呼吸系統(tǒng)的比較形: :1.觀察慢性支氣管炎、支氣管擴張癥的大體標本及病理1.觀察慢性支氣管炎、支氣管擴張癥的大體標本及病理化。了解支氣管痙攣、支氣管哮喘、異物阻塞氣道 區(qū)別。了解 掌握硅肺 掌握肺癌小葉性小葉性慢性支氣管炎肺不張肺不張（36，示教大泡性肺氣腫肺氣腫（肺結(jié)核)硅肺（伴結(jié)核硅肺（38，示教肺癌 大大葉Lobar大葉大葉（（33號切片（33號切片（33號切片描述要描述要1.病變分布部2.肺泡3.肺泡lobular ）AtAttheleftthealveoliarefilledwithaneutrophilicexudatethatcorrespondstotheareasofconsolidationseengrosslywiththebronchop onia.Thiscontrastswiththeaeratedlungontherightofthisphotomicrograph.）Athighermagnificationcanbeseenapatchyareaofalveolithatarefilledwithinflammatorycells.Thealveolarstructureisstillmaintained,whichiswhyap oniaoftenresolveswithminimalresidualdestructionordamagetothelung.（34號切片（34號切片描述要1.描述要1.2.3.4.5.-號）Hereisthemicroscopicappearanceofaviralponiawithinterstitialinfiltrates.Notethatthereisnoalveolarexudate.Thus,thepatientwiththistypeponiawillprobablynothaveaproductivecough.Themostcommoncausesforviralponiaareinfluenza,parainfluenza,adeno,andrespiratorysyncytial(RSVappearsmostlyinchildren).Cytomegalocanappearin promisedhosts.（35號切片，示教（35號切片，示教觀觀察要點-）Thisphotomicrographdemonstratesabronchuswithincreasednumbersofchronicinflammatorycellsinthesubmucosa.Chronicbronchitisdoesnothavecharacteristicpathologicfindings,butisdefinedclinicallyasapersistentproductivecoughforatleastthreeconsecutivemonthsinatleasttwoconsecutiveyears.Mostpatientsaresmokers.Often,therearefeaturesofemphysemaaswell.慢性支氣管炎慢性支氣管炎（73號切片觀察要點血管腺體增生肥大，粘液腺化生，物粘稠（痰粘稠不易咳-）Acloserviewdemonstratesthefocalareaofdilatedbronchiwithbronchie istendstobelocalizedwithdiseaseprocessessuchasneoplasmsandaspiratedforeignbodiesthatblockaportionoftheairways.Widespread isistypicalforpatientswithcysticfibrosiswhohaverecurrentinfectionsandobstructionofairwaysbymucusthroughoutthelungs.支氣管內(nèi)膜粗糙、增厚，周有不同程度纖維化Themidlowerportionofthisphotomicrographdemonstratesadilatedbronchusinwhichthemucosaandwallisnotclearlyseenbecauseofthenecrotizinginflammationwithdestruction.Thisisthemicroscopicappearanceofbronchieis.Bronchieisisnotaspecificdisease,butaconsequenceofanotherdiseaseprocessthatdestroysairways.指全指全肺或部分肺呈收縮和無氣狀分性肺不張（死胎管外：腫大的淋、腫Acutemassivecollapseof肺不張（36，示教肺不張（36，示教觀察要觀察要1.肺泡壁——2.肺泡腔——pulmonary肺泡性：型、全腺泡型、腺泡周圍間質(zhì)性：肺葉間隔、肺膜下、肺門縱膈皮Oncutsectionofthelung,thedilatedairspaceswithemphysemaareseen.Althoughtheretendstobesomescarringwithtimebecauseofsuperimposedinfections,theemphysematousprocessisoneoflossoflungparenchyma,notfibrosis.Therearetwomajortypesofemphysema:centrilobular(centriacinar)andpanlobular(panacinar).Theformerinvolvesprimarilytheupperlobeswhilethelatterinvolvesalllungfields,particularlythebases.Centrilobularemphysemaoccurswithlossoftherespiratorybronchiolesintheproximalportionoftheacinus,withsparingofdistalalveoli.Thispatternismosttypicalforsmokers.Panacinaremphysemaoccurswithlossofallportionsoftheacinusfromtherespiratorybronchioletothealveoli.Thispatternistypicalforalpha-1-antitrypsinThechestisopenedatautopsytorevealnumerouslargebullaeapparentonthesurfaceofthelungsinapatientdyingwithemphysema.Bullaearelargedilatedairspacesthatbulgeoutfrombeneaththepleura.EmphysemaischaracterizedbyalossoflungparenchymabydestructionofalveolisothatthereispermanentdilationofBullous大泡性肺氣腫（105號大體大泡性肺氣腫（105號大體觀察要觀察要點1.狀Microscopicallyathighmagnification,thelossofalveolarwallswithemphysemademonstrated.Remainingairspacesare肺氣腫（37號切片肺氣腫（37號切片觀察要觀察要點1.肺泡間隔——2.肺泡腔——Cor右室肌肥大，變扁Silicosiswith 有些地區(qū)組織結(jié)構(gòu)，呈灰黃Sometimestheinflammatoryreactionismainlyoneofscarring,asseenherewithasilicoticnoduleofthelung.Theinhaledsilicapersistsindefiniyandproducesaninflammatoryreactionthatismarkedbyprominentfibrosis.Densepinkcollagenisseeninthecenterofthenodule.硅肺（38，示教硅肺（38，示教肺癌肺癌

鱗鱗癌占40-50%，多有吸煙于支氣管粘膜上皮鱗化惡Carcinomaof塊，約8×8cm大小，質(zhì)地粗糙，形狀不Thisisasquamouscellcarcinomaofthelungthatisarisingcentrallyinthelung(asmostsquamouscellcarcinomasdo).Itisobstructingtherightmainbronchus.Theneoplasmisveryfirmandhasapalewhitetotancutsurface.Thisisalargersquamouscellcarcinomainwhichaportionofthetumordemonstratescentralcavitation,probablybecausethetumoroutgrewitsbloodsupply.Squamouscellcarcinomasareoneofthemorecommonprimarymalignanciesoflungandaremostoftenseenin(())Thisisthemicroscopicappearanceofsquamouscellcarcinomawithnestsofpolygonalcellswithpinkcytoplasmanddistinctcellborders.Thenucleiarehyperchromaticandangular.(())Thepinkcytoplasmwithdistinctcellbordersandintercellularbridgescharacteristicforasquamouscellcarcinomaareseenhereathighmagnification.Suchfeaturesareseeninwell-differentiatedtumors(thosethatmorecloselymimicthecelloforigin).(())Inthissquamouscellcarcinomaattheupperleftisasquamouseddywithakeratinpearl.Attheright,thetumorislessdifferentiatedandseveraldarkmitoticfiguresareseen.Thisisanothertypeofadenocarcinomaoflungknownasbronchioloalveolarcarcinoma.Seenhereisthemultifocalvariantthatappearsgrossly(andonchestradiograph)asap consolidation.Mostoftheupperlobetowardtherighthasapaletantogreyappearance. Microscopically,thebronchioloalveolarcarcinomaiscomposedofcolumnarcellsthatproliferatealongtheframeworkofalveolarseptae.Thecellsarewell-differentiated.Theseneoplasmsingeneralhaveabetterprognosisthanmostotherprimarylungcancers.Arisingcentrallyinthislu