DiseasesofRespiratorySystem呼吸系統(tǒng)疾病

AantomyandFunctionUpperrespiratorytract

nasopharynx(鼻咽),larynx(喉)Lowerrespiratorytract

trachea(氣管),bronchi(支氣管) Rightbronchusdivergingatalesser angle,foreignmaterialmorefrequently aspirated

Lobar,segmental,lobular22023/2/19

1. Bronchialtree(通氣）

conductingportion

frommainbronchitoterminalbronchioles2. Terminallungunit(gasexchange)

respiratoryportion

fromrespiratorybronchioletoalveoli32023/2/19Bronchialtree1. Mucosa

pseudostratifiedciliatedcolumncell gobletcell,producingmucus basalcell-stemcell smallgranulescell highlyspecializedbronchialliningcells, containingneurosecretorygranules2. Submucosalgland

serousandmucus3. Wallsmoothmusclecontractile

elasticfibers,provideflexibility cartilageplate,forsupport42023/2/19Bronchioles

Φ<1mm

1. Mucosa

ciliatedepithelialcell Claracell(non-ciliatedsecretorycell)2. Wall

smoothmusclenoglandnocartilage52023/2/1962023/2/1972023/2/19Respiratorymembrane

? AlveolitypeIcells

95%ofthesurfacegaspermeable? AlveolitypeIIcells 5%ofthesurface producingsurfactant,loweringthesurfacetension

Involvedintherepairofalveolarepithelium? Capillarynetwork 85%~95%ofthesurface

Arrangedideallyforgasexchange82023/2/19PulmonaryvasculatureDoublebloodsupply,protectingfromischemia

Pulmonarycirculation:functional Bronchialsystem:nutrientPulmonarylymphcirculationDeepandsuperficialnetwork

drainingtothehilumlymphnodesNolymphaticsinmostalveolarwalls92023/2/19LocationHostDefenseMechanismUpperAirwaysNasopharynxOropharynxNasalhairTurbinatesMucociliaryapparatusIgAsecretionSalivaSloughingofepithelialcellsLocalcomplementproductionInterferencefromresidentfloraDefensemechanisms102023/2/19ConducingAirwaysTrachea,bronchiLowerRespiratoryTractTerminalairways,alveoliCough,epiglotticreflexesSharp-angledbranchingofairwaysMucociliaryapparatusImmunoglobulinproduction(IgG,IgM,IgA)Alveolarliningfluid(surfactant,immunoglobulin,complement,fibronectin)Cytokines(IL-1,TNF)AlveolarmacrophagesPolymorphonuclearleukocytesCell-mediatedimmunity112023/2/19Lungdefensemechanisms122023/2/19Remarks

1. Respiratorysystemiscommunicatingwithexternalenviroment,fromwhichpathogens,noxiousgasorparticles,soitissusceptibletothediseases.2. Allbloodfromthebodywillpassthroughthelungandthebiologicalpathogens(e.gbacterial,neoplasmic)embolusetc.canbetrappedinthelung.

132023/2/19Remarks3.Thelungiscloselyrelatedtotheheart,notonlybytheirlocationbutalsobythepulmonarycirculation.4.Damageanddisturbancetothespecializedstructuresandfunctionofthelungwillleadtothedevelopmentofthediseasesspecifictothelung.(e.gdamagetothewallofbronchialtree,obstructionofbronchiolesanddisintegrationofalveolar/capillarymembrane)

142023/2/19silicosis152023/2/19I.Pneumonia肺炎162023/2/19Pulmonaryinfections1/6ofalldeathsintheU.S.ACausesEpithelialsurfaceexposedtocontaminatedairNasopharyngealfloraaspiratedduringsleepLungparenchymavulnerabletovirulentorganismsDefectsininnateimmunityandhumoralimmunodeficiencyCell-mediatedimmunedefectsLifestylefactors(eg.cigarettesmoke,alcohol)causedFacilitatinginfections172023/2/19PneumoniacanbeverybroadlydefinedasanyinfectioninthelungAcute,fulminantorchronicHistologicspectrum

