosis poor: rapidly progressive to death within 3 months Mitomycin 8% patients; 50% overall mortality; full recovery possible DAD with fibrinous pleuritis; BOOP, pulmonary edema, hemorrhage ANTIMETABOLITES Methotrexate 5-10% incidence; most recover completely, <10% die Peripheral eosinophilia, diffuse pulmonary infiltrates CIP with nodular interstitial infiltrates of lymphocytes, plasma cells, histiocytes, occasional giant cells Hypersensitivity pneumonitis, BOOP, DAD can be seen ANTIMICROBIALS Nitrofurantoin Commonly used, therefore causes most lung disease Acute reaction in 90%: peripheral eosinophilia, pulmonary edema, DAD Insidious onset in 10%: UIP, DIP, eosinophilic pneumonia Sulfonamides Eosinophilic pneumonia is underlying pathology Amphotericin B Diffuse alveolar hemorrhage when given in combination with leukocyte transfusion ANTI-INFLAMMATORY DRUGS Gold 1% patients: some MHC associations Rheumatoid lung disease, DAD, CIP, BOOP OTHERS Antiarrhythmics: amiodarone, tocainide Antihypertensives: hydrochlorothiazide, propranolol, hexamethonium, hydralazine, Captopril Tocolytics: ritodrine, tertbutaline, albuterol, MgSO4 Anticonvulsants: phenytoin, carbamazepine Psychotherapeutics: haloperidol, chlordiazepoxide, amitriptyline, imipramine Opioids: morphine, methadone, codeine, heroin John H.
Sinard Page 33 Sebaceous Carcinoma Rare; most common in parotid Pleomorphic, atypical cells arranged in sheets and nests Often present as painful mass with facial nerve paralysis Other Neoplasms Malignant Lymphoma Prototypical location for MALT lymphomas Usually follicular center cell lymphomas, with slow evolution and good long-term prognosis Those arising in Mikulicz’s disease usually immunoblastic with more rapid clinical course Capillary Hemangioma (Benign Hemangioendothelioma) Most common salivary gland tumor in infants and children Permeate through glandular elements, often with mitoses Do not become malignant; often spontaneously regress Neurilemoma Pilomatrixoma Embryoma Highly cellular epithelial parotid tumor of infancy with blastomatous appearance - rare Giant cell tumors Epidermoid Carcinoma Usually represent metastases to intraparotid lymph nodes Small Cell (Anaplastic) Carcinoma Scanty cytoplasm, small cells, solid pattern, many mitoses Neuroendocrine features found in some Lymphoepithelioma-like Carcinoma More frequent among Eskimos and Chinese Similar to Mikulicz’s disease at low power, but epithelial islands are malignant cytologically As with lymphoepithelioma (nasopharyngeal carcinoma), may be EBV related Overall outcome not too bad “Lung” John H.
5 cm gray-white inflammatory consolidation seen at the periphery of the upper part of lower lobe or lower part of upper lobe (greatest volume of air flow) which becomes granulomatous and then centrally necrotic by the second week - primary infection focus, usually clinically silent Ghon complex: combination of primary lung lesion and ipsilateral lymph node involvement Rarely, primary focus will rapidly enlarge, erode into bronchi, giving rise to satellite lesions - may seed bloodstream resulting in miliary dissemination or meningitis Secondary TB arises usually from reactivation of old primary lesions - present as apical or posterior segment lesions (tuberculomas), may be bilateral - can either scar down, create progressive pulmonary TB, lead to tuberculous empyema, intestinal TB (if aspirated material is swallowed), or miliary seeding.