呼吸系统疾病-三课件.pptVIP

Fibrosing diseasesIdiopathic pulmonary fibrosis (IPF) Unknown etiology Diffuse interstitial fibrosis Usual interstitial pneumonia The pleural surfaces have the appearance of cobblestones Idiopathic pulmonary fibrosis Fibrosis Lower lobes Usual interstitial pneumonia Usual interstitial pneumonia Sarcoidosis The etiology remains unknown 40 years old Danish and Swedish Several immunologic abnormalities Nonsmokers Morphology Noncaseating epithelioid granuloma Asteroid body Schaumann body Extrapulmonary sarcoidosis Lymph nodes Skin lesions: erythema nodosum Eye and lacrimal glands Spleen Liver Bone marrow Skin lesions: erythema nodosum Grossly Type Hilar：最常见，位于肺门 Peripheral：发生于段以下支气管 Diffuse：少见 Cigarette smoking is the main cause of lung carcinoma Heavy cigarette smokers have a 20-fold increases in incidence compared with nonsmokers Cessation of smoking decrease the risk A large number of potent carcinogens are present in cigarette smoke Including polycyclic hydrocarbons, aromatic amines, and heavy metals such as nickel Produce changes in the respiratory: Loss of cilia—squmous metaplasia, dysplasia ,carcinoma in situ, Dysplasia is very uncommon in nonsmokers, Dysplasia ,carcinoma in situ * Stellate inclusions enclosed within giant cels Laminated concretions composed of calcium and protein 25% of patients Acute Raised ,red, tender nodules on the anterior of forehead Intraluminal type（管内型） Peribronchial type（管周型） Infiltrative type（管壁浸润型） D. Occult lung cancer隐性肺癌* Both clinical and X-ray are negative Cytology of sputum smears 痰液涂片shows cancer cells Biopsy and surgical materials are diagnosed as cancer in situ or early infiltrating carcinoma Without lymph node metastasis E. Spread of lung carcinoam Local: central tumors invade the surrounding lung. Direct extension into pleura, pericardium, superior vena cava Lymphatic spread: carcinomas spread to the peri-bronchial and hilar lymph nodes ---- supraclavicular node (Virchow node). Seeding of cancers: tum