Fibrinopurulentalveolarexudate acutebacterialpneumonias

Mononuclearinterstitialinfiltrates viralandotheratypicalpneumonias Granulomasandcavitation chronicpneumonias182023/2/19AcuteBacterialPneumoniasLobarpneumonia

ConsolidationofanentirelobeLobularpneumonia(Bronchopneumonia)

Scatteredsolidfociinthesameorseverallobes192023/2/19LobarPneumoniaContiguousairspacesofpartorallofalobearehomogeneouslyfilledwithanexudatethatcanbevisulizedonradiographsasalobarorsegmentalconsolidation.Adiseaseofacuteexudativeinflammation202023/2/19PathogenesisHealthyadultHostdefensesdepressedNormalinhabitantsoftheoropharynxandNasopharynx,Pneumococcus AspirationofpharyngealfloraLowerlobesortherightmiddlelobemostfrequentlyinvolved212023/2/19PathologyandclinicalfeaturesAratherclearcut4stagedbattleintheaffectedlunginaperiodabout7-8daysAcompleteandunsloppyrecovery

Fourstagesa.Congestionb.Redhepatizationc.Grayhepatizationd.Resolution222023/2/19Congestion(1-2d)

Gross Heavy,red,boggyLM VascularcongestionProteinaceousfluidcontainingnumerouspneumococcifillingthealveoliScatteredneutrophilsClinicalfeature

Acute,fever,chillCrepitation,moistraleChestradiographdim,uniformshadow232023/2/19Redhepatization(3-4d)Gross Aliver-likeconsistency AfibrinousorfibrinopurulentexudateofpleuraLM Intra-alveolarhemorrhage Massiveneutrophils

Fibrinpackingwithinalveolarspaces NumeruspneumococcidetectedClinicalfeature

Hemoptysis(rusty) Chestradiograph:asolidappearanceextending toentirelobesorsegments Dyspnea,debility,chestpain

242023/2/19Grayhepatization(4-6d)

“Aturningpoint”Gross Dry,gray,firm,granularLM Redcellslysed Fibrinousexudatepersistingwithinalveoli NopneumococcidetectedClinicalfeature252023/2/19ResolutionGross Pleuralresolvedororganized fibrousthickeningorpermanent

adhesionsLM Exudateswithinalveoli enzymaticallydigested eitherresorbedorexpectoratedClinicalfeatures recovery262023/2/19Complications

NotcommonDeathrate:3-5% Carnification (肺肉化,organizingpneumonia)PulmonaryabscessandpyothoraxSepticemia

Toxicpneumonia272023/2/19Lobularpneumonia(Bronchopneumonia)Resultingfromaninitialinfectionofthebronchi andbronchioleswithextensionintotheadjacentalveoliApurulentinflammationApatchydistributionofinflammationthatgenerallyinvolvesmorethanonelobeMostfrequentlybilateralandbasal282023/2/19PathogenesisOrganismsRelativelyavirulent Pneumococcus,staphylococcus,and streptococcus,etc.“Opportunisticinfection”O(jiān)ftenasecondarydisease Terminallyillpatients,infantsandtakingimmunosuppressivedrugs,etc.Acommoncauseofdeath “terminalpneumonia”Aspirationpneumonia

292023/2/19PathologyandclinicalfeaturesGrossInthelowerandposteriorportions Becauseofthetendencyforsecretionstogravitateintothelowerlobes

Ф3-4cm,graytoyellow Confluenceoffoci theappearanceofalobarconsolidation Hyperemicandedematous—surroundingareasScatteredirregularfociofpneumoniaarecenteredonterminalbronchiolesandrespiratorybronchioles302023/2/19LM

