15---慢支炎—呼肿 病理学课件

This is a peripheral adenocarcinoma of the lung. Adenocarcinomas and large cell anaplastic carcinomas tend to occur more peripherally in lung. Adenocarcinoma is the one cell type of primary lung tumor that occurs more often in non-smokers and in smokers who have quit. If this neoplasm were confined to the lung (a lower stage), then resection would have a greater chance for cure. The solitary appearance of this neoplasm suggests that the tumor is primary rather than metastatic.
The chest cavity is opened at autopsy to reveal numerous large bullae apparent on the surface of the lungs in a patient dying with emphysema.Bullae are large dilated is characterized by airspaces that bulge out from beneath the pleura.Emphysema a loss of lung parenchyma by destruction of alveoli so that there is permanent dilation of airspaces.
• 2 病因和发病机制
• 管径维持：管壁弹力纤维 平滑肌回缩
•
周围肺组织牵张
• 病变基础： 炎症，阻塞
• （1）炎症 — 破坏管壁支撑结构
• （平滑肌、弹力纤维、软骨）
• （2）阻塞 — 感染 — 炎症
• （3）先天发育不全
• 咳嗽— 管内压，胸腔负压 — 扩张 • 呼气：弹性削弱 — 回缩 ↓
• 3 病理变化
N M — 弹力蛋白酶↑ — 自由基 — 抑制α1-AT活性 — 破坏
• B α1-抗胰蛋白酶缺乏症 原发性肺气肿 欧洲
3. 病理变化
部位 肺腺泡（1级呼吸细支气管范围）
LM: 大 薄 断 少
肉眼：体积大 边缘钝 质地软 灰白
•
弹性差(压痕) 捻发音
•
呼吸性细支气管
• 中央型
扩张
• 周围型
---
• 全小叶型 扩张
4 临床 右心衰 肺性脑病
第三节 肺尘埃沉着症
•
尘肺
长期吸入有害粉尘 — 沉积于肺 — 肺广泛纤维化
职业病Leabharlann 粉尘无机：硅 石棉 煤 有机：真菌代谢物
细菌产物 动物性蛋白
硅肺 silicosis 1 概述 职业病
概念 SiO2— 肺纤维化为主要病变 特点 脱离矽尘环境后，病变仍发展。
最常见 进展最快 危害最严重
• 性质
• 部位 肺段以下（3、4级），
•
下多于上，左多于右
• 肉眼 圆柱状 囊状 胸膜下
•
肺蜂窝状
• LM 慢性炎症伴组织破坏
•
管周纤维化
• 4 并发症 • 脓肿、脓胸 • 肺气肿、肺心病
三 肺气肿 pulmonary emphysema
1 概述 概念 呼吸性细支气管以下 末梢肺组织 含气量
A 炎性损伤：N M — 弹力蛋白酶 氧自由基
α1-AT失活 B 吸烟：N M — 弹力蛋白酶 α1-AT 失活
* α1-抗胰蛋白酶（ α1-antitrypsin, α1-AT)
产生 分泌：肝细胞 存在：血清 组织液 炎细胞等 作用：抑制多种蛋白水解酶
（弹力蛋白酶 基质金属蛋白酶等） A 炎症：
This is a small cell anaplastic (oat cell) carcinoma in which small dark blue cells with minimal cytoplasm are packed together in sheets. Oat cell carcinomas, which are a highly malignant form of neuroendocrine tumor, are often associated with paraneoplastic syndromes from hormonal effects. The ectopic ACTH syndrome and the syndrome of inappropriate ADH are two such syndromes.
• 呼吸性细支气管— 肺泡管— 肺泡囊—肺泡
分类 * 阻塞性 代偿性 老年性 * 肺泡性 间质性
• 2 病因和发病机制(阻塞性)
• 病因 并发症（慢支炎等）
• 机制 进气容易出气难
• (1)阻塞性通气障碍
• 支气管炎--- 气道小--- 吸气（主动，细支气管扩张 ）
•
呼气（黏液栓，管壁塌陷）
• (2)细支气管壁 肺泡壁结构损伤—弹性回缩
4 临床病理联系及并发症 • 临床: 气短 呼吸困难 紫绀 桶状胸 • 并发症： • 肺心病 • 肺大泡破裂—自发性气胸 • 呼吸衰竭 • 肺性脑病
四 慢性肺源性心脏病
chronic cor pulmonale
1 概念 慢性肺部疾病— 肺动脉高压 — 右心室
2 病因和发病机理
（1）慢性阻塞性肺疾病
发病 SiO2主要存在石英中（97-99%） 采矿 采石 石英厂 玻璃厂等
2 病因和发病机制
• 致病因子 游离SiO2
•
〈5 m 被吸入肺内
•
1-2m 形状（四面体）
• SiO2— 巨噬细胞—沿淋巴液到肺门
•
淋巴液阻塞
•
— 肺间质— 矽结节
•
— 间质纤维化
机制：
氢键
1 吞噬 ：SiO2+ H2O → 硅酸 →溶酶体膜破裂 →水解酶 → SiO2 →吞噬 →细胞死亡
钙化、矽结节
• 4 临床分期
• Ⅰ期：主要局限肺门LN
• Ⅱ期：全肺 〈1/3全肺
•
硬度增加
• Ⅲ期：融合团块状
•
竖之不倒
• 5 并发症 • 肺感染 • 肺结核 • 肺心病 • 肺气肿 气胸
第四节 呼吸系统肿瘤
肺癌 鼻咽癌 喉癌
一 肺癌 carcinoma of the lung
• 1 概述 • 常见 • 发病高峰 • 性别
This is another less common type of adenocarcinoma of lung known as a bronchioloalveolar carcinoma. Seen here is variant that appears grossly (and on chest radiograph) as a less welldefined area resembling pneumonic consolidation. An poorly defined mass involving the upper lobe toward the right here has a pale tan to grey appearance.
肺泡管 肺泡囊 肺泡
--扩张 扩张
肺大泡: 气肿 > 1cm 破坏小叶间隔
The dilated airspaces with emphysema are seen. Although there tends to be some scarring with time because of superimposed infections, the emphysematous process is one of loss of lung parenchyma, not fibrosis. The former involves primarily the upper lobes while the latter involves all lung fields, particularly the bases. Centrilobular emphysema occurs with loss of the respiratory bronchioles in the proximal portion of the acinus, with sparing of distal alveoli. This pattern is most typical for smokers. Panacinar emphysema occurs with loss of all portions of the acinus from the respiratory bronchiole to the alveoli. This pattern is typical for alpha-1-antitrypsin deficiency.
＜2cm 局限于支气管内或浸润管壁 无淋巴结转移
隐性肺癌 临床和X线 阴性；痰 阳性； 并经病理证实为原位癌或早浸癌但无LN转移
This is a squamous cell carcinoma of the lung that is arising centrally in the lung (as most squamous cell carcinomas do). It is obstructing the right main bronchus. The neoplasm is very firm and has a pale white to tan cut surface.