Focalsuppurativeexudatefillingthebrochi,bronchiolesandadjacentalveolarspaces

clinicalfeatures

312023/2/19ComplicationsCommonPoorinprognosis“terminalpneumonia” Abscessformation Empyema Meningitis,arthritis,infectiveendocarditis Resparitoryinsufficient Cardiacinsufficient322023/2/19ComparisonbetweenlobarandlobularpneumonialobarlobularPrimaryAdefinitediseaseentitySecondaryNotadefiniteentityPrimaryorsecondaryAgedistributionAdiseaseofhealthyadultsOfteninfantsandtheelderlyCausativeorganismsMostlypneumococcusAtleast20differentagents,oftencommensalsorrelativelyavirulentPrognosis&recoveryAcompleterecoveryPoorinprognosis,“terminalpneumonia”Multiplecomplications332023/2/19lobarlobularPathologicfeaturesAnacuteexudativeinflammationApurulentinflammationFrequentlybilateralandbasalLowerlobesortherightmiddlelobeGrossLiver-like,orgray,dry,firm,granularApachydistributionLMAfibrinousexudate

Centrallylocatedbronchioleswhichareintenselyinflammedandfilledwithpus342023/2/19Interstitialpneumonia

Atypicalpneumonia

Modestsputumproduction Nophysicalfindingsofconsolidation WhitecellcountmoderatelyelevatedMononuclearinflammatoryinfiltrationin pulmonaryinterstitium352023/2/19PathogenesisMycoplasmathemostcommoncauseViruses,ChlamydiaeandRickettsiae,etc.Aprimarilyupperrespiratorytractinfectionwith coryza,pharyngitis,laryngitisandtracheobronchitis

AttachmentoftheorganismstotherespiratoryepitheliumNecrosisandaninflammatoryresponseInterstitialinflammation362023/2/19

Damageto/denudationoftheepitheliumChildren&youngadultsfrequentlyattackedSporadicallyoraslocalepidemicsViralinfections—atanyageInfluenzavirusesAandB—adults-Mucociliaryclearance+

Secondarybacterialinfections372023/2/19PathologyGross Patchy,involvingwholelobesbilaterallyor unilaterally Red-yellow,congestedandsubcrepitantLM Inflammatoryreactionlargelyconfinedwithinthe wallsofalveoli Septawidenedandedematous

Amononuclearinflammatoryinfiltrate

Freeofcellularexudate Full-blowndiffusealveolardamagewithhyaline membranesinseverecases Amixedhistologicpicturewithsecondary infection

382023/2/19ClinicalcourseExtremelyvaried asevereupperrespiratorytractinfection chestradiographs transient,ill-definedpatchesmainlyinthelowerlobes physicalfindingscharacteristicallyminimal

Prognosis

good,completerecovery Mostseriousinfectionscomplicatedbybacterialsuperinfection

poorinprognosis392023/2/19SARS(Severeacuterespiratorysyndrome)FirstidentifiedinNovember2002inChinaSARScoronavirus

Laboratorydiagnosticcriteria—Serologicaltestofanti-SARSCoVClinicalfeatures

Fulminant,fever,contagious RapidlyprogressingtoseverrespiratorysyndromePathologicalfeatureSevereatypicalpneumonia402023/2/19Atelectasis(肺不張/肺萎陷）LossoflungvolumecausedbyinadequateexpansionofairspacesCategories:

ResorpationAtelectasis

Amucousormucopurulentplug,foreignbody,tumors,enlargedlymphnodes,vascularaneurysms,etc.CompressionAtelectasis

Accumulationoffluid,blood,orairwithinthepleuralcavityElevatedpositionofdiaphragm412023/2/19Microatelectasis

Lossofsurfactant,postsurgicalatelectasisContractionAtelectasis

LocalorgeneralizedfibroticchangesinthelungorpleuraAtelectasis(肺不張/肺萎陷）422023/2/19ⅡAdultRespiratoryDistressSyndrome

(ARDS)432023/2/19BriefintroductionDiffusealveolardamage

Injuryofalveolarepithelial,basementmembraneandcapillaryendothelialcells(therespiratorymembrane)Developingrapidlyprogressiverespiratoryfailure

AccompaniedbyDecreasedlungcomplianceHypoxemia(cyanosis)Extensiveradiologicalopacitiesinbothlungs (“white-out”)442023/2/19PathogenesisinducedbyalargevarietyofinsultsPulmonary Respiratorytractinfections,aspirationofgastriccontents, inhalationoftoxicgases,near-drowning,radiationpneumonitis, alargeassortmentofdrugsandotherchemicalsOutofpulmonarySepsis,shock,DIC,etc.

Injuriesofrespiratorymembrane452023/2/19OxygenradicalsHydrolyticenzymesCytokinesActivationofthecomplementsystemSequestrationofneutrophilsandmacrophageDamagetothecapillaryendotheliumDamagetotheepithelialjunctionsExudationoffluidandproteinsfromtheinterstitiumintothealveolarspaces462023/2/19PathologyGrossEarlystage Wine,liver-like,large,heavy Cutsurfaceconsolidation,dim fluid 1weeklater-Diffusegray, lustering472023/2/193phasesExudativephase(1-3d)Edema,exudationofplasmaproteinsHyperemia,hemorrhageAccumulationofinflammatorycellsHyalinemembranes

DamagetobothendothelialcellsandtypeIpneumocytesSloughingoftypeIcells&appearanceofdenudedbasementmembranesFibrinthrombiincapillariesandarterioles482023/2/19Proliferativephase(3-10d)ProliferationoftypeIIpneumocytesandfibroblastsAlveolarseptathickenedFibroticphaseDiffuseinterstitialfibrosis“Honeycomblung”Multiplecyst-likespacesthroughoutthelungRemodelingofthelungarchitecture492023/2/19ClinicalfeatureTachypnea,dyspnea,cyanotic,etc.Radiologicallybilateraldiffuseshadow

PrognosisPoor,progressive,50%diedinacutephaseScarredlungs,respiratorydysfunction, pulmonaryhypertension,etc.Recoveringnormalpulmonaryfunction4~6monthslater502023/2/19Idiopathicpulmonaryfibrosis

characteristics:patchyfibroblastexpansiontissueremodelingexcessiveaccumulationoftheextracellularmatrix

classficationusualinterstitialpneumoniaDesquamativeInterstitialPneumoniaRespiratoryBronchiolitisInterstialLungDiseaseAcuteInterstitialPneumoniaNonspecificInterstitialPneumonia512023/2/19ⅢChronicObstructivePulmonaryDiseases(COPD)慢性阻塞性肺部疾病522023/2/19ConceptionAgroupofdiseasesinwhichfundamentaldisorderistheincreaseresistancetorespiratoryairflowcausedbydiseasesaffectingtheconductingairwayand/orlungparenchymaIncluding

ChronicbronchitisEmphysemaBronchiectasisAsthma532023/2/19Airflowcanbereducedintwoways

Byincreasingtheresistancetoairflow Narrowedairways-chronicbronchitisorasthma Byreducingtheoutflowpressure Lossofelasticrecoil-emphysema

Smallairwaydisease

ObstructionofsmallbronchiolesФ<2mm

narrowchannel thinwall lackofcartilage lessciliatedcells542023/2/19Chronicbronchitis

ChronicinflammationofbronchiandbronchiolesDefinedclinicallyasthepresenceofapersistent productivecoughwithoutadiscerniblecauseforatleast3consecutivemonthsinatleast2consecutiveyears552023/2/19PathogenesisPhysicalandchemicalfactors

cold,humid primarilyadiseaseofcigarettesmoking,airpollution(SO2,NO2,Cl2,etc.)

InfectionsBacteria,virus

inflammation

562023/2/19Mucousepitheliuminjured Destructionofciliatedcolumnarcell,interferingofcilia movement,MetaplasiaofthebronchialepitheliumInflammationextendingdeeplyintothewall Hypersecretionofthebronchialmucousglands,hypertrophyofmucousglands,smoothmuscleandelasticfibersinjuredinvolvementofbronchioles Mucusplugging,thickeningofthewall resultinginnarrowingandobstructionofthelumenincapabilityofIgAsynthesisorphagocytosis572023/2/19Pathology

GrossMucousmembraneduskyred(hyperemic) andswollenbyedemafluidLumenfilledwithmucusandpusDilatedbronchialglandducts“Pits”onthesurfaceofthebronchialepithelium582023/2/19LMEpithelialdamage

Alternationofcilia Epithelialcell-degenerative,proliferative Increasednumberofgobletcells Squamousmetaplasia

Hypertrophyofmucinousglands

“Thereidindex” Ameasureoftheincreaseinthesizeofthemucousglands592023/2/19inflammationinthewall

Infiltrationoflymphocytesandmacrophage Destructionofsmoothmuscle(hypertrophy,hyperplasia) Destructionofelasticfibers FibrosisDestructionofcartilage

Atrophy,degenerationExpiratoryoutflowobstruction602023/2/19ClinicalcourseAprominentcoughandtheproductionofsputumMoresevereinthewintermonthsFromhibernaltoperennialAccompaniedbyhypercapnia,hypoxemia,cyanosisandemphysemaComplicatedbypulmonaryhypertension&cardiacfailure(corpulmonale)RecurrentinfectionsandrespiratoryfailureTreatments

Stopingsmoking,promptantibiotictreatment,administrationofbronchodilatordrugs,etc.

612023/2/19Emphysema(肺氣腫)DefinedasastateofpathologicallyincreasedinflationofterminallungunitPermanentenlargementoftheacinuswithdestructionoftheirwallsbutwithoutfibrosisOverinflationwithoutdestructionofwallAclearassociationbetweenheavycigarettesmokingandemphysema

622023/2/19Typesandpathology

AccordingtoitsdistributioninthelobuleandacinusAcinus Distaltotheterminalbronchiole including:therespiratorybronchiole,alveolarducts,alveoliAlobule Aclusterofthreetofiveacinithreetypes

centriacinar panacinar distalacinar632023/2/19CentriacinartypeCentralorproximalpartsoftheaciniaffectedwhiledistalalveolisparedMorecommonandsevereintheupperlobes,particularlyintheapicalsegmentsSeverecases:DistalacinusalsoinvolvedAsequenceofcigarettesmoking

642023/2/19PanacinartypeEntireAcinienlargedfromtherespiratorybronchioletotheterminalblindalveoliMorecommonlyinthelowerlungzonesPaleandvoluminouslungsoftenobscuringtheheartinautopsy1-antitrypsindeficiency652023/2/19Distalacinar(paraseptal)typeDistalpartoftheacinusdominantlyinvolvedDistributionalongthelobularsepta AtthemarginsofthelobulesandadjacenttothepleuraAdjacenttoareasoffibrosis,scarring,oratelectasisMoresevereintheupperhalfofthelungsCharacteristicfindings

multiple,contiguous,enlargedairspacesthatrangeindiameterfrom<0.5mmto>2.0cm,sometimesformingcystlikestructures(bullae),Causeofthecasesofspontaneouspneumothoraxinyoungadults662023/2/19LMThinninganddestructionofalveolarwallsMarkedenlargementofairspacesFibrosisofrespiratorybronchiolesCollapsingduringexpiration672023/2/19Pathogenesis

Incompleteobstructionornarrowofbronchiole chronicbronchiolitis obstructionofthelumen destructionofthewallandtheadjacentalveoli

increasingtheresistancetotheexpiratoryairflowInjuryofalveolarwall

682023/2/19692023/2/19Theprotease-antiproteaseimbalance

—Ageneticdeficiencyofα1-antitrypsin

—Neutrophilsandmacrophagesreleaseingprotease-containinggranulesElastictissuedestruction—DestructiveeffectofhighproteaseactivityinsubjectswithlowantiproteaseacitivityNormallypresentinserum,tissuefluids,andmacrophages,amajorinhibitorofproteases(particularlyelastase)secretedbyneutrophilsduringinflammation702023/2/19712023/2/19ClinicalfeaturesDyspnea:theusualfirstsymptomRespiratoryacidosisBarrel-chestProlongedexpiration,hyperventilationAchronicbronchitisCyanotic,corpulmonale,edema, secondarypulmonaryhypertension

722023/2/19Bronchiectasis(支氣管擴(kuò)張癥)DefinitionThepermanentdilationofbronchiandbronchiolescausedbydestructionofthemuscleandelasticsupportingtissue,resultingfromorassociatedwithchronicnecrotizinginfections.

732023/2/19Notaprimarydiseasebutsecondarytopersistinginfectionorobstruction

AcharacteristicsymptomcomplexdominatedbycoughandexpectorationofcopiousamountsofpurulentsputumCommoninolderchildrenandyoungadults742023/2/19PathogenesisBronchialobstruction Tumors,foreignbodies,impactionofmucus

LocalizedtotheobstructedlungsegmentCongenitalorhereditaryconditions

Cysticfibrosis,immunoglobulindeficiencies, KartagenersyndromeNecrotizingorsuppurativepneumonia

Childhoodpneumoniasthatcomplicated

measles, whoopingcoughandinfluenza752023/2/19PathologyGross

UsuallythelowerlobesbilaterallyDiffuseorsegmental

SomesharplylocalizedtoasinglesegmentTumorsoraspirationofforeignbodies

AirwaysdilatedextendingalmosttothepleuraBronchialmembraneroughed,redandconveredwithmucopusFociofcollapse,fibrosisoremphysema

Dilation Uniformthroughout-cylindricaltype Localwidening-fusiformorsacculartype762023/2/19LMVariedwiththeactivityandchronicityofthediseaseEpithelium

Atrophic,proliferativeorsquamousmetaplasia Desquamation,necrosisandulcerationinacutephaseSubmucosa

InfiltrationofmononuclearcellsWall

Destructionofelasticfibers,musclesandevencartilageFibrosis,peribronchiolarfibrosisAbnormaldilationandscarringLungabscess772023/2/19Clinic-pathologicalcorrelationSevere,persistentcoughwithexpectorationofmucopurulent IrritatedbyaccumulationofpusanddrainageofcollectedpoolsofpusintotheunaffectedportionofbronchiHemoptysis-Damageofthewallofbloodvesselsorruptureofbloodvesselduringcough

Constitutionalmanifestation,suchasfever,weightlossandmalaise-infectionandintoxication

782023/2/19ⅣSilicosis(肺硅沉著病,硅肺)792023/2/19BriefintroductionInhalationofcrystallinesilicaPathologicallycharacterizedby

formingnumerousminutesilicoticfibroticnodulesanddiffusefibrosisinthelungandeventuallyleadstorespiratoryinsufficiency802023/2/19Personsworkinginmine,sandblastingandstonecuttingwithoutprotectionareattheriskofdevelopingsilicosis.Ittakesatleastmorethan10years,usually20-30yearstodevelopsilicosis.AslowprogressivecourseTheseveritydirectlyproportionaltothedurationtoexposureandtheamountoftheinhaledparticles812023/2/19Pathogenesis

Smallerthan5umreachingtheterminalairways Approximately1umtoberetainedandtocause fibrosis

EngulfmentoftheparticlebythemacrophageIncorporationofphagocytosedparticlewithlysosomeandformationofphagolysosomeDisruptionofphagolysosomewithreleaseof lysosomeenzyme822023/2/19DeathofmacrophagebylysisandsilicaparticlesreleaseFreeparticlere-ingestedbyanothermacrophageMacrophagemigratestothelymphaticandaccumulatesinrespiratorybronchioleandlymphnodecellularaggregationofthemacrophageformedandlatelybecomescollagenousnodulesSilicacidLysozymeMechanicalstimulationOxygenfreeradicalandproteaseChemokineFibrogenesisfactorderivedfrommacrophageImmunologicmechanism

832023/2/19Pathology

TwocharacteristicfeaturesSilicoticnoduleGross Tiny,barelypalpable,discrete,pale-to blackenednodulesLM Concentricallyarrangedhyalinized collagenfiberssurroudingacentralbloodvessel Weaklybirefringentsilicaparticles primarilyinthecenterbypolarized microscopically Expansionandcoalescence,

Hard, collagenousscars842023/2/19Pathology

Twocharacteristicfeatures

Diffusefibrosis

PulmonarymassivefibrosisFibrosisalsointhehilarlymphnodesandpleuraCalcification852023/2/19Stagesandclinico-pathologicalcorrelationsStageISmallnodulesscatteringinthehilarlymphnodesandcentralzonesofmiddleandlowerlobesLessfibrosis,withoutsymptomStageII

Largernodules,coalescing,scatteringalloverthelung,pleurathickening,emphysematouschangeStageIIINodulescoalescingintolargefibrousmass,centralareanecrotic,calcifiedorwithcavityformation,pulmonarymassivefibrosisPleurathickeningandadhesionirregularemphysemaandbullaeformation862023/2/19ComplicationsCorpulmonale chronichypoxia-inducedvasoconstriction andparenchymaldestructionTuberculosis—mostcommon adepressionofcell-mediatedimmunity Silicotuberculosis

（硅肺結(jié)核?。㏒pontaneouspneumothorax(自發(fā)性氣胸)872023/2/19Ⅴ.Corpulmonale(肺源性心臟病)882023/2/19DefinitionRightventricularhypertrophy,dilation,andpotentiallyfailuresecondarytopersistedpulmonaryhypertensioncausedbydisordersofthelungsorpulmonaryvasculature892023/2/19Causesandpathogenesis

PrimarydiseaseswithinthelungCOPD,Silicosis,TuberculosisPrimarydiseasesofpulmonaryarteriesAcutePulmonaryembolismPrimarydisordersofthoraciccageChronicPulmonaryhypertensionthemostcommoncause-COPD

902023/2/19Pathology

Changesoftheheart Increaseweightoftheheart Hypertrophyofrightheart Apexformedbytherightheartisblunt BulgingofcornuspulmonalePulmonaryencephalopathy

912023/2/19Clinico-pathologicalcorrelationsRight-sidedheartfailure

Tachycardia,cyanosis,swellingoflowerextremityRespiratoryinsufficiencyHeadache,convulsion,coma

922023/2/19ⅥTumorsofrespiratorysystem呼吸系統(tǒng)腫瘤

932023/2/19Nasopharyngealcarcinoma>40years,men>womensmokingPathogenesisEBvirusPathology

Pearlygray,ulcerating,fungating Squamouscellcarcinoma95% Adenocarcinomasrare942023/2/19952023/2/19ClinicalcoursePersistenthoarseness,pain,haemoptysis,dysphagiaTreatmentResectionand/orradiotherapy962023/2/19Primarylungcancer

Bronchogeniccarcinomas Arisingfromthebronchialepithelium95% USA1/3ofcancerdeathsinmentheleadingcauseofcancerdeathsinwomen Peakincidence50~59years Male:female=1.5:1Amiscellaneousgroup5%972023/2/19EtiologyandpathogenesisCigarettesmokingEnvironmentalinsultsAstepwiseaccumulationofamultitudeofgeneticabnormalitiesTransformationofbenignprogenitorintoneoplastictissueHereditary(genetic)factorsP-450monooxygenaseenzymesystemP-450genesInactivationoftheputativetumorsuppressorgeneslocatedon3p,

TP53

mutations,KRASactivation,EGFRmutations,EML4-ALKtyrosinekinasefusiongenesandc-METtyrosinekinasegeneamplications.982023/2/19MorphologyGrossSmallmucosallesions Firm,gray-white

Intraluminalmasses Invadingthebronchialmucosa Forminglargebulkymassespushingintoadjacentlungparenchyma Cavitation-centralnecrosis Focalhemorrhage

992023/2/19Tumorsarisingfromlargebronchus InCentralzoneoflungorinthehilarregion Aglobusshape,non-capsulated,andistinctirregularboundaryTumorsarisingfromsmallerbronchiorbronchiole

InperipheralregionoflungSmall,